Rogier E. van Gelder, MD Erwin Birnie, PhD Jasper Florie, MD Michiel P. Schutter Joep F. Bartelsman, MD Pleun Snel, MD, PhD Johan S. Lame ´ris, MD, PhD Gouke J. Bonsel, MD, PhD Jaap Stoker, MD, PhD Index terms: Cancer screening Colon, CT, 76.12115 Colonoscopy Published online before print 10.1148/radiol.2331031208 Radiology 2004; 233:328 –337 Abbreviation: CI = confidence interval 1 From the Departments of Radiology (R.E.v.G., J.F., M.P.S., J.S.L., J.S.), So- cial Medicine (Public Health) (E.B., G.J.B.), and Gastroenterology (J.F.B.), Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; and Department of Gastroenterology, Slot- ervaart Hospital, Amsterdam, the Neth- erlands (P.S.). From the 2003 RSNA scientific assembly. Received August 4, 2003; revision requested September 30; revision received December 17; accepted February 4, 2004. Supported by the Netherlands Organization for Health Research and Development (grant no. 2100.0059). Address cor- respondence to R.E.v.G. (e-mail: r.e .vangelder@amc.uva.nl). Authors stated no financial relation- ship to disclose. Author contributions: Guarantors of integrity of entire study, R.E.v.G., J.S.; study concepts and de- sign, R.E.v.G., E.B., G.J.B., J.S.; litera- ture research, R.E.v.G.; clinical studies, R.E.v.G., J.F.; data acquisition, R.E.v.G., J.F., M.P.S., J.F.B., P.S.; data analysis/ interpretation, R.E.v.G., E.B., J.F., J.S.L., J.S.; statistical analysis, R.E.v.G., E.B.; manuscript preparation, R.E.v.G., E.B., J.B.; manuscript definition of intellec- tual content, R.E.v.G., E.B.; manu- script editing, R.E.v.G.; manuscript re- vision/review and final version approval, all authors © RSNA, 2004 CT Colonography and Colonoscopy: Assessment of Patient Preference in a 5-week Follow-up Study 1 PURPOSE: To prospectively evaluate short- and midterm patient preference of computed tomographic (CT) colonography relative to colonoscopy in patients at increased risk for colorectal cancer and to elucidate determinants of preference. MATERIALS AND METHODS: Consecutive patients at increased risk for colorectal cancer underwent CT colonography prior to scheduled colonoscopy. Patient expe- rience and preference were assessed both directly after the examinations and 5 weeks after the examinations. Differences in pain, embarrassment, discomfort, and preference were assessed with the Wilcoxon signed rank sum test or a binomial test. Potential determinants of preference were investigated with logistic regression analyses. RESULTS: Data for 249 patients were included. Fewer patients experienced severe or extreme pain during CT colonography (seven [3%] of 245) than during colonos- copy (81 [34%] of 241) (P  .001). Directly after both examinations, 168 (71%) of 236 patients preferred CT colonography; 5 weeks later, 141 (61%) of 233 patients preferred CT colonography (P  .001). Initially, a painful colonoscopy examination (odds ratio, 0.17; 95% confidence interval [CI]: 0.08, 0.38) was a determinant of CT colonography preference. Similarly, a painful (odds ratio, 3.70; 95% CI: 1.54, 8.92) or an embarrassing (odds ratio, 4.46; 95% CI: 1.18, 16.88) CT colonography examination was a determinant of colonoscopy preference. After 5 weeks, the presence of polyps emerged as a determinant of colonoscopy preference (odds ratio, 1.94; 95% CI: 1.02, 3.70), while the role of experiences waned. CONCLUSION: Patients preferred CT colonography to colonoscopy; however, this preference decreased in time, while outcome considerations gradually replaced temporary experiences of inconvenience. © RSNA, 2004 Colorectal cancer is the second leading cause of cancer-related mortality in the Western world, accounting for an estimated 56 700 deaths in 2001 in the United States (1). There is compelling evidence that screening for colorectal cancer reduces the incidence of this disease and the disease-specific mortality (2). Thus, many organizations have established screening guidelines and recommended screening methods, such as fecal occult blood testing, flexible sigmoidoscopy, colonoscopy, and double barium enema examination (3– 6). Despite the widespread promotion of colorectal cancer screening, a recent survey dem- onstrated that only 23.4% of the United States population aged 50 years and older underwent a fecal occult blood test in the previous year, and only 37.4% of the population underwent sigmoidoscopy or colonoscopy in the past 5 years (6). Factors that influence adherence to established guidelines are patient attitudes toward the tests, physician recommendations, and coverage by the health care system (7). In line with reports indicating that colonoscopy is more sensitive than double barium enema examination (8) or sigmoidoscopy (combined with a fecal occult blood test) (9), the American College of Gastroenterology currently recommends that asymptomatic individ- uals aged 50 years and older undergo colonoscopy once every 10 years (4). The fact that Gastrointestinal Imaging 328 R adiology