CT colonography. a survey of general practitioners’ knowledge and interest

Purpose: To verify the knowledge and interest of general practitioners on computed tomography colonography (CTC). Materials and methods: In 2014, a Web-based questionnaire was proposed to all general practitioners of [Milan, Italy]. The questionnaire consisted of ten questions concerning general practitioners’ knowledge about CTC, including application of guidelines in clinical scenarios and diagnostic performance. Results: Out of 1,053 general practitioners, 231 (22 %), 155 men and 76 women (mean age 58 years), completed the survey. We found a significant difference between the age of responders and that of non-responders (p = 0.0033). Of the 231 responders, 84 % were aware of the possibility of using CTC as a method for examining the colon–rectum. However, only 57 % were aware about low X-ray exposure delivered by CTC and about the possibility of using a reduced cleansing protocol. Only 48 % were aware that CTC accuracy in diagnosing 10-mm or larger polyps and colorectal cancers was similar to that of conventional colonoscopy, while 62 % were informed about CTC advantages in comparison with double-contrast barium enema; 59 % thought that CTC had a potential role as a screening test; 85–86 % suggested CTC in the case of refused or incomplete conventional colonoscopy; 79 % suggested immediate conventional colonoscopy in the case of at least one 10-mm polyp. About 54 % usually prescribe one CTC every 4–6 months, while 36 % never have, 3 % one CTC per month, and 7 % one every 2–3 months. Ninety-four per cent declared that they were willing to attend a course on CTC. Conclusion: General practitioners have limited knowledge concerning CTC. Radiological societies should fill this gap offering dedicated educational initiatives

Computed tomography coronary angiography in patients without known coronary artery disease can demonstrate possible non-cardiovascular causes of non-acute retrosternal chest pain

Abstract Objectives To assess the computed tomography coronary angiography (CTCA) accuracy for demonstrating possible non-cardiovascular causes of non-acute retrosternal chest pain in patients without known coronary artery disease (CAD) and to correlate CTCA results with the patient management and relief from pain. Methods This prospective observational study was approved by the ethical committee. Consecutive patients suffering non-acute chest pain who underwent CTCA and with not known CAD were enrolled and classified as having coronary diseases (CD) or extracardiac diseases (ECD). Association between age, sex, body mass index (BMI), cardiovascular risk factors, and type of chest pain with CD or ECD was estimated. Correlation between BMI classes and each risk factor was also calculated. Results A total of 106 patients (60 males; age 62 ± 14 years [mean ± standard deviation]; mean BMI 27) were enrolled. Hypertension was found in 71/106 (67%); smoking was significantly more frequent among males (p = 0.003) and hypercholesterolemia among females (p = 0.017); hypertension and hypercholesterolemia significantly correlated with age, and hypertension also with BMI. Pain was atypical in 70/106 (66%) patients. The kind of pain did not correlate with disease or gender. CTCA showed possible causes of chest pain in 69/106 (65%) patients; 32/69 (47%) having only CD, 23/69 (33%) only ECD, and 14/69 (20%) both CD and ECD. Prevalence was: hiatal hernia 35/106 (33%); significant CAD 24/106 (23%); myocardial bridging 22/106 (21%). At follow-up of 94/106 (89%) patients, 71/94 (76%) were pain-free, 14/17 (82%) significant CAD had been treated, and only one patient with non-significant CAD was treated after CTCA. Conclusion CTCA suggested possible causes of non-acute pain in 65% of patients. Main messages • CTCA can either rule in or rule out possible causes of chest pain alternative to CAD. • Clinically relevant findings were detected in 65% of patients with non-acute chest pain. • Non-cardiovascular diseases potentially explained symptoms in 35% of patients