Extracolonic Findings Research Articles

CT Colonography in Senior versus Nonsenior Patients: Extracolonic Findings, Recommendations for Additional Imaging, and Polyp Prevalence

To retrospectively evaluate the frequency of recommendations for additional imaging (RAIs) for important extracolonic findings and polyp prevalence among a cohort of seniors (age ≥ 65 years) and nonseniors (age < 65 years) undergoing low-dose computed tomographic (CT) colonography. Institutional review board approval was obtained for this HIPAA-compliant retrospective study. Four hundred fifty-four patients (204 nonseniors: mean age, 52 years; 250 seniors: mean age, 69 years) underwent CT colonography at an outpatient facility. Cases were prospectively reported by one of four abdominal radiologists with expertise in CT colonography. The dictated reports were reviewed to determine the frequency of polyps (≥6 mm), the number of extracolonic findings, and the number of RAIs generated. The Fisher exact test was used to compare the percentage of seniors and nonseniors with at least one reported polyp, with at least one extracolonic finding, as well as the frequency of RAIs. The percentage of patients with at least one reported polyp was 14.2% (29 of 204) for the nonsenior group and 13.2% (33 of 250) for seniors, which was not significantly different (P = .772). The percentage of patients with at least one extracolonic finding was 55.4% (113 of 204) for nonseniors and 74.0% (185 of 250) for seniors (P < .0001). The percentage of patients in which an RAI was suggested was 4.4% (nine of 204) for nonseniors and 6.0% (15 of 250) for seniors, which was not significantly different (P = .450). Extracolonic findings were more frequent in seniors than in nonseniors; however, there was no significant difference in the frequency of RAIs between the two groups. http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11102144/-/DC1.

Extracolonic findings at CT colonography: A review of 258 consecutive cases

Computed tomographic colonography (CTC) is a non-invasive method of examining the colon and is used for colorectal polyp and mass diagnosis. As the entire abdomen is examined, incidental extracolonic pathologies can be diagnosed. The types of extracolonic findings (ECFs) and their frequency have not been explored in an Australian setting. A retrospective review of all CTC examinations performed in an Australian tertiary hospital between February 2004 and July 2009 were reviewed to extract patient demographic data, reason for referral, presence of colonic polyps and masses, presence of other colonic and extracolonic pathologies. Statistical significance was determined using a Student's t-test or Fisher's exact test where appropriate. Two hundred fifty-eight CTC examinations were performed and an ECF was present in 70.1% and were more common with increasing age (P ≤ 0.01), but were not related to gender, or source of referral or the presence of colonic findings. Major ECFs were diagnosed in 8.9% of patients. ECFs are more frequent with increasing age and although they are common, only a minority are of high significance.

Evolution of CT colonography

Many public health organizations, including the American Cancer Society, recommend colorectal carcinoma screening for all average risk adults beginning at the age of 50 years. Colorectal cancers are known to develop from precursor adenomatous polyps that progress from small to large size and from dysplasia to cancer over the course of many years. Despite the potential for prevention, patient compliance is markedly suboptimal. Additional screening options could lead to improved detection rates for early discovery of polyps and cancers and thus lead to fewer cancer deaths. Many early studies have confirmed the ability of CT colonography to accurately detect polyps and colorectal cancers. This article will provide an overview of the current ‘state of the art’ of CT colonography, focusing on relevant recent research in the areas of colonic cleansing and distention, data acquisition, interpretation methods, validation and extracolonic findings. New guidelines, including the indications for CT colonography, are...

Colonic polyps: inheritance, susceptibility, risk evaluation, and diagnostic management.

