From The Minnies
It might be a bit of an overstatement to say that 2016 saw the fulfillment of a life’s work in research for Dr. Perry Pickhardt (for one thing, he still has many years left in his career), but it’s not far from the truth. This year, the U.S. Preventive Services Task Force (USPSTF) included CT colonography among the tests it recommends—a watershed event that will ultimately lead to Medicare reimbursement and more widespread use of imaging-based screening for colon cancer.
The USPSTF’s action represents a validation for Pickhardt, who was the lead author on a landmark study published in 2003 that demonstrated the value of CT colonography (also known as virtual colonoscopy) as a colon screening tool. Since then, numerous attempts to gain a USPSTF recommendation fell short, despite the publication of a growing body of evidence—much of it involving Pickhardt and his colleagues—in favor of the test.
Pickhardt came to radiology through an early interest in physics. While taking a graduate school course in medical physics, he realized it was the images that piqued him the most. Following medical school at the University of Michigan, he entered radiology residency at Mallinckrodt Institute of Radiology at Washington University in St. Louis.
The U.S. Navy had paid for Pickhardt’s medical school, so instead of a fellowship, he started a four-year stint in the U.S. Navy as a military radiologist. His service took him from the U.S. military base at Guantanamo Bay, Cuba, just prior to the 9/11 terrorist attacks, to Walter Reed National Naval Medical Center in Bethesda, MD, in the early 2000s.
It was at Walter Reed that Pickhardt performed the research study screening veterans with CT that would ultimately be published in 2003, even though he was a junior radiologist at the time. “In the Navy, you can advance quickly,” he noted.
Over the years, Pickhardt has examined CT colonography from a number of angles, estimating that he’s published more than 100 papers on the topic, a number that rises close to 200 when research on extracolonic findings is included. But he pointed out that he’s also actively researching other areas, such as volumetric texture analysis, liver disease, and low-dose CT protocols.
“It’s not about the numbers; it’s that each paper answers a question,” he told AuntMinnie.com. “I always feel like each paper solves little pieces of a puzzle, and that’s what drives me.”
Pickhardt currently has two main areas of research interest. First, he is trying to determine the factors that lead some polyps to develop into colorectal cancer, while the vast majority remain benign. More knowledge in this area could help make CT colonography more precise and help physicians better determine which patients should be sent on for invasive colonoscopy.
Second, he is studying opportunistic screening, or using the data from CT colonography studies to screen for other conditions, such as osteoporosis. That would make CT colonography even more cost-effective as a screening test, he believes.
While the USPSTF recommendation was welcome news, Pickhardt believes that there’s still much work to be done before CT colonography becomes a routine screening test—in particular, convincing primary care physicians to refer patients. If that doesn’t happen, then all the research papers and clinical studies could be for nothing.
“Now I want to see [CT colonography] help the bottom line in terms of patients,” Pickhardt said. “If it doesn’t lead to that, then it’s all just academics.”