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The New England Journal of Medicine

"Accuracy of CT Colonography for Detection of Large Adenomas and Cancers", C. Daniel Johnson, M.D., M.M.M., Mei-Hsiu Chen, Ph.D., Alicia Y. Toledano, Sc.D., Jay P. Heiken, M.D., Abraham Dachman, M.D., Mark D. Kuo, M.D., Christine O. Menias, M.D., Betina Siewert, M.D., Jugesh I. Cheema, M.D., Richard G. Obregon, M.D., Jeff L. Fidler, M.D., Peter Zimmerman, M.D., Karen M. Horton, M.D., Kevin Coakley, M.D., Revathy B. Iyer, M.D., Amy K. Hara, M.D., Robert A. Halvorsen, Jr., M.D., Giovanna Casola, M.D., Judy Yee, M.D., Benjamin A. Herman, S.M., Lawrence J. Burgart, M.D., and Paul J. Limburg, M.D., M.P.H., September 18, 2008, (Vol. 359, No. 12)

In this study of asymptomatic adults, CT colonographic screening identified 90% of subjects with adenomas or cancers measuring 10 mm or more in diameter. These findings augment published data on the role of CT colonography in screening patients with an average risk of colorectal cancer (ACRIN 6664)

"CT Colonography Versus Colonoscopy for the Detection of Advanced Neoplasia", David H. Kim, M.D., Perry J. Pickhardt, M.D., Andrew J. Taylor, M.D., Winifred K. Leung, M.D., Thomas C. Winter, M.D., J. Louis Hinshaw, M.D., Deepak V. Gopal, M.D., Mark Reichelderfer, M.D., Richard H. Hsu, M.D., and Patrick R. Pfau, M.D., October 4, 2007, (Vol. 357, No. 14)

Primary CTC and OC screening strategies resulted in similar detection rates for advanced neoplasia, although the numbers of polypectomies and complications were considerably smaller in the CTC group. These findings support the use of CTC as a primary screening test before therapeutic OC

"Computed Tomographic Virtual Colonsocopy to Screen for Colorectal Neoplasia in Asymptomatic Adults",
Perry J. Pickhardt, M.D., J. Richard Choi, Sc.D., M.D., Inku Hwang, M.D., James A. Butler, M.D., Michael L. Puckett, M.D., Hans A. Hildebrandt, M.D., Roy K. Wong, M.D., Pamela A. Nugent, M.D., Pauline A. Mysliwiec, M.D., M.P.H., and William R. Schindler, D.O., December 2003 issue (Vol. 349, No. 23)

Viatronix was an exclusive participant in the largest-ever clinical trial utilizing 3D virtual colonoscopy as the primary read. This trial compared virtual and optical colonoscopy. Results showed a higher sensitivity for virtual colonoscopy than for optical colonoscopy (the "gold" standard) for adenomas 8mm and larger.

American Gastroenterological Association

"AGA Supports New Guidelines Favoring Tests That Prevent Colorectal Cancer ", March 5, 2008

The AGA Institute supports CTC as a promising screening test for colorectal cancer, which we believe will be in widespread clinical use in the near future.

Alimentary Pharmacology & Therapeutics

"Virtual vs. optical colonoscopy in symptomatic gastroenterology out-patients: the case for virtual imaging followed by targeted diagnostic or therapeutic colonoscopy", M.Bose, J.Bell, L.Jackson, P.Casey, J.Saunders, O.Epstein Volume 26 Issue 5 Page 727-736, September 2007

In symptomatic patients, three-dimensional virtual colonoscopy is equivalent to optical colonoscopy for diagnosing colon cancer and clinically significant polyps. A case can be made for three-dimensional virtual colonoscopy as a primary modality followed if necessary by same day-targeted optical colonoscopy.

American Cancer Society

"Prevention the Focus of New Colon Cancer Screening Guidelines", Article date: 2008/03/05

CT colonography (virtual colonoscopy) is recommended every 5 years

"Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology",
Bernard Levin, MD, David A. Lieberman, MD, Beth McFarland, MD, Robert A. Smith, PhD, Durado Brooks, MD, MPH, Kimberly S. Andrews, Chiranjeev Dash, MD, MPH, Francis M. Giardiello, MD, Seth Glick, MD, Theodore R. Levin, MD, Perry Pickhardt, MD, Douglas K. Rex, MD, Alan Thorson, MD, Sidney J. Winawer, MD and for the American Cancer Society Colorectal Cancer Advisory Group, the US Multi-Society Task Force, and the American College of Radiology

Based on the accumulation of evidence since that time, the expert panel concludes that there are sufficient data to include CTC as an acceptable option for CRC screening.

