Recognizing that CT colonography will play a role in screening for colorectal cancer (CRC), and the critical need to increase overall CRC screening rates, the American Gastroenterological Association (AGA) Institute issued minimum standards for gastroenterologist performance of the test. To ensure competence, a minimum of 75 endoscopically confirmed cases should be interpreted by the physician.
Despite the fact that CT colonography has not yet been endorsed as a primary screening test in asymptomatic, normal risk adults, many patients have shown interest in this test. The indications for CT colonography are controversial, with many payers recommending that this test only be indicated for patients who have had a failed optical colonoscopy or who have a mass obstructing the colon where examination of the entire colon is required prior to surgical resection. Nonetheless, CT colonography may be considered for patients unwilling to undergo other colorectal screening tests, note the authors of the standards paper, which is published in Gastroenterology, the official journal of the AGA Institute.
Because of our specialized training, gastroenterologists are experts in CRC screening and colorectal disease. It follows that if patients want a virtual colonoscopy it may be highly appropriate to see a qualified gastroenterologist for the test, notes Don Rockey, MD, AGAF, chair of the AGA Institute Task Force on CT Colonography. As CT colonography technology is evolving, it is important to check that your physician has been properly trained to ensure that the test is performed and interpreted accurately.
After formal training, during which at least 75 tests should be interpreted, the AGA Institute Task Force on CT Colonography, which authored the standards paper, recommends that gastroenterologists should participate in a mentored CT colonography preceptorship with the candidate physically present and involved in the interpretation of at least 25-50 additional cases. In addition, it is expected that those performing CT colonography will undertake ongoing training and self assessment including attending formal continuing medical education-accredited courses in CT colonography.
The AGA Institute Task Force on CT Colonography offers the following recommendations. The full recommendations are available in the September issue of Gastroenterology.
Quality Control and Safety
Exam and Equipment Specifications
Guidelines from multiple agencies and professional societies, including the AGA Institute, underscore the importance of colorectal cancer screening for all individuals 50 years of age and older (younger for certain groups known to be at higher risk). The U.S. Preventive Services Task Force, the Multi-Specialty Task Force, and others have published recommendations for screening for colorectal cancer, the second-leading cause of cancer deaths in the United States. Currently, recommended screening tests include colonoscopy, flexible sigmoidoscopy, barium enema, and fecal occult blood tests.
The AGA Institute formed the CT Colonography Task Force to develop minimum training standards for gastroenterologists in order to provide guidance, and to ensure minimum training competencies are upheld for the performance of the exam. The AGA Institute continues to monitor CT colonography along with other potential colorectal cancer screening tests, and will continue to develop guidance tools and reports as appropriate. The AGA Institute will host a course on CT colonography for gastroenterologists on March 7-8, 2008, in Washington, DC. Additional information will be available this fall.
|Contact: Aimee Frank|
American Gastroenterological Association