Sai Tim Yam is a non-SET surgical registrar from Wellington with an interest in General Surgery, colorectal surgery and trauma.
Appropriateness of Computed Tomography Colonography Request in Wellington Hospital
Aims CT Colonography (CTC) is an investigative tool for colonic polyps and lesions. However, CTC has limitations for assessing small lesions as well as mucosal changes, endoscopic visualization remains the gold standard. Colonoscopy is a limited resource in most public centres and CTC has been used as an alternative. We endeavoured to assess the appropriateness of CTC requests in Wellington Public Hospital (WPH) based on New Zealand Ministry of Health (NZMOH) recommendations for CTC or colonoscopy (Ministry of Health, 2015), the rate of significant findings on CTC and subsequent referral to endoscopic referral.
Method All CTC requests in WPH between Jan 2015 and April 2017 were collected from the radiology department database. Demographic information, referral reason, findings on CTC, recommendation for colonoscopy on CTC report and rate of follow up endoscopy were collected.
Results A total of 650 CTC were requested at WPH and 641 were performed. 99.06% were performed in the outpatient setting, and 87.52% were contracted to private radiology facilities. 13.26% of scans performed fell within NZMOH 2 week category, while 44.93% of scans met NZMOH 6 week category. Conversely 41.97% did not fit MOHNZ criteria. 4.37% were performed due to patient’s inability to tolerate colonoscopy or incomplete colonoscopies. CTC performed due to rejection for colonoscopy was poorly documented. Polyps, bowel masses/lesions or inflammatory lesions pickup rate between all groups were 17.65% (2 week group), 16.32% (6 week group) and 14.50% (did not meet NZMOH criteria). Radiology recommended endoscopic visualization for 53 patients, of which 41 were performed.
Conclusion Almost half of CTC requests in WPH did not fit NZMOH guidelines. Surprisingly, the pickup of significant gastrointestinal findings between all groups was similar; whereas, it would be expected that the pickup rate in the 2 week group would be larger.