Virtual colonoscopy for primary screening. The future is now

Virtual colonoscopy (VC) is a minimally invasive tool that utilizes modern CT technology for colorectal evaluation. Since its inception in 1994, VC has continued to rapidly evolve and improve as a diagnostic screening tool. Early success using primary two-dimensional (2D) detection in polyp-rich cohorts was followed by disappointing results in low prevalence populations. Subsequent introduction of the three-dimensional (3D) endoluminal display for primary polyp detection and oral contrast tagging has transformed VC into an effective primary screening tool. This state-of-the-art VC technique has already proven to be a viable enterprise when combined with existing optical colonoscopy practice. More widespread implementation of VC screening faces multiple challenges, but these are all greatly overshadowed by the immediate need for increased participation in effective colorectal screening. Given its relatively noninvasive nature and the wide availability of CT, VC holds significant potential for addressing a very important yet preventable public health concern. This review will cover current VC technique, compare the existing multi-center VC trials, discuss issues related to primary VC screening, and briefly update the progress of our VC screening program.