CAD techniques for CTC have advanced substantially during the last several years. As a result, a fundamental CAD scheme for the detection of polyps has been established, and commercial products are now appearing. Thus far, CAD shows the potential for detecting polyps and cancers with high sensitivity and with a clinically acceptable low false-positive rate. However, CAD for CTC needs to be improved further for more accurate and reliable detection of polyps and cancers. There are a number of technical challenges that CAD must overcome, and the resulting CAD systems should be evaluated based on large-scale, multi-center, prospective clinical trials. If the assistance in interpretation offered by CAD is shown to improve the diagnostic performance substantially, CAD is likely to make CTC a cost-effective clinical procedure, especially in the screening setting.

In the future, no matter what types of visualization method (endoscopic, virtual dissection view, etc.) and reading method (2D primary or 3D primary reading) are widely used, it is expected that the detection of polyps by CTC will make use of some form of CAD. As the benefits of CAD are established, it will become more difficult to justify not using it, just as it would be difficult for a radiologist to justify not using a magnifying glass for reading mam-mographic films. CAD will be a powerful diagnostic tool that will provide radiologists with an opportunity to expand their sphere of influence by placing these CAD systems under their control, rather than losing procedures irretrievably to other specialists.

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