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TRUVACE RECORD VERSION
record: TRV-2026-0314
version: 1
kind: certified
reason: Certified into the record
timestamp: 2026-07-20T08:46:27.470275Z
status: published
lens: trace
sector: health
headline: Quantifying the impact of slice thickness on cardiovascular risk stratification in lung cancer screening: a multi-center "RESCUE" study
dek: Background: Patients undergoing routine non-gated chest computed tomography (CT) for health checkups or atypical chest discomfort often present with a coronary artery calcium (CAC) score of zero on standard 5.0 mm reconstructions. We hypothesized that these thick slices obscure mild calcification due to partial volume effects (PVEs), which could be recovered by retrospective analysis of native thin-slice images. This study aimed to quantify the rate of unrecognized coronary calcification on standard thick-slice…
gain_title: Retrospective AI quantification of routinely available thin-slice chest CT reclassifies patients from CAC zero to positive, improving sensitivity for early subclinical atherosclerosis without additional radiation.
problem_title: Standard 5.0 mm chest CT reconstructions obscure mild calcification due to partial volume effects, causing significant false-negative CAC zero assessments in routine screening.
trace_subject: AI-based coronary artery calcium scoring on routine non-gated chest CT for cardiovascular risk stratification
gain_reading: Retrospective AI quantification of routinely available thin-slice chest CT reclassifies patients from CAC zero to positive, improving sensitivity for early subclinical atherosclerosis without additional radiation.
gain_evidence: Analyzing routinely available thin slice reconstructions improves sensitivity for early subclinical atherosclerosis without additional radiation
problem_reading: Standard 5.0 mm chest CT reconstructions obscure mild calcification due to partial volume effects, causing significant false-negative CAC zero assessments in routine screening.
problem_evidence: Standard 5 mm reconstructions cause significant false negative CAC assessments. | these thick slices obscure mild calcification due to partial volume effects (PVEs)
quick_read: By July 2026, researchers had tested whether native thin-slice images could recover coronary calcification missed on standard 5.0 mm chest CT. Using a validated deep learning algorithm to quantify CAC on paired reconstructions, they found 19.0% of internal cohort patients and 10.2% of NLST participants were reclassified from CAC =0 to CAC >0 on thinner slices.

The finding matters because a CAC zero on thick slices is often used to de-escalate prevention, yet nearly a third of symptomatic zero patients in this study had obstructive disease. Thin-slice review offers a no-extra-radiation opportunistic screening gain, but most rescued cases were mild Agatston 1-99, leaving uncertainty about downstream management and outcomes.
limitation: 
tag: Model-prefilled trace
key_points: Internal cohort RESCUE rate was 19.0% when comparing 1.0 mm to 5.0 mm reconstructions. | NLST cohort RESCUE rate was 10.2% using 2.0 mm scans. | 91-99% of reclassified patients fell into mild risk category Agatston 1-99. | 31% of symptomatic patients with CAC =0 on standard scans had obstructive CAD >50% stenosis. | AI correlated strongly with expert annotations r=0.956 and risk categorization showed weighted kappa 0.705-0.816.
rundown: The multi-center RESCUE study compared paired thin- and thick-slice reconstructions from routine non-gated chest CT, using a validated deep learning algorithm and TotalSegmentator n=645 for robustness.

In symptomatic patients with CAC =0 on 5.0 mm scans, 31% had obstructive CAD >50% stenosis, and many were rescued to positive CAC status by thin-slice analysis, while overall risk categorization maintained strong agreement.
sources:
- peer_reviewed | Quantitative Imaging in Medicine and Surgery | https://doi.org/10.21037/qims-2026-1-0318 | 2026-07-01
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