Survey update on implementation, indications, and technical performance of computed tomography colonography in Sweden

Background: Computed tomographic colonography (CTC) has gained increased acceptance in the last few years as a valid substitute for double-contrast barium enema (DCBE). However, implementation of new technologies is complex, since several factors may influence the process. Purpose: To evaluate the current situation in Sweden concerning implementation of CTC, as compared to a previous national survey in 2005. Material and Methods: In December 2008, a structured, self-assessed questionnaire regarding implementation and technical performance of CTC was mailed to all radiology departments in Sweden. In March 2009, departments who had not replied were contacted by e-mail or by telephone. All (100%, 119/119) departments answered the questionnaire. Results: CTC is currently performed in 50/119 (42%) departments, i. e., 18 additional departments compared to 2005. Twenty-three out of 60 (38%) responding departments stated that they intend to start to perform CTC in the near future. DCBE is currently performed in 77/119 (65%) departments, 12 departments less compared to 2005. The most common reasons for non-implementation of CTC are non-availability of spiral CT scanner (41%, 26/64) and/or multidetector-row CT scanner (39%, 25/64), and lack of doctors' time (34%, 22/64). Only 3% (2/64) of departments are "awaiting further scientific documentation" on CTC, a significant reduction compared to 2005 (P = 0.002). Until 2009, 59% (29/49) of CTC centers had performed more than 200 CTCs compared to 13% (4/32) of CTC centers in 2005. Intravenous contrast material is routinely administered in 86% (42/49), and carbon dioxide is used to distend the colon in 90% (44/49). Almost all radiology departments (93%, 93/100) currently believe that CTC will "absolutely" or "probably" replace barium enema in the future, while in 2005 only 56% (55/99) gave similar answers. Conclusion: The survey reflects a further transition process from DCBE to CTC, with attitudes of radiologists increasingly in favor of CTC, although DCBE is still performed by the majority of radiology departments. DCBE should be replaced by colonoscopy and CTC, but the transition requires both human and economic resources.