Recent promising trials that use low-dose CT for the early detection of lung cancer have reinvigorated the interest in screening approaches. At the same time the development of fast image acquisition techniques, such as multislice CT, have sparked renewed interest in cardiac imaging within the radiological community. In addition to special cardiac capabilities, multislice CT has several other features such as high acquisition speed and low-dose requirements that may make this modality a universal radiological screening tool. Non-invasive disease detection is the radiologist's domain. In this paper we identify criteria for effective screening and apply these criteria to screening approaches with multislice CT when used for detection of three disease entities: colon cancer; lung cancer; and cardiovascular disease.
MDCT offers a wealth of new opportunities that help us to come to a fast and accurate diagnosis in suspected abdominal disease. Traditional indications for performing CT are reemphasized and new clinical applications can be exploited.
In principle, virtual colonoscopy is capable to be used as method for early detection of colorectal cancer (CRC), even if the accuracy of the method and radiation exposure are matters discussion in the radiological community. Virtual colonoscopy is able to detect any pathology which is relevant for early detection of CRC especially when using multislice CT, but also with single slice CT. The diagnosis of small lesions, less than 7 mm in diameter (polyps and flat lesions) is still problematic as it is in conventional colonoscopy. The exposure to x-rays in asymptomatic patients, without any increased risk of developing cancer is highly problematic and should be reduced to a minimum. Using special post processing filters on the volume dataset it can be shown that a tube current of 20 mAs is sufficient without any loss in accuracy. Measurements on the Alderson-phantom showed, that an effective dose exposure of 1.2 mSv is obtained using these reduced mAs values. It has to be differentiated between virtual colonoscopy for early detection of polyps and CRC in individual patients or as a screening examination of a large population. Virtual colonoscopy as a screening examination necessitates reduction of radiation dose, a high degree of automatization in 3D reconstructions as well as the assessment of the entire mucosa. High risk patients, whom refuse fibreoptic colonoscopy should undergo virtual colonoscopy. Virtual colonoscopy has a good chance to become an accepted tool for general screening, if efficient dose reduction, complete visualization of the colon mucosa and automatization of the post processing procedures can be achieved.
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