The cardiothoracic system includes two of our most important organs, the heart and lungs. Heart health and lung health are strongly intertwined and play an enormous role in our daily health, overall body function, and ultimately, our quality of life. Preventive cardiothoracic screenings can identify issues before they become serious problems, leading to better patient outcomes. For example, patients who undergo low-dose lung CT screenings have a 63% greater likelihood of surviving five years or more. Lung cancer often has few or subtle symptoms until the disease has become advanced; lung screenings in at-risk individuals can catch cancer before symptoms even begin. 

Regarding heart health, techniques like echocardiograms, stress tests, and coronary artery calcium scoring can detect signs of heart disease like coronary artery blockages, valve dysfunction, and irregular heart rhythms. Early detection can lead to timely interventions and minimally invasive procedures that can prevent heart attacks and improve overall heart health.

What is the Cardiothoracic System?

Let’s start with the basics, what’s part of the cardiothoracic system? It includes the heart, which has four distinct chambers, two atria (upper chambers) and two ventricles (lower chambers). The right atrium receives deoxygenated blood from the body and pumps it into the right ventricle, which then sends it to the lungs for oxygenation. The left atrium receives oxygenated blood from the lungs and pumps it into the left ventricle, which then distributes it to the rest of the body. The heart also has four valves to ensure blood flow and connects to the rest of the body and lungs through various arteries and veins. There is even a conduction system that regulates the heart’s rhythm and ensures synchronized contractions. 

The next key component is the lungs. The right lung has three lobes and the left lung has two. The lobes facilitate the exchange of oxygen and carbon dioxide. There are also bronchi and bronchioles which lead air into the alveoli where oxygen is exchanged for carbon dioxide in the blood. 

There are a few other key components to the cardiothoracic system including the Pleural Membranes which line the outside of the lungs and lubricate them, and the diaphragm which separates this system from the abdominal cavity and aids in breathing. Various other muscles in the chest cavity also assist with breathing as they expand and contract. 

This is a very intertwined system of the body; healthy lungs ensure that oxygen levels in the blood remain high, which is crucial for the heart to function effectively. Conversely, a well-functioning heart ensures that blood circulates efficiently through the lungs, facilitating effective gas exchange. For example, lung diseases like COPD lead to reduced oxygen levels and put extreme strain on the heart. Another example is sleep apnea, a condition where breathing repeatedly stops and starts during sleep. It can increase the risk of high blood pressure, irregular heartbeats, and heart disease. On the other hand, cardiac diseases like Coronary Artery Disease can restrict blood flow to the heart muscle, leading to reduced heart function which contributes to the development of pulmonary complications, like fluid in the lungs. 

Heart and lung disease often share the same set of key risk factors, smoking, high blood pressure, and obesity. That’s why it’s important to encourage at-risk patients to not only consider medication, lifestyle changes, and smoking cessation but also to pursue regular preventative testing.

Benefits of Cardiothoracic Screenings

Cardiothoracic screenings are crucial for identifying heart and lung disease early when it’s often more manageable and less likely to result in severe complications. Cardiac imaging techniques and tests like echocardiograms, stress tests, and coronary artery calcium scoring can detect signs of heart disease like coronary artery blockages, valve dysfunction, and irregular heart rhythms. Diagnosing and managing high blood pressure and cholesterol early on with medication can prevent heart disease. 

Lung health screenings can reveal issues such as chronic obstructive pulmonary disease (COPD), lung cancer, or interstitial lung disease. Tools like chest X-rays, CT scans, and pulmonary function tests provide insights into lung function and structure. By catching problems early, these screenings can help initiate treatments that preserve lung function and improve quality of life. For example,  a study in the UK found that patients with what they defined as early diagnosis for COPD had a longer time to first exacerbation, decreased risk of first exacerbation, decreased exacerbation rate, and decreased hospitalizations.

Cardiothoracic screenings are not a one-size-fits-all approach. They are tailored to an individual’s specific risk factors, which might include age, family history, lifestyle choices (such as smoking), and pre-existing conditions. And, for individuals already diagnosed with heart or lung conditions, regular cardiothoracic screenings can be an essential part of managing their health. These screenings help monitor disease progression, evaluate the effectiveness of ongoing treatments, and adjust management strategies as needed. The results of cardiothoracic screenings often serve as a wake-up call for individuals to adopt healthier lifestyle habits. This may mean quitting smoking or vaping, increasing physical activity, eating healthier, or enrolling in pulmonary rehabilitation programs.

New and Innovative Screening Tools

A barrier to patient adherence is often the time associated with screenings. Patients have to make an appointment, sit through a (sometimes long) exam, wait for the results from radiology, and then circle back with their primary care or specialty care physician. Sometimes results and valuable information are also lost along the way; industry metrics indicate that up to 50% of patients never make that referral appointment. 

However, new and innovative imaging techniques are paving the way to make screenings much more streamlined. Preventative lung CT scans can reduce lung cancer mortality by 20-25% among high-risk populations. A preventative lung CT scan is a specialized CT that provides detailed images of the lungs. Unlike regular X-rays, CT scans can detect tiny nodules or abnormalities that might not be visible with standard imaging techniques. The “low-dose” aspect refers to the reduced amount of radiation used compared to a conventional CT scan, making it safer for regular screenings. Preventative lung CT scans are generally recommended for individuals at high risk of developing lung cancer like current or former smokers, especially those with a significant smoking history of 20 pack-years or more. 

New tools can be combined to provide more comprehensive cardiothoracic screening than in the past. With a single inspiratory “low dose” CT scan, combined analysis with LDAi™, CAC™ and Riverain™ ClearRead™ can provide insights into cardiothoracic health: quantification of low attenuation area (LAA), cardiac artery calcification, and lung nodules.

• 4DMedical /Imbio Technology, Inspiration analysis (LDAi™), provides rapid detection and diagnosis of emphysema. It provides a fully automated assessment of areas of low attenuation (LAA, indicative of emphysema) and high attenuation (HAA) based on a single inspiratory chest CT. It is validated for use alongside low-dose CT scans as a component of lung cancer screening programs and includes a physician report and a patient-centered LungMap^™ report. The patient-centered report can act as a real “wake-up call” for patients by highlighting areas of low density and smoking damage to the lungs. The University of Chicago saw the potential of Imbio’s Population Screening Program as a way to identify patients seen anywhere in the hospital system that should have been referred to pulmonology based on their imaging. Today, the clinic is utilizing Imbio’s artificial intelligence technology to identify and treat more patients who have COPD, including those with severe emphysema.

• 4DMedical/Imbio Technology CAC™ is an FDA-cleared, fully automated solution that detects, visualizes, and quantifies coronary artery calcification from a qualifying chest CT scan. CAC provides visualizations and reports for radiologists and cardiologists to rapidly and accurately determine the location and extent of calcification. 

• ClearRead™ CT advantage by Riverain™ help to further the benefits of CTs by producing a vessel-suppressed image within the existing PACS workflow and automatically detecting nodules of all types (solid, part-solid, ground glass) at or above 5mm. This reduces the amount of imaging a patient needs to undergo and may speed up diagnosis.  

Early detection through advanced imaging and diagnostic techniques can significantly enhance treatment outcomes, reduce the severity of conditions, and improve patient care. Today, we have powerful resources to identify and manage cardiothoracic health more efficiently than ever before. These advancements not only streamline the screening process but also offer deeper insights into both heart and lung health, enabling more personalized and timely interventions.