0:00

These are some of the active areas of, uh, research.

0:04

Um, that I think, uh, will take us

0:06

through the next five years

0:07

or so is really, you know, is there a role

0:10

for CTC in the younger than 50 year old patients?

0:14

Um, and we need to evaluate

0:15

and, um, uh, perform some

0:17

of the validation studies in younger patients.

0:21

We really need to continue

0:22

to look at minimal prep CTC if we can't entirely get rid

0:26

of the laxative,

0:28

but to decrease the rigor of, uh, preparation for ctc.

0:32

And I think that we can get there looking at ultra low dose

0:36

CTC and that already, um, has been studies continues

0:40

to be studied, but to decrease as I mentioned,

0:42

from the three milli seaver very low dose

0:45

that we are achieving now to even sub milli Seaver.

0:48

So less than one milli Seaver.

0:50

And then what's the role of some of the new technology

0:52

by dual energy ct, which we are evaluating here at Moncure,

0:57

um, but also, uh, artificial intelligence.

1:00

And this was, um, a study that, uh,

1:03

looked at sub milli secret ctc

1:05

and you can see that, um,

1:06

there was no difference in image quality.

1:08

This was a small pilot study of only 26 patients,

1:12

but you can see that low dose

1:14

for them was at less than one milli secret, um,

1:17

without compromise of image quality.

1:20

What about dual energy?

1:22

Um, well, um, in this one study, again,

1:25

this was a pilot type study.

1:26

They did not use, uh, oral contrast,

1:28

but they used IV contrast.

1:30

You know, those sensitivity didn't really change

1:33

because it was already fairly high.

1:35

You can see that with the use

1:36

of the iodine map from dual energy ct, uh, we were able

1:40

to achieve a very high, uh, specificity, much higher than

1:45

with conventional ctc.

1:47

Here's an example from that study giving IV contrast

1:50

where you can see that stools showed no iodine, uh, content,

1:54

content on the iodine map.

1:55

Whereas, um, this polyp, I mean, I'm sorry,

1:58

this large poly point carcinoma showed, uh,

2:01

enhancement in high iodine content

2:03

and polyps in general, um, outside of carcinoma even, uh,

2:07

tend to enhance IB contrast.

2:10

I just wanted to bring to your attention

2:12

that there is AC rads out there

2:15

and I leave it here for you to, uh, take a look at.

2:18

But, um, we are in the process through the American College

2:21

of Radiology Cold Cancer Committee, um,

2:24

advising the RADS classification,

2:26

but this is still in use, um, with, uh, C one normal, uh,

2:30

study C two one

2:32

or two small polyps that are in the six to nine ER category.

2:36

C three is one large polyp or three

2:39

or more of the small polyps, and C four is a clear mass.

2:42

And so what is this case?

2:44

A six year old now with a single seven millimeter

2:46

polyp is a c2.

2:49

Here's a 65 year old with a large 12 millimeter Apollo,

2:54

and clearly this is a3.

2:56

There's also an classification

2:59

Along, um, just to show you, um, E one is normal, E two

3:03

clinically um, insignificant.

3:05

E three is likely clinically unimportant.

3:08

E four is potentially clinically important and

3:11

therefore you would definitely need to work it up.

3:14

So here's a patient with, um,

3:16

a right-sided adrenal mylo lipoma, uh,

3:19

clinically insignificant.

3:21

So an E two. Here's a patient with what, a left-sided.

3:28

You can see a renal cell carcinoma with all the, uh,

3:31

associated adenopathy, retro peritoneum.

3:34

And this is an E four.