The creators of CT screening colonography have not waited for the medical establishment and insurers to accept it as an alternative to optical colonoscopy. Dr. Elizabeth G. McFarland described during RSNA's Annual Oration in Diagnostic Radiology how they have established the necessary training, practice management, and governance mechanisms to aid its growth once it is routinely reimbursed.

Whether Medicare will grant reimbursement remained an open question, as McFarland, medical director of CT colonography at the Center for Diagnostic Imaging in Minneapolis, described past achievements and ongoing initiatives she believes will lead to the modality's acceptance.

CT colonography was given a mixed reception at a Nov. 19 hearing before the influential Medicare Evidence Development & Coverage Advisory Committee (MedCAC). A rating of "insufficient" by the U.S. Preventive Health Task Force contradicted a new American Cancer Society guideline issued in September. The guideline concluded that enough data have accumulated to consider CTC an acceptable alternative to optical colonoscopy for colorectal cancer screening.

The ACS's willingness to wait for a confidential briefing on the results of a major American College of Radiology Imaging Network trial on colonography partially explains the differences in findings, McFarland said.

The advisory committee appeared to be more influenced by the task force's assessment, she said. It recently concluded that three tests are acceptable: fecal occult testing, flexible sigmoidoscopy, and colonoscopy.

But CT colonography was scored as insufficient, based largely on the premise that the potential harm from radiation exposure and extracolonic findings could outweigh the benefits.

"This is a little bit neutralizing," McFarland said.

The MedCAC opinion increases the likelihood that the Centers for Medicare and Medicaid Services will mandate a "coverage with evidence development" requirement if it decides to grant Medicare coverage for colonography. CMS's decision is expected in February.

Yet McFarland believes that the cohesive group of radiologists who first developed colonography will eventually win over the doubters.

"The community of CT colonography has been like a family. . . It revitalizes energy. It focuses direction. It gives us purpose. It is the culture of the effort that will motivate the future," she said.