A Semiautomatic Procedure to Assist Physicians in Paediatric Airway Stenting

Tracheomalacia (TM) is a tracheal weakening that causes the cartilage structure to collapse during breathing. The term tracheobronchomalacia (TBM) is used when the bronchi are also implicated in the disease. This illness can be treated in a variety of methods, including the insertion of stents in the cartilage-restricted region. Stents are commercially available in numerous sizes (diameter and length), different shapes and materials. The shape of the stent is chosen based on where the disease is located, while the size is derived from measurements on CT images or by endoscopic investigations. This task is extremely critical for the patient's health since improper stent can have serious and even deadly repercussions for the patient. Therefore, it is necessary to choose a stent that fits the patient's anatomy as closely as possible. To this end, it is possible to employ a three-dimensional model of the investigated anatomy and choose the most suitable type of stent following measurements made on the model itself. In this work, a method to assist physicians in the choice of the stent to be used in TM or TBM patients, is proposed. By analyzing the tracheobronchial tree and measuring successive cross-sections along the centerline of the lumen, the automated procedure allows to localize the diseased area and to identify the optimal shape and size of the stent to be implanted. Four case studies of paediatric patients were performed and the results were validated by a team of physicians specialized in the treatment of upper and lower airways.