Gastroenterology
Volume 133, Issue 3 , Pages 1005-1024 , September 2007

Standards for Gastroenterologists for Performing and Interpreting Diagnostic Computed Tomographic Colonography

  • Don C. Rockey

      Affiliations

    • University of Texas Southwestern Medical Center, Division of Digestive and Liver Diseases, Dallas, Texas
    • ,
  • Matthew Barish

      Affiliations

    • Department of Radiology, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts
    • ,
  • Joel V. Brill

      Affiliations

    • Predictive Health, LLC, Phoenix, Arizona
    • ,
  • Brooks D. Cash

      Affiliations

    • Uniformed Services University of the Health Sciences, Bethesda, Maryland
    • ,
  • Joel G. Fletcher

      Affiliations

    • Mayo Clinic, Department of Radiology, Rochester, Minnesota
    • ,
  • Prateek Sharma

      Affiliations

    • Veterans Affairs Medical Center and University of Kansas School of Medicine, Department of Medicine, Kansas City, Missouri
    • ,
  • Sachin Wani

      Affiliations

    • Veterans Affairs Medical Center and University of Kansas School of Medicine, Department of Medicine, Kansas City, Missouri
    • ,
  • Maurits J. Wiersema

      Affiliations

    • Indiana Medical Associates, Fort Wayne, Indiana
    • ,
  • Laura E. Peterson

      Affiliations

    • Independent Health Care Consultant, Boston, Massachusetts
    • ,
  • Jennifer Conte

