Several factors will likely converge in the very near future to precipitate wide-spread acceptance of CTC
for colorectal screening.
• Continued excellent results from single center trials will add to existing cumulative data of its efficacy.
• Evidence-based comparisons with existing approved screening tests (FOBT, flexible sigmoid-oscopy, double contrast barium enema, colonos-copy) will show that none is perfect and that CTC has a sufficient number of benefits and unique attractions to make it a legitimate addition.
• Continued deployment of modern CT scanner capability will make it apparent to community hospitals and private practitioners that there is a very low entry cost to introduce this new imaging product and hospital administrators will persuade radiologists, referring clinicians and gastroenter-ologists to adopt the procedure.
• Radiology professional organizations will develop and promulgate appropriate practice standards, guidelines, reporting schema, training curricula and accreditation programs to insure that the technique and the reading radiologists have credibility with the public and insurance carriers, as well as other physicians and governmental policy makers. The precedent of mammography in the U.S. where quality standards have been developed by the American College of Radiology has been invaluable to the public and radiologists alike. Similar programs are necessary and in fact inevitable for CTC.
• Gastroenterologists performing colonoscopy will increasingly understand that CTC is not so much a competitive threat, as it is in fact a case multiplier in that it will detect and deliver patients to them with truly actionable large polyps for beneficial polypectomy.
• Practical models for integration of virtual and optical colonoscopy into practice will evolve, especially those involving single day one stop shopping cross referral between radiologists and colonoscopists for positive findings at CTC and by the same token for failed colonoscopies allowing an immediate follow-up same day virtual exam with only a single colon prep.
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