Colorectal cancer (CRC) is the third-ranked neoplasm in order of incidence and mortality, worldwide, and the second cause of cancer death in industrialized countries. One of the most important environmental risk factors for CRC is a Western-type diet, which is characterized by a low-fiber and high-fat content. Up to 25% of patients with CRC have a family history for CRC, and a fraction of these patients are affected by hereditary syndromes, such as familial adenomatous polyposis, Gardner or Turcot syndromes, or hereditary nonpolyposis colorectal cancer. The onset of CRC is triggered by a well-defined combination of genetic alterations, which form the bases of the adenoma-carcinoma sequence hypothesis and justify the set-up of CRC screening techniques. Several screening and diagnostic tests for CRC are illustrated, including rectosigmoidoscopy, optical colonoscopy (OC), double contrast barium enema (DCBE), and computed tomography colonography (CTC). The strengths and weaknesses of each technique are discussed. Particular attention is paid to CTC, which has evolved from an experimental technique to an accurate and mature diagnostic approach, and gained wide acceptance and clinical validation for CRC screening. This success of CTC is due mainly to its ability to provide cross-sectional analytical images of the entire colon and secondarily detect extracolonic findings, with minimal invasiveness and lower cost than OC, and with greater detail and diagnostic accuracy than DCBE. Moreover, especially with the advent and widespread availability of modern multidetector CT scanners, excellent quality 2D and 3D reconstructions of the large bowel can be obtained routinely with a relatively low radiation dose. Computer-aided detection systems have also been developed to assist radiologists in reading CTC examinations, improving overall diagnostic accuracy and potentially speeding up the clinical workflow of CTC image interpretation.

Colonic polyps: inheritance, susceptibility, risk evaluation, and diagnostic management

Colonic polyps: inheritance, susceptibility, risk evaluation, and diagnostic management Emanuele Neri, Lorenzo Faggioni, Lorenzo Cini, Carlo BartolozziDiagnostic and Interventional Radiology, University of Pisa, Pisa, ItalyAbstract: Colorectal cancer (CRC) is the third-ranked neoplasm in order of incidence and mortality, worldwide, and the second cause of cancer death in industrialized countries. One of the most important environmental risk factors for CRC is a Western-type diet, which is characterized by a low-fiber and high-fat content. Up to 25% of patients with CRC have a family history for CRC, and a fraction of these patients are affected by hereditary syndromes, such as familial adenomatous polyposis, Gardner or Turcot syndromes, or hereditary nonpolyposis colorectal cancer. The onset of CRC is triggered by a well-defined combination of genetic alterations, which form the bases of the adenoma-carcinoma sequence hypothesis and justify the set-up of CRC screening techniques. Several screening and diagnostic tests for CRC are illustrated, including rectosigmoidoscopy, optical colonoscopy (OC), double contrast barium enema (DCBE), and computed tomography colonography (CTC). The strengths and weaknesses of each technique are discussed. Particular attention is paid to CTC, which has evolved from an experimental technique to an accurate and mature diagnostic approach, and gained wide acceptance and clinical validation for CRC screening. This success of CTC is due mainly to its ability to provide cross-sectional analytical images of the entire colon and secondarily detect extracolonic findings, with minimal invasiveness and lower cost than OC, and with greater detail and diagnostic accuracy than DCBE. Moreover, especially with the advent and widespread availability of modern multidetector CT scanners, excellent quality 2D and 3D reconstructions of the large bowel can be obtained routinely with a relatively low radiation dose. Computer-aided detection systems have also been developed to assist radiologists in reading CTC examinations, improving overall diagnostic accuracy and potentially speeding up the clinical workflow of CTC image interpretation.Keywords: colonic polyps, colorectal cancer, colonoscopy, double contrast barium enema, computed tomography colonography

Imaging of endometriosis with computerized tomography colonography

We demonstrate the use of computerized tomography colonography for the imaging of intestinal endometriosis to facilitate preoperative management in our hospital setting.

