• atherosclerosis disease
• lung disease
• photon-counting computed tomography
• screening

ACTA is a screening program using photon-counting computed tomography (PCCT) to detect subclinical atherosclerotic disease in the chest and neck, as well as lung disease. General practitioners invite asymptomatic adults aged 45–75 at high risk (≥10-year type 2 diabetes, current or former smoking, or Framingham Hard Coronary Heart Disease risk ≥10%). A PCCT protocol is completed within a single breath-hold (effective dose 11–13 mSv). This interim analysis includes 172 participants enrolled from January to June 2025. Coronary atherosclerosis was present in 75%, obstructive disease (≥50% stenosis) in 15%, and extensive non-obstructive disease in 41%. Five percent were referred for invasive coronary angiography; 2% underwent percutaneous coronary intervention and 1% coronary artery bypass grafting. Carotid plaques were identified in 55% and were bilateral in 35%; 1% were referred to vascular surgery for near-occlusive stenoses. Thoracic findings included Lung-RADS 3-4 nodules in 12% and emphysema in 24%. Incidental findings included a thyroid nodule subsequently diagnosed as papillary carcinoma. Following the PCCT scan, antiplatelet therapy was initiated in 62%, lipid-lowering therapy in 45%, and uptitrated in 22%. In summary, PCCT enables a single-visit, high-definition, integrated assessment of coronary, carotid, and pulmonary health, revealing widespread, clinically actionable disease in a largely asymptomatic, high-risk community cohort and enabling proactive prevention.