      Affiliations

    • AGA Institute, Bethesda, Maryland

References 

  1. American Gastroenterological Association (AGA) Institute Position on computed tomographic colonography. Gastroenterology. 2006;131:1627–1628
  2. Bar-Meir S, Wallace MB. Diagnostic colonoscopy: the end is coming. Gastroenterology. 2006;131:992–994
  3. Rockey DC, Paulson E, Niedzwiecki D, Davis W, Bosworth HB, Sanders L, et al. Analysis of air contrast barium enema, computed tomographic colonography, and colonoscopy: prospective comparison. Lancet. 2005;365:305–311
  4. Cotton PB, Durkalski VL, Pineau BC, Palesch YY, Mauldin PD, Hoffman B, et al. Computed tomographic colonography (virtual colonoscopy): a multicenter comparison with standard colonoscopy for detection of colorectal neoplasia. JAMA. 2004;291:1713–1719
  5. Pickhardt PJ, Choi JR, Hwang I, Butler JA, Puckett ML, Hildebrandt HA, et al. Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med. 2003;349:2191–2200
  6. Johnson CD, Harmsen WS, Wilson LA, Maccarty RL, Welch TJ, Ilstrup DM, et al. Prospective blinded evaluation of computed tomographic colonography for screen detection of colorectal polyps. Gastroenterology. 2003;125:311–319
  7. Pineau BC, Paskett ED, Chen GJ, Espeland MA, Phillips K, Han JP, et al. Virtual colonoscopy using oral contrast compared with colonoscopy for the detection of patients with colorectal polyps. Gastroenterology. 2003;125:304–310
  8. McFarland EG, Pilgram TK, Brink JA, McDermott RA, Santillan CV, Brady PW, et al. CT colonography: multiobserver diagnostic performance. Radiology. 2002;225:380–390
  9. Yee J, Akerkar GA, Hung RK, Steinauer-Gebauer AM, Wall SD, McQuaid KR. Colorectal neoplasia: performance characteristics of CT colonography for detection in 300 patients. Radiology. 2001;219:685–692
  10. Fletcher JG, Johnson CD, Welch TJ, MacCarty RL, Ahlquist DA, Reed JE, et al. Optimization of CT colonography technique: prospective trial in 180 patients. Radiology. 2000;216:704–711
  11. Fenlon HM, Nunes DP, Schroy PC, Barish MA, Clarke PD, Ferrucci JT. A comparison of virtual and conventional colonoscopy for the detection of colorectal polyps. N Engl J Med. 1999;341:1496–1503
  12. Van Dam J, Cotton P, Johnson CD, McFarland BG, Pineau BC, Provenzale D, et al. AGA future trends report: CT colonography. Gastroenterology. 2004;127:970–984
  13. Rex DK, Cutler CS, Lemmel GT, Rahmani EY, Clark DW, Helper DJ, et al. Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology. 1997;112:24–28
  14. Hoppe H, Quattropani C, Spreng A, Mattich J, Netzer P, Dinkel HP. Virtual colon dissection with CT colonography compared with axial interpretation and conventional colonoscopy: preliminary results. AJR Am J Roentgenol. 2004;182:1151–1158
  15. Rockey DC. Advances in Digestive Disease. In:  Howden CW editors. Bethesda, MD: AGA Institute Press; 2007;p. 169–176
  16. Yoshida H, Nappi J, MacEneaney P, Rubin DT, Dachman AH. Computer-aided diagnosis scheme for detection of polyps at CT colonography. Radiographics. 2002;22:963–979
  17. Yoshida H, Masutani Y, MacEneaney P, Rubin DT, Dachman AH. Computerized detection of colonic polyps at CT colonography on the basis of volumetric features: pilot study. Radiology. 2002;222:327–336
  18. Halligan S, Altman DG, Mallett S, Taylor SA, Burling D, Roddie M, et al. CT colonography: assessment of radiologist performance with and without computer-aided detection. Gastroenterology. 2006;131:2006–2009
  19. Callstrom MR, Johnson CD, Fletcher JG, Reed JE, Ahlquist DA, Harmsen WS, et al. CT colonography without cathartic preparation: feasibility study. Radiology. 2001;219:693–698
  20. Zalis ME, Perumpillichira J, Del Frate C, Hahn PF. CT colonography: digital subtraction bowel cleansing with mucosal reconstruction initial observations. Radiology. 2003;226:911–917
  21. McFarland EG, Zalis ME. CT colonography: progress toward colorectal evaluation without catharsis. Gastroenterology. 2004;127:1623–1626
  22. Iannaccone R, Laghi A, Catalano C, Mangiapane F, Lamazza A, Schillaci A, et al. Computed tomographic colonography without cathartic preparation for the detection of colorectal polyps. Gastroenterology. 2004;127:1300–1311
  23. Lefere P, Gryspeerdt S, Marrannes J, Baekelandt M, Van Holsbeeck B. CT colonography after fecal tagging with a reduced cathartic cleansing and a reduced volume of barium. AJR Am J Roentgenol. 2005;184:1836–1842
