Imalife is an additional assessment, performed in ~12,000 adult Lifelines participants in collaboration with the UMCG Department of Radiology.
The aim of Imalife is to use a new computed tomography (CT) scan technique to evaluate quantitative imaging biomarkers of early stages of lung cancer, chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) (the “Big-3”) at ultra-low radiation dose. Imaging biomarkers, combined with clinical and laboratory biomarkers and medical decision support systems, can in the future open up new avenues for effective prevention and/or early diagnostic and treatment protocols. This study provides an invaluable resource for the development and validation of biomarker profiles in the context of personalized medicine.

The participants will undergo ultra-low-dose CT scanning of lungs and heart with third-generation dual-source CT (SOMATOM Force, Siemens). Scanning will be performed during suspended inspiration, according to the standard vendor recommended protocol, with tube current adjusted automatically by the system for body size based on the scout images. The scout images are followed by a CT scan of the lungs in inspiration, and, in a subset of 100 participants per 5-year age/gender category, also in expiration. The latter is performed to determine normal values for expiratory lung density.
To obtain a CT scan of the heart at the moment that the movement of the coronary arteries is the lowest, participants are fitted with ECG electrodes by CT personnel. The software of the CT scanner decides what the best moment is during a regular heartbeat to acquire the CT data of the heart, and subsequently the CT scan of heart is obtained.
The primary end-point is the establishment of reference values of:

• lung density
• bronchial wall thickness
• vascular calcification
• lung nodules

Imalife will run from 2017 to 2021.

Imalife will be performed in 12.000 Lifelines participants of ≥45 years who have completed the second Lifelines screening including lung function testing.

• Xia, C et al. (2019) Cardiovascular Risk Factors and Coronary Calcification in a Middle-aged Dutch Population. Journal of Thoracic Imaging 36(3): 174-180
• Van den Oever L.B. et al. (2020) Deep learning for automated exclusion of cardiac CT examinations negative for coronary artery calcium. European Journal of Radiology 129, 109114
• Xia, C et al. (2021) High-pitch dual-source CT for coronary artery calcium scoring: A head-to-head comparison of non-triggered chest versus triggered cardiac acquisition. Journal of Cardiovascular Computed Tomography 15(1): 65-72
• Lancaster, H et al. (2021) Seasonal prevalence and characteristics of low-dose CT detected lung nodules in a general Dutch population. Sci Rep 11(1): 9139

A precise list of variables derived from CT-scans will be described later.