0:01

Okay, let's move on to practice of CT colonography.

0:04

And I just gonna put out there some of the advantages

0:06

of CTC, which I think are pretty straightforward.

0:09

It is considered a minimally invasive exam.

0:12

And so this translates typically

0:14

with better patient tolerance.

0:15

It's a very short procedural time,

0:17

and we know that sometimes it takes more time

0:20

to get the patient, um, uh, on the table positioned

0:24

and insulated than it's for.

0:25

The actual scanning time is very short.

0:28

At, uh, typically, uh, less than 15 seconds,

0:31

uh, in each position.

0:32

There's no need for sedation.

0:34

So, uh, you don't need, uh, anyone to accompany the patient.

0:38

And we'll see that this actually is a real advantage.

0:41

Uh, during, uh, the pandemic.

0:43

Uh, it's considered a safe exam, so very low risk

0:47

for perforation, uh, 10

0:49

to 20 times lower than the perforation rate for, uh,

0:53

colonoscopy, for example.

0:55

It can be less costly.

0:57

Um, and even though, uh,

0:59

CTC screening CTC is not reimbursable, uh, by Medicare, um,

1:04

it is, when it's reimbursed by private cares,

1:06

the cost is actually less than for colonoscopy.

1:10

And you have the ability

1:11

for opportunistic evaluation of other diseases.

1:13

So, for example, inherently you can look

1:16

for abdominal uric aneurysm, um,

1:19

and for, uh, steatosis of the liver, uh,

1:23

and for, uh, bone mineral density.

1:26

What are some of the limitations of CTC?

1:29

Well, as we all know, currently still

1:30

requires bowel cleansing.

1:32

There have been several large studies that have looked at,

1:35

uh, decreasing the prep for CT C

1:39

and I think that, uh, additional work is still ongoing.

1:42

So we have not come to a point where we can, uh, say

1:46

that you don't need a prep for CT C.

1:48

It does use, uh, radiation,

1:50

although we have significantly lowered the dose.

1:53

And I don't think that that is a real issue at this point.

1:56

Uh, for, um, the U uspstf, um,

2:00

extra colon findings, the incidents, uh, and,

2:03

and you know, we always look at, um, you know,

2:06

there are lots of extra findings that occur,

2:09

but when you look, and I think the key is really, um,

2:13

looking at the, uh, rate of colorectal extra findings in,

2:17

uh, that will actually change management

2:20

and that, uh, actually have impact on the patient.

2:23

Uh, and those, um, uh, wind up, uh,

2:27

triggering very few additional exams.

2:29

Uh, so, you know, I think that, uh, there's a lot,

2:32

there are a lot of studies that been published looking at

2:34

this and, uh, should not be an issue again for, uh,

2:38

the major, um, societies.

2:41

Um, patients are required

2:42

to undergo colonoscopy if there is a positive finding.

2:46

Um, and I would say that, uh, this, uh,

2:49

if it's not done on the same day, this means the patient has

2:53

to repeat the, um, bowel cleansing.

2:55

Um, and then there is additional cost. So,

2:59

Um, but that can be said for any other,

3:01

I think colorectal cancer screening test outside

3:04

of colonoscopy.

3:05

So it's not just a limitation for CT C, it really is

3:08

for all the other screening tests like, um,

3:11

people immunochemical tests and for stool DNA testing or.