Extracolonic Findings on CT Colonography Increases Yield of Colorectal Cancer Screening

The purpose of this study is to evaluate the impact of extracolonic findings when screening is undertaken by CT colonography (CTC). We performed a retrospective cohort study of patients completing a screening CTC from August 2003 to June 2006 at Walter Reed Army Medical Center. Extracolonic findings were categorized using a CTC reporting and data system that classifies findings as highly significant, likely significant, and insignificant. All final diagnoses, surgeries, malignancies, and costs of diagnostic radiology procedures were calculated for each category. Of 2,277 patients (mean +/- SD age, 59 +/- 11 years; 60% white; 56% male) undergoing CTC, extracolonic findings were identified in 1,037 (46%) patients, with 787 (34.5%) insignificant and 240 (11.0%) significant findings. Evaluation of significant findings generated 280 radiology procedures and 19 surgeries over a mean follow-up time of 19 +/- 10 months. The total cost of the radiology studies was $113,179; the studies added approximately $50 extra per patient. Seven high-risk lesions were identified (six extracolonic malignancies and one large aortic aneurysm) in patients with significant findings. CTC also identified six intracolonic malignancies and three adenomas with high-grade dysplasia. When considering extracolonic findings, CTC increased the odds of identifying high-risk lesions by 78% (nine intracolonic lesions vs 16 intracolonic plus extracolonic lesions; p = 0.0156). Of the 16 intracolonic and extracolonic high-risk lesions, 11 (69%) underwent curative resection, and 5 of 11 (44.4%) were extracolonic. CTC increased the odds of identifying high-risk lesions by 78%. CTC should be considered as an alternative to optical colonoscopy for colorectal cancer screening or as a onetime procedure to identify significant treatable intracolonic and extracolonic lesions.

Virtual Colonography Detects Unsuspected Extraclonic Cancers

A study of >10,000 adults found that >1 in every 200 asymptomatic people screened with computed tomographic (CT) colonography, or virtual colonoscopy, had clinically unsuspected malignant cancer and more than half of cancers were extracolonic. The findings were published in the April issue of the journal Radiology. “We are finding that virtual colonoscopy screening actually identifies more unsuspected cancers outside of the colon than within it,” says lead author Perry J. Pickhardt, MD, professor of radiology and chief of GI Imaging, at the University of Wisconsin School of Medicine & Public Health. “As with asymptomatic colorectal cancers identified by virtual colonoscopy screening, these cancers are often detected at an early, curable stage.” In addition to the intended colorectal evaluation, CT colonography also provides for limited assessment of extracolonic structures, including the abdomen, pelvis, and lungs. Additional diagnostic imaging work-up for unsuspected extracolonic findings is performed in approximately 6% of cases, nearly half of which ultimately prove to be clinically relevant, the authors note. The researchers retrospectively determined the detection rates, clinical stages, and short-term patient survival for all unsuspected malignancies in an asymptomatic screening population. They reviewed the medical records of 10,286 adults (5,388 men and 4,898 women) with a mean age of 59.8 years who were evaluated at either the University of Wisconsin or the National Naval Medical Center. All of the adults had undergone colorectal cancer screening with virtual colonoscopy at the two centers between April 2004 and March 2008. The mean time for follow-up was 30.2 months. Unsuspected cancer was confirmed in 58 patients, including 33 women and 25 men. Invasive colorectal cancer was found in 22 patients, and extracolonic cancer was found in 36 patients. Cancers in 31 patients (53.4%) were stage 1 or localized cancers. Extracolonic malignancies included renal cell carcinoma (n = 11), lung cancer (n = 8), non-Hodgkin lymphoma (n = 6), or a variety of other tumors (n = 11). At the most recent clinical follow-up (mean, 30.0 months; range, 12–56), 3 patients (5.2%) had died of their cancer. “To our knowledge, none of the patients who presented with stage 1, stage 2 or localized disease at diagnosis has progressed to a higher stage,” Pickhardt says. “The fact that so many of the cancers in our study were localized or detected at an early stage appears to have positively affected survival.” See: Radiology 2010;255:1 orhttp://radiology.rsna.org/content/255/1/83.full.

