Portland doctor among first in his region to use 3D technology for detecting colon cancer

Portland 03 March 2003A quick, 3D virtual inspection of the colon may convince more people to undergo critical screening for one of the deadliest forms of cancer. According to the American Cancer Society, colon cancer is the leading cause of cancer deaths among non-smokers and the second leading cause of cancer deaths overall, developing in almost 6 percent of the population. Yet 60 percent of those at risk are playing Russian roulette, avoiding the very screening that could save their lives. On the upside, if detected early, colon cancer is one of the easiest cancers to cure.


Dr. Joel Rubenstein, a radiologist at EPIC Imaging in Portland, is among the first in the Northwest to use the Virtual Colonoscopy, an alternative to the traditional screening methods, colonoscopy and sigmoidoscopy. Virtual Colonoscopy combines the power of the ultra-fast CT scanner and sophisticated, 3-dimensional reconstruction software, which transfers data into a digital workstation. The resulting 3D images show the colon with the same detail a gastro-enterologist would see through a fiber optic camera but spare the patient the pain and danger of an invasive procedure.

While Virtual Colonoscopy is not a replacement for colonoscopy and sigmoidoscopy, Dr. Rubenstein believes the procedure will reduce the 60 percent non-compliance rate for at risk patients, and successfully screen patients who had a failed colonoscopy. "We can cure this deadly disease if we can just get people screened. Virtual Colonoscopy is far less invasive, has fewer risks, comparable accuracy and is a more comfortable procedure", stated Dr. Rubenstein. "I think you'll see Virtual Colonoscopy increasing the number of people regularly screened for this terrible disease which will ultimately reduce the number of deaths from colon cancer."

Why are so many people dying from colon cancer if it is so easily detected? Screening can detect the kind of polyps that are the precursor to 95 percent of colorectal cancers. When diagnosed early, 90 percent of those patients are alive five years later. But here's the problem: only 37 percent of colorectal cancers are diagnosed at this critical, early stage. In terms of patient acceptance, colon cancer screening is where mammography was several years ago.

Patients are avoiding the tests that could save their lives. Reasons include:

  • Lack of awareness;
  • Uncomfortable, traditional procedures;
  • Embarrassment;
  • Length of procedure: up to 1 hour plus recovery;
  • Expense;
  • Procedures not recommended by physician or covered by insurance.

Why would patients prefer the Virtual Colonoscopy over traditional methods of screening for colon cancer? The traditional methods of screening include the sigmoidoscopy and colonoscopy, in which a long "scope" is inserted into the rectum and moved through the colon to inspect for polyps and colon cancer. These methods take up to an hour to complete, often require sedation to alleviate the pain of the procedure and involve recovery time. Even the most skilled physician will not be able to manipulate the scope through the entire length of the colon in a certain number of patients, ending in an "incomplete" exam.

As an alternative, doctors at EPIC Imaging in Portland are among the first in the region to offer the Virtual Colonoscopy, using an ultra-fast CT scanner equipped with sophisticated, virtual reality software. A small flexible rubber tube is inserted into the rectum and gentle puffs of air inflate the cleansed colon, providing a clear roadmap of colon health. The only discomfort is a mild sensation like a gas pain, when the air is introduced.

Other patient benefits involve the following:

  • Virtual Colonoscopy is fast: less than a minute for the actual procedure;
  • Evaluates areas of the colon that cannot be reached by conventional colonoscopy due to blockages, twists and folds in the colon. It is the procedure of choice to follow a failed Colonoscopy (up to 10 percent of all colonoscopies) and is considered a total colon exam;
  • Less invasive, no threat of rupture and no death rate;
  • Less discomfort and no need for sedation. A study in Radiology, February 2002 Vol. 222:2, found 82 percent of patients preferred Virtual Colonoscopy and 69 percent found Colonoscopy more painful and difficult;
  • Immediate recovery;
  • Fewer false positives;
  • No waiting at EPIC Imaging for a Virtual Colonoscopy, for patients who have just had a failed, traditional colonoscopy. For other Virtual Colonoscopy patients there is a short wait of several weeks compared to the 4-6 month wait for a traditional colonoscopy at other facilities and hospitals;
  • Allows patients a choice regarding the removal of certain polyps (polypectomy). Small polyps, less than 10mm, usually do not develop into cancer. Virtual Colonoscopy may be best at detecting the polyps that should be removed.

Who should get a Virtual Colonoscopy? One is a good candidate for a Virtual Colonoscopy if one is over 50, has a strong family history of colon cancer, cannot complete a Colonoscopy, has unexplained abdominal pain, rectal bleeding or has a history of chronic inflammatory bowel disease.

The future of Virtual Colonoscopy looks like this:

  • Prepless exam
  • Right now colonoscopy, sigmoidoscopy and Virtual Colonoscopy require pre-cleansing of the bowels before screening. Soon however, Virtual Colonoscopy patients will avoid that. They will simply ingest oral iodine or barium faecal tagging agents combined with electronic cleansing software that digitally subtracts faecal matter from the CT images;
  • New software and display options that will allow the radiologist to see more of the colon and better distinguish polyp from stool and even different types of polyps;
  • Greater computer processing power and cheaper data storage will make Virtual Colonoscopy even faster, simpler and more affordable.

For an overview on the differences between virtual and traditional colonoscopy, please read the VMW February 2003 article 3D virtual colonoscopy screening quick, effective and patient-friendly alternative to traditional colonoscopy. You can also consult the VMW March 2003 article Doctors support Viatronix Virtual Colonoscopy screening system to save more lives.

Leslie Versweyveld

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