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Published in: European Radiology 12/2012

Open Access 01-12-2012 | Gastrointestinal

Can radiographers be trained to triage CT colonography for extracolonic findings?

Authors: Thierry N. Boellaard, C. Yung Nio, Patrick M. M. Bossuyt, Shandra Bipat, Jaap Stoker

Published in: European Radiology | Issue 12/2012

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Abstract

Objectives

Radiographers have been shown to be capable CT colonography observers. We evaluated whether radiographers can be trained to triage screening CT colonography for extracolonic findings.

Methods

Eight radiographers participated in a structured training program. They subsequently evaluated extracolonic findings in 280 low-dose CT colonograms (cases). This dataset contained 66 cases with possibly important findings (E3) and 27 cases with probably important findings (E4) [classification based on the highest classified finding (C-RADS)]. The first 40 and last 40 CT colonograms were identical test cases. Immediate feedback was given after each reading, except for test cases. Radiographers triaged cases based on C-RADS classification and indicated the need for a radiologist read. We constructed learning curves for correct case triaging by calculating moving averages.

Results

In the final test series, 84/120 (70 %) cases with E3 or E4 findings and 139/200 (70 %) without E3 or E4 findings were correctly triaged. Correct identification of cases with E3 findings improved with training from 46/88 (52 %) to 62/88 (70 %) (P < 0.0001) but not for E4 findings [both 22/32 (69 %) P = 1.00].

Conclusions

Radiographers improve after training in correctly triaging extracolonic findings at CT colonography but do not reach a high enough accuracy to consider their structural involvement in screening.