Limited-Preparation CT Colonography in Frail Elderly Patients: A Feasibility Study

Full colonic preparation can be onerous and may be poorly tolerated in frail elderly patients. The purpose of this study was to prospectively assess the image quality and diagnostic yield of limited-preparation CT colonography (CTC) in elderly patients with suspected colorectal cancer who were deemed medically unfit or unsuitable for colonoscopy. A prospective study was performed of 67 elderly patients with reduced functional status referred for CTC. Participants were prescribed a limited bowel preparation consisting of a low-residue diet for 3 days, 1 L of 2% oral diatrizoate meglumine (Gastrografin) 24 hours before CTC, and 1 L of 2% oral Gastrografin over the 2 hours immediately before CTC. No cathartic preparation was administered. All colonic segments were graded from 1 to 5 for image quality (1, unreadable; 2, poor; 3, equivocal; 4, good; 5, excellent) and reader confidence. Clinical and conventional colonoscopy follow-up findings were documented, and all colonic and extracolonic pathologic findings were documented. Overall image quality and reader confidence in the evaluation of the colon was rated good or excellent in 84% of the colonic segments. Colonic abnormalities were identified in 12 patients (18%), including four colonic tumors, two polyps, and seven colonic strictures. Incidental extraintestinal findings were detected in 43 patients (64%), including nine patients with lesions radiologically consistent with malignancy. Limited-preparation low-dose CTC is a feasible and useful minimally invasive technique with which to evaluate the colon and exclude gross pathology (mass lesions and polyps > 1 cm) in elderly patients with diminished performance status, yielding good to excellent image quality.

Computer-aided polyp detection on CT colonography: Comparison of three systems in a high-risk human population

Purpose To compare the detection performances of two commercial and one academic computer-aided diagnosis (CAD) systems for polyp detection on CT colonography (CTC) in a high-risk human population and to assess their detection characteristics. Materials and methods This retrospective study had institutional review board approval, but informed consent was waived. Sixty-eight patients who were suspected of having colonic polyps and scheduled for colonoscopic polyp removal were included. After CTC was performed using a 64-row MDCT, two commercial (PEV, CAR) and one academic (Hessian matrix-based) CAD systems were applied to each CTC dataset. Colonoscopy using the segmental unblinded technique was performed as a standard of reference. Per-polyp and per-patient sensitivities were calculated and compared for each CAD system. The mean number of false-positives (FPs) and false-negatives (FNs) was computed and the causes of all FPs and FNs were analyzed. Results A total of 151 polyps in 61 patients were detected (77 polyps <6 mm, 48 6–9.9 mm, 26 ≥ 10 mm). Per-polyp sensitivity for PEV, CAR, and Hessian matrix-based CAD were: 71.6%, 78.4%, and 83.8% for polyps ≥6 mm, and 88.5%, 96.2%, and 96.2% for polyps ≥10 mm. Per-patient sensitivity for polyps ≥6 mm was 80.4%, 89.1%, and 93.5%, and 87%, 95.7%, and 95.7% for polyps ≥10 mm, respectively. Per-polyp and per-patient sensitivities were not significantly different among the three CAD systems regardless of size threshold. Mean number of FPs was 6.9 for PEV, 7.3 for CAR, and 14 for Hessian matrix-based CAD. The most common cause of FPs were feces, followed by extracolonic findings, prominent folds and ileocecal valve, and rectal tube. The distribution of the causes of FPs was significantly different among the three systems. Conclusion Sensitivity of the three CAD systems for polyp detection was comparable regardless of the polyp size threshold; however, the number of FPs was higher in the Hessian matrix-based CAD. In addition, the distribution of the causes of FPs was significantly different among the three systems.

Extracolonic Findings at CT Colonography

Computed tomographic colonography (CTC) is a validated tool for the evaluation of the colon for polyps and cancer. The technique employed for CTC includes a low-dose CT scan of the abdomen and pelvis that is typically performed without the administration of intravenous contrast. Using this technique it is possible to discover findings outside of the colon. By far, most extracolonic findings are determined to be clinically inconsequential on CTC and most patients are not recommended for further testing. However, some findings may result in additional diagnostic evaluation or intervention, which can lead to patient anxiety and increased morbidity and health care costs. Alternatively, some findings can lead to the earlier diagnosis of a clinically significant lesion, which could result in decreased patient morbidity and mortality as well as overall savings in downstream health care costs. The controversies of detecting and evaluating these incidental extracolonic findings on CTC are discussed.