  24. Zalis ME, Perumpillichira JJ, Magee C, Kohlberg G, Hahn PF. Tagging-based, electronically cleansed CT colonography: evaluation of patient comfort and image readability. Radiology. 2006;239:149–159
  25. Rex D, Imperiale T, Latinovich D, Bratcher LL. Impact of bowel preparation on efficiency and cost of colonoscopy. Am J Gastroenterol. 2002;97:1696–1700
  26. Macari M, Berman P, Dicker M, Milano A, Megibow AJ. Usefulness of CT colonography in patients with incomplete colonoscopy. AJR Am J Roentgenol. 1999;173:561–564
  27. Morrin MM, Kruskal JB, Farrell RJ, Goldberg SN, McGee JB, Raptopoulos V. Endoluminal CT colonography after an incomplete endoscopic colonoscopy. AJR Am J Roentgenol. 1999;172:913–918
  28. Fajobi O, Yiu CY, Sen-Gupta SB, Boulos PB. Metachronous colorectal cancers. Br J Surg. 1998;85:897–901
  29. Smith RA, Cokkinides V, Eyre HJ. American Cancer Society guidelines for the early detection of cancer, 2006. CA Cancer J Clin. 2006;56:11–25quiz 49–50
  30. Fenlon HM, McAneny DB, Nunes DP, Clarke PD, Ferrucci JT. Occlusive colon carcinoma: virtual colonoscopy in the preoperative evaluation of the proximal colon. Radiology. 1999;210:423–428
  31. Galia M, Midiri M, Carcione A, Cusma S, Bartolotta TV, Angileri T, et al. Usefulness of CT colonography in the preoperative evaluation of patients with distal occlusive colorectal carcinoma. Radiol Med (Torino). 2001;101:235–242
  32. Gollub MJ, Ginsberg MS, Cooper C, Thaler HT. Quality of virtual colonoscopy in patients who have undergone radiation therapy or surgery: how successful are we?. AJR Am J Roentgenol. 2002;178:1109–1116
  33. Lin OS, Kozarek RA, Schembre DB, Ayub K, Gluck M, Drennan F, et al. Screening colonoscopy in very elderly patients: prevalence of neoplasia and estimated impact on life expectancy. JAMA. 2006;295:2357–2365
  34. Hara AK, Johnson CD, Reed JE, Ahlquist DA, Nelson H, MacCarty RL, et al. Detection of colorectal polyps with CT colography: initial assessment of sensitivity and specificity. Radiology. 1997;205:59–65
  35. Royster AP, Fenlon HM, Clarke PD, Nunes DP, Ferrucci JT. CT colonoscopy of colorectal neoplasms: two-dimensional and three-dimensional virtual-reality techniques with colonoscopic correlation. AJR Am J Roentgenol. 1997;169:1237–1242
  36. Dachman AH, Kuniyoshi JK, Boyle CM, Samara Y, Hoffmann KR, Rubin DT, et al. CT colonography with three-dimensional problem solving for detection of colonic polyps. AJR Am J Roentgenol. 1998;171:989–995
  37. Rex DK, Vining D, Kopecky KK. An initial experience with screening for colon polyps using spiral CT with and without CT colography (virtual colonoscopy). Gastrointest Endosc. 1999;50:309–313
  38. Macari M, Bini EJ, Jacobs SL, Naik S, Lui YW, Milano A, et al. Colorectal polyps and cancers in asymptomatic average-risk patients: evaluation with CT colonography. Radiology. 2004;230:629–636
  39. Cash BD, Kim CH, Cullen PA, Kim M, Dykes CA, Jensen DW, et al. Accuracy of computed tomographic colonography for colorectal cancer (CRC) screening in asymptomatic, average risk individuals. Gastroenterology. 2006;130:A46
  40. Mulhall BP, Veerappan GR, Jackson JL. Meta-analysis: computed tomographic colonography. Ann Intern Med. 2005;142:635–650
  41. Pignone M, Rich M, Teutsch SM, Berg AO, Lohr KN. Screening for colorectal cancer in adults at average risk: a summary of the evidence for the US Preventive Services Task Force. Ann Intern Med. 2002;137:132–141
  42. Winawer S, Fletcher R, Rex D, Bond J, Burt R, Ferrucci J, et al. Colorectal cancer screening and surveillance: clinical guidelines and rationale—update based on new evidence. Gastroenterology. 2003;124:544–560
  43. Pickhardt PJ, Taylor AJ, Kim DH, Reichelderfer M, Gopal DV, Pfau PR. Screening for colorectal neoplasia with CT colonography: initial experience from the first year of coverage by third-party payers. Radiology. 2006;241:417–425
  44. Gluecker TM, Fletcher JG, Welch TJ, MacCarty RL, Harmsen WS, Harrington JR, et al. Characterization of lesions missed on interpretation of CT colonography using a 2D search method. AJR Am J Roentgenol. 2004;182:881–889
  45. ACR practice guideline for performing and interpreting diagnostic computed tomography (CT). ACR Practice Guideline 2002. 2002;27–30(Res. 2)
  46. ACR practice guideline for the performance of computed tomography (CT) colonography in adults. ACR Practice Guideline 2002. 2005;29:295–299(Res. 2)
  47. Gastroenterology Core Curriculum, Third edition. Gastroenterology. 2007;132:2012–2018
