Feasibility of cardiovascular population-based CT screening

The prevalence of cardiovascular disease (CVD) is high in The Netherlands, with annual incidence of 123,200 (only coronary heart disease). There is an urgent need for large-scale population-based randomized-controlled trials showing the impact of CVD screening followed by treatment in high risk individuals according to their CVD risk based on classical factors and/or based on coronary calcium quantified with CT. The goal of CVD CT screening is to determine the amount of coronary calcium of an individual and to stratify individuals with high levels of coronary calcium and to reduce the morbidity and mortality by offering these individuals treatment at an early stage to stop or delay progression of subclinical CVD.
One of the challenges in CVD CT screening is to secure the validity of coronary calcium quantification to perform proper risk stratification on one hand, while screening large populations at a radiation dose as-low-as-possible on the other hand.The results described in this thesis show that cardiovascular population-based CT screening is feasible with a standardized and validated imaging biomarker (in this case coronary calcium) protocol. This protocol was applied in the ROBINSCA trial in which 13,000 participants were screened. Combining screening protocols, optimizing scan parameters and using latest generation of dual-source CT can significantly reduce the radiation dose. An imaging biomarker profile including quality control guidelines for coronary calcium is needed to ensure proper use of dose-reduced protocols in population-based screening in the future.