Virtual Colonoscopy Effective for Screening Older Patients

Computed tomographic colonography (CTC) remains effective in screening older patients for colorectal cancer (CRC), produces low referral for colonoscopy rates similar to other screening exams now covered by Medicare, and does not result in unreasonable levels of additional testing resulting from extracolonic findings, according to a study published in the February 2010 issue of Radiology. Previous CTC trials have demonstrated excellent performance in average-risk individuals. However, concerns remained that such results may not be applicable to older Medicare beneficiaries. Researchers at the University of Wisconsin School of Medicine and Public Health analyzed various CTC performance and program outcome measures for screening individuals aged 65–79. “These results confirm that CTC is a safe and effective colorectal cancer screening tool for the older individual. There is no significant difference in the way CTC performs in older patients as opposed to younger patients,” said David H. Kim, MD, Associate Professor of Radiology at the University of Wisconsin School of Medicine and Public Health, and principal investigator of the study. In the study, for this older screening group, the prevalence of advanced neoplastic lesions was 7.6% (44 of 577). There was no significant difference between older patients and the general screening population in terms of the characteristics of advanced neoplasia—including mean size, histologic type, and morphology—indicating similar accuracy to that found in other trials involving younger patients. The overall referral rate to optical colonoscopy of 15.3% (88 of 577) is actually slightly lower than other Medicare covered CRC screening exams such as flexible sigmoidoscopy. Potentially important extracolonic findings were seen in 15.4% of patients (89 of 577), with a work-up rate of 7.8% (45 of 577). The majority of important extracolonic diagnoses were vascular aneurysms (n = 18). No major complications were encountered. The authors note that CTC is now one of the preferred options in the American Cancer Society colorectal cancer screening guidelines. They point to the possibility that the recent addition of CTC may have a major effect on future public health, “as up to 40% of the eligible population does not undertake screening with the traditional options. Reported screening adherence is even worse for the older cohort of Medicare patients.” “The lack of complications, particularly no perforations, attests to the safety of this procedure even in the older population,” said Kim. “Given what we know of the increasing risk for complications for optical colonoscopy in older patients, perhaps we should consider CT colonography more strongly in this particular group.” See: Radiology, 2010;254:493–500; http://radiology.rsna.org/content/254/2/493.full.

Is Computed Tomographic Colonography Being Held to a Higher Standard?

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.

CT Colonography: Performance and Program Outcome Measures in an Older Screening Population

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. This HIPAA-compliant study was approved by the institutional review board; informed consent waived. Retrospective analysis of the 65-79-year-old cohort (n = 577) from the University of Wisconsin CT colonography screening program (n = 5176) was undertaken. Performance and outcome measures including advanced neoplasia prevalence and colonoscopy referral, extracolonic finding, extracolonic work-up, and complication rates were obtained by using a CT colonography database and review of medical records. Comparisons between the older cohort and the general screening population were made by using the Student t, Pearson chi(2), and Fisher exact tests. A P value <or= .05 was considered to indicate a significant difference. With a 6-mm threshold for positivity, the overall referral rate to optical colonoscopy was 15.3% (88 of 577), leading to 277 polypectomies and the removal of 103 nondiminutive adenomas. For adenomas, the per-patient positivity rates were 10.9% (63 of 577) and 6.8% (39 of 577) at the 6- and 10-mm thresholds, respectively. The prevalence of advanced neoplasia was 7.6% (44 of 577). Fifty-four adenomas met advanced status, and five unsuspected cancers were detected. The advanced neoplasias identified were typically large, with a mean size of 21 mm. Potentially important extracolonic findings were seen in 15.4% (89 of 577) of patients, with a work-up rate of 7.8% (45 of 577). The majority of important extracolonic diagnoses were vascular aneurysms (n = 18). No major complications were encountered. CT colonography is a safe and effective screening modality for the older population.

Abstract CN14-06: Screening for colorectal cancer: 2009

Abstract CN14-06: Screening for colorectal cancer: 2009

Computed tomographic colonography: Hope or hype?

