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.