CT colonography—a CT scan that produces 3D images of the colon, mimicking a conventional colonoscopy without the invasive scope—is already used in 35% of NHS hospitals, but this programme aims to make it the standard for diagnosing colorectal cancer in both symptomatic patients and the national screening programme. The problem is that current diagnostic methods, such as optical colonoscopy, are invasive, uncomfortable, and carry risks of perforation, which deters patients from attending screening. CT colonography is safer and more acceptable, but the NHS lacks robust evidence on how best to deploy it—whether with computer-assisted diagnosis, on modern digital displays, or as a screening tool to boost compliance. The programme also tackles a methodological gap: existing statistical methods for evaluating diagnostic imaging are inadequate, and this research will develop new, transferable techniques for assessing any imaging technology in the NHS. If successful, the work could reshape how bowel cancer is diagnosed across the UK, increasing screening uptake and catching cancers earlier. It will also provide a framework for evaluating other diagnostic imaging technologies, from lung scans to mammograms, ensuring the NHS adopts only those that are both effective and cost-efficient.
View original technical description
Aims and objectivesThis programme aims to deliver efficient and acceptable diagnosis of colon cancer in both symptomatic and screening populations using CT colonography. In doing so we will develop novel approaches to technology assessment that will have important applications for the broader assessment of new diagnostic imaging technologies in the NHS.BackgroundCT colonography is a novel technology combining CT scanning with 3D imaging to produce images of the colon that mimic those from colonoscopy [1], hence the alternative term, "virtual colonoscopy" [2]. CT detects colon cancer and its polyp precursors, and has attracted considerable medical and lay attention because diagnosis is safer and more acceptable to patients than alternatives. As a result, CT colonography is widely available in Europe/USA – it is practised in 35% of NHS hospitals, mainly to diagnose symptomatic cancer.The HTA has funded a multi-centre, randomised trial comparing CT with standard alternatives: the SIGGAR trial (HTA 02/02/01). SIGGAR has randomised over 5k patients and preparations are underway to discuss how NHS diagnosis/screening for colorectal cancer may be modified by the results. A group Chaired by the National Lead for Endosocpy is formulating clinical performance guidelines anticipating broader NHS implementation. The National Bowel Cancer Screening Programme, implemented 2007, is also increasing demand.SIGGAR has stimulated the investigators and Data Monitoring Committee to continue their work for the NIHR. A programme grant affords the ideal opportunity to build on existing work and extrapolate it into the broader assessment of diagnostic imaging in the NHS. While it is increasingly recognised that imaging should be subject to assessment as vigorous as used for therapeutics, the necessary methodology is immature – eg we have discovered existing statistical methods are inadequate but statistical research, while central to evidence-based assessment of technology in the NHS, is difficult to fund individually under other programmes.Research plan - We will:1. Determine the benefit (or otherwise) of computer-assisted-diagnosis (CAD) by testing observers with and without CAD, varied by reading paradigm, and by reader experience and background (eg non-medical).2. Develop novel statistical methods for analysis of multiple reader/case studies that are evidence-based and fit-for-purpose. Routines will be transferrable to other NHS diagnostic scenarios involving lesion location.3. Investigate the effect of modern digital displays on medical image perception and identify factors (eg experience, NHS background, display type) associated with good and bad performance, using these to optimise training schedules for CT and other modalities.4. Determine enhanced compliance attributable to screening by CT via discrete choice modelling to build an optimised model of CT via focus groups and questionnaires, and comparing with alternatives.5. Use the derived estimates to populate models framed to determine health and economic utility of different tests for bowel cancer screening.6. Alongside evaluation we will build a programme of technological development. Initially we will fuse medical image data from prior CT with endoscopy in real time, directing the endoscopist to detected lesions rapidly and safely.Research TeamThe multidisciplinary team has world-leading expertise in CT colonography, computer-assisted diagnosis, statistical research, psychological reactions to screening, economic modelling, medical image perception, and fusion. The team has over £60m funding (50% as PIs) and >1,400 publications. Importantly, it has a proven NIHR track-record in health services research. This programme consolidates and builds on existing expertise/infrastructure initiated by the HTA, meaning value-for-money and outputs within 3 years.EnvironmentMany team members can access the UCL NIHR Comprehensive Biomedical Centre. UCL topped the DH RAND anslysis in medical imaging. Oth
Plain English summaries and category classifications on this site are generated by AI and may not perfectly reflect the original research.
Is something wrong? Let us know