1846, The Beginning of Modern Lung Function Testing
In 1846—179 years ago—British surgeon John Hutchinson published his seminal study in the Medico-Chirurgical Transactions, introducing both the spirometer and the concept of vital capacity (VC). This groundbreaking research marked the beginning of modern pulmonary function testing.
Hutchinson referred to vital capacity as the “capacity of life,” emphasizing its prognostic significance, as he found a strong correlation between reduced vital capacity and early mortality. He also systematized how VC varies with height, age, and sex, proposing its potential as a standardized clinical tool for disease diagnosis.
In short, Hutchinson’s spirometer was more than a measurement device; it represented one of the earliest attempts to quantify physiological function and bring objectivity to medical decision-making.
What is a Spirometer?
A spirometer measures lung function by quantifying exhaled air after full inspiration and exhales forcefully. It calculates key indices such as:
• FVC (Forced Vital Capacity)
• FEV₁ (Forced Expiratory Volume in 1 Second)
• FEV₁/FVC ratio
These are essential for diagnosing and monitoring obstructive lung diseases such as asthma, COPD, and interstitial lung diseases, represented by ILD. Test accuracy depends on patient cooperation, and typically at least three reproducible trials are performed to ensure reliability.
2023–2025: “From Imaging to Function” — AI as the New Bridge
1) Clinical Limitations of Conventional Spirometry
Although spirometry remains the gold standard for lung function assessment, it has limitations:
• Patient cooperation dependency: difficult for elderly or cognitively impaired patients
• Infection control: restricted use during pandemics
• Access barriers: limited availability of specialized equipment and trained staff
• Time burden: requires separate scheduling and waiting
2) Breakthroughs in the Past Three Years
• 2023: Coreline Soft developed estimated FVC (eFVC) using chest CT images.
• 2024: We presented eFVC preliminary results in Korean Congress of Radiology and Radiologic Society of North America.
• 2025: We present eFVC algorithm with clinical results in European Respiratory Society.
eFVC: Not a “Replacement” but an “Extension”
1) What is eFVC?
Proposed by Coreline Soft in 2023, eFVC (estimated FVC) is derived solely from CT quantitative analysis.
• mFVC = measured via spirometry (requires active patient participation)
• eFVC = image-based physiology (derived instantly from CT scans)
2) Clinical Value Proposition
The value of eFVC lies in redundancy of information:
• When consistent with mFVC → diagnostic confidence increases
• When discrepant → signals the need for further evaluation
• When mFVC cannot be obtained → serves as a temporary surrogate
3) First Public Presentation
At RSNA 2024, Coreline Soft unveiled its AVIEW Lung Texture–based FVC estimation model, showcasing CT texture analysis as a novel approach to functional assessment.
Data Ecosystem and Collaborative Research
1) The OSIC-Kaggle Initiative
The Open-Source Imaging Consortium (OSIC) democratized image-based lung function research.
2) Reproducible and Generalizable Research
Open data ecosystems enable both reproducibility and generalizability—essential conditions for moving innovations like eFVC from research to real-world clinical use.
Clinical Use Scenarios
• Pre-screening & Triage: automatic eFVC calculation during CT, delivered alongside radiology reports to inform decision-making
• Research Applications: structure–function correlation studies, longitudinal disease monitoring (ILD, COPD, cystic fibrosis), sensitive biomarkers in clinical trials
Future Outlook: Toward Precision Respiratory Medicine
• Personalized Norms: unlike population-based predictions, eFVC can reflect patient-specific CT morphology
• Multimodal Integration: evolving into a platform uniting imaging, function, genomics, and clinical data
• Shift to Preventive Medicine: enabling early detection of subclinical decline and proactive interventions
179 Years of Progress, A New Beginning
From Hutchinson’s spirometer in 1846 to Coreline Soft’s eFVC in 2025, lung function testing has evolved from function → diagnosis, to structure → function → diagnosis, and is now moving toward integration → prediction → prevention.
eFVC embodies this paradigm shift. It is not just an incremental tool but a new pathway that fuses radiology and respiratory physiology, paving the way toward patient-centered precision medicine.
At the upcoming
ERS 2025 in Amsterdam, Coreline Soft will present the clinical achievements of eFVC, setting a new benchmark for AI-driven lung function assessment—and working with the global respiratory medicine community to shape its future direction.
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