Chest CT imaging after asbestos exposure

The complementary examination recommended in France for the follow-up of populations previously exposed to asbestos is the thoracic computed tomography (CT) exa-mination, without injection of contrast product, with millimetric sections. The most frequently observed abnormalities related to this exposure are localized fibrosis of the parietal pleura (or pleural plaques), a benign condition with no therapeutic issue but involving significant medico -social issues in France (in particular recognition as an occupational disease, compensation by the Fund compensation for asbestos victims). In a French study, involving more than 5,000 sub-jects previously exposed to asbestos, discrepancies in interpretation were reported according to the expertise of the doctor in charge of interpreting the CT scan (substantial percentage of false positives, and even higher frequency of false negatives for pleural plaques when comparing the interpretation of the radiologist who performed the examination and that of a radiologist expert in thoracic imaging). Given the medico-social issues and from a perspective of social equity, it seems important to be very rigorous in the technical methods of carrying out and interpreting the chest CT examinations performed in the follow-up assessments after exposure to asbestos, in particular with a view to medico-social requests. It is recommended that the occupational physician involved in asbestos post-exposure follow-up, and also the physician in charge of examining a case for compensation, request a re-reading by an expert physician based on the tools offered by the Haute Autorite de sante and updated in 2019.