Institute for Healthcare Studies, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611, USA.
J Am Coll Radiol. 2011 Mar;8(3):169-74. doi: 10.1016/j.jacr.2010.08.008.
Computed tomographic colonography (CTC) is a new noninvasive technology proposed as an option for colorectal cancer screening. The purpose of this study was to identify the percentage of US hospitals that offered CTC between 2005 and 2008 and factors that motivated or impeded adoption.
Data on the provision of colorectal cancer screening services by nonfederal, general hospitals were analyzed using the 2005 to 2008 American Hospital Association annual surveys. Additionally, in 2009, exploratory interviews were conducted with representatives from radiology departments at 9 hospitals; 6 that provided CTC and 3 that did not.
In 2008, 17% of hospitals offered CTC, up from 13% in 2005. Sixty-nine percent of hospitals that offered CTC in 2008 also offered optical colonoscopy services. Factors motivating the adoption of CTC included a desire to provide an alternative screening option for frail, elderly patients and patients with failed optical colonoscopy; long waits for optical colonoscopy; and promising evidence on CTC published in peer-reviewed literature. Lack of reimbursement was a commonly cited barrier.
Growth of CT colonographic services at US hospitals occurred even in the absence of Medicare coverage or agreement among national guideline-setting organizations regarding CTC's use in screening. Almost one-third of hospitals that offer CTC do not offer optical colonoscopy and may not be prepared to provide adequate follow-up for patients with failed CTC.
计算机断层结肠成像（CTC）是一种新的非侵入性技术，被提议作为结直肠癌筛查的一种选择。本研究的目的是确定 2005 年至 2008 年间提供 CTC 的美国医院的百分比，以及促使或阻碍采用的因素。
使用 2005 年至 2008 年美国医院协会年度调查，分析非联邦普通医院提供结直肠癌筛查服务的数据。此外，在 2009 年，对 9 家医院放射科代表进行了探索性访谈；其中 6 家提供 CTC，3 家不提供。
2008 年，提供 CTC 的医院比例从 2005 年的 13%上升至 17%。2008 年提供 CTC 的医院中有 69%还提供光学结肠镜检查服务。促使采用 CTC 的因素包括为体弱、老年患者和光学结肠镜检查失败的患者提供替代筛查选择的愿望；光学结肠镜检查的等待时间长；以及同行评议文献中发表的关于 CTC 的有前途的证据。缺乏报销是一个常见的障碍。
即使没有医疗保险覆盖或国家指南制定组织就 CTC 在筛查中的使用达成一致，美国医院的 CT 结肠成像服务也在增长。近三分之一提供 CTC 的医院不提供光学结肠镜检查，可能没有准备好为 CTC 检查失败的患者提供充分的随访。