  48. Gluecker T, Meuwly JY, Pescatore P, Schnyder P, Delarive J, Jornod P, et al. Effect of investigator experience in CT colonography. Eur Radiol. 2002;12:1405–1409
  49. Spinzi G, Belloni G, Martegani A, Sangiovanni A, Del Favero C, Minoli G. Computed tomographic colonography and conventional colonoscopy for colon diseases: a prospective, blinded study. Am J Gastroenterol. 2001;96:394–400
  50. Bodily KD, Fletcher JG, Engelby T, Percival M, Christensen JA, Young B, et al. Nonradiologists as second readers for intraluminal findings at CT colonography. Acad Radiol. 2005;12:67–73
  51. Taylor SA, Halligan S, Burling D, Morley S, Bassett P, Atkin W, et al. CT colonography: effect of experience and training on reader performance. Eur Radiol. 2004;14:1025–1033
  52. Slater A, Taylor SA, Tam E, Gartner L, Scarth J, Peiris C, et al. Reader error during CT colonography: causes and implications for training. Eur Radiol. 2006;16:2275–2283
  53. Budoff MJ, Cohen MC, Garcia MJ, Hodgson JM, Hundley WG, Lima JA, et al. ACCF/AHA clinical competence statement on cardiac imaging with computed tomography and magnetic resonance: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training. J Am Coll Cardiol. 2005;46:383–402
  54. Baker M, Obuchowsky N, Dass C, Kendzierski R, Einstein D, Remer E. Efficacy of computer-aided detection of colorectal polyps when applied to initial, inexperienced radiologist interpretations of CT colonography: a pilot study. RSNA. 2005;337A
  55. Summers RM, Yao J, Pickhardt PJ, Franaszek M, Bitter I, Brickman D, et al. Computed tomographic virtual colonoscopy computer-aided polyp detection in a screening population. Gastroenterology. 2005;129:1832–1844
  56. Wexner SD, Beck DE, Baron TH, Fanelli RD, Hyman N, Shen B, et al. A consensus document on bowel preparation before colonoscopy: prepared by a task force from the American Society of Colon and Rectal Surgeons (ASCRS), the American Society for Gastrointestinal Endoscopy (ASGE), and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Gastrointest Endosc. 2006;63:894–909
  57. Lefere PA, Gryspeerdt SS, Dewyspelaere J, Baekelandt M, Van Holsbeeck BG. Dietary fecal tagging as a cleansing method before CT colonography: initial results polyp detection and patient acceptance. Radiology. 2002;224:393–403
  58. Macari M, Lavelle M, Pedrosa I, Milano A, Dicker M, Megibow AJ, et al. Effect of different bowel preparations on residual fluid at CT colonography. Radiology. 2001;218:274–277
  59. Bosworth HB, Rockey DC, Paulson EK, Niedzwiecki D, Davis W, Sanders LL, et al. Prospective comparison of patient experience with colon imaging tests. Am J Med. 2006;119:791–799
  60. Pickhardt PJ, Choi JH. Electronic cleansing and stool tagging in CT colonography: advantages and pitfalls with primary three-dimensional evaluation. AJR Am J Roentgenol. 2003;181:799–805
  61. Fenlon HM, Royster AP, Clarke PD, Ferrucci JT. Virtual colonoscopy in the pre-operative evaluation of patients with obstructing colorectal carcinoma. Radiology. 1997;205:195A
  62. Shinners TJ, Pickhardt PJ, Taylor AJ, Jones DA, Olsen CH. Patient-controlled room air insufflation versus automated carbon dioxide delivery for CT colonography. AJR Am J Roentgenol. 2006;186:1491–1496
  63. Yee J, Hung RK, Akerkar GA, Wall SD. The usefulness of glucagon hydrochloride for colonic distention in CT colonography. AJR Am J Roentgenol. 1999;173:169–172
  64. Burling D, Taylor SA, Halligan S, Gartner L, Paliwalla M, Peiris C, et al. Automated insufflation of carbon dioxide for MDCT colonography: distention and patient experience compared with manual insufflation. AJR Am J Roentgenol. 2006;186:96–103
  65. Young BM, Fletcher JG, Earnest F, Fidler JL, MacCarty RL, Johnson CD, et al. Colonic perforation at CT colonography in a patient without known colonic disease. AJR Am J Roentgenol. 2006;186:119–121
  66. Chen SC, Lu DS, Hecht JR, Kadell BM. CT colonography: value of scanning in both the supine and prone positions. AJR Am J Roentgenol. 1999;172:595–599
  67. Hara AK, Johnson CD, MacCarty RL, Welch TJ, McCollough CH, Harmsen WS. CT colonography: single- versus multi-detector row imaging. Radiology. 2001;219:461–465
  68. Kalra MK, Naz N, Rizzo SM, Blake MA. Computed tomography radiation dose optimization: scanning protocols and clinical applications of automatic exposure control. Curr Probl Diagn Radiol. 2005;34:171–181
