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Computed tomographic colonography (CTC or virtual colonoscopy) is a new technique for imaging the colon for the detection of colorectal neoplasm. Early clinical assessment of this procedure has shown that the performance of this test is acceptable for colorectal screening examinations. The current version of CTC utilizes an interactive combination of axial, reformatted 2D and 3D images (from an endoluminal perspective) that are generated in real time. Navigating the colorectum within the virtual endoscopy (VE) metaphor is tedious. To alleviate this problem and free the radiologist to concentrate on diagnosis, a two pass approach has been adopted. In the first pass, the colon is semiautomatically navigated and its midline is recorded. Then in a second pass, the radiologist moves the view point (virtual endoscope tip) along this midline. This second pass alone takes from 15 to 40 minutes per scan. Additional volume rendered displays have been developed which show longer segments of the colon in formats analogous to views which may be seen at autopsy. These include a technique called planar virtual pathology' (PVP) which uses image planes of the two longitudinal transcolonic sections as cut planes within isometric volume rendered images. Scenes are rendered with rays passing orthogonally through these planes from both sides. Each of the four resulting images depicts approximately one half of the inner surface of a 12 cm bowel segment. Interpretation is performed by viewing these colon segments at approximately 8 cm intervals. In this way, the entire colon can be rapidly examined with a minimum of navigational input from the radiologist. Other virtual pathology views have also been developed. These include cylindrical virtual pathology (CVP) and mercator virtual pathology (MVP). CVP views are formed by casting rays perpendicular to a straight line which approximates a segment of the colon midline. These views are analogous to the result of splitting a segment of excised colon and opening it to expose its inner surface. Interpretation can be performed interactively or by viewing a series of precomputed CVP views as described for PVP above. With MVP, views are generated by casting rays from a single viewpoint in all directions. The resulting view is a panoramic image. Interpretation of CVP is performed interactively in a manner similar to that of VE. Conclusion: A new display mode, referred to as virtual pathology (VP) has been developed which enables the radiologist to interpret long segments of the colon at one time. This new display metaphor has great promise in reducing interpretation time for CT Colonography.
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