American Journal of Roentgenology

"Automated Measurement of Colorectal Polyp Height at CT Colonography: Hyperplastic Polyps Are Flatter Than Adenomatous Polyps", Ronald M. Summers, Jiamin Liu, Jianhua Yao, Linda Brown, J. Richard Choi, and Perry J. Pickhardt, Am. J. Roentgenol., Nov 2009; 193: 1305 - 1310

"CT Colonography Predictably Overestimates Colonic Length and Distance to Polyps Compared With Optical Colonoscopy", James E. Duncan, Michael P. McNally, W. Brian Sweeney, Andrew B. Gentry, Duncan S. Barlow, Donald W. Jensen, and Brooks D. Cash, Am. J. Roentgenol., Nov 2009; 193: 1291 - 1295

"CT Colonography: Coming of Age", C. Daniel Johnson, Am. J. Roentgenol., Nov 2009; 193: 1239 - 1242

"Normalized Distance Along the Colon Centerline: A Method for Correlating Polyp Location on CT Colonography and Optical Colonoscopy", Ronald M. Summers, Jeffrey A. Swift, Andrew J. Dwyer, J. Richard Choi, and Perry J. Pickhardt, Am. J. Roentgenol., Nov 2009; 193: 1296 - 1304

"Comparison of Optical Colonoscopy and CT Colonography for Polyp Detection", Dachman, A.H., Am. J. Roentgenol., 2009; 193:1289-1290

"Comparison of Polyp Size and Volume at CT Colonography: Implications for Follow-Up CT Colonography", Emily Bethea, Ogonna K. Nwawka, and Abraham H. Dachman, Am. J. Roentgenol., Dec 2009; 193: 1561 - 1567

"Clinical Management of Small (6- to 9-mm) Polyps Detected at Screening CT Colonography: A Cost-Effectiveness Analysis", Perry J. Pickhardt, Cesare Hassan, Andrea Laghi, Angelo Zullo, David H. Kim, Franco Iafrate, and Sergio Morini, Am. J. Roentgenol., Nov 2008; 191: 1509 - 1516.

"Performance of a previously Validated CT Colonography Computer-Aided Detection System in a New Patient Population", Ronald M. Summers, Laurie R. Handwerker, Perry J. Pickhardt, Robert L. Van Uitert, Keshav K. Deshpande, Srinath yeshwant, Jianhua Yao, and Marek Franaszek
Am. J. Roentgenol., Ju 2008; 191: 168-174

"Replacing Barium Enema with CT Colonography in Patients Older Than 70 Years: The Importance of Detecting Extracolonic Abnormalities",
Damian J. M. Tolan, Euan M. Armstrong, and Anthony H. Chapman, Am. J. Roentgenol., Nov 2007; 189: 1104 - 1111

" Primary 2D Versus Primary 3D Polyp Detection at Screening CT Colonography",
Perry J. Pickhardt, Andrew D. Lee, Andrew J. Taylor, Steven J. Michel, Thomas C. Winter, Anthony Shadid, Ryan J. Meiners, Peter J. Chase, J. Louis Hinshaw, John G. Williams, Tyler M. Prout, S. Hamid Husain, David H. Kim, 189, December 2007

"Translucency Rendering in 3D Endoluminal CT Colonography: A Useful Tool for Increasing Polyp Specificity and Decreasing Interpretation Time", P. J. Pickhardt August 2004 AJR:183(2),429 - 436

"Three-Dimensional Endoluminal CT Colonography (Virtual Colonoscopy): Comparison on Three Commerically Available Systems", P. J. Pickhardt December 4, 2003 AJR: 181, 1599-1606
Among Viatronix,GE and Vital Images products, V3D-Colon was heavily favored by participating physicians, ranking consistently higher in all categories (92%), including polyp conspicuity, 3D effect, likeness to OC and navigational features.

"Electronic Cleansing and Stool Tagging in CT Colonography: Advantages and Pitfalls with Primary Three Dimensional Evaluation", Perry J. Pickhardt, September 2003:181, 799-805

"Performance of a Previously Validated CT Colonography Computer-Aided Detection System in a New Patient Population", Ronald M. Summers, Laurie R. Handwerker, Perry J. Pickhardt, Robert L. Van Uitert, Keshav K. Deshpande, Srinath Yeshwant, Jianhua Yao, and Marek Franaszek
Am. J. Roentgenol., Jul 2008; 191: 168 - 174.

