CT Virtual Colonoscopy should replace Barium Enema in radiological imaging of the colon

Radiological imaging of the colon has undergone significant transformation in the past 50 years.  Barium enema (BE) has been in use since the early part of the 20th century for detection of intraluminal colon pathology.   The introduction of CT technology in the 1970′s provided opportunity for clinicians to be able to visuaizel 2-D images of the large intestine and be able to diagnose additional extraluminal pathology.   In the 1980′s use of BE started to deminish significantly as colonoscopy, with direct visualization of the colon, became the study of choice for evaluation of the large bowel.  As therapeutic colonoscopy and colorectal screening became more prevalent in the 1990′s and beyond, BE became essentially obsolete except in very special circumstance.  Nonetheless the American Cancer Society guidelines for  colorectal screening continued to include BE as an diagnostic option for evaluation of asymptomatic patients.  In the past decade the  CT colonography (CTC) has become the preminent tool in imaging of the large intestine.  Several studies have shown this modaility to be superior to B.E. and comparable to colonoscopy in the detection of large colon polyps and other gross pathology.   However the use of CT colonography beyond a few institutions in the country is non existent.  Due to lack of insurance reimbursement (except for very limited indications) most communities lack the software or the expertise to carry out these studies.

Further comments to follow……..