1;Copyright Page;4 2;Foreword;5 3;Preface to the Second Edition;6 4;Preface to the First Edition;7 5;Contents;9 6;Chapter 1;11 6.1;Why We Do CTC: Screening for Colorectal Cancer;11 6.1.1;1.1 Introduction: What Is Screening?;11 6.1.2;1.2 Types of Screening: Some Defi nitions;11 6.1.3;1.3 Why Screen for Colorectal Neoplasm?;12 6.1.4;1.4 Screening Tests;14 6.1.4.1;1.4.1 The "Ideal" Screening Test;14 6.1.4.2;1.4.2 Problems with Screening;14 6.1.5;1.5 Screening Tests for Colorectal Neoplasm;15 6.1.5.1;1.5.1 Risk Stratification for CRN;15 6.1.5.2;1.5.2 Fecal Occult Blood Testing;15 6.1.5.3;1.5.3 Flexible Sigmoidoscopy;16 6.1.5.4;1.5.4 Colonoscopy;16 6.1.5.5;1.5.5 Barium Enema;17 6.1.6;1.6 CT Colonography as a Screening Test for CRN;17 6.1.6.1;1.6.1 Accuracy;17 6.1.6.1.1;1.6.1.1 The Problem of Flat, Depressed and Serrated Lesions;18 6.1.6.2;1.6.2 Acceptability and Participation Rates;19 6.1.6.3;1.6.3 Availability of CTC;19 6.1.6.4;1.6.4 Cost-Effectiveness of CTC Screening;19 6.1.6.5;1.6.5 Risks and Side-Effects of CTC;20 6.1.6.5.1;1.6.5.1 Risks of Preparation;20 6.1.6.5.2;1.6.5.2 Radiation Exposure;20 6.1.6.5.3;1.6.5.3 Colorectal Perforation;20 6.1.6.6;1.6.6 CTC as Triage in FOBT Positive Subjects;20 6.1.7;1.7 CT Colonography Screening: Technique;20 6.1.7.1;1.7.1 Preparation;20 6.1.7.1.1;1.7.1.1 Diet;20 6.1.7.1.2;1.7.1.2 Purgation;20 6.1.7.1.3;1.7.1.3 Fecal and Fluid Tagging;20 6.1.7.2;1.7.2 Colonic Distension;20 6.1.7.3;1.7.3 The Use of Intravenous Contrast Agents;21 6.1.7.4;1.7.4 Scanning Parameters and Radiation Dose;21 6.1.7.5;1.7.5 Reading the CTC Examination;21 6.1.7.6;1.7.6 Effect of Computer Aided Polyp Detection on Screening CTC;21 6.1.7.7;1.7.7 CT Colonography Reporting;21 6.1.7.7.1;1.7.7.1 Reporting of Polyps at CTC;22 6.1.7.7.2;1.7.7.2 Extracolonic Pathology;22 6.1.8;1.8 Future Developments;23 6.1.9;References;23 7;Chapter 2;26 7.1;The Performance of CTC;26 7.1.1;2.1 Introduction;26 7.1.2;2.2 CT Colonography;27 7.1.3;2.3 Our Experience;28 7.1.3.1;2.3.1 Patient Acceptance;28 7.1.3.2;2.3.2 Polyp Detection;29 7.1.3.3;2.3.3 Referral to Optical Colonoscopy;31 7.1.3.4;2.3.4 Interpretation;32 7.1.3.5;2.3.5 CAD;32 7.1.3.6;2.3.6 Polyp Measurements;34 7.1.3.7;2.3.7 The Issue of Radiation;34 7.1.4;2.4 Conclusion;35 7.1.5;References;35 8;Chapter 3;38 8.1;Starting CT Colonography in Your Department;38 8.1.1;3.1 Introduction;38 8.1.2;3.2 Technical Requirements;38 8.1.3;3.3 CT Colonography Protocols;40 8.1.4;3.4 Reading and Training;40 8.1.5;3.5 Reading Conditions;42 8.1.6;3.6 Patient Information, Referral and Follow Up;43 8.1.7;3.7 Cost and Financial Implications;43 8.1.8;3.8 Quality Assurance;43 8.1.9;References;43 9;Chapter 4;45 9.1;The Eligible Patient: Indications and Contraindications;45 9.1.1;4.1 History;45 9.1.2;4.2 Indications;46 9.1.2.1;4.2.1 Screening CT Colonography;46 9.1.2.2;4.2.2 Diagnostic CT Colonography;49 9.1.2.3;4.2.3 Preoperative Assessment;49 9.1.2.4;4.2.4 Preoperative Colorectal Cancer Surveillance;50 9.1.2.5;4.2.5 Incomplete Optical Colonoscopy;50 9.1.2.6;4.2.6 Inflammatory Bowel Disease Surveillance;51 9.1.3;4.3 Contraindications;51 9.1.3.1;4.3.1 Absolute Contraindications;52 9.1.3.2;4.3.2 Relative Contraindications;52 9.1.4;4.4 Current Reimbursable Indications;53 9.1.5;4.5 Future Indications;53 9.1.6;4.6 Summary;53 9.1.7;References;53 10;Chapter 5;56 10.1;Patient Preparation for CT Colonography;56 10.1.1;5.1 Introduction;56 10.1.2;5.2 Colonic Preparation;57 10.1.2.1;5.2.1 Polyethylene Glycol;57 10.1.2.2;5.2.2 Sodium Phosphate;59 10.1.2.3;5.2.3 Magnesium Citrate;60 10.1.3;5.3 Colonic Distension;60 10.1.3.1;5.3.1 Room Air;62 10.1.3.2;5.3.2 Carbon Dioxide;62 10.1.4;5.4 Anti-Spasmodic Agents;63 10.1.4.1;5.4.1 Glucagon;63 10.1.4.2;5.4.2 Hyoscine n-Butylbromide;64 10.1.5;References;64 11;Chapter 6;67 11.1;The Prerequisite: Faecal Tagging;67 11.1.1;6.1 Introduction;67 11.1.2;6.2 What Is Fecal Tagging?;68 11.1.3;6.3 Rationale: Why We Do It!;68 11.1.3.1;6.3.1 Improving Diagnosis;68 11.1.3.2;6.3.2 Improving Patient Compl