Annals of Internal Medicine

Is Computed Tomographic Colonography Being Held to a Higher Standard?, Samita Garg, MD, and Dennis J. Ahnen, MD

Recent guidelines for colorectal cancer screening have reached different conclusions on whether computed tomographic colonography (CTC) is an acceptable screening option, and the Centers for Medicare & Medicaid Services recently decided not to cover CTC screening. The rationale against recommending or covering CTC screening includes concerns about radiation exposure, false negative rates for small polyps, the discovery of extracolonic findings, variability in performance, a lack of targeted studies, a higher adenoma rate in the Medicare-eligible age group, and an absence of evidence that covering CTC would increase overall screening rates. Similar concerns can be raised for other recommended and covered colon cancer screening tests, but it seems that CTC is being held to a new and higher standard.

"Location of Adenomas Missed by Optical Colonoscopy", Perry J. Pickhardt, MD; Pamela A. Nugent, MD; Pauline A. Mysliweic, MD, MPH; J. Richard Choi, ScD, MD; and William R. Schnindler, DO, September 7, 2004 | Volume 141 Issue 5| Pages 352-359

Archives of Internal Medicine

Computed Tomographic Colonography to Screen for Colorectal Cancer, Extracolonic Cancer, and Aortic Aneurysm Model Simulation With Cost-effectiveness Analysis
Cesare Hassan, MD; Perry Pickhardt, MD; Andrea Laghi, MD; Daniel Kim, MD; Angelo Zullo, MD; Franco Iafrate, MD; Lorenzo Di Giulio, MD; Sergio Morini, MD
Arch Intern Med. 2008;168(7):696-705

When detection of extracolonic findings such as AAA and extracolonic cancer are considered in addition to colorectal neoplasia in our model simulation, CT colonography is a dominant screening strategy (ie, more clinically effective and more cost-effective) over both colonoscopy and colonoscopy with 1-time ultrasonography.

AuntMinnie.com

"Obama gets virtual colonoscopy, keeps presidential powers (Viatronix V3D-Colon software used for performing VC)"

As part of his first annual comprehensive physical exam as chief executive, U.S. President Barack Obama underwent a virtual colonoscopy exam (also known as CT colonography or CTC) that found him free of colorectal polyps or cancer, chief White House physician and Navy Captain Dr. Jeffrey Kuhlman told reporters yesterday.

"VC obviates need for colonoscopy even in symptomatic patients" By Eric Barnes, AuntMinnie.com staff writer February 24, 2010

Even among individuals with symptoms suggesting a higher risk of colorectal polyps and cancer, virtual colonoscopy screening is enough to prevent most of them from having to undergo invasive colonoscopy. Researchers from Venlo, Netherlands, said that referrals to optical colonoscopy after VC (also known as CT colonography or CTC) remained low even among the oldest symptomatic patients in the group's recent study.

"VC screening maintains performance in Medicare population" by Eric Barnes, AuntMinnie.com, November 9, 2009

"Meta-analysis reveals paucity of advanced neoplasia in small polyps" by Eric Barnes, AuntMinnie.com, November 2, 2009

"VC CAD nabs undetected polyps in jumbo screening study" ,Eric Barnes, 10/29/09

"VC's high positive predictive value important for colonoscopy follow-up ", Eric Barnes, 4/30/09

"VC CAD plus 3D improves sensitivity for novice readers", Eric Barnes, 4/21/09

"VC/AAA Screening combo cost-effective in older adults", Eric Barnes, 3/26/09

"Model finds small polyp surveillance safe, cost-effective", Eric Barnes, 11/4/2008

"Wider 3D viewing angle may aid polyp detection", Eric Barnes, 9/9/2008

"ACR, others exhort CMS to cover virtual colonoscopy", By Aunt Minnie.com Staff Writers, 6/19/2008

"VC's extracolonic findings lend an edge in cost-effectiveness", Eric Barnes, 4/15/2008

"American Cancer Society recognizes virtual colonoscopy screening benefit", Erik L. Ridley, 3/5/2008
The ACS says "Provided that advanced, proven techniques are employed in the clinical setting, CTC is included in the guidelines as an option for colorectal cancer screening and prevention in average-risk adults aged 50 years and older"

"Disparate VC results suggest 2D/3D debate isn't over", Eric Barnes, 12/11/2007

"Primary 3D VC equivalent to colonoscopy", Eric Barnes, 9/12/2007

"Significant Extracolonic Cancer Found in VC Screening Patients", Eric Barnes, 6/12/2007

"Translucency rendering aids prepless 3D VC", Eric Barnes, 5/14/2007

"Screening model calls VC most cost-effective colon exam", Eric Barnes, 4/24/2007

