{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T09:55:23Z","timestamp":1791971723120,"version":"4.3.4"},"reference-count":29,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Employees at coal-fired power plants experience cumulative occupational exposure to respirable particulates alongside a high prevalence of smoking, both contributing to chronic respiratory disease and elevated lung cancer risk, and organized-screening implementation data remain scarce in this specific industrial setting outside asbestos-exposed cohorts. We evaluated a two-step occupational screening strategy integrating an anamnestic questionnaire with targeted low-dose CT (LDCT) imaging, assessing risk distribution, structured imaging findings, and the discriminative value of questionnaire-based triage relative to its underlying continuous predictors. Methods: In this cross-sectional study, all workers at a coal-fired power plant completed a structured questionnaire (F1) and were classified as high-risk or non-high-risk using a predefined eligibility rule (respiratory symptoms, or age \u2265 50 years with current\/former smoking). All workers were invited to voluntary LDCT (F2), interpreted using Lung-RADS v2022 with structured emphysema and coronary artery calcium (CAC) assessment. Associations were assessed using Fisher\u2019s exact tests, multivariable logistic regression, and ROC analysis with DeLong\u2019s test; voluntary LDCT uptake was characterized with a multivariable propensity model. Results: Among 870 screened workers, 364 (41.8%) were high-risk. LDCT uptake was higher among high-risk workers (130\/364, 35.7%) than non-high-risk workers (56\/506, 11.1%), yielding 186 examinations. Only 14\/186 (7.5%) had Lung-RADS \u2265 3. High-risk status was associated with higher prevalence of any nodule (80.8% vs. 62.5%; OR 2.52) and CAC (46.9% vs. 14.3%; OR 5.30); a composite abnormality outcome was present in 92.3% vs. 69.6% (OR 5.23). Only age (OR 1.11\/year) and ever-smoking status (OR 4.38) independently predicted abnormalities on multivariable analysis; dichotomized risk classification showed reduced discrimination for CAC versus a continuous age\u2013smoking model (AUC 0.647 vs. 0.779). Conclusions: Questionnaire-based triage effectively enriched the LDCT-screened population for smoking-related and cardiometabolic risk. Age and smoking history, rather than the full questionnaire, principally drove imaging abnormalities, supporting an integrated occupational model combining lung cancer screening with COPD and cardiovascular risk management.<\/jats:p>","DOI":"10.3390\/diagnostics16193202","type":"journal-article","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T10:14:56Z","timestamp":1790936096000},"page":"3202","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Two-Phase Occupational Screening in Coal-Fired Power Plant Workers: Anamnestic Risk Stratification and Targeted Low-Dose CT Findings"],"prefix":"10.3390","volume":"16","author":[{"given":"Adrian","family":"Cranta","sequence":"first","affiliation":[{"name":"Biophysics Department, University of Medicine and Pharmacy of Craiova, 2 Petru Rare\u0219 Street, 200349 Craiova, Romania"},{"name":"Centre for Research in Gastroenterology and Hepatology (CCGH), University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9224-8000","authenticated-orcid":false,"given":"Eugen","family":"Osiac","sequence":"additional","affiliation":[{"name":"Biophysics Department, University of Medicine and Pharmacy of Craiova, 2 Petru Rare\u0219 Street, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"}]},{"given":"Dan Ionu\u021b","family":"Gheonea","sequence":"additional","affiliation":[{"name":"Centre for Research in Gastroenterology and Hepatology (CCGH), University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"},{"name":"Gastroenterology Department, University of Medicine and Pharmacy of Craiova, 2 Petru Rare\u0219 Street, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Costin Teodor","family":"Streba","sequence":"additional","affiliation":[{"name":"Pneumology Department, University of Medicine and Pharmacy of Craiova, 2 Petru Rare\u0219 Street, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"visualization","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0870-104X","authenticated-orcid":false,"given":"Carmen Nicoleta","family":"Oancea","sequence":"additional","affiliation":[{"name":"Biochemistry Department, University of Medicine and Pharmacy of Craiova, 2 Petru Rare\u0219 Street, 200349 Craiova, Romania"},{"name":"Department for Community Projects, University of Medicine and Pharmacy of Craiova, 2 Petru Rare\u0219 Street, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"resources","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"funding-acquisition","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0954-1266","authenticated-orcid":false,"given":"Ioana Andreea","family":"Gheonea","sequence":"additional","affiliation":[{"name":"Radiology and Imaging Department, University of Medicine and Pharmacy of Craiova, 2 Petru Rare\u0219 Street, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Madalin","family":"Niculici","sequence":"additional","affiliation":[{"name":"Centre for Research in Gastroenterology and Hepatology (CCGH), University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"},{"name":"Gastroenterology Department, University of Medicine and Pharmacy of Craiova, 2 Petru Rare\u0219 Street, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6528-5735","authenticated-orcid":false,"given":"Cristina","family":"Ciofiac","sequence":"additional","affiliation":[{"name":"Department for Community Projects, University of Medicine and Pharmacy of Craiova, 2 Petru Rare\u0219 Street, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Daiana","family":"Petrescu","sequence":"additional","affiliation":[{"name":"Biochemistry Department, University of Medicine and Pharmacy of Craiova, 2 Petru Rare\u0219 Street, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1824-6354","authenticated-orcid":false,"given":"Mircea-Sebastian","family":"\u0218erb\u0103nescu","sequence":"additional","affiliation":[{"name":"Informatics and Biostatistics, University of Medicine and Pharmacy of Craiova, 2 Petru Rare\u0219 Street, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,10,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1264711","DOI":"10.1080\/20018525.2017.1264711","article-title":"A systematic review of occupational exposure to coal dust and the 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