Computed tomographic colonography (CTC) is a promising emerging technology for imaging of the colon. This concise review discusses the currently available data on CTC technique, test characteristics, acceptance, safety, cost-effectiveness, follow-up strategy, and extracolonic findings. In summary, CTC technique is still evolving, and further research is needed to clarify the role of automated colonic insufflation, smooth-muscle relaxants, intravenous and oral contrast, software rendering, and patient positioning. Currently, full bowel preparation is still required to achieve optimal results. The sensitivity for detecting large polyps (> 1 cm) can be as high as 85%, with specificity of up to 97%. These test characteristics are almost comparable to those of conventional colonoscopy. Patient acceptance of CTC is generally higher than that for colonoscopy, especially in patients who have never undergone either procedure. CTC is generally safe, although uncommon instances of colonic perforation have been documented. In terms of cost-effectiveness, most decision analyses have concluded that CTC would only be cost-effective if it were considerably cheaper than conventional colonoscopy. The proper follow-up strategy for small polyps or incidental extracolonic findings discovered during CTC is still under debate. At present, the exact clinical role of virtual colonoscopy still awaits determination. Even though widespread CTC screening is not available today, in the future there may eventually be a role for this technology. Technological advances in this area will undoubtedly continue, with multi-detector row CT scanners allowing thinner collimation and higher resolution images. Stool-tagging techniques are likely to evolve and may eventually allow for low-preparation CTC. Perceptual and fatigue-related reading errors can potentially be minimized with the help of computer-aided detection software. Further research will define the exact role of this promising technology in our diagnostic armamentarium.

Colorectal cancer screening: The role of CT colonography

Computed tomography colonography (CTC) in colorectal cancer (CRC) screening has two roles: one present and the other potential. The present role is, without any further discussion, the integration into established screening programs as a replacement for barium enema in the case of incomplete colonoscopy. The potential role is the use of CTC as a first-line screening method together with Fecal Occult Blood Test, sigmoidoscopy and colonoscopy. However, despite the fact that CTC has been officially endorsed for CRC screening of average-risk individuals by different scientific societies including the American Cancer Society, the American College of Radiology, and the US Multisociety Task Force on Colorectal Cancer, other entities, such as the US Preventive Services Task Force, have considered the evidence insufficient to justify its use as a mass screening method. Medicare has also recently denied reimbursement for CTC as a screening test. Nevertheless, multiple advantages exist for using CTC as a CRC screening test: high accuracy, full evaluation of the colon in virtually all patients, non-invasiveness, safety, patient comfort, detection of extracolonic findings and cost-effectiveness. The main potential drawback of a CTC screening is the exposure to ionizing radiation. However, this is not a major issue, since low-dose protocols are now routinely implemented, delivering a dose comparable or slightly superior to the annual radiation exposure of any individual. Indirect evidence exists that such a radiation exposure does not induce additional cancers.

The Benefits of Computed Tomographic Colonography in Reducing a Long Colonoscopy Waiting List

Purpose The Radiology Department, Royal Jubilee Hospital, Victoria, BC, with the support of gastroenterologists and surgeons, was awarded a BC Innovation fund to run a pilot project of computed tomographic colonography to reduce an unacceptably long 2-year colonoscopy waiting list. Funds were approved in April 2007 for a 1-year project, which was completed on March 31, 2008. Methods This article describes the challenges of delivering a high-volume computed tomographic colonography program at a busy community hospital, with discussion of the results for the 2,005 patients who were examined. Results Colonoscopy was avoided in 1,462 patients whose computed tomographic studies showed no significant lesions. In the remainder of patients, only lesions larger than 5 mm were reported, with a total of 508 lesions identified in 433 patients. There were 57 cancers of which 52 were reported as either definite or possible cancers, whereas 5 were not seen on initial scans. Some of the patients with cancer had been on the colonoscopy waiting list for 2 years. In addition, there were 461 patients with significant extracolonic findings, including 84 who required urgent or semi-urgent further management for previously unsuspected conditions, such as pneumonia, aneurysms larger than 5 cm, and a range of solid renal, hepatic, and pancreatic masses. There were no procedural complications from the computed tomographic colon studies. Conclusions We have shown that it is feasible to run a high volume CTC service in a general hospital given hospital support and funding. The benefits in this group of over 2000 patients included avoidance of colonoscopy in over 70% of patients, detection of significant polyps or cancer in approximately 20% of patients, and identification of clinically important conditions in 7%–18% depending on the definition used. The estimated costs including capital, operating, and professional fees were in the range of $400.

