Witold Rzyman

Population-based lung cancer screening with low-dose computed tomography (LDCT) is expanding across Europe, including a publicly funded Polish programme starting in October 2026. Because screening-eligible individuals share substantial tobacco-related cardiovascular risk, LDCT also offers cardiovascular risk assessment without additional radiation. We conducted a narrative review of the PubMed literature published up to September 2026, prioritising guidelines, lung cancer screening cohorts and systematic reviews. We summarise the cardiovascular findings on non-contrast, non-electrocardiography (ECG)-gated LDCT: coronary artery, aortic valve, mitral annular and thoracic aortic calcification, ascending aortic dilatation, pericardial effusion, and pulmonary artery enlargement, as well as investigational cardiac volumetry, epicardial adipose tissue and artificial intelligence (AI)-assisted quantification. We grade each finding by reportability, defined downstream action and supporting evidence, and align reporting thresholds with the European Respiratory Society/European Society of Thoracic Imaging (ERS/ESTI) statement on incidental findings. LDCT cannot replace dedicated cardiac imaging or establish haemodynamic diagnoses. The prognostic value of coronary and aortic valve calcification and of ascending aortic dilatation is established, whereas the evidence for mitral annular calcification and pulmonary artery enlargement is more limited; observational data indicate that reporting these markers changes preventive management, but whether this improves cardiovascular outcomes has not yet been demonstrated. Standardised reporting, proportionate thresholds, and coordinated pathways linking radiology, pulmonology, primary care and cardiology are needed to translate incidental cardiovascular findings into scalable prevention and should be evaluated in implementation studies.

Population-based lung cancer screening with low-dose computed tomography (LDCT) is expanding across Europe, including a publicly funded Polish programme entering the guaranteed-benefits basket in October 2026. Because screening-eligible individuals share substantial tobacco-related cardiovascular risk, LDCT also provides an opportunity for cardiovascular risk assessment without additional radiation. We conducted a structured narrative review of PubMed literature, prioritising guidelines, major cohort studies, systematic reviews and cardiovascular outcome data, with targeted updates for recent regulatory and clinical developments. We summarise clinically actionable findings on non-contrast, non-ECG-gated LDCT: coronary artery calcification, aortic valve and mitral annular calcification, thoracic aortic disease, pericardial effusion, and pulmonary artery enlargement, as well as investigational cardiac volumetry, epicardial adipose tissue and AI-assisted quantification. Screening LDCT can provide robust risk-informative markers and pragmatic visual grading, but it cannot replace dedicated cardiac imaging or establish haemodynamic diagnoses. Standardised reporting, proportionate referral thresholds, and coordinated pathways linking radiology, pulmonology, primary care and cardiology are needed to translate incidental cardiovascular findings into scalable prevention while avoiding unnecessary downstream testing.

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, and emphysema is present in the majority of affected patients and can be identified on computed tomography (CT). This study investigated whether radiomic features derived from automatically and adaptively segmented low-attenuation lung regions can capture distinct imaging characteristics of COPD beyond conventional emphysema measures. Radiomic features were extracted from 6078 chest CT scans of 2243 participants from the COPDGene cohort. Emphysematous regions were segmented using the MimSeg method based on Gaussian mixture modelling with patient-adjusted thresholding, and radiomic features were computed for individual lesion clusters and aggregated per patient using summary statistics, yielding 780 features per subject. Uniform Manifold Approximation and Projection (UMAP) was used to generate a low-dimensional embedding, and feature contributions were evaluated using SHAP analysis and statistical testing. The resulting embedding demonstrated structured patterns broadly aligned with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages, with greater overlap among GOLD 0–2 and more consolidated groupings for GOLD 3 and 4, reflecting differences in disease severity. The most influential features were predominantly derived from Grey Level Run Length Matrix measures, capturing textural heterogeneity and spatial organisation of emphysematous changes that are not directly described by standard density-based metrics. These findings suggest that radiomic analysis of adaptively segmented CT data may provide complementary and structurally distinct information relative to conventional emphysema measures, supporting a more nuanced characterisation of emphysema patterns in COPD.