"VC CAD delivers accuracy on unfamiliar datasets", Eric Barnes, 2/5/2007

"Low Incidence of Serious Extracolonic Findings Seen in VC Screening Population", Eric Barnes, 12/18/2006

"New Data Reveal Higher Efficacy for Primary VC Screening", Eric Barnes, 10/18/2006

"VC Finds Early Niche in Screening", Eric Barnes, 9/27/2006

"VC Finds Risky Polyps, Might Reduce Polypectomies", Eric Barnes, 6/8/2006

Barbara Cubin

"Cubin Promotes New Technology to Combat Cancer: Legislation Makes Virtual Colonoscopies a Reality", Barbara Cubin, U.S. Representative Barbara Cubin (R-WY)

Cubin introduced H.R. 4879, the Virtual Screening for Cancer Act (VSCA) of 2007. Cubin's bill includes Computed Tomography Colonography (CTC) as a colorectal screening test covered under the Medicare program.

Cancer

"Age and Illness Increase Colonoscopy Risks", Gregory S. Cooper, MD, Tzuyung Doug Kou, PH, MA, CANCER, Volume 112, Issue 2, Pages 293-299, Published Online

In a population-based cohort of Medicare beneficiaries, despite insurance reimbursement, there is significant underuse of colorectal testing. Given the ability of screening tests to reduce cancer incidence and mortality, continued efforts to promote screening are clearly warranted.

Cancer Consultants.com

"Underuse of colorectal cancer screening in a cohort of medicare beneficiaries",
Reference: Warren JL, Klabunde CN, Mariotto AB et al. Adverse events after outpatient colonoscopy in the Medicare population. Annals of Internal Medicine. 2009;150:849-857.

This study suggests that the overall risk of colonoscopy complications among Medicare beneficiaries is low. Nevertheless, risk increases with age and with certain chronic health problems. These observations suggest that some elderly or debilitated patients might have fewer complications from a CT colonography when the risks of perforation and bleeding are nonexistent.

Diagnostic Imaging

"Extracolonic Findings from CT Colonography Can Uncover Serious Disease", James Brice, 05/21/2009

"CT Colonography bests conventional screening in cost-effectiveness test", Pia Pyne Miller, 4/23/2007

"GI Docs Find Value in Virtual Colonoscopy", C.P. Kaiser, 5/31/2006

Gastroenterology

"Standards for Gastroenterologists for Performing and Interpreting Diagnostic Computed Tomographic Colonography", Don C. Rockey, Matthew Barish, Joel V. Brill, Brooks D. Cash, Joel G. Fletcher, Prateer Sharma, Sachin Wani, Maurits J. Wiersema, Laura E. Peterson, and Jennifer Conte, 2007;133:1005–10242-158

"Surface Visualization at 3D Endoluminal CT Colonography: Degree of Coverage and Implications for Polyp Detection", Perry J. Pickhardt, MD; Andrew J. Taylor, and Deepak V. Gopal, 2006 | 130: 1582-1587

"Computed Tomographic Virtual Colonoscopy Computer-Aided-Polyp-Detection in Screening", Ronald M. Summers, Jianhua Yao, Perry J. Pickhardt, Marek Franaszek, Ingmar Bitter, Daniel Brickman, Vamsi Krisna, and J. Richard Choi, 2005 | 129: 1832-1844

"Position of the American Gastroenterological Association (AGA) Institute on Computed Tomographic Colonography", 2006 | 131: 1627-1628

Health Imaging & IT

"Virtual Colonoscopy Going for the Gold (Standard)", Beth Walsh, 9/01/07

"Wait and "C", Renee DiIulio, August 2007

"Third-Party Payor-Reimbursed Study Validates Virtual Colonoscopy", Cat Vasko, 12/04/2006

Health Imaging.com

"Low-dose protocol doesn’t affect 3D CTC" by Editorial Staff, Healthimaging.com

Journal of Computer Assisted Tomography

"Polyp Detection at 3-Dimensional Endoluminal Computed Tomography Colonography: Sensitivity of One-Way Fly-Through at 120 Degrees Field-of-View Angle" by Pickhardt, Perry J. MD; Schumacher, Clark MD; Kim, David H. MD, Journal of Computer Assisted Tomography: July/August 2009 - Volume 33 - Issue 4 - pp 631-635 doi: 0.1097/RCT.0b013e31819778ea

The Journal of Urology

"Prevalence of Urolithiasis in Asymptomatic Adults: Objective Determination Using Low Dose Noncontrast Computerized Tomography", Cody J. Boyce, Perry J. Pickhardt, Edward M. Lawrence, David H. Kim, and Richard J. Bruce

A clinical study of more than 5,000 asymptomatic individuals is shedding new light on the prevalence and sequelae of stone disease in adults screened with virtual colonoscopy. Researchers found evidence of calculi in nearly 9% of the study population, results that tweak assumptions about groups thought to be at higher risk of stone disease.

