Objectives: The introduction of photon-counting detector computed tomography (PCCT) has allowed for significant dose reductions compared to energy-integrating-detector CT, making it particularly relevant for applications such as lung cancer screening. Coronary artery calcification is an important incidental finding in lung cancer screening, warranting attention in this context. This study aims to assess the impact of dose reduction to levels comparable to that of a chest radiography on opportunistic evaluation of coronary artery calcification on PCCTs of the chest. Materials and Methods: Sixty-eight out of 115 patients with age >45 years and body mass index ≤30 kg/m ² undergoing noncontrast low- and chest-radiography-comparable-dose PCCT in the same session were included. Scans were performed at 100 kVp with image quality settings 12 (low-dose) and 2 (radiography-comparable-dose). Visual calcium scoring was conducted by 2 readers using 2 scoring approaches (CAD-RADS 2.0 and Shemesh). Semiautomated quantitative analysis was performed using commercially available software. Image quality was evaluated using 5-point Likert scales. Results: Sixty-eight patients (65.9 ± 8.6 years; 49 men) were subjected to evaluation. CTDI was lower for radiography-dose scans (0.11 mGy vs 0.68 mGy; P < 0.001). Image quality was found to be inferior for radiography-dose scans (4.01 vs 2.03; P < 0.001). In both visual scoring approaches, coronary calcification was scored significantly lower in radiography-dose scans ( P < 0.001 for both) with almost perfect reader agreement (CAD-RADS score Cohen's kappa =0.82; Shemesh score Cohen's kappa =0.81), most importantly reclassification from mild to absent occurred for CAD-RADS score in 31%/21% of cases and for Shemesh score in 23%/15% of cases (reader 1/reader 2). Semiautomated assessment showed no significant differences between low and radiography dose ( P = 0.121). Strong correlation between scores (Pearson's r = 0.98, P < 0.001) with good agreement (Cohen's kappa =0.61) was found. Conclusions: Coronary artery calcifications are underestimated on radiography-dose PCCT visually, whereas semiautomatic analysis provides more robust results. Visual underestimation of coronary artery calcification in low-dose imaging is further amplified with the additional dose reduction to radiography-comparable dose levels, indicating that while estimation of high cardiovascular risk is feasible, exclusion of such risk is not possible.

Objective: To investigate the prevalence and progression of macrocalcifications or sporadic scattered microcalcifications, breast arterial calcifications (BAC) and grouped microcalcifications in women undergoing lung transplantation (LTX). Materials and Methods: In this retrospective single-center cohort study, 176 adult female patients who underwent mammography between 2008 and 2025 were included: 82 LTX recipients and 94 age-matched controls. Mammographic findings were assessed using standardized BI-RADS criteria and a visual BAC scoring system. Clinical and demographic data were extracted from electronic medical records. Multivariable logistic regression and cumulative incidence analysis were used to evaluate associations and progression patterns. Interobserver agreement was assessed using Fleiss’ kappa. Results: BAC and grouped microcalcifications were significantly more prevalent in the LTX group in the last mammography (BAC: OR 6.57, 95% CI 2.34–20.7; microcalcifications: OR 14.6, 95% CI 3.93–73.9; both p < 0.001). Cumulative incidence analysis showed accelerated progression of BAC and grouped microcalcifications in LTX recipients (p ≤ 0.01), while macrocalcifications or sporadic scattered microcalcification progression did not differ significantly. BAC was often more extensive and potentially mimicked malignant findings. Interobserver agreement was highest for the four-level BAC scoring system (κ = 0.61), followed by BAC presence (κ = 0.59) and macrocalcifications (κ = 0.51), while grouped microcalcifications showed only fair agreement (κ = 0.33). Conclusions: Lung transplant recipients demonstrate significantly higher prevalence and faster progression of BAC and grouped microcalcifications compared to controls, complicating mammographic interpretation. Given their elevated risk of aggressive malignancies and diagnostic overlap between benign and suspicious calcifications, transplant recipients may benefit from tailored screening strategies.

Background/Objectives: The aim of this study was to evaluate the prevalence of incidental findings in thoracic computed tomography (CT) performed because of COVID-19 and their potential impact on patient management. Methods: This retrospective analysis included 683 CT scans from 327 patients who underwent CT imaging of the thorax with or without the application of intravenous contrast-agents because of the primary indication of COVID-19. Radiological findings were categorized according to the COVID-19 Pneumonia Imaging Classification by four independent readers. Incidental findings were categorized according to a scale ranging from 0 (no patient impairment) to 3b (severe permanent impairment). Results: In the 683 CT-scans, typical COVID-19 findings were present in 273 scans (40.0%), atypical signs in 97 (14.2%), indeterminate findings in 40 (5.9%), and no signs of COVID-19 in 273 (40.0%). Incidental findings were reported in 94 out of 683 cases (13.8%), of which 63 (67.0%) were classified as category 0, 12 (12.8%) as category 1, 9 (9.6%) as category 2a, none (0.0%) as category 2b, 5 (5.3%) as category 3a, and 5 (5.3%) as category 3b. Conclusions: CT scans of the thorax for COVID-19 show a small but significant number of incidental findings that require further investigation.

Background/Objectives: To evaluate the prevalence of incidental findings in thoracic computed tomography (CT) performed because of COVID-19 and their potential impact on patient management. Methods: This retrospective analysis included 683 CT scans from 327 patients who underwent CT imaging of the thorax with or without the application of intravenous contrast-agents because of the primary indication of COVID-19. Radiological findings were categorized according to the COVID-19 Pneumonia Imaging Classification by 4 independent readers. Incidental findings were categorized according to a scale ranging from 0 (no patient impairment) to 3b (severe permanent impairment. Results: In the 683 CT-scans, typical COVID-19 findings were present in 273 scans (40.0%), atypical signs in 97 (14.2%), indeterminate findings in 40 (5.9%), and no signs of COVID-19 in 273 (40.0%). Incidental findings were reported in 93 out of 683 cases (13.6%), of which 63 (67.0%) were classified as category 0, 12 (12.8%) as category 1, 9 (9.6%) as category 2a, none (0.0%) as category 2b, 5 (5.3%) as category 3a, and 5 (5.3%) as category 3b. Conclusions: CT scans of the thorax for COVID-19 show a substantial proportion of incidental findings that require further investigation.