A RadioGraphics review sets out the case that CT colonography (CTC) is now a first-tier colorectal cancer screening test. In the US it gained Medicare coverage in 2025, ending a long policy stalemate, and the review summarises evidence that CTC matches colonoscopy for detecting clinically significant polyps with an excellent safety record.

The argument that matters for requesting clinicians is selectivity. Only CTC and colonoscopy are accurate enough for primary prevention — detecting and allowing removal of precursor polyps — whereas stool- and blood-based tests mainly catch established cancer in a shorter window. CTC lets you risk-stratify: refer large polyps for removal, surveil small ones, and ignore diminutive lesions, avoiding the pseudodisease and perforation risk of removing everything.

In India, where organised colorectal screening is limited and CTC access is uneven, this is less a programme than a reminder: where CTC is available, it is a legitimate, accurate screening and problem-solving option, not a second-rate substitute for colonoscopy. Technique — bowel preparation, stool tagging, distension — is what makes it reliable.

CTC matches colonoscopy for detecting clinically significant polyps, with an excellent safety record.
Only CTC and colonoscopy are accurate enough for primary prevention; stool- and blood-based tests mainly detect established cancer.
CTC allows selective management — refer large polyps, surveil small, ignore diminutive — reducing unnecessary polypectomy.
High-quality CTC depends on bowel preparation, stool tagging and adequate colonic distension.

Why it matters

It reframes CTC from a niche alternative to an equal screening test that is being underused.

Don't overread it

This is a narrative review advocating for CTC, centred on US policy and reimbursement — it is not an Indian screening recommendation or new primary data.