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Colorectal cancer (CRC) is a widespread malignancy with significant impact, representing the third most common cancer worldwide. Its prevalence underscores the critical importance of screening, early treatment, and diagnosis in mitigating its burden on the public health sector. Screening initiatives, such as colonoscopies and faecal oral blood tests, play a pivotal role in detecting CRC at its earliest stages when treatment options are most effective. Early diagnosis not only improves survival rates but also reduces the need for aggressive interventions and enhances the quality of life for patients. Moreover, timely identification of precancerous lesions through screening enables the implementation of preventive measures, such as polyp removal, further reducing CRC incidence. Public awareness campaigns emphasising the value of regular screenings and symptom recognition are essential in fostering proactive healthcare-seeking behaviours. By prioritising screening, diagnosis, and early treatment, we can significantly reduce the morbidity and mortality associated with CRC, underscoring the importance of proactive measures in combating this formidable disease.

A vital screening procedure in this regard is the colonoscopy. Used to examine the inner lining of the colon and rectum, with the aid of a camera and a light source, the colonoscopy enables direct visualisation of the colon’s interior, allowing for the detection of abnormalities such as polyps, tumours, inflammation, and ulcers. Additionally, during the procedure, tissue samples, or biopsies, can be obtained for further analysis. Therefore, as a diagnostic tool, the colonoscopy plays a crucial role in detecting and diagnosing CRC at its earliest stages, when treatment is most effective. It is also instrumental in the prevention of CRC through the removal of precancerous polyps. This ability, to provide both diagnostic and therapeutic interventions, makes the colonoscopy a cornerstone in the management and prevention of CRC, highlighting its indispensable role in modern healthcare.

In this regard, skilled colonoscopists play a pivotal role in the accurate diagnosis and effective management of gastrointestinal conditions, particularly CRC. Through their expertise in performing procedures such as a colonoscopy, colonoscopists can navigate the complexities of the gastrointestinal tract, ensuring a thorough examination and the detection of abnormalities. Their proficiency extends beyond technical expertise to include an eye for detail and the ability to interpret colonoscopic findings, enabling timely diagnosis of conditions ranging from inflammatory bowel disease to CRC.

Colonoscopists also possess the dexterity and judgement to perform therapeutic interventions during a colonoscopy, such as polyp removal and tissue biopsy, contributing to both diagnostic and treatment modalities. Their role also extends beyond procedural, to encompass patient-centred care, in guiding patients, with effective communication and compassion, through the diagnostic and treatment process. In essence, skilled colonoscopists are instrumental in improving patient outcomes, enhancing the quality of patient care, and advancing the field of gastroenterology through their expertise.

According to research, the detection rates of polyps and adenomas vary widely among colonoscopists, with experience playing a significant role. Senior clinicians tend to exhibit higher detection rates compared to their junior counterparts. This discrepancy underscores the importance of tailored training programs designed to hone the skills of junior clinicians. Comprehensive training programs are essential to equip colonoscopists with the necessary skills and knowledge to navigate the intricacies of the procedure effectively. Addressing this skills and knowledge gap entails not only mastering technical aspects such as scope manipulation and lesion detection but also developing critical thinking skills to interpret colonoscopic findings accurately. Moreover, ongoing education and quality assurance initiatives are essential to address these gaps and maintain high standards of practice.

One approach to addressing this challenge is through the integration of advanced artificial intelligence-based (AI) technologies in colonoscopy training. AI technologies are already mature enough to automatically recognise tissue lesions and other abnormalities appearing in medical images. By leveraging the information on how the AI is capable of differentiating between healthy and non-healthy tissue, these technologies can be used as a training tool for junior colonoscopists. Diving into how an AI model makes the distinction between healthy and unhealthy tissue (what we call the model’s explainability), offers insights into the decision-making process of the algorithms, providing transparency and facilitating human learning. Through AI-powered training platforms, trainees can access instructions tailored to their skill level and learning objectives. Additionally, AI can analyse vast datasets of colonoscopy images, identifying patterns and common pitfalls, which enhance trainee awareness and proficiency. By integrating explainable AI models into colonoscopy training, we can improve traditional teaching methodologies.

ONCO-AICO (AI-assisted Colonoscopy) is one such tool being developed by CERTH under the ONCOSCREEN project. It is a training platform for clinicians to review colonoscopy images, and, with the help of AI, to learn to properly discern healthy tissue from polyps and lesions. There is clearly a transformative potential in AI-assisted approaches to colonoscopy training for CRC prevention. By embracing AI as a tool for training and quality assurance, healthcare providers can usher in a new era of CRC prevention, characterised by heightened accuracy, efficiency, and ultimately, improved patient outcomes. To learn more about our initiatives, such as how CERTH is working together with other ONCOSCREEN partners to make this type of training available to junior colonoscopists, subscribe to the ONCOSCREEN newsletter on LinkedIn and keep up with new developments here.