Computed tomography colonography (CTC, also known as virtual colonoscopy) has been used for over a decade to investigate the colon for colorectal neoplasia. Numerous clinical and technical advances have allowed CTC to advance from a research tool to a viable option for colorec-tal cancer screening. Slowly the clinical community is beginning to realize its promise. However, controversy remains among radiologists, gastroenterologists, and other clinicians, regarding its utilization in clinical practice.

On the one hand there is tremendous excitement about a noninvasive imaging examination that can reliably detect clinically significant colorectal lesions. However, this is tempered by several recent studies that show the sensitivity of CTC may not be as great when performed and interpreted by radiologists without expertise and training. The potential to miss significant lesions exists even among experts, and moreover, if polyps are unable to be differentiated from folds and residual fecal matter, it will result in unnecessary colonoscopies.

A recent meta-analysis of published CTC studies has determined that several factors may be important for increasing the sensitivity of CTC. These include the use of a multi-detector CT (MDCT) scanner, the use of thin CT sections, and possibly the utilization of a three dimensional (3D) fly-through data interpretation technique [1].

Currently, there are not enough trained endoscopists to screen the U.S. population at average risk for colorectal cancer. There are certainly not enough trained radiologists to make a substantial impact on colon caner screening with CTC. Radiologists need to understand the issues related to colon cancer screening, how CTC may impact on colon cancer evaluation, and importantly, learn the techniques of patient preparation, data acquisition, and data interpretation. If radiologists do not embrace CTC, ultimately gastroenterologists will.

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