CT Colonography for Colorectal Cancer Prevention and Detection: Integration Into Clinical Practice, From the AJR Special Series on Screening.

CT colonography (CTC) is a CT examination performed with low radiation dose and typically without IV contrast material, optimized to detect colorectal polyps and cancer. Despite extensive supporting data, CTC has had variable acceptance and use over the past 2 decades, particularly for a main indication of colorectal cancer (CRC) screening. CTC is now at an inflection point after the approval in 2025 by CMS for reimbursement of CTC performed for CRC screening. Widespread use of CTC for CRC screening could help increase screening adherence rates and prevent cancer incidence. Nonetheless, radiologists must incorporate emerging knowledge regarding the natural history of polyps and recognition of sessile serrated lesions to leverage the screening efficiencies of CTC-based screening. The purposes of this article are to describe the current status of CTC in the United States and United Kingdom with consideration of the historical reasons that have limited the test's use along with recent events that may portend a marked change in the test's acceptance, to highlight the challenges and potential solutions toward successful widespread CTC implementation, and to present new concepts in CTC and CRC screening relevant to radiologists.