costly than conventional colonoscopy. It also is more convenient, typically taking 10 minutes or less, because patients need not recover from sedation.

"Both virtual colonoscopy and optical colonoscopy are excellent screening tests," Dr. Pickhardt said. "The advantages of virtual colonoscopy over optical colonoscopy at our institution are that it is safer, faster, less costly, more convenient, involves an easier bowel prep, and yet is just as effective for detecting important polyps and cancers."

In April 2004, local third-party insurance coverage was initiated for virtual colonoscopy screening by the major managed care providers in the Madison area. Over a one-year period, the researchers performed virtual colonoscopy screening exams on 1,110 asymptomatic adults, consisting of 585 women and 525 men with a mean age of 58.1 years.

Large (10 millimeters [mm] or more) colorectal polyps were identified in 43 (3.9 percent) of patients. Medium-sized lesions (6 mm - 9 mm) were identified in 77 (6.9 percent) patients. Patients without polyps 6 mm or larger were advised to follow a routine screening interval of five years. Most patients with medium-sized lesions chose to undergo follow-up with virtual colonoscopy. If all the patients with either a polyp larger than 6 mm or a nondiagnostic segment had undergone subsequent optical colonoscopy, the maximum referral rate would have been 11.9 percent.

Seventy-one of the 1,110 patients (6.4 percent) underwent subsequent optical colonoscopy. Sixty-one of these procedures were performed on the same day as virtual colonoscopy to avoid the need for repeat bowel preparation. The optical colonoscopy findings were in agreement with the virtual colonoscopy findings in 65 of the 71 patients.

The high rate of accuracy coupled with the low necessity for subsequent optical colonoscopy show virtual colonoscopy to be an attractive screening tool for colorectal cancer. "In our experience, provid
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