Advancing Virtual Colonoscopy for Early Cancer Screening

结直肠癌（CRC）仍然是第三大最常见的癌症和第二大原因 在美国男性和女性中死于癌症的人数。它通常在晚期被诊断出来， 在病人出现症状后，解释了它的高死亡率。幸运的是，大多数CRC 可预防的，因为它们是由结直肠息肉在5至15年的恶变期内引起的。 因此，筛选程序在转化过程中检测并去除息肉（或前体 这一时期一直提倡预防癌症。不幸的是，许多人（目前， 35%的人口，CRC高发病率的比例非常高）不遵循建议， 另一方面，许多接受筛查的人由于以下几个原因而被诊断不足或过度， 现有筛查方法的局限性。该项目的健康相关性是为了促进 一种方便、几乎无风险的筛查方法，称为基于计算机断层扫描（CT）的虚拟结肠镜检查 (VC)或CT结肠造影（CTC），以克服局限性。 光学结肠镜检查（OC）是目前检测和切除息肉的金标准。因为 OC在某种程度上过于侵入性，遵守OC筛查的建议仍然是一个问题。 此外，OC将需要大量资源来筛选建议的大量人口，年龄超过 50，因此不是最佳的初级筛选试验。另一方面，基于粪便的测试（例如， 粪便血液或DNA测试）容易进行，但具有非常低的可检测性。我们一直是 发展CTC作为一种微创的成本效益高的方法，以减轻OC的筛查负担 目的，并已显示其在检测8 mm及更大尺寸息肉方面与OC相当的性能。 我们非常了解现时CT辐射水平和CTC的两个主要关注点 检测小息肉（<10 mm）的不一致性，如果CTC准备就绪， 大规模的医疗保险筛查我们对CTC在检测任务之外的潜力有着深刻的见解 用于表征增生性（无风险）与腺瘤性（风险）息肉，以进行个性化的最佳息肉治疗。 这项建议旨在消除人们的关切，并将目前反恐委员会只进行侦查的模式提升到一个新的水平。 不仅检测息肉，而且还在筛选阶段通过 具体目标有两个：（1）.开发和评估自适应图像重建方法，以保留 足够的图像质量（特别是增强图像纹理），用于息肉检测和表征， 尽可能低的CT辐射（二）、探索和评价图像纹理特征作为影像学生物标志物 来检测息肉和表征息肉亚型。 我们假设，上述具体目标将促进CTC成为一种具有成本效益的筛查试验， 补充OC以简化程序，提高患者依从性并降低CRC发生率。

Colorectal carcinoma (CRC) remains the third most commonly diagnosed cancer and the second leading cause of death from cancer for both man and women in the United States. Often it is diagnosed at an advanced stage, after the patient has developed symptoms, explaining its high mortality rate. Fortunately, most CRC are preventable because they arise from colorectal polyps over a 5 to 15 year period of malignant transformation and, therefore, screening programs to detect and remove the polyps (or precursor) during the transformation period have been advocated for cancer prevention. Unfortunately many people (at present time, more than 35% of the population, a very high rate for the high CRC incidence) do not follow the recommendation and, on the other hand, many of the screened people are either under- or over-diagnosed for several reasons related to the limitations of currently available screening methods. The health relatedness of this project is to advance a convenient, nearly risk-free screening method, called computed tomography (CT)-based virtual colonoscopy (VC) or CT colonography (CTC), to overcome the limitations. Optical colonoscopy (OC) is currently the gold standard for detection and removal of the polyps. Because OC is somehow too invasive, compliance to recommendation with OC screening would remain a concern. Furthermore, OC would demand a great resource to screen the large population as recommended with age over 50 and, therefore, would not be an optimal primary screening test. On the other hand, stool-based tests (e.g. fecal blood or DNA tests) are easy to perform but have a very low detectability. We have been the pioneers in developing CTC as a minimal-invasive cost-effective method to relieve the burden of OC for the screening purpose and have shown its comparable performance to OC on detection of polyps with size 8mm and larger. We understand very well on the two major concerns on the current CT radiation level and the current CTC inconsistency in detecting small polyps (<10mm), which were discussed by the expert panel if CTC is ready as massive screening for Medicare coverage. We have deep insight on CTC potential beyond the detection task for characterizing Hyperplastic (no-risk) vs. Adenoma (risk) polyps for personalized optimal polyp treatment. This proposal intends to relieve the concerns and bring the current CTC detection-only paradigm up to a new level of not only detecting polyps, but also characterizing the detected polyps at the screening stage via the following two specific aims: (1). To develop and evaluate adaptive image reconstruction methods to retain adequate image quality (particularly to enhance image textures) for polyp detection and characterization with as low as achievable CT radiation. (2). To explore and evaluate image texture features as imaging biomarkers to detect polyps and characterize polyp subtypes. We hypothesize that the above specific aims will advance CTC to be a cost-effective screening test and to supplement OC for a streamlined procedure to increase patient compliance and reduce CRC incident rate.