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Aim of special session The World Trade Centre research enterprise posed particular logistical and strategical challenges, and its research findings have made contribution to occupational health and the understanding of respiratory health and chronic airway disease. All of those aspects will be discussed in this session. 1 Philip J. Landrigan, MD, MS, DIH, 1 Roberto G. Lucchini, MD, 2 Laurie Breyer, JD, MA, 2 Dr. Max Lum, Ed.D, MPA, 1 Rafael E. de la Hoz, MD, MPH, MSc 1 Icahn School of Medicine at Mount Sinai, New York, NY, USA 2 Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health, Atlanta, GA, USA

The terrorist attack on 9/11/2001, and subsequent rescue, recovery, and service restoration of the World Trade Centre disaster site in New York City, created an unprecedented and unique occupational and environmental exposure that affected a large and diverse group of rescue workers and volunteers. The workers were exposed to a mixture of poorly characterised inhaled toxicants. A variety of acute and chronic respiratory illnesses have been reported among all exposed workers, which are the subject of large scale ongoing investigation and follow up. The predominant WTC related chronic lower airway disorders have been clinically characterised as irritant-induced asthma, nonspecific chronic bronchitis, chronic bronchiolitis, and aggravated pre-existent chronic airway disease. In addition to those, several often limited case reports, case series, and small studies have suggested other associated lung diseases among those workers. Lung function surveillance, which demonstrated an exaggerated one time expiratory flow loss (about 500 ml), has shown an average expiratory flow decline in subsequent years that seems to follow age-related rates. This episode clearly invited reflection on the characterisation of chronic airway diseases, risk factors for respiratory health, and respiratory epidemiology methods.

Aim of special session Advances with chest CT scanning and CT scan-based lung cancer screening are changing the way diagnosis and screening for occupational lung diseases are conducted. We plan to review existing methodologies and experience-based emerging strategies. Thomas Kraus, MD, PhD 1 , Kurt G. Hering, MD 2 , Narufumi Suganuma, MD, PhD 3 , and Rafael E. de la Hoz, MD, MPH, MSc 4 1 RWTH Aachen, Aachen, Germany 2 Knappschafstkrankenhaus Dortmund, Dortmund, Germany 3 Kochi Medical School, Kochi University, Nankoku 783–8505, Japan 4 Icahn School of Medicine at Mount Sinai, New York, NY, USA

The terrorist attack on 9/11/2001, and subsequent rescue, recovery, and service restoration of the World Trade Centre disaster site in New York City, created an unprecedented and unique occupational and environmental exposure that affected a large and diverse group of rescue workers and volunteers. The workers were exposed to a mixture of poorly characterised inhaled toxicants. A variety of acute and chronic respiratory illnesses have been reported among all exposed workers, which are the subject of large scale ongoing investigation and follow up. Our group created the WTC Chest Imaging Archive as a repository for more than 3500 chest CT scan studies in about 1700 WTC workers. We systematically assessed imaging abnormalities by means of the International CT Classification of Occupational and Environmental Respiratory Diseases. An examination of the first available chest CT scan for each subject (n=1453) with complete available data, a median of 6.8 years after September 11, 2001 revealed that the most frequent recorded abnormalities were pleural abnormalities (parietal in 7.9% of the workers, and visceral in 12.8% of them), inhomogeneous attenuation (13.2%), irregular/linear opacities (12.9%), and emphysema (12.0%). With regards to pleural abnormalities, although we found them across all 5 broad occupational groups, they were more frequent among construction labourers/asbestos handlers/building cleaners, most of whom were first-generation immigrants. Many of those abnormalities were not reported by clinical radiological readings. Visceral, but not parietal pleural changes were associated with mild pulmonary function impairment. Future studies will examine the evolution of imaging abnormalities, and add computerised quantitative CT scan to their assessment.