Urolithiasis is an expensive and time-consuming condition for healthcare providers to treat, accounting for more than 2 million office visits and nearly 200,000 hospital admissions each year, with estimated costs of more than $2 billion annually in the U.S., noted study authors Dr. Cody Boyce, Dr. Perry Pickhardt, Dr. Edward Lawrence, Dr. David Kim, and Dr. Richard Bruce from the University of Wisconsin School of Medicine and Public Health in Madison. Studies also suggest that the incidence of symptomatic stone disease is increasing, they wrote.

Kay Granger

"CMS Made the Wrong Decision", 05/12/2009

Nature Reviews Clinical Oncology

"Screening: CT colonography: time for clinical implementation", Perry J. Pickhardt, MD, April 2009

The Wall Street Journal / Journal Watch

"CT Scans Gain Favor as Option for Colonoscopy", By Rhonda L. Rundle, The Wall Street Journal, 10/28/2008

"Why We'll Never Cure Cancer", Peter B. Bach, The Wall Street Journal, 10/27/07

"CT Colonography vs. Colonoscopy", Allan S. Brett, M.D., Journal Watch, November 1, 2007, Vol 27 No. 21

Radiology

CT Colonography: Performance and Program Outcome Measures in an Older Screening Population, David H. Kim, MD, Perry J. Pickhardt, MD, Meghan E. Hanson, MD and J. Louis Hinshaw, MD
Purpose: To evaluate computed tomographic (CT) colonography performance and program outcome measures in an older cohort (65–79 years) of an established large-scale colorectal cancer screening program.

"Unsuspected Extracolonic Findings at Screening CT Colonography: Clinical and Economic Impact",Perry J. Pickhardt, MD, Meghan E. Hanson, MD, David J. Vanness, PhD, Justin Y. Lo, MS, David H. Kim, MD, Andrew J. Taylor, MD, Thomas C. Winter, MD, and J. Louis Hinshaw, MD, Radiology 2008;249:151-159
Detection of relevant unsuspected extracolonic disease at CT colonographic screening is not rare, accounting for a relatively large percentage of cases in which additional workup was recommended. Judicious handling of potential extracolonic findings is warranted to balance the cost of additional workup against the potential for early detection of important disease, because many findings will prove to be of no clinical consequence.

"Screening for Colorectal Neoplasia with CT Colongraphy: Initial Experience from the 1st Year of Coverage by Third-Party Payers", Perry J. Pickhardt, MD, Andrew J. Taylor, MD, David H. Kim, MD, Mark Reicheldferfer, MD, Deepak V. Gopal, MD, and Patrick R. Pfau, MD, 2006. 0:2412052007
As a primary colorectal screening tool, CT colonography covered by third-party payers has an acceptably low endoscopic referral rate and a high concordance of positive findings at optical colonoscopy.

"Linear Polyp Measurement at CT Colonography: In Vitro and in Vivo Comparison of Two-Dimensional and Three-dimensional Displays", Perry J. Pickhardt, MD, Andrew D. Lee, MD, Elizabeth G. McFarland, MD, Andrew J. Taylor, MD, 2005; 236:872-878
Linear polyp measurement on 3D endoluminal views was significantly more accurate than measurement on 2D transverse, coronal, or sagittal views, both in vitro and in vivo, for the CT colonography system evaluated. Use of the optimized 2D view substantially reduced 2D measurement error and may be valuable when used in conjunction with 3D measurement.

"Building a CT Colonography Program: Necessary Ingredients for Reimbursement and Clinical Success", Perry J. Pickhardt, MD,Andrew J. Taylor, MD, Gary L. Johnson, MD, Lawrence A. Fleming, MD, Debra A. Jones, MD, Patrick R. Pfau, MD, Mark Reichelderfer, MD, 2005; 235:17-20
The challenges facing widespread implementation of CT colonography programs for primary screening are substantial but certainly not insurmountable.

"Incidence of Colonic Perforation at CT Colonography: Review of Existing Data and Implications for Screening of Asymptomatic Adults", Perry J. Pickhardt, MD, 2006; 239: 313-316
The actual risk of colonic perforation at CT colonography is exceedingly low and may likely approach zero in asymptomatic patients who are undergoing screening when specific techniques are employed.

Radiology Today

"Virtual Colonoscopy — On Its Way to Being a Real Screening Tool?" by Beth W. Orenstein, Radiology Today, Vol. 9 No. 23 P. 22