Prerequisites to a successful CT colonography examination are an accurate bowel cleansing followed by a moderate distension of the colon by insufflation. These steps of bowel preparation, together with the choice of patient position (e.g. both supine and prone), are determinant in optimizing the visualization of the colonic wall and the detection of polyps. Intraluminal insufflation can be achieved with different procedures that must always be tailored to the individual patient, as the deliverable volume of gas and the tolerated pressure vary greatly. This commentary examines current issues regarding colonic insufflation for CT colonography.