Computed tomography colonography ("virtual colonoscopy") in Israel: Results of the National CT Colonography Survey of the Israeli Association of Abdominal Imaging and the Israeli Radiological Association

Background: Computed tomographic colonography, also known as virtual colonoscopy, is a rapid, non-invasive imaging technique to detect colorectal masses and polyps that is becoming increasingly popular. Objectives: To evaluate the availability, technique, standards of performance and indications for CT colonography in Israel. Methods: A questionnaire on CT colonography was sent to all radiology departments and private institutions that perform CTC in Israel. We evaluated multiple technical parameters regarding the performance and interpretation of CTC as well as radiologists' training and experience. Results: Fourteen institutions - 7 hospitals and 7 private clinics - participated in the study. Most of the small radiology departments and nearly all of the more peripheral radiology departments do not perform CTC studies. Since 2000 and until March 2007, a total of 15,165 CTC studies were performed but only 14% (2123 examinations) were performed at public hospitals and 86% (13,042 exams) at private clinics. CTC was performed after an incomplete colonoscopy or for various contraindications to endoscopic colonoscopy in up to a third of cases. In the various institutions patients were self-referred in 20-60% of cases, more commonly in private clinics. All CTC examinations were performed on 16-64 slice CT scanners and only a small minority was performed on 4-slice scanners in 2001. All but one center used low radiation protocols. Nearly all facilities used a 2 day bowel-cleansing protocol. All except one facility did not use stool tagging or computer-aided diagnosis. All facilities inflated the colon with room air manually. All institutions used state-of-the-art workstations, 3D and endoluminal navigation, and coronal multi-planar reconstructions routinely. There are 18 radiologists in the country who perform and interpret CTC studies; half of them trained abroad. Ten of the radiologists (56%) have read more than 500 CTC studies. Conclusions: In Israel, CTC examinations are performed by well-trained and highly experienced radiologists using the latest CT scanners and workstations and adhering to acceptable CTC guidelines.