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BACKGROUND Positron emission tomography/computed tomography (PET/CT) is used pre-operatively in patients with metastatic or recurrent colorectal cancer to identify those who have potentially curative disease. However, a recent randomized trial questioned the added benefit of PET/CT over conventional imaging in patients with liver metastases. The aim of this study was to determine the proportion of patients with colorectal cancer in whom PET/CT altered surgical management, in a single tertiary centre. METHODS This was a retrospective study of all patients with colorectal cancer who had a PET/CT for colorectal cancer, funded by the Canterbury District Health Board between 2010 and 2014. RESULTS Some 111 PET/CT scans were performed on 105 patients. A total of 38% of PET/CT were for patients with known or suspected liver metastases, 23% for suspected local recurrence and 18% for known or suspected lung metastases. Five scans were for post-operative patients with a rising carcinoembryonic antigen and no attributable source on conventional imaging. PET/CT identified additional extrahepatic sites of disease in 19 of 111 (17%) scans in patients deemed to have potentially operable disease. Overall, PET/CT altered surgical management following six of 42 (14%) scans for patients with liver metastases, four of 20 (20%) scans for patients with lung metastases and six of 26 (23%) scans for patients with local recurrence. CONCLUSION PET/CT remains a useful adjunct to conventional imaging in the pre-operative workup of patients with colorectal cancer.

Introduction The Canterbury earthquake of 22 February 2011 initiated a mass casualty event for Christchurch Hospital, which suffered damage itself, and faced logistical difficulties in continued operation. Radiology was part of the hospital-wide response. This paper reviews the radiology department response and surveys opinions of emergency doctors to provide an overview of events of the day and thoughts regarding any potential future response. Methods Two main approaches were undertaken: (i) informal data gathering and discussions with staff including radiographers, sonographers, radiologists, emergency doctors and others present on the day regarding their experiences; and (ii) survey of emergency doctors regarding their experiences and recommendations. A comparison with other similar events was also conducted. Results (1) Diagnostic radiology services were initially constrained by a lack of power and lift access. Usual imaging and reporting pathways were interrupted. Alternative processes were initiated to ensure an ongoing radiology service with available resources. Lessons were learned and changes implemented locally.(2) Survey data confirmed several primary outcomes: (i) Ultrasound was crucial while CT was down; (ii) all available imaging modalities remain important in a disaster response; and (iii) preliminary reports from radiologists in the emergency department (ED) were useful in the immediate post-earthquake period. Conclusion Although resources were limited, a diagnostic radiology service remained operational. The Christchurch experience reinforces the need for disaster planning and rehearsal of plans.

Introduction The aims of this study were to investigate the diagnostic performance of computed tomography colonography (CTC) performed in a rural secondary hospital, and to describe the local pattern of CTC service provision. Method A single site, retrospective observational analysis was conducted for all patients undergoing CTC during the 12-month period from 1st of January to 31st of December 2014 with comparison to available colonoscopy. Results There were 639 CTCs performed during the 12-months period. The average time from referral to performance of CTC scan was 21.3 days. The diagnostic yield of CTC for CRC was 5.8%; and for large polyps ≥10 mm was 8.0%. The sensitivity and specificity of CTC for detecting CRC were 97.1% and 88.2% respectively. The most predictive symptoms for finding colorectal lesions were rectal bleeding and anaemia. The referral rate from CTC to colonoscopy was 16.9%. 63 patients (9.9%) had follow up recommendations made in their reports due to extracolonic findings. Conclusion Computed tomography colonography performed in a rural secondary hospital provided sufficient sensitivity to detect large polyps or CRC. The specificity for CRC was lower than reported figures in the literature. Technical issue of CTC performance due to poor insufflation techniques was identified as a main contributing factor reducing CTC accuracy. CTCs were performed with acceptable waiting time and showed high overall diagnostic yield for colorectal neoplasm in a rural hospital.

Positron emission tomography/computed tomography (PET/CT) is used pre-operatively in patients with metastatic or recurrent colorectal cancer to identify those who have potentially curative disease. However, a recent randomized trial questioned the added benefit of PET/CT over conventional imaging in patients with liver metastases. The aim of this study was to determine the proportion of patients with colorectal cancer in whom PET/CT altered surgical management, in a single tertiary centre.This was a retrospective study of all patients with colorectal cancer who had a PET/CT for colorectal cancer, funded by the Canterbury District Health Board between 2010 and 2014.Some 111 PET/CT scans were performed on 105 patients. A total of 38% of PET/CT were for patients with known or suspected liver metastases, 23% for suspected local recurrence and 18% for known or suspected lung metastases. Five scans were for post-operative patients with a rising carcinoembryonic antigen and no attributable source on conventional imaging. PET/CT identified additional extrahepatic sites of disease in 19 of 111 (17%) scans in patients deemed to have potentially operable disease. Overall, PET/CT altered surgical management following six of 42 (14%) scans for patients with liver metastases, four of 20 (20%) scans for patients with lung metastases and six of 26 (23%) scans for patients with local recurrence.PET/CT remains a useful adjunct to conventional imaging in the pre-operative workup of patients with colorectal cancer.

