Introduction
The issues of virtual colonoscopy vs. conventional colonoscopy are often raised in the contemporary medical literature. In spite of the simplicity and comfort of the former, the latter is still considered simpler and more effective. On the one hand, such evaluation is originated from the conservative approach of the medical workers who resort to conventional colonoscopy, on the other hand, the virtual colonoscopy is not fully researched at the moment, consequently, the distrust is evident, and the lack of information should be filled with the additional researches. The aim of this paper is to estimate the technology of virtual colonoscopy from the perspective of several factors, for filling the mentioned gap with the proper amount of arguments.
The Benefits of Virtual Imaging
The main benefit of virtual colonoscopy is the better tolerance of the procedure in general by the patients. While conventional procedure requires preliminary preparation for it and causes uncomfortable feelings in the rectum.
Originally, as it is stated in Jeong and Kaufman (2007, p. 560):
The Virtual Colonoscopy may resolve the reticence felt by those who would most beef from by this screening. Men over the age of fifty are at greatest risk and, often, are the least inclined to pick up the phone and schedule this procedure. But, as this procedure becomes more commonplace, that may change. The VC, though still requiring some preparation, is a much more tolerable procedure than its predecessor.
Considering this fact, there is a strong necessity to emphasize that the Virtual Colonoscopy is generally performed by the means of the standard imaging process, and technique, which is used is similar to the CAT scanning, consequently, the universal techniques may be used for the proper diagnosis, and simpler approach for the achieving the required image. Thus, as CAT scans are often used for the internal structures and organs, it should be emphasized that the presence of a tumor may be achieved by virtual colonoscopy as easily as by the means of CAT scanning.
As for the matters of injuring a patient, it is emphasized that VC is less dangerous from this point of view. Thus, as Liu Subramanian and Uitert (2007, p 491) emphasize:
There is a very small risk that inflating the colon with air could injure or perforate the bowel. This has been estimated to happen in fewer than one in 2,000 patients. There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk.
Consequently, all the patients will agree for less risky procedure.
Patient Insurance coverage
Unfortunately, since Virtual colonoscopy is regarded to be an innovative technique, as is not listed among the traditional and accepted methods of examination and curing, consequently, the virtual colonoscopies are not covered by the insurance yet, moreover, it requires payment for the exam precisely ate the time when it is performed. (Wan, Liang and Ke, 2004) On the one hand, it will distract patients from resorting to VC, on the other hand, lack of insurance coverage may be regarded as a great opportunity for deeper study of this innovative technology and method of diagnosing colon cancer. Moreover, most insurance companies cover the expenses if patients have the symptoms of colon cancer, and, if originally VC is more effective then the conventional colonoscopy, lack of insurance coverage will not be a barrier for implementing and further research of the new technology.
Impact on Patient Safety
The issues of patient safety are not touched upon, as the procedure is even more safe then the conventional colonoscopy, nevertheless, the patients should be informed about all the possible consequences and discomforts, which patient will have to experience. As for the radiation, it should be stated that as it is emphasized by Liu, Subramanian and Uitert (2004, p. 567): “The effective radiation dose from this procedure is about 5 mSv, which is about the same as the average person receives from background radiation in 20 months.” In the light of this fact, it should be emphasized that patient safety, and measures, which are taken during the procedure do not endanger the patient’s health. Nevertheless, pregnant people, people with the increased sensivity to x-rays should be subjected to conventional colonoscopy, in order to avoid the increased risks.
Who should make the final decision on the issue
Originally, the final decision on the procedure should be made by the patient him or herself, as it is up to the patient to decide whether subject or not the health to risks. Anyway, the risk, even tiny, is present, consequently, any patient should be consulted by a radiologist and technologist before performing an operation. As Jeong and Kaufman (2007, p. 550) claim in one of the researches:
As with all colorectal screening methods including conventional colonoscopy, there is no guarantee that a virtual colonoscopy will identify all cancers and polyps. However, it is one of the most accurate colorectal cancer screening exams currently available.
In the light of this fact, it should be stated that the original value of the decision taking and the procedures, which follow this decision is covered in the notion of the performed exam, and the risks, which are generally involved. Nevertheless, the patient should be explained all the alternatives, and the possibility of independent choice should be provided.
In order to assess the issue, why type of clinical trial or study should be required?
The necessity in the additional research is covered in the notion that there are lots of restrictions found while practicing virtual colonoscopy. The fact is that, some of these restrictions have not been confirmed, and all the capabilities of this procedure have not been studied in full measure. Thus, as Jeong and Kaufman (2007, p. 555) state:
A person who is very large may not fit into the opening of a conventional CT scanner or may be over the weight limit for the moving table. CT colonography is strictly a diagnostic procedure. If any significant polyps are found, they will have to be removed by conventional colonoscopy. Many insurance companies do not cover CT colonography as a screening test for colonic polyps, but they may cover the cost if a patient has symptoms related to the colon.
Consequently the additional researches are needed for defining the additional capabilities and restrictions associated with the process of virtual colonoscopy.
Conclusion
Finally, it should be stated that all the issues, associated with the matters of virtual colonoscopy generally require additional research and deep study as well as the awareness of the patients. Nevertheless, in comparison with the conventional colonoscopy, it is safer and simpler.
References
Chen, D., Wax, M.R., Li, L., Liang, Z., Li, B., Kaufman, A.E., (2002) “A novel approach to extract colon lumen from CT images for virtual colonoscopy” MedImg(19), No. 12, pp. 1220-1226.
Jeong, S.J., Kaufman, A.E. (2007) “Interactive wireless virtual colonoscopy” VC(23), 2007, pp. 545-557.
Liu, J.F., Subramanian, K., Yoo, T., van Uitert, R. (2004) “A stable optic-flow based method for tracking colonoscopy images” Tensor No. 1. Vol. 8
Wan, M., Liang, Z.R., Ke, Q., Hong, L.C., Bitter, I., Kaufman, A. (2004) “Automatic centerline extraction for virtual colonoscopy” MedImg21, No. 12, pp. 1450-1460.