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To the Editor: We have a number of concerns about the study by Dr Cotton and colleagues,¹ including the thickness of the CT slices, the lack of oral contrast, the format for image interpretation, and variable numbers of patients across institutions. In our experience, collimation that exceeds 3 mm substantially reduces image quality and lesion conspicuity. Similarly, other studies suggest that oral contrast should be routinely administered.^2-3 The selection of slice-by-slice viewing for primary CTC interpretation over an appropriate 3-dimensional volume rendering or fly-through viewing system also may have made CTC less sensitive in identifying lesions.⁴ Finally, a single institution with experienced readers contributed 30% of the cases. In the other institutions, the readers' lack of experience in CTC may be another reason why the apparent sensitivity was lower in these institutions.

The authors did not report several additional features such as the quality of bowel preparation, extent of colonic . . . [Full Text of this Article]

Ronald M. Summers, MD, PhD
rms@nih.gov

Ingmar Bitter, PhD
Department of Radiology
National Institutes of Health
Bethesda, Md

Nicholas Petrick, PhD
Center for Devices and Radiological Health
US Food and Drug Administration
Rockville, Md

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