Opportunistic chest CT screening could identify undiagnosed heart disease in many patients
Approximately 20 million routine chest CT scans are performed for non-cardiac reasons in the U.S. each year. They represent a large untapped opportunity to detect coronary artery disease.
That's according to a presentation at SCCT2026, the Society of Cardiovascular Computed Tomography (SCCT) annual meeting, by Suhny Abbara, MD, MSCCT, senior associate consultant and professor of radiology at Mayo Clinic in Jacksonville, Florida, editor-in-chief of Radiology, the flagship journal of the Radiological Society of North America (RSNA), and a former SCCT president. He urged health systems to capitalize on the incidental findings already visible on millions of imaging exams.
"As a cardiac CT person, I think I can make less of a difference population-wise with coronary CT," Abbara said. "Those are patients that are already on our radar. There is a huge number of patients, 20 to 40 times more, where we can detect coronary atherosclerosis serendipitously in a CT done for other reasons."
Abbara, who previously practiced at UT Southwestern, said his old institution has reported coronary artery calcium on both non-contrast and contrast-enhanced chest CTs for over a decade. Research has shown incidental calcium seen on routine chest CT correlates well with dedicated coronary calcium scoring, making these scans valuable for identifying previously unrecognized cardiovascular risk.
Today, FDA-cleared artificial intelligence (AI) algorithms now exist to look for coronary calcium in any type of chest CT, report an estimated calcium score and flag the exam for patient follow-up. The technology can also be applied to previous chest CT exams archived in PACS systems.
The greatest opportunity, Abbara said, is detecting coronary atherosclerosis in younger patients undergoing CT for unrelated reasons, such as trauma or emergency department evaluations.
"If we detect moderate to severe atherosclerosis in somebody who is 40 years old, the cumulative exposure to unfavorable lipids that person has ahead of them is relatively large," Abbara explained. "That creates a much bigger opportunity for prevention."
Based on population modeling, Abbara estimated that if just 1% of chest CT patients were found to have previously unrecognized coronary artery disease qualifying for guideline-directed therapy, reporting those findings could translate into more than 200,000 life-years saved annually. However, he emphasized that identifying calcium is only the first step.
A system needs to be in place to followup on calcium findings
"This only works if we make a change at the other end by a referring physician, or maybe an emergency physician or an oncologist," Abbara said. "The coronary risk assessment may not be on their radar."
To realize the potential benefits, he said health systems need automated workflows that notify referring clinicians when coronary artery disease is identified and flag patients who are not receiving appropriate preventive therapies. AI could play a big role in health systems that pursue these types of opportunistic screening programs.
However, Abbara stressed that AI is not required to begin improving care.
"You don't need AI," he said. "You can start today on your contrast-enhanced chest CTs by simply reporting coronary calcium. We know it correlates really well with actual calcium scores."
While reimbursement for opportunistic AI screening remains limited, Abbara said the primary value lies in preventing future cardiovascular events rather than generating downstream revenue. On the other hand, he added that health systems will likely benefit financially from increased imaging and testing utilization if they do go through with this opportunistic screening.
"The biggest benefit is to the patients," he said. "Every health system has to figure out a way to actually act upon these findings. That's what has the potential to unlock those 200,000 life-years saved every year."
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]