Virtual colonoscopy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Editor-in-Chief: Bulent Ender, M.D. [2] Wake Gastroenterology, Raleigh, North Carolina

Overview

Virtual colonoscopy (VC) is a Medical imaging procedure which uses x-rays and computers to produce two- and three-dimensional images of the colon (large intestine) from the lowest part, the rectum, all the way to the lower end of the small intestine and display them on a screen. The procedure is used to diagnose colon and bowel disease, including polyps, diverticulosis and cancer. VC can be performed with computed tomography (CT), sometimes called a CAT scan, or with magnetic resonance imaging (MRI).

Procedure

While preparations for VC vary, the patient will usually be asked to take laxatives or other oral agents at home the day before the procedure to clear stool from the colon. A suppository is also used to cleanse the rectum of any remaining fecal matter.

VC takes place in the radiology department of a hospital or medical center. The examination takes about 10 minutes and does not require sedatives. During the procedure,

  • The patient is placed in a supine position on the examination table
  • A thin tube is inserted into the rectum, so that air can be pumped through the tube in order to inflate the colon for better viewing.
  • The table moves through the scanner to produce a series of two-dimensional cross-sections along the length of the colon. A computer program puts these images together to create a three-dimensional picture that can be viewed on the video screen.
  • The patient is asked to hold his/her breath during the scan to avoid distortion on the images.
  • The scan is then repeated with the patient lying in a prone position.

After the examination, the images produced by the scanner must be processed into a 3D image, +/- a fly through (a cine program which allows the user move through the bowel as if performing a normal colonoscopy). A radiologist evaluates the results to identify any abnormalities.

The patient may resume normal activity after the procedure, but if abnormalities are found and the patient needs conventional colonoscopy, it may be performed the same day.

Advantages

VC is more comfortable than conventional colonoscopy for some people because it does not use a colonoscope. As a result, no sedation is needed, and the patient can return to his/her usual activities or go home after the procedure without the aid of another person. VC provides clearer, more detailed images than a conventional x-ray using a barium enema, sometimes called a lower gastrointestinal (GI) series. It also takes less time than either a conventional colonoscopy or a lower GI series.

Disadvantages

According to a recent article on Eurekalert.org, the main disadvantage to VC is cost. Another disadvantage is that a radiologist cannot take tissue samples (biopsy) or remove polyps during VC, so a conventional colonoscopy must be performed if abnormalities are found. Also, VC does not show as much detail as a conventional colonoscopy, so polyps smaller than 2 millimeters in diameter may not show up on the images. Furthermore Virtual Colonoscopy performed with CT exposes the patient to ionizing radiation, however some research has demonstrated that ultra-low dose VC can be just as effective in demonstrating colon and bowel disease due to the great difference in x-ray absorption between air and the tissue comprising the inner wall of the colon.

Optical colonoscopy is taken as the "gold standard" for colorectal cancer screening by some groups but not by others. Some radiologists recommend VC as a preferred approach to colorectal screening. However, optical colonoscopy is considered the gold standard by some professionals because it permits complete visualization of the entire colon, hence providing the opportunity to identify precancerous polyps and cancer, and then to do diagnostic biopsies or therapeutic removal of these lesions, as soon as possible.

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Source

  • Adapted from public domain Virtual Colonoscopy. National Digestive Diseases Information Clearinghouse.

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