The article by Dr Bungay1succinctly describes the attributes of the various radiological techniques now available to examine the small bowel, and highlights the potential barriers to implementation of newer cross-sectional methodologies. It is suggested that MRI and CT techniques will replace conventional fluoroscopy as the mainstay of small bowel imaging over the next decade, with the emphasis very much on MRI given the current radiation burden of CT.

As Dr Bungay points out, many questions, however, remain unanswered—is this transition justified based on robust trial evidence considering comparative diagnostic performance? Can we identify specific clinical symptom complexes that indicate one particular test over the other, and where are the tests best placed in the diagnostic pathways? Will the translation be cost effective for healthcare providers and how will capacity and training issues be handled?

While the answers to some of these questions are slowly emerging, the lack of definitive trial evidence is undoubtedly hampering appropriate dissemination of the new technologies in clinical practice. The current literature mainly consists of relatively small single-site cohort studies performed in centres with an academic interest in one or other of the newer technologies.

Across the NHS, there is ad hoc provision and utilisation of MRI, ultrasound and CT in Crohn's disease, with little consistency between hospitals and …