Lung cancer, the leading cause of cancer-related deaths globally and in Poland, accounts for 25% of all cancer-related deaths, with smoking being its predominant cause. While primary prevention through smoking cessation is crucial, the effectiveness of lung cancer screening (LCS) with low-dose computed tomography in reducing mortality has gained international recognition. This expert consensus, developed through multidisciplinary collaboration, proposes a comprehensive framework for smoking cessation interventions within LCS. Key recommendations include providing participants with educational materials, cognitive-behavioral counseling, and pharmacotherapy. Proactive follow-up, biochemical addiction validation, and teleconsultations are essential to ensure long-term cessation. Besides, participants should be discouraged from using alternative nicotine products, such as heated tobacco or electronic cigarettes due to their limited efficacy, highly probable health risks and potential for nicotine addiction. By integrating evidence-based cessation methods, LCS programs can serve as a model for broader smoking cessation strategies in healthcare.

Background: The prediction of postoperative functional status in non-small cell lung cancer patients based on preoperative assessment of physical and respiratory capacity is inadequate based on recent RCTs. Material and methods: Prospectively collected spirometry data and the six-minute walk test results of 57 patients treated with lobectomy for non-small cell lung cancer were analyzed. The tests were performed before surgery, and 30 and 90 days after lobectomy. All patients underwent a respiratory functional and physical capacity assessment. Results: All 57 patients underwent lobectomy. Before surgery, mean FEV1 was 2.4 ± 0.7 L, corresponding to %FEV1 of 88.3 ± 17.3%. The mean absolute and expected 6MWT distance was 548 ± 74.6 m and 108.9 ± 14.5%, respectively. At the first postoperative evaluation 30 days after surgery, FEV1 and %FEV1 decreased significantly by an average of 0.5 ± 0.3 L and 15.1 ± 10.7%, while 6MWT and expected 6MWT decreased minimally by an average of 1.0 m and 0.8%, respectively. Three months after lobectomy, FEV1 and %FEV1, compared with the initial assessment, decreased by an average of 0.3 ± 0.3 l and 7.8 ± 10.0%, while 6MWT and its expected score increased to 564.6 ± 84.6 m and 112.8 ± 15.8%, respectively. Conclusions: After lobectomy, FEV1 decreased slightly and less than expected, while 6MWT increased proportionally compared to the preoperative evaluation.

(1) Background: Lung cancer screening (LCS) consists of low-dose computed tomography (LDCT) results to reduce lung cancer-related mortality. The LCS program has a unique opportunity to impact CVD mortality by providing tools for CVD risk assessment and implementing preventative strategies. In this study, we estimated standardized CVD risk (SCORE) and assessed the prevalence of coronary artery calcium (CAC) in a Polish LCS cohort. (2) Methods: In this observational study, 494 LCS participants aged 50–79 years with a cigarette smoking history of at least 30 pack-years were included. Medical history, anthropometric measurements, blood pressure measurements, serum glucose, and cholesterol levels were assessed in one visit. CVD risk assessment using SCORE tables was performed. The results were compared to the general population (NATPOL 2011 study). On LDCT scans, CAC was classified using an Ordinal Score ranging from 0 to 12. (3) Results: The prevalence of classic cardiovascular risk factors was very high. Among study participants, 83.7% of men and 40.7% of women were classified with a very high CVD SCORE risk (>10%). CAC was reported in 190 (47%) participants. Calcification was categorized as severe (CAC ≥ 4) in 84 (21%) participants. (4) Conclusions: Due to the high cardiovascular risk, intensive preventive strategies are recommended for LCS participants.

Radiomics is an emerging approach to support the diagnosis of pulmonary nodules detected via low-dose computed tomography lung cancer screening. Serum metabolome is a promising source of auxiliary biomarkers that could help enhance the precision of lung cancer diagnosis in CT-based screening. Thus, we aimed to verify whether the combination of these two techniques, which provides local/morphological and systemic/molecular features of disease at the same time, increases the performance of lung cancer classification models. The collected cohort consists of 1086 patients with radiomic and 246 patients with serum metabolomic evaluations. Different machine learning techniques, i.e., random forest and logistic regression were applied for each omics. Next, model predictions were combined with various integration methods to create a final model. The best single omics models were characterized by an AUC of 83% in radiomics and 60% in serum metabolomics. The model integration only slightly increased the performance of the combined model (AUC equal to 85%), which was not statistically significant. We concluded that radiomics itself has a good ability to discriminate lung cancer from benign lesions. However, additional research is needed to test whether its combination with other molecular assessments would further improve the diagnosis of screening-detected lung nodules.