786 AJR:184, March 2005 AJR 2005;184:786–792 0361–803X/05/1842–786 © American Roentgen Ray Society Gastrointestinal Imaging Barish et al. Virtual Colonoscopy Consensus on Current Clinical Practice of Virtual Colonoscopy Matthew A. Barish 1 Jorge A. Soto 2 Joseph T. Ferrucci 2 Barish MA, Soto JA, Ferrucci JT Received April 18, 2004; accepted after revision July 22, 2004. 1 Department of Radiology, 3D and Image Processing Center, Brigham and Women’s Hospital, 75 Francis St., Boston, MA 02115. Address correspondence to M. A. Barish (mabarish@partners.org). 2 Department of Radiology, Boston Medical Center, 88 E Newton St., Boston, MA 02118. OBJECTIVE. The purpose of our study was to determine the current opinions regarding the performance, interpretation, reporting, and clinical role of virtual colonoscopy among a group of selected experts to develop a consensus statement. MATERIALS AND METHODS. A questionnaire was sent to 33 selected experts in vir- tual colonoscopy. Responses were tabulated and results were used to develop a consensus state- ment. The results of the questionnaire and consensus statement were sent to respondents for comment and approval. RESULTS. Thirty-one (93.9%) of 33 surveys were returned. Eighty-seven percent (27/31) of respondents believe virtual colonoscopy is a credible screening method. Oral sodium phos- phate solution is the laxative preferred by more than 66% (18/27), whereas 62% (13/21) do not believe fecal tagging is necessary. All respondents (25/25) think that both prone and supine im- aging is required, with most (81%, 21/26) believing IV contrast material is not necessary. The routine use of spasmolytics is suggested by only 15% (4/26). The largest acceptable slice thick- ness of 3 mm is agreed on by 88% (22/25). All respondents believe screening virtual colonos- copy should be performed at a lower dose per slice than conventional CT. Most (80%, 20/25) believe the optimum method of interpreting virtual colonoscopy should be primary axial re- view, with 3D used for problem solving. All but one respondent (96%, 26/27) agree there is a threshold size below which polyps are not clinically important. When reporting virtual colonos- copy results, 59% (16/27) believe polyps less than 4 mm need not be reported. CONCLUSION. A consensus is developing among experts as to the appropriate manner in which virtual colonoscopy should be performed, interpreted, and reported. irtual colonoscopy or CT colonog- raphy is a rapidly evolving method for the detection of colorectal pol- yps and cancers. Multiple studies have shown that it has similar accuracy to con- ventional colonoscopy both in high-risk groups and, more recently, in a low-prevalence screening population [1–4]. Virtual colonos- copy is a viable alternative to existing screen- ing tests for colorectal cancer because it is safe and noninvasive. However, issues relating to clinical implementation remain as virtual colonoscopy moves from being a research technique to becoming a generally accepted screening test. Transitioning a new technology into clini- cal practice is facilitated by development of a set of standards and practice guidelines. Tra- ditionally, development of such guidelines follows from an accumulation of clinical data, literature reviews, and consensus opinions from knowledgeable experts in the field. The goal of this study was to develop an expert consensus statement to help prepare guide- lines for clinical practice. The methodology of using an initial questionnaire to survey opinions and allowing participating individu- als to comment on the consensus statement and offer minority opinions allows a repre- sentative opinion of the current state of virtual colonoscopy. Materials and Methods The authors developed a questionnaire (Appen- dix 1) to survey opinions of leading experts in vir- tual colonoscopy. Experts were selected from one of the following groups: radiologists with experi- ence in performing and interpreting virtual colonoscopy, gastroenterologists familiar with vir- tual colonoscopy practices and having extensive experience in colorectal cancer screening pro- grams, and other individuals familiar with virtual colonoscopy who represent health care policy deci- sion makers. Selection of experts within these V