No Prep CT Colonography

Purpose	Find colon cancers and polyps on CT colonography without the need for bowel prep. Fecal tagging if necessary.
Tag(s)
Panel	Abdominal Panel
Define-AI ID	20020013
Originator	William Ladd
Panel Chair	Luther B. Adair
Panel Reviewers	Luther B. Adair and Andrew Smith
License	Creative Commons 4.0
Status	Public Comment
RadElement Set	RDES177

Clinical Implementation

Value Proposition

It would be a game changer for making CT colonography more acceptable to patients than fiberoptic colonoscopy, barium enema, or CT colonography post bowel prep. Most patients feel that the bowel prep is the worst part of colon cancer screening procedures. CT colonography is a current standard but not widely used screening procedure to detect colon cancer, one of the most common lethal cancers. A CT scan is performed with colon inflation by inserting a rectal tube with balloon tip and inflating with room air by hand with the rectal tube inflation bulb, but without pre-procedure colon cleansing, followed by CT scanning of the abdomen in supine and prone positions, would increase acceptability and hence lead to more widespread use. It could be with or without stool tagging.

Narrative(s)

A 65-year-old patient is due for colon cancer screening. The patient had a screening colonoscopy 10 years ago; however, they are anxious about a repeat exam because of the uncomfortable bowel preparation. Artificial intelligence-enabled CT colonography does not require bowel preparation and is a more convenient option for the patient. Upon receiving this option, a colon polyp with a small focus of early in-situ cancer is discovered and subsequently removed, preventing development of a potentially lethal colon cancer.

Workflow Description

A CT scan is performed with colon inflation by inserting a rectal tube with balloon tip and inflating with room air by hand with the rectal tube inflation bulb, but without pre-procedure colon cleansing, followed by CT scanning of the abdomen in supine and prone positions. The data is sent directly from modality to the AI engine, which would identify colon inner wall abnormalities, primarily pedunculated and sessile polyps, flat (low plateau-like) lesions, and adherent pieces of stool (for exclusion). This information is then sent to PACS for incorporation into a radiology report. It should not be necessary to identify diverticular outpouchings.

Considerations for Dataset Development

Procedures	CTC
View(s)	Axial CT slices, obtained both supine and prone.
Age	Adults older than the age of 50
Sex at birth	Male or Female
Training set	Training on bowel-prepped CTC exams, since no supply of non-prep exams are available initially.

Technical Specifications

Inputs

DICOM Study

Procedure	Colon inflation
Views	Axial CT slices with multiplanar and 3D surface reconstructions, obtained supine and prone
Data Type	DICOM
Modality	CTC
Body Region	Colon

Primary Outputs

Detect presence of colon lesion

RadElement ID	RDE1233
Definition	Detect if a colon lesion is present
Data Type	Categorical
Value Set	Absent Present Undetermined
Units	N/A

Secondary Outputs

Location of lesion

RadElement ID	RDE1234
Definition	Identify the location of all lesions
Data Type	Coordinates
Value Set
Units	N/A

Probability of marked finding representing a true colon wall tumor

RadElement ID	RDE1235
Definition	Probability of true lesion
Data Type	Numeric
Value Set	[0,1]
Units	N/A

Probability of lesion malignancy

RadElement ID	RDE1236
Definition	Probability of malignant lesion
Data Type	Numeric
Value Set	[0,1]
Units	N/A

Future Development Ideas

Try to see if it can work acceptably well without colon inflation.

Related Datasets

The Cancer Imaging Archive (TCIA)

Know of more related datasets? Please let us know