Related Experiment Video
Updated: Aug 1, 2026
Systematic Bronchoscopy: the Four Landmarks Approach
Published on: June 23, 2023
A new method for objective identification and measurement of airway lumen in paediatric flexible videobronchoscopy
I B Masters1, M M Eastburn, R Wootton
1Department of Respiratory Medicine, Royal Children's Hospital, Herston 4029, Brisbane, Australia. brent_masters@health.qld.gov.au
Insights
A new colour histogram mode technique (CHMT) accurately measures paediatric airway dimensions using videobronchoscopy. This objective method is crucial for diagnosing and managing airway malacia disorders in children.
Area of Science:
- Medical imaging
- Paediatric pulmonology
- Endoscopic techniques
Background:
- Accurate airway and lesion dimension measurement is vital for paediatric bronchoscopy development.
- Airway malacia disorders cause significant paediatric respiratory morbidity.
- Current methods lack accuracy for measuring these lesions and the airway lumen.
Purpose of the Study:
- To introduce and validate a novel, objective measurement technique for paediatric airway lumen dimensions.
- To address the limitations of existing methods in paediatric airway assessment.
Main Methods:
- Defined magnification power of a paediatric videobronchoscope.
- Developed an objective technique (colour histogram mode technique, CHMT) using Image J software for airway lumen measurement.
Main Results:
- Demonstrated high intra- and inter-observer repeatability (coefficients 0.9 mm² and 1.6 mm²).
- Achieved high accuracy in vitro (0.1 mm resolution) and clinical settings (92% acceptable results with CHMT alone).
- Showed comparable measurements to established methods for cricoid cross-sectional areas.
Conclusions:
- The CHMT is an objective, accurate, and versatile method for identifying and measuring airway dimensions.
- This technique is important for advancing flexible paediatric videobronchoscopy.
- CHMT offers a reliable solution for assessing airway malacia disorders.
Background:
Accurate measurements of airway and lesion dimensions are important to the developmental progress of paediatric bronchoscopy. The malacia