Informatics in radiology: Electronic cleansing for noncathartic CT colonography: a structure-analysis scheme

Computed tomographic (CT) colonography performed after tagging of fecal matter but without a cathartic agent, or noncathartic CT colonography (also known as laxative-free CT colonography), is regarded as a promising next-generation technique for reducing or eliminating the discomfort associated with cathartic bowel preparation, which is the major barrier to undergoing colon cancer screening. Electronic cleansing is an emerging technique for the removal of tagged fecal materials from CT colonographic images. Three major electronic cleansing artifacts--soft-tissue degradation, pseudo-soft-tissue structures, and incomplete cleansing--severely impair the quality of electronically cleansed noncathartic CT colonographic images and limit the diagnostic utility of this modality. A structure-analysis electronic cleansing scheme was developed that makes use of local morphologic information to identify submerged colonic soft-tissue structures while removing the tagged material. Combined with other cutting-edge image processing techniques, including local roughness analysis, mosaic decomposition, and level set segmentation, structure-analysis cleansing helps eliminate the aforementioned artifacts, providing diagnostic-quality cleansed CT colonographic images for the detection of colon cancer. Noncathartic CT colonography with the application of structure-analysis cleansing is expected to help promote CT colonography as a patient-friendly method of colorectal cancer screening.