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A New Approach to Quantifying Risk of Developing Lung Cancer is published in Academic Radiology

Groundbreaking study finds a strong association between airway bifurcation CT densities, loss of lung function and lung cancer risk

Clifton Park, NY (Vocus) June 27, 2010 -- Kitware announces today the first published report of a new and quantitative method for measuring lung cancer risk within the July issue of Academic Radiology. The paper provides a multi-disciplinary scientific literature rationale and preliminary study data showing that increased calcification at upper airway bifurcations, when combined with pulmonary function test scores, can be used to estimate an individual’s risk of developing lung cancer.

The new approach, described within the paper “A Quantitative Method for Estimating Individual Lung Cancer Risk,” utilizes a low dose Computed Tomography (CT) scan and a pulmonary function test to measure lung damage and cancer risk. The use of two commonly available clinical tests allows the new approach to be independently studied at most healthcare institutions, and if validated, would allow for rapid translation to clinical practice. The risk assessment approach also provides a new path for studying both lung cancer, the leading cause of U.S. cancer deaths, and Chronic Obstructive Pulmonary Disease (COPD), the fourth leading cause of death in the United States.

The scientific rationale for the new approach is based on the underlying physics of air flow governing how micron size toxic particulates are distributed in the lung. Lung cancer is caused primarily by repeated exposure to carcinogenic particulate matter and noxious gasses with high particulate matter deposition localized to airway bifurcations and the lung periphery. The study shows that quantitative measurement and analysis of these sites has the potential to stratify lung cancer risk. The paper provides the first evidence of a mathematical relationship between loss of lung function, as expressed by FEV1/FVC, the CT density of upper airway bifurcations, and lung cancer.

Kitware’s Senior Director of Healthcare Solutions, Rick Avila, was the lead investigator of the research. His findings show this new approach to measuring lung tissue damage, which measures in both lung function and structure, has the potential to provide a new set of quantitative clinical tools to patients and physicians.

“With further investigation and proper validation studies, there is the potential to provide an objective method for monitoring and managing individual lung cancer risk as well as improving our understanding of lung carcinogenesis,” say Rick Avila, lead investigator and senior director of healthcare solutions at Kitware. “Perhaps even more important, the approach provides a new and unexplored opportunity to better understand the fundamental biology and underlying relationships behind the development of chronic obstructive pulmonary disease (COPD) and lung cancer.”

A preliminary study of the approach involved 108 subjects from the low-dose CT lung cancer screening study at the University of Navarra, Spain, under the direction of Dr. Javier Zulueta. The lung cancer risk study included 15 lung cancer patients and 93 control subjects. A newly developed Lung Cancer Risk Index (LCRI) was evaluated on all subjects and was found to have a strong association with lung cancer. Independent statistical analysis showed that a small increase in LCRI (+0.03) was associated with a 1.84 lung cancer odds ratio (95% CI: 1.18-2.85, P=.0067).

A more recent analysis of additional cases from the University of Navarra, as well as anecdotal cases, appears to support the utility of LCRI. In particular, a lung cancer case that was donated to an open image archive run by the Lung Cancer Alliance, called Give a Scan (, is of high interest to lung cancer researchers and has been presented at several international lung cancer meetings. The CT dataset within Give a Scan case P0006, a 62 year old never smoker with good lung function, showed clear evidence of high levels of airway bifurcation calcification, providing researchers with initial anecdotal evidence that the approach may be able to help identify lung cancer risk in never smokers.

The publication will appear in the July 2010 issue of Academic Radiology. To view the paper in the Academic Radiology online database, please visit:


About Kitware
Kitware, Inc. is a leader in the creation and support of open-source software and state of the art technology, and is one of the fastest growing software companies in the country. Kitware leverages its open-source communities and diverse technical expertise to provide advanced custom solutions for a host of complex technical problems.

Founded in 1998, Kitware’s team is widely recognized for their major contributions to a variety of open-source software systems including the Visualization Toolkit (VTK), the Insight Segmentation and Registration Toolkit (ITK), CMake and ParaView.

Kitware has made an impact in areas such as visualization, data publishing, medical imaging, quality software process, computer vision, and informatics. Among Kitware’s global customers and collaborators are a variety of academic research facilities, government institutions and private corporations worldwide. Kitware’s products and services include software support, consulting, custom application development, and training and productivity tools that leverage our open-source systems.


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