Aim Assessment of the chest in colorectal cancer (CRC) staging is variable. The aim of this review was to look at different chest staging strategies and determine which has the greatest efficacy. Method A review of studies assessing chest staging modalities for patients with CRC was performed. Modalities included chest X-ray (CXR), CT and positron emission tomography (PET). Results The majority of data consisted of case series. Two studies identified a low pick-up rate for CXR as a staging tool. Five studies showed increased detection rates of pulmonary metastases for chest CT vs CXR and abdominal CT. The clinical benefit of the increased detection rates was not clear. The incidence of indeterminate lung lesions (ILL) on staging chest CT varied from 4 to 42%. The majority (≥ 70%) of ILLs did not have any clinical significance. On CT scans, the incidence of pulmonary metastases in patients with rectal cancer ranged from 10 to 18% and in patients with colon cancer the incidence of pulmonary metastases ranged from 5–6%. The incidence of synchronous liver and pulmonary metastases compared with the overall incidence of pulmonary metastases ranged from 45 to 70%. There was no evidence reporting the superiority of PET/CT vs CT for the detection of pulmonary metastases or characterization of ILL. Conclusion Studies show that chest CT scanning increases the detection rates for ILL and pulmonary metastases. The clinical benefit of the increased detection rates is not clear. There is a paucity of data assessing the optimal chest staging strategy for patients presenting with CRC.

The Canterbury earthquake of 22 February 2011 initiated a mass casualty event for Christchurch Hospital, which suffered damage itself, and faced logistical difficulties in continued operation. Radiology was part of the hospital-wide response. This paper reviews the radiology department response and surveys opinions of emergency doctors to provide an overview of events of the day and thoughts regarding any potential future response.Two main approaches were undertaken: (i) informal data gathering and discussions with staff including radiographers, sonographers, radiologists, emergency doctors and others present on the day regarding their experiences; and (ii) survey of emergency doctors regarding their experiences and recommendations. A comparison with other similar events was also conducted.(1) Diagnostic radiology services were initially constrained by a lack of power and lift access. Usual imaging and reporting pathways were interrupted. Alternative processes were initiated to ensure an ongoing radiology service with available resources. Lessons were learned and changes implemented locally.(2) Survey data confirmed several primary outcomes: (i) Ultrasound was crucial while CT was down; (ii) all available imaging modalities remain important in a disaster response; and (iii) preliminary reports from radiologists in the emergency department (ED) were useful in the immediate post-earthquake period.Although resources were limited, a diagnostic radiology service remained operational. The Christchurch experience reinforces the need for disaster planning and rehearsal of plans.

New Zealand has one of the highest incidences of rectal cancer in the world, and its optimal management requires a multidisciplinary approach. A National Rectal Cancer Summit was convened in August 2013 to discuss management of rectal cancer in the New Zealand context, to highlight controversies and discuss domestic priorities for the future. This paper summarises the priorities for treatment, research and policy for rectal cancer services in New Zealand identified as part of the Summit in August. The following priorities were identified: - Access to high-quality information for service planning, review of outcomes, identification of inequities and gaps in provision, and quality improvement; - Engagement with the entire sector, including private providers; - Focus on equity; - Emerging technologies; - Harmonisation of best practice; - Importance of multidisciplinary team meetings. In conclusion, improvements in outcomes for patients with rectal cancer in New Zealand will require significant engagement between policy makers, providers, researchers, and patients in order to ensure equitable access to high quality treatment, and strategic incorporation of emerging technologies into clinical practice. A robust clinical information framework is required in order to facilitate monitoring of quality improvements and to ensure that equitable care is delivered.

Colorectal cancer is an important public health problem and one of the most common cancers registered in New Zealand. In 2009 the New Zealand Guidelines Group were commissioned to produce and evidence-based summary of current New Zealand and international data to inform best practice in the management of people with early bowel cancer. A guideline development team was convened, representing a range of stakeholder groups who met to discuss and agree on the recommendations for a clinical practice guideline. This article summarises the guideline methods and reports the recommendations from the Management of Early Bowel Cancer guideline, published in 2011.

Background This study aimed to determine the sensitivity of computed tomographic colonography (CTC) in diagnosing colorectal cancer and to explore the reasons why these cancers are missed on CTC. Methods Patients who underwent CTC in the 56-month period from 1 January 2004 to 1 September 2008, and all cases of colorectal cancer recorded in the National Cancer Registry database from 1 January 2004 to 1 December 2008, were identified. Cases from the two data sets were then matched to identify all patients in whom CTC had been performed more than 6 weeks before a histological report was available. CTC reports and patients' records were reviewed to determine the cancer site, and images were reviewed. Results A total of 3888 patients underwent CTC over a 56-month interval. After matching with the National Cancer Registry database, colorectal cancer was identified in 131 patients, whereas it had been suspected on CTC in 123 patients. One of the patients with missed cancer was excluded, leaving seven (5·3 per cent) missed cancers, four of which were located in the caecum. Five cancers were missed because of technical limitations of CTC and two were due to perceptive errors. Systems errors and severe patient co-morbidity contributed to three of the cases. The sensitivity of CTC for colorectal cancer was 95 (95 per cent confidence interval 89 to 98) per cent. Conclusion The sensitivity of 95 per cent for CTC in the diagnosis of colorectal cancer compares favourably with that of double-contrast barium enema (92 per cent) and colonoscopy (94 per cent).