  69. Kalra MK, Rizzo SM, Novelline RA. Reducing radiation dose in emergency computed tomography with automatic exposure control techniques. Emerg Radiol. 2005;11:267–274
  70. Laghi A, Lannaccone R, Panebianco V, Carbone L, Passariello R. Multislice CT colonography: technical developments. Semin Ultrasound CT MR. 2001;22:425–431
  71. Taylor SA, Halligan S, Bartram CI, Morgan PR, Talbot IC, Fry N, et al. Multi-detector row CT colonography: effect of collimation, pitch, and orientation on polyp detection in a human colectomy specimen. Radiology. 2003;229:109–118
  72. Wessling J, Fischbach R, Meier N, Allkemper T, Klusmeier J, Ludwig K, et al. CT colonography: protocol optimization with multi-detector row CT—study in an anthropomorphic colon phantom. Radiology. 2003;228:753–759
  73. Laghi A, Iannaccone R, Carbone I, Catalano C, Di Giulio E, Schillaci A, et al. Detection of colorectal lesions with virtual computed tomographic colonography. Am J Surg. 2002;183:124–131
  74. Macari M, Bini EJ, Xue X, Milano A, Katz SS, Resnick D, et al. Colorectal neoplasms: prospective comparison of thin-section low-dose multi-detector row CT colonography and conventional colonoscopy for detection. Radiology. 2002;224:383–392
  75. van Gelder RE, Venema HW, Serlie IW, Nio CY, Determann RM, Tipker CA, et al. CT colonography at different radiation dose levels: feasibility of dose reduction. Radiology. 2002;224:25–33
  76. Iannaccone R, Laghi A, Catalano C, Brink JA, Mangiapane F, Trenna S, et al. Detection of colorectal lesions: lower-dose multi-detector row helical CT colonography compared with conventional colonoscopy. Radiology. 2003;229:775–781
  77. Johnson CD, Toledano AY, Herman BA, Dachman AH, McFarland EG, Barish MA, et al. Computerized tomographic colonography: performance evaluation in a retrospective multicenter setting. Gastroenterology. 2003;125:688–695
  78. Kemerink GJ, Borstlap AC, Frantzen MJ, Schultz FW, Zoetelief J, van Engelshoven JM. Patient and occupational dosimetry in double contrast barium enema examinations. Br J Radiol. 2001;74:420–428
  79. Brenner DJ, Georgsson MA. Mass screening with CT colonography: should the radiation exposure be of concern?. Gastroenterology. 2005;129:328–337
  80. Morrin MM, Farrell RJ, Kruskal JB, Reynolds K, McGee JB, Raptopoulos V. Utility of intravenously administered contrast material at CT colonography. Radiology. 2000;217:765–771
  81. Macari M, Milano A, Lavelle M, Berman P, Megibow AJ. Comparison of time-efficient CT colonography with two- and three-dimensional colonic evaluation for detecting colorectal polyps. AJR Am J Roentgenol. 2000;174:1543–1549
  82. Barish MA, Soto JA, Ferrucci JT. Consensus on current clinical practice of virtual colonoscopy. AJR Am J Roentgenol. 2005;184:786–792
  83. Pickhardt PJ. Three-dimensional endoluminal CT colonography (virtual colonoscopy): comparison of three commercially available systems. AJR Am J Roentgenol. 2003;181:1599–1606
  84. McFarland EG, Brink JA, Pilgram TK, Heiken JP, Balfe DM, Hirselj DA, et al. Spiral CT colonography: reader agreement and diagnostic performance with two- and three-dimensional image-display techniques. Radiology. 2001;218:375–383
  85. Fidler JL, Johnson CD, MacCarty RL, Welch TJ, Hara AK, Harmsen WS. Detection of flat lesions in the colon with CT colonography. Abdom Imaging. 2002;27:292–300
  86. Pickhardt PJ, Lee AD, McFarland EG, Taylor AJ. Linear polyp measurement at CT colonography: in vitro and in vivo comparison of two-dimensional and three-dimensional displays. Radiology. 2005;236:872–878
  87. Young BM, Fletcher JG, Paulsen SR, Booya F, Johnson CD, Johnson KT, et al. Polyp measurement with CT colonography: multiple-reader, multiple-workstation comparison. AJR Am J Roentgenol. 2007;188:122–129
  88. Xiong T, Richardson M, Woodroffe R, Halligan S, Morton D, Lilford RJ. Incidental lesions found on CT colonography: their nature and frequency. Br J Radiol. 2005;78:22–29
  89. Hara AK, Johnson CD, MacCarty RL, Welch TJ. Incidental extracolonic findings at CT colonography. Radiology. 2000;215:353–357
  90. Gluecker TM, Johnson CD, Wilson LA, Maccarty RL, Welch TJ, Vanness DJ, et al. Extracolonic findings at CT colonography: evaluation of prevalence and cost in a screening population. Gastroenterology. 2003;124:911–916
  91. Miao YM, Amin Z, Healy J, Burn P, Murugan N, Westaby D, et al. A prospective single centre study comparing computed tomography pneumocolon against colonoscopy in the detection of colorectal neoplasms. Gut. 2000;47:832–837
