Hassan C et al. (2008) Projected impact of colorectal cancer screening with computerized tomographic colonography on current radiological capacity in Europe. Aliment Pharmacol Ther 27: 366–374

The feasibility of population-wide screening for colorectal cancer with CT colonography (CTC) in Europe is unknown; however, widespread medical demand for CT has raised concern that its availability would be insufficient. In a simulation study, Hassan and colleagues assessed whether the number of CT machines available in Europe would be adequate for start-up and steady-state phases of such a mass screening program.

The analysis used data on the number of hospital-based CT machines <10 years old in nine main European countries and the demographics of these countries. The compliance rate was assumed to be 30%. A mathematical model was used to predict CTC demand during the 5-year start-up period when individuals aged 50–80 years would require their first screen. A Markov model was used to estimate demand for CTC during the steady-state phase when both 10-year follow-up screening and first-time screening would occur.

The simulation estimated that demand for CTC in the start-up and steady-state phases would be 6.6 and 4.3 procedures daily per machine, respectively. The researchers suggest that a steady-state demand for four procedures daily would probably be feasible; however, they concede that, when other demands on CT machines are considered, the start-up demand would be excessive.

The authors conclude that high start-up demand and future increased demand for CTC screening (e.g. with compliance rates >30%) could be met by increased CT capacity and/or combining CTC with colonoscopy—CTC might be reserved for initial screening.