Ameriscan

[Woots32]

I'm not sure if this is the right place to post this question, but my dad just had his 50th birthday, and I've been harping on him to have a colonoscopy - especially since I recently learned that his side of the family has a history or colorectal problems. He sent me this link for a virtual colonoscopy from Ameriscan. He and my mom were also thinking of getting the total body scan (my dad was having chest pains a few weeks ago).

Has anyone heard anything about these services? If so, are they as reliable as the traditional procedures?

Any input would be greatly appreciated.

Thanks.

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[deleted6669]

my understanding of these virtual ct procedures is that they have a lot of false positives so people end up having big workups/biopsies/surgeries that they don't need. however, is this better than no colonoscopy at all? probably, but push for the real colonoscopy as it is the current study of choice.also regarding your dad's chest pain, he needs a real workup with his primary provider and probably an asprin a day if he does not have any contraindications.

 

[mpp]

If your father refuses to get a colonoscopy, then the virtual colonoscopy is the next best thing. Colonoscopy is still the gold standard and the efficacy of virtual colonoscopy has yet to be validated (do a search on PubMed and there is plenty of recent literature about it...one citation is below). As far as the total body scans go, the American College of Radiology does not believe they are effective in prolonging life (link). On the financial side, insurance usually will not cover either but they will cover a colonoscopy or a visit to your primary care provider to investigate the chest pains.

Gastroenterology 2003 Feb;124(2):544-60
Colorectal cancer screening and surveillance: Clinical guidelines and rationale-Update based on new evidence.

Winawer S, Fletcher R, Rex D, Bond J, Burt R, Ferrucci J, Ganiats T, Levin T, Woolf S, Johnson D, Kirk L, Litin S, Simmang C.

We have updated guidelines for screening for colorectal cancer. The original guidelines were prepared by a panel convened by the U.S. Agency for Health Care Policy and Research and published in 1997 under the sponsorship of a consortium of gastroenterology societies. Since then, much has changed, both in the research rature and in the clinical context. The present report summarizes new developments in this field and suggests how they should change practice. As with the previous version, these guidelines offer screening options and encourage the physician and patient to decide together which is the best approach for them. The guidelines also take into account not only the effectiveness of screening but also the risks, inconvenience, and cost of the various approaches. These guidelines differ from those published in 1997 in several ways: we recommend against rehydrating fecal occult blood tests; the screening interval for double contrast barium enema has been shortened to 5 years; colonoscopy is the preferred test for the diagnostic investigation of patients with findings on screening and for screening patients with a family history of hereditary nonpolyposis colorectal cancer; recommendations for people with a family history of colorectal cancer make greater use of risk stratification; and guidelines for genetic testing are included. Guidelines for surveillance are also included. Follow-up of postpolypectomy patients relies now on colonoscopy, and the first follow-up examination has been lengthened from 3 to 5 years for low-risk patients. If this were adopted nationally, surveillance resources could be shifted to screening and diagnosis. Promising new screening tests (virtual colonoscopy and tests for altered DNA in stool) are in development but are not yet ready for use outside of research studies. Despite a consensus among expert groups on the effectiveness of screening for colorectal cancer, screening rates remain low. Improvement depends on changes in patients' attitudes, physicians' behaviors, insurance coverage, and the surveillance and reminder systems necessary to support screening programs.

PMID: 12557158 [PubMed - in process]

 

[PACtoDOC]

I don't need a study to show me that something prolongs life to know that is has obvious serious benefits! It gives serious peace of mind, and that is something that we sell every day in medicine. I just had my own full body scan (without the virtual colonoscopy), at age 31. It was awesome. My coronaries were sliced at 2mm and were graded on a scale of 0-6 for calcifications. Mine were graded zero in all places. I had this done because I have a strong family history of heart disease, but yet I wasn't about to go get a cath just to feel good about myself. This is the next best thing. Also, I was able to visualize all my organs and see that I did not have some asymptomatic mass in my pancreas for instance. The bottom line is that many cancers go undetected until very late, and things like lung cancer can be found when it is the size of a BB compared to the size of a quarter on a chest x-ray. I will have one every year forever, and my patients who can afford it will too!!

