Non-Bronchoscopic Assessment of the Airways

Bronchoscopy is the current gold standard for assessing structure, function, anomalies, and secretions of the central airways, but bronchoscopic procedures have some important limitations. Alternative techniques for central airway evaluation are possible through radiological assessment. Current clinical practice primarily includes modalities such as radiography, computed tomography, and magnetic resonance imaging (MRI), which can noninvasively detect and assess static and dynamic airway conditions. Emerging techniques have obviated some of the challenges of current imaging methods related to patient safety and natural breathing conditions, particularly in MRI. Additionally, computational fluid dynamics simulations can yield functional information related to abnormal airflow, work of breathing, and inhaled particle deposition. With a high level of safety and repeatability, modern imaging-based methods allow for serial monitoring of disease progression and response to therapeutic and/or surgical treatment. Non-bronchoscopic tomographic imaging of the central airways has the potential to play a pivotal role in quantitatively assessing a wide range of pediatric airway conditions and in refining our understanding of how airway anatomy, motion, and airflow affect an individual patient’s ventilation and work of breathing.