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July 28, 2004

Virtual Colonoscopy

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292(4):431-433. doi:10.1001/jama.292.4.431-a

To the Editor: I am concerned that Dr Cotton and colleagues1 primarily used 2-dimensional images for polyp detection, with only sporadic 3-dimensional correlation. My colleagues and I have found that state-of-the-art 3-dimensional endoluminal virtual colonoscopy (VC) fly-through colonography (with requisite 2-dimensional confirmation) is comparable to conventional colonoscopy for detection of clinically relevant polyps.2 The retrospective addition of 3-dimensional endoluminal VC fly-throughs also improved polyp detection for Dr Cotton et al. Furthermore, the software system used for interpretation is critical because of the significant differences that exist in 3-dimensional capabilities.3 Therefore, the fact that the VC fly-through system(s) used in this trial was not reported is an important omission. The lack of oral contrast for tagging residual colonic fluid and stool may have further decreased VC fly-through performance. We have reported that barium and water-soluble contrast are valuable for the purposes of stool tagging and fluid opacification, respectively.2,4 Additional shortcomings include a lack of proper training, lack of feedback to facilitate learning, and use of 5-mm slices in some cases. Finally, it is important to note that this trial ended in October 2001, whereas, our multicenter trial began in May 2002. It is becoming increasingly clear that VC fly-through performance is highly dependent upon many specific technical factors, all of which must be adequately addressed to ensure success.

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