Feasibility of remote CT colonography at two rural Native American medical centers.
OBJECTIVE
Fort Defiance Indian Hospital and Tuba City Regional Health Care Center are two rural hospitals with limited availability of optical colonoscopy (OC) and other methods of colorectal cancer screening. Our goals were to determine whether adequate examinations could be obtained with remote supervision after brief onsite instruction and to share lessons learned in our experience with a remote CT colonography (CTC) screening program.


METHODS
After brief onsite instruction, including performing a CTC examination on a volunteer to train the CT technologists, both sites began performing CTC using standard bowel preparation, fecal tagging, automatic insufflation, and low-dose technique. Studies were transferred to the University of Arizona Hospital for image quality assessment of stool, residual fluid, distention, and interpretation, with reports returned via the teleradiology information system. Clinical follow-up was performed on those patients referred for polypectomy or biopsy.


RESULTS
Three hundred twenty-one subjects underwent CTC, including 280 individuals referred for screening examinations (87%). Ninety-two percent of subjects (295/321) had acceptable amounts of residual stool, 91% (293/321) had acceptable levels of fluid, and 92% (294/321) had acceptable distention. Fourteen percent (44/321) of CTC patients had polyps 6 mm or larger in size, with a positive predictive value of 41% for those who subsequently underwent colonoscopy-polypectomy (11/27).


CONCLUSIONS
CTC can be introduced to rural underserved communities, performed locally, and interpreted remotely with satisfactory performance, thereby increasing colorectal cancer screening capacity. Important aspects of implementation should include technologist training, referring physician education, careful attention to image transmission, and clearly defined methods of communication with patients and referring providers.
Department of Radiology, University of Arizona, Tucson, 85724, USA. arnief51@yahoo.com
Arnold C
AC
Friedman
David
D
Downing
Joachim
J
Chino
Elizabeth
E
Krupinski
Caroline
C
Kilian
Peter
P
Lance
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001130:Arizona; D023881:Colonography, Computed Tomographic; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging*; D004502:Education, Medical, Continuing; D005260:Female; D006780:Hospitals, Rural; D006801:Humans; D021621:Imaging, Three-Dimensional; D007198:Indians, North American; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D014481:United States