zdmeЗдоровье мегаполисаCity Healthcare2713-2617ГБУ «НИИОЗММ ДЗМ»10.47619/2713-2617.zm.2026.v.7i2;71-88zdme-355Research ArticleОБЗОРЫREVIEWSКлинико-экономическая целесообразность КТ-технологий скрининга коронарного кальция и его значение в составе комбинированных профилактических программ типа BIG-3Clinical and Economic Considerations of CT Coronary Calcium Screening and Its Role in Integrated BIG 3 Preventive Strategieshttps://orcid.org/0000-0003-0745-9474АндреевД. А.AndreevD. A.

Андреев Дмитрий Анатольевич – канд. наук, аналитик.

115088, Москва, ул. Шарикоподшипниковская, д. 9

Dmitry A. Andreev – Cand. Sci. in Medicine, Analyst of the Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department.

9, Sharikopodshipnikovskaya ul., 115088, Moscow

AndreevDA@zdrav.mos.ruhttps://orcid.org/0000-0003-1825-1871ЗавьяловА. А.ZavyalovA. A.

Завьялов Александр Александрович – д-р мед. наук, профессор, руководитель Онкологического центра ФГБУ «ГНЦ РФ – ФМБЦ им. А.И. Бурназяна», профессор.

123098, Москва, ул. Маршала Новикова, д. 23

Aleksander A. Zavyalov – D. Sci. in Medicine, Professor, Head of the Oncology Center, State Research Center – Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency (SRC – FMBC).

23, Marshal Novikov ul., 123098, Moscow

azav06@mail.ruНаучно-исследовательский институт организации здравоохранения и медицинского менеджмента Департамента здравоохранения города МосквыResearch Institute for Healthcare Organization and Medical Management of Moscow Healthcare DepartmentГосударственный научный центр Российской Федерации – Федеральный медицинский биофизический центр имени А.И. БурназянаState Research Center – Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency (SRC – FMBC)202630062026727188Copyright © Андреев Д.А., Завьялов А.А., 20262026Андреев Д.А., Завьялов А.А.Andreev D.A., Zavyalov A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.city-healthcare.com/jour/article/view/355

Введение. До 34% всех смертей, обусловленных атеросклеротической болезнью, приходятся на бессимптомных пациентов. Согласно прогнозным данным, к 2050 г. кардиоваскулярные заболевания, хроническая обструктивная болезнь легких и рак легкого сохранят лидирующие позиции в общей структуре причин смертности. Данные нозологии относятся к группе большой тройки (Big-3), накладывающей тяжелое социально-экономическое бремя на системы здравоохранения большинства стран. Компьютерная томография (КТ) позволяет диагностировать Big-3-патологии на латентных стадиях. Высказано предположение, что одномоментный скрининг нескольких заболеваний (Big-3-скрининг) в рамках одного сеанса КТ-сканирования органов грудной клетки способен повысить результативность обследования при минимальных дополнительных затратах. Предварительные оценки медицинских технологий подтверждают экономический потенциал Big-3-скрининга. Материалы и методы. В работе проанализированы технологические КТ-инновации в области оценки коронарного кальция, современные подходы на основе искусственного интеллекта (ИИ) к реализации комбинированных протоколов КТ-визуализации, а также вопросы клинико-экономической целесообразности внедрения данных программ. Результаты. Установлено, что прорывные технологические решения, такие как КТ с двойным источником излучения (DSCT) и фотонно-счетная томография (ФСТ), демонстрируют высокую воспроизводимость результатов скрининга коронарного кальциноза. Данные методы позволяют надежно оценивать выраженность коронарного кальциноза по протоколу низкодозной компьютерной томографии (НДКТ) без применения ЭКГ-синхронизации. Для медицинских центров, не оснащенных сканерами с высоким временным разрешением, альтернативой выступают алгоритмы ИИ. Они обеспечивают автоматическую градацию тяжести кальциноза коронарных артерий с параллельным контролем качества изображений, верификацией надежности полученного результата и определением показаний к выбору маршрутизации и проведению дополнительной стандартной визуализации. Заключение. Совершенствование режимов выполнения КТ-скрининга, а также критериев включения и исключения пациентов должно основываться на результатах клинических исследований и математического моделирования. Это позволит сбалансировать клинико-экономическую пользу и ятрогенные риски и обосновать целесообразность оценки коронарного кальция в программах типа BIG-3.

Introduction. Asymptomatic individuals account for almost 34% of all atherosclerosis-related deaths. Prognostic data says that cardiovascular diseases, chronic obstructive pulmonary disease, and lung cancer will continue to dominate the overall structure of causes of death until 2050. These conditions form the Big-3 Group, imposing a significant socioeconomic burden on the healthcare systems of most countries. CT-based methods enable the diagnosis of Big-3 diseases at the latent stage. It is suggested that single screening for multiple diseases (Big-3 screening) performed within one chest CT scan session improves the efficiency of examination at minimal additional cost. The economic potential of Big-3 screening has been demonstrated in early-stage technology assessments. Materials and methods. The authors analyzed CT innovations for coronary calcium scans, current AI-driven approaches to integrating combined protocols for CT imaging, and clinical effectiveness and cost-effectiveness of implementing these tools. Results. Advanced technology, such as dual-source computed tomography (DSCT) and photon-counting computed tomography (PCCT), showed a high reproducibility of coronary calcium screening results. These techniques allow the reliable evaluation of calcium score using the protocol for non-ECG-gated low-dose computed tomography (LDCT). Medical centers not equipped with high-resolution CT scanners can use AI algorithms instead. Such algorithms enhance the automatic grading of coronary calcium severity while also assessing the quality of images, validating the reliability of results, and making decisions on next steps in the patient journey, including further standard imaging tests. Conclusion. The optimization of protocols for CT screening, as well as patient inclusion and exclusion criteria, must be guided by the results of clinical trials and mathematical modeling. This will balance clinical and economic benefits against iatrogenic risks, thereby establishing the feasibility of coronary artery calcium screening within BIG-3-type strategies.

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The authors declare that there are no conflicts of interest present.