Matt

 

[deleted6669]

" every year forever" sounds a bit overkill matt. I saw a study on the rate at which thyroid cancers are caused by repeated ct scans a few years ago and it is not insignificant. I am all for ct scans as part of a general workup but not as a stand alone study. for instance if there was a (benign) 1 mm mass on your pancreas would you have undergone ercp with f/u biopsy? what if the procedure perfed something inportant? scans of this type in my opinion may lead to procedures which have the potential to cause long term harm. there probably is an indication for these procedurtes on occassion but I do not think they should be used as screening tools in otherwise healthy pts. just my personal opinion, no flames please.

 

[FutrFPDO]

You are entitled to your opinion emed, but I will take my chances with the radiation. And further, I should have clarified. The CT annually will be for my coronaries (heart scan). I will only have the full body scan done about every 5 years. The botton line is that each of us knows of cases where people have been diagnosed with terminal cancers before when they have had few symptoms. We then scan then to find that half of their pancreas or lung is eaten up with a cancer. You can't tell me that it iwould not have been helpful to find that out sooner. And if something does show up, like some unusual calcification, then I alone have the option of deciding how to procede. You forget, there is no contract that says you must immediately succumb to exploratory surgery if something is found. In coordination with your personal physician who knows you well, these tests are excellent. If you don't think so, then you should see the number of physicians who are having them!! And as an example, there was a bright calcification found in my jejunum that the radiologist was worried about. However, with a better history from my physician, they agreed that it was my error by forgetting to refrain from taking my HTN and GERD meds for the day. The calcification as a tablet!! See, I didn't have to get cut open to figure this out. But for me, this is a good test. I have years of smoking behind me and dealing with hazardous things in the service. I am still on the Gulf War registry for serving in a unit that could have potentially been exposed to certain agents. For me this is good piece of mind and you can't sell me that with anything comparable. No flames emedpa, because you always produce such an interesting viewpoint that deserves to be respected. Later man.

 

[womansurg]

I'm curious, who pays and how much?

 

[droliver]

futrFPDO,

Just curious, by what evidence did you decide upon interval heart scans? Did a cardiologist recommend this & wouldn't a stress test be a better screen for subclinical ischemia? Are there any recommendations by the Amer. Heart Association re. the use of those type scans for screening or diagnosis?

As I understand it, @ this point in time using these non-contrasted CT scans for screening of visceral disease is a pretty poor use of resources when applied to non-selected populations. The lack of IV contrast really hurts the usefulness of these things. I think most of organized medicine feels that these things are a giant money-making scam by the owners of the multiple outpatient CT centers around.

As to the CT colonoscopy, they are a long way from ironing out the kinks in that technology & recommending patients for it outside of clinical trials could well be considered malpractice if you have a bad outcome at this point in time. It remains to be seen whether some of the early positive results @ a few tertiary centers can be reproduced when unleashed into the community. These things in radiology frequently fail to live up to the hype (at least in the short term). Hopefully this technology will live up to its promise, but I think the consensus is we are a ways from there

 

[FutrFPDO]

The coronary CT (heart scan) is about 300 dollars, and the full body scan which included the heartscan is about 600 dollars. You pay for this yourself unless you have some spectacular insurance that does.

Dr.Oliver,
I have had a stress test, but not a nuke. My family has a very atypical form of coronary artery disease that is not correlated with high cholesterol levels or any lipid abnormalities. You generally have to have calcifications in your coronaries in order to have disease, and these CT's are very good at picking this up. The down side of the scan is if you do start to have significant calcification, you still really need a cath to see the level of true flow. I have seen patients who had the scan which showed grade 5-6 lesions (the worst) but their cath was significantly better than that. For me it makes sense, but for anyone already with disease, there is probably no use.
There may be some aspect of scam to these businesses, but for me, to take home a CD with images of all my organs is very comforting. I can see that my aorta, coronaries, pancreas, lungs, stomach, etc... is without any issue. That makes me feel good, and I can promise you that I know more physicians who are having them than not.