Extracolonic Findings From CTC: Balancing Risks and Benefits

Extracolonic Findings From CTC: Balancing Risks and Benefits

Recommendations for Additional Imaging in Radiology Reports: Radiologists' Self-Referral or Good Clinical Practice?

HomeRadiologyVol. 253, No. 2 PreviousNext Recommendations for Additional Imaging in Radiology Reports: Radiologists' Self-Referral or Good Clinical Practice?Ronald L. ArensonRonald L. ArensonAuthor Affiliations1From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, Room M-391, San Francisco, CA 94143-0628.Address correspondence to the author (e-mail: [email protected]).Ronald L. ArensonPublished Online:Nov 1 2009https://doi.org/10.1148/radiol.2532091216MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractWhether recommendations for additional imaging in radiology reports are considered self-referral or good clinical practice depends on the appropriateness of both the original and recommended additional procedures, which can only be determined through good outcomes studies.© RSNA, 2009 References 1 Sistrom CL, Dreyer KJ, Dang PPet al.. 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Crossref, Medline, Google ScholarArticle HistoryReceived July 7, 2009; revision requested July 22; revision received July 24; final version accepted July 24.Published in print: Nov 2009 FiguresReferencesRelatedDetailsCited ByJournal of Medical Imaging and Radiation Oncology, Vol. 64, No. 3Pediatric Radiology, Vol. 47, No. 13Journal of the American College of Radiology, Vol. 14, No. 5Journal of the American College of Radiology, Vol. 13, No. 9Emergency Radiology, Vol. 21, No. 4JMIR Medical Informatics, Vol. 2, No. 1JMIR Medical Informatics, Vol. 2, No. 1Clinical Radiology, Vol. 68, No. 2Journal of Nuclear Medicine, Vol. 54, No. 5Journal of the American College of Radiology, Vol. 8, No. 12Compliance with Fleischner Society Guidelines for Management of Lung Nodules: Lessons and Opportunities1Heber MacMahon, 10 March 2010 | Radiology, Vol. 255, No. 1Recommended Articles Overview of Noninterpretive Artificial Intelligence Models for Safety, Quality, Workflow, and Education Applications in Radiology PracticeRadiology: Artificial Intelligence2022Volume: 4Issue: 2Whole-Body Clinical Applications of Digital TomosynthesisRadioGraphics2016Volume: 36Issue: 3pp. 735-750Factors Affecting Interpretative Accuracy: How Can We Reduce Errors?Radiology2018Volume: 287Issue: 1pp. 213-214Electronic Health Record Closed-Loop Communication Program for Unexpected Nonemergent FindingsRadiology2021Volume: 301Issue: 1pp. 123-130Patient Exposure from Radiologic and Nuclear Medicine Procedures in the United States: Procedure Volume and Effective Dose for the Period 2006–2016Radiology2020Volume: 295Issue: 2pp. 418-427See More RSNA Education Exhibits A Cased-Based Health Equity Primer for Radiologists: Real Cases, Real Problems, Real SolutionsDigital Posters2020Introduction to Artificial Intelligence and Big Data Research in Chest RadiologyDigital Posters2019The Value of Adding Contrast Enhanced Spectral Mammography to the Diagnostic Breast Imaging Practice: How to Implement a Program and Examples of the Utility of CESM as a Problem Solving ToolDigital Posters2018 RSNA Case Collection Chagas diseaseRSNA Case Collection2021SclerodermaRSNA Case Collection2022Neonatal tuberous sclerosis RSNA Case Collection2020 Vol. 253, No. 2 Metrics Altmetric Score PDF download