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Medicare's 'No' on Virtual Colonoscopy Stirs Expert Debate
Date:5/13/2009

Abraham Dachman, from the American College of Radiology's Colon Cancer Committee, concurred. "I think it's a bad decision," Dachman said. "I don't think it's in the best interests of our country. I think it's contrary to President Obama's stated emphasis on prevention and using new technology to benefit patients."

Dachman, who is also director of computed tomography at the University of Chicago Medical Center, noted that CT colonography is an effective screening tool and that Blue Cross and Blue Shield currently approve and pay for it.

CT colonography has been tested in older patients and found to be effective, Dachman added. So "to base a decision somewhat -- if not primarily -- on the fact that the cohort, and the effectiveness in that cohort, has not been studied is suspect, even for the layman," he said.

Other physicians agreed with the agency's move, but not always for the same reasons.

"I don't disagree with CMS's decision, but not because it doesn't visualize lesions in the colon," said Dr. Robert Fletcher, a professor of ambulatory care and prevention at Harvard Medical School. "The evidence that CT colonoscopy is accurate is quite strong. It's nearly as good as colonoscopy and much better than most of the other tests."

However, other aspects must also be considered, Fletcher said. He noted that if something suspicious does turn up on CT colonography, doctors must then go in and investigate it using traditional, invasive colonoscopy. In that scenario, patients would end up having to go through two difficult bowel-preparation regimens and two costly, uncomfortable procedures.

In a standard colonoscopy, polyps can be removed during the scoping procedure itself, Fletcher pointed out.

In addition, there is a concern about the dose of potentially harmful radiation received by the patient from the X-ray, Fletcher noted. Multiple CT colonographies would mean multiple doses of this radiation
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