  92. Robinson P, Burnett H, Nicholson DA. The use of minimal preparation computed tomography for the primary investigation of colon cancer in frail or elderly patients. Clin Radiol. 2002;57:389–392
  93. Zalis ME, Barish MA, Choi JR, Dachman AH, Fenlon HM, Ferrucci JT, et al. CT colonography reporting and data system: a consensus proposal. Radiology. 2005;236:3–9
  94. Bond JH. Screening guidelines for colorectal cancer. Am J Med. 1999;106:S7–S10
  95. Rex DK, Lieberman D. ACG colorectal cancer prevention action plan: update on CT-colonography. Am J Gastroenterol. 2006;101:1410–1413
  96. Winawer SJ, Zauber AG, Fletcher RH, Stillman JS, O’Brien MJ, Levin B, et al. Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. Gastroenterology. 2006;130:1872–1885
  97. Rex DK, Johnson DA, Lieberman DA, Burt RW, Sonnenberg A. Colorectal cancer prevention 2000: screening recommendations of the American College of Gastroenterology (American College of Gastroenterology). Am J Gastroenterol. 2000;95:868–877
  98. Rex DK. PRO: Patients with polyps smaller than 1 cm on computed tomographic colonography should be offered colonoscopy and polypectomy. Am J Gastroenterol. 2005;100:1903–1905discussion 1907–1908
  99. Ransohoff DF. CON: Immediate colonoscopy is not necessary in patients who have polyps smaller than 1 cm on computed tomographic colonography. Am J Gastroenterol. 2005;100:1905–1907discussion 1907–1908
  100. Taylor SA, Laghi A, Lefere P, Halligan S, Stoker J. European society of gastrointestinal and abdominal radiology (ESGAR): consensus statement on CT colonography. Eur Radiol. 2007;17:575–579
  101. 147 NRN. In: Structural shielding design for medical x-ray imaging. Maryland: National Council for Radiation Protection & Measurements B; 2004;p. 20814–30945
  102. Johnson C, Swensen S, Applegate K, Blackmore C, Borgstede J, Cardella J, et al. Quality improvement in radiology: white paper report of the Sun Valley Group Meeting. J Am Coll Radiol. 2006;3:544–549
  103. Swensen SJ, Johnson CD. Radiologic quality and safety: mapping value into radiology. J Am Coll Radiol. 2005;2:992–1000
  104. Moser JW, Wilcox PA, Bjork SS, Cushing T, Dennis M, Greissing JE, et al Pay for performance in radiology: ACR white paper. J Am Coll Radiol. 2006;3:650–664
  105. Limburg PJ, Fletcher JG. Making sense of CT colonography-related complication rates. Gastroenterology. 2006;131:2023–2024
  106. 42 USC §1320a-7b(b). Available at: http://www.aaasc.org/advocacy/documents/WDC99_937585_1.PDF. Accessed March 12, 2007.
  107. Centers for Medicare and Medicaid Services, Physician Self-Referral Section. Available at: http://www.cms.hhs.gov/PhysicianSelfReferral/01_overview.asp#TopOfPage. Accessed March 12, 2007.
  108. 42 USC §1320a-7b(b), United States Code: Title 42, 1320a-7b. Criminal penalties for acts involving Federal health care programs and 42 USC §1395nn, United States Code: Title 42, 1395nn. Limitation on certain physician referrals. Available at: http://www.cms.hhs.gov/PhysicianSelfReferral/Downloads/section_1877.pdf. Accessed March 12, 2007.
  109. 42 CFR §411.351.
  110. 42 CFR §411.354.
  111. 42 CFR §411.357(d) and (l).
  112. http://www.ama-assn.org/ama1/pub/upload/mm/362/07catiiicodes4507.pdf. American Medical Association, Category III Codes. Accessed June 29, 2007.
  113. 66 Federal Register 55269 (November 1, 2001).
  114. 42 CFR §1001.952(d).
  115. Medicare Part B Reference Manual: Appendix L - Physician Supervision of Diagnostic Tests. http://www.highmarkmedicareservices.com/partb/refman/appendix-l.html. Accessed June 29, 2007.

 Address requests for reprints to: Chair, Clinical Practice and Quality Management Committee. AGA Institute National Office, c/o Membership Department, 4930 Del Ray Avenue, Bethesda, Maryland 20814. Fax: (301) 654-5920.Disclosures: The authors have no disclosures to report concerning this work.The literature review and the recommendations therein were prepared for the AGA Institute Clinical Practice and Economics Committee by the AGA Institute CT Colonography Task Force. The paper was approved by the Committee on March 19, 2007, and by the AGA Institute Governing Board on May 19, 2007.

PII: S0016-5085(07)01114-6

doi: 10.1053/j.gastro.2007.06.001

Gastroenterology
Volume 133, Issue 3 , Pages 1005-1024 , September 2007

Article Tools

* Image Usage & Resolution