Key Points

Radiographers were trained to triage CT colonography for extracolonic findings.
After training, radiographers improved sensitivity for likely unimportant findings.
After training, radiographers did not improve sensitivity for possibly important findings.
Radiographers should probably not be expected to identify all extracolonic findings.
Literature
1.
go back to reference McFarland EG, Levin B, Lieberman DA et al (2008) Revised colorectal screening guidelines: joint effort of the American Cancer Society, U.S. Multisociety Task Force on Colorectal Cancer, and American College of Radiology. Radiology 248:717–720PubMedCrossRef McFarland EG, Levin B, Lieberman DA et al (2008) Revised colorectal screening guidelines: joint effort of the American Cancer Society, U.S. Multisociety Task Force on Colorectal Cancer, and American College of Radiology. Radiology 248:717–720PubMedCrossRef
2.
go back to reference Lansdorp-Vogelaar I, Knudsen AB, Brenner H (2011) Cost-effectiveness of colorectal cancer screening. Epidemiol Rev 33:88–100PubMedCrossRef Lansdorp-Vogelaar I, Knudsen AB, Brenner H (2011) Cost-effectiveness of colorectal cancer screening. Epidemiol Rev 33:88–100PubMedCrossRef
3.
go back to reference Lansdorp-Vogelaar I, van Ballegooijen M, Zauber AG, Boer R, Wilschut J, Habbema JD (2009) At what costs will screening with CT colonography be competitive? A cost-effectiveness approach. Int J Cancer 124:1161–1168PubMedCrossRef Lansdorp-Vogelaar I, van Ballegooijen M, Zauber AG, Boer R, Wilschut J, Habbema JD (2009) At what costs will screening with CT colonography be competitive? A cost-effectiveness approach. Int J Cancer 124:1161–1168PubMedCrossRef
4.
go back to reference Jensch S, van Gelder RE, Florie J et al (2007) Performance of radiographers in the evaluation of CT colonographic images. AJR Am J Roentgenol 188:W249–W255PubMedCrossRef Jensch S, van Gelder RE, Florie J et al (2007) Performance of radiographers in the evaluation of CT colonographic images. AJR Am J Roentgenol 188:W249–W255PubMedCrossRef
5.
go back to reference Liedenbaum MH, Bipat S, Bossuyt PM et al (2011) Evaluation of a standardized CT colonography training program for novice readers. Radiology 258:477–487PubMedCrossRef Liedenbaum MH, Bipat S, Bossuyt PM et al (2011) Evaluation of a standardized CT colonography training program for novice readers. Radiology 258:477–487PubMedCrossRef
6.
go back to reference Kim DH, Pickhardt PJ, Taylor AJ et al (2007) CT colonography versus colonoscopy for the detection of advanced neoplasia. N Engl J Med 357:1403–1412PubMedCrossRef Kim DH, Pickhardt PJ, Taylor AJ et al (2007) CT colonography versus colonoscopy for the detection of advanced neoplasia. N Engl J Med 357:1403–1412PubMedCrossRef
7.
go back to reference van den Biggelaar FJ, Nelemans PJ, Flobbe K (2008) Performance of radiographers in mammogram interpretation: a systematic review. Breast 17:85–90PubMedCrossRef van den Biggelaar FJ, Nelemans PJ, Flobbe K (2008) Performance of radiographers in mammogram interpretation: a systematic review. Breast 17:85–90PubMedCrossRef
8.
go back to reference Brealey S, Scally A, Hahn S, Thomas N, Godfrey C, Coomarasamy A (2005) Accuracy of radiographer plain radiograph reporting in clinical practice: a meta-analysis. Clin Radiol 60:232–241.10PubMedCrossRef Brealey S, Scally A, Hahn S, Thomas N, Godfrey C, Coomarasamy A (2005) Accuracy of radiographer plain radiograph reporting in clinical practice: a meta-analysis. Clin Radiol 60:232–241.10PubMedCrossRef
9.
go back to reference Bradley AJ, Rajashanker B, Atkinson SL, Kennedy JN, Purcell RS (2005) Accuracy of reporting of intravenous urograms: a comparison of radiographers with radiology specialist registrars. Clin Radiol 60:807–811PubMedCrossRef Bradley AJ, Rajashanker B, Atkinson SL, Kennedy JN, Purcell RS (2005) Accuracy of reporting of intravenous urograms: a comparison of radiographers with radiology specialist registrars. Clin Radiol 60:807–811PubMedCrossRef
10.
go back to reference Law RL, Titcomb DR, Carter H, Longstaff AJ, Slack N, Dixon AR (2008) Evaluation of a radiographer-provided barium enema service. Colorectal Dis 10:394–396PubMedCrossRef Law RL, Titcomb DR, Carter H, Longstaff AJ, Slack N, Dixon AR (2008) Evaluation of a radiographer-provided barium enema service. Colorectal Dis 10:394–396PubMedCrossRef
11.
go back to reference Brandt A, Andronikou S, Wieselthaler N et al (2007) Accuracy of radiographer reporting of paediatric brain CT. Pediatr Radiol 37:291–296PubMedCrossRef Brandt A, Andronikou S, Wieselthaler N et al (2007) Accuracy of radiographer reporting of paediatric brain CT. Pediatr Radiol 37:291–296PubMedCrossRef
12.
go back to reference Xiong T, Richardson M, Woodroffe R, Halligan S, Morton D, Lilford RJ (2005) Incidental lesions found on CT colonography: their nature and frequency. Br J Radiol 78:22–29PubMedCrossRef Xiong T, Richardson M, Woodroffe R, Halligan S, Morton D, Lilford RJ (2005) Incidental lesions found on CT colonography: their nature and frequency. Br J Radiol 78:22–29PubMedCrossRef
13.
go back to reference Flicker MS, Tsoukas AT, Hazra A, Dachman AH (2008) Economic impact of extracolonic findings at computed tomographic colonography. J Comput Assist Tomogr 32:497–503PubMedCrossRef Flicker MS, Tsoukas AT, Hazra A, Dachman AH (2008) Economic impact of extracolonic findings at computed tomographic colonography. J Comput Assist Tomogr 32:497–503PubMedCrossRef
14.
go back to reference Gluecker TM, Johnson CD, Wilson LA et al (2003) Extracolonic findings at CT colonography: evaluation of prevalence and cost in a screening population. Gastroenterology 124:911–916PubMedCrossRef Gluecker TM, Johnson CD, Wilson LA et al (2003) Extracolonic findings at CT colonography: evaluation of prevalence and cost in a screening population. Gastroenterology 124:911–916PubMedCrossRef
15.
go back to reference Liedenbaum MH, van Rijn AF, de Vries AH et al (2009) Using CT colonography as a triage technique after a positive faecal occult blood test in colorectal cancer screening. Gut 58:1242–1249PubMedCrossRef Liedenbaum MH, van Rijn AF, de Vries AH et al (2009) Using CT colonography as a triage technique after a positive faecal occult blood test in colorectal cancer screening. Gut 58:1242–1249PubMedCrossRef
16.
go back to reference Jensch S, de Vries AH, Peringa J et al (2008) CT colonography with limited bowel preparation: performance characteristics in an increased-risk population. Radiology 247:122–132PubMedCrossRef Jensch S, de Vries AH, Peringa J et al (2008) CT colonography with limited bowel preparation: performance characteristics in an increased-risk population. Radiology 247:122–132PubMedCrossRef
17.
go back to reference Stoop EM, de Haan MC, de Wijkerslooth TR et al (2012) Participation and yield of colonoscopy versus non-cathartic CT colonography in population-based screening for colorectal cancer: a randomised controlled trial. Lancet Oncol 13:55–64PubMedCrossRef Stoop EM, de Haan MC, de Wijkerslooth TR et al (2012) Participation and yield of colonoscopy versus non-cathartic CT colonography in population-based screening for colorectal cancer: a randomised controlled trial. Lancet Oncol 13:55–64PubMedCrossRef
18.
go back to reference Einstein DM, Singer AA, Chilcote WA, Desai RK (1991) Abdominal lymphadenopathy: spectrum of CT findings. Radiographics 11:457–472PubMed Einstein DM, Singer AA, Chilcote WA, Desai RK (1991) Abdominal lymphadenopathy: spectrum of CT findings. Radiographics 11:457–472PubMed
19.
go back to reference Johnson PT, Horton KM, Fishman EK (2009) Adrenal mass imaging with multidetector CT: pathologic conditions, pearls, and pitfalls. Radiographics 29:1333–1351PubMedCrossRef Johnson PT, Horton KM, Fishman EK (2009) Adrenal mass imaging with multidetector CT: pathologic conditions, pearls, and pitfalls. Radiographics 29:1333–1351PubMedCrossRef
20.
go back to reference Zalis ME, Barish MA, Choi JR et al (2005) CT colonography reporting and data system: a consensus proposal. Radiology 236:3–9PubMedCrossRef Zalis ME, Barish MA, Choi JR et al (2005) CT colonography reporting and data system: a consensus proposal. Radiology 236:3–9PubMedCrossRef
21.
go back to reference Dachman AH, Kelly KB, Zintsmaster MP et al (2008) Formative evaluation of standardized training for CT colonographic image interpretation by novice readers. Radiology 249:167–177PubMedCrossRef Dachman AH, Kelly KB, Zintsmaster MP et al (2008) Formative evaluation of standardized training for CT colonographic image interpretation by novice readers. Radiology 249:167–177PubMedCrossRef
Metadata
Title
Can radiographers be trained to triage CT colonography for extracolonic findings?
Authors
Thierry N. Boellaard
C. Yung Nio
Patrick M. M. Bossuyt
Shandra Bipat
Jaap Stoker
Publication date
01-12-2012
Publisher
Springer-Verlag
Published in
European Radiology / Issue 12/2012
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-012-2541-z

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