It looks like a pink tunnel projected onto the wall of the Center for Primary Care in Evans. It is really a colon, or rather a 3-D image of the inside of a colon. And it is the future, center officials said.
The Center for Primary Care is among the first in the area to offer the virtual colonoscopy, also called CT colonography, which uses CT images reconstructed with special software to give an inside view of the colon.
"We believe it is a technology that is so good that it is going to become the standard way for people to have colon cancer screening," said Paul Fischer, a partner at the center. However, earlier this month, the Centers for Medicare and Medicaid Services decided it would not reimburse for the procedure under Medicare after a review of years of studies comparing it to the standard colonoscopy.
"Overall, when considering potential benefits and potential harms, there is insufficient evidence to conclude that the use of CT colonography improves health outcomes in Medicare beneficiaries," the agency concluded. It cited a lack of data on improved survival using CT colonography, the relatively low rate of picking up polyps smaller than 5 millimeters, although polyps greater than 10 millimeters were picked up between 90 and 93 percent of the time, and concerns about radiation.
Dr. Fischer believes the agency will eventually come around.
"This is a political issue rather than a scientific issue I think at this point in time," he said.
Gastroenterologists, who read colonoscopies, might feel threatened by the new technology, but Dr. Fischer said they should read the new virtual scans. Gastroenterologist Ayaz Chaudhary, for instance, reads the center's virtual scans at the Center for Primary Care-Imaging.
"It's a great view here," he said, as he clicked back and forth through a virtual colon scan. Although it is more difficult to pick up the smallest polyps, they are often benign, Dr. Chaudhary said.
One of the most critical issues will be how many people who get the virtual colonoscopy would need the invasive kind later because something is found that needs to be collected, Dr. Fischer said. While CMS estimated rates of referral of close to 20 percent, Dr. Fischer said it should be closer to 7 percent. And the center plans to offer the virtual scans for $750, about a third of the cost for a colonoscopy when the fees for anesthesia and reading the scan are figured in, Dr. Fischer said.
"Clearly if we can have 93 percent of the people avoid an invasive colonoscopy and just get a CT scan, that's the cost-effective way to go, assuming that it picks up the right things that need biopsy," he said.
The virtual scan avoids some of the complications of the invasive scan, such as the need for anesthesia, the risk of perforation during the exam, and the risk for infection, Dr. Fischer said. Patients on blood thinners have to go off the drug before the scan because of the risk of excessive bleeding.
There are some, such as retired teacher Clara McAlhany, who have a narrow spot or twist in the colon that prevents the scope from passing through. Mrs. McAlhany, who has anemia, twice failed a colonoscopy and considers the virtual scan her only option. But her insurance company, United Healthcare, does not cover it because it considers it "unproven," the company said in a statement.
Still, because Dr. Fischer is recommending it, she plans to do it to rule out bleeding. "I don't see any other avenue," she said.
Mrs. McAlhany said she spent hours in the exams last summer, but the virtual scan takes "15 minutes, maybe" said CT technologist Quiona McConico.
More importantly, with less risk and discomfort, there are people who previously refused to get a colonoscopy who will now consider it.
Reach Tom Corwin at (706) 823-3213 or tom.corwin@augustachronicle.com.
COLONOSCOPY COMPARISON: STANDARD VS. VIRTUAL
The Center for Primary Care, which has offices around the area, is now offering virtual colonoscopy to its patients. Here is a comparison to standard or optical colonoscopy.
| Virtual | Invasive or Optical Colonoscopy | |
| Cost | $750 | $2,000-$3,000, with anesthesia, facility and physician fees |
| Need for anesthesia? | No | Yes |
| Risks | Minimal, some concern about radiation that is not well-established; will need an invasive colonoscopy if something is detected | Potential complications from anesthesia, risk of perforation, risk of infection |
| Accuracy | Not considered reliable for polyps less five millimeters, for polyps 10 millimeters or greater it is 90-93 percent accurate | Generally considered reliable |
| Covered by insurance | Not by Medicare or United Healthcare but is covered by other companies | Usually |
Sources: Center for Primary Care; Centers for Medicare and Medicaid Services
Comments
I know a few folks that have had the traditional colonoscopy procedure, and was with them when they came out of the operating room. I vote for the virtual colonography -- especially as my "date with the scope" draws nearer with each passing year. I urge everyone, especially those whose families have histories of cancer, to have the procedure completed -- virtual or traditional. It can be a real life saver!
I agree trucksareforgirlz. I had the traditional one when I was 30 w/o any anesthesia. The virtual would be a great relief.
That figures. I have United Healthcare. They suck.
I agree purmkinhead I have them also. Getting them to pay is like pulling teeth.
with the virtual you still have to go through the prep the night before with laxatives. Also, your colon still has to "inflated" to get a good view with the CT. Personally, its a great option for those who cant go through the traditional colonoscopy.
420Time, I'm thinking that what you had was a sigmoidoscopy, because they traditionally do not sedate patients for that because they don't go that far "in". Either way, sorry you weren't sedated. As this article alludes to, the reason insurance companies don't want to pay for the virtual procedure is because, IF a polyp is found, it cannot be removed until you go back in with an actual colonoscopy procedure. Another reason is because a virtual procedure cannot see everything that an actual procedure does. I bet you that if you asked Dr. Fischer AND Dr. Chaudhary, they would tell you the same thing. Dr. Fischer is promoting this virtual procedure because they spent big bucks for the machine. Dr. Chaudhary lent his name to this because he's being paid to read the results. It's all about money, folks. BTW, if you go to a real gastroenterologist, see one that is going to take his time doing your test so he can see everything, not like Speedy Chaudhary who takes about 3 minutes (maybe!) to look at your colon! To be truly safe and thorough, it takes time to look for ANY polyps, even the ones THOUGHT to be small and "usually benign"....what if they aren't benign??
JMO, 5mm polyps have a ~0.5% chance of malignancy.
bail, it doesn't really matter about it's chance for malignancy. What matters is that, when the polyp is possibly detected in a virtual procedure, the doc doesn't have the oppurtunity to cauterize, or "zap" the sight. He'll most likely tell the patient to come back in about 3 years, at which point he will inform the patient that an actual colonoscopy must be performed in order to excise the once small polyp. Am I right?
My advice (worth nothing). Do the Virtual Colonoscopy the FIRST time undergoing a colonoscopy. If no polyps are found, repeat the virtual every few years (your doctor will determine the frequency; 5 to 10 years). If polyps are found, do the traditional colonoscopy every time thereafter. I have had several traditional colonoscopies, some without anesthesia, some with (the latter are preferable). Many could have been done safely with virtual if it had been available at the time. In latter years polyps were found EVERY time, making the virtual procedure worthless in my case. Hope this helps you make your decision. GGpap
I am surely not fond of the traditional way, but... if polyps are found like mine were , they were removed right then and there. The new way sure sounds good and easy, but I would feel safer with the traditional way, espically since you have to do the prep anyway.
this is not a future i want to see. where are the flying cars already?
I've had several colonoscopies. The trick is to start your cleanout in the morning, not the afternoon (or else you'll be up all night). Buy a tube of Desitin ointment and get some wipes, dont use toilet paper. If you do all that, it's not too bad.
I have united health care and my bills are astronomical. They don't want to pay anything. I have had two of the colon procedures. Its really not that bad. I don't think I would do the virtual one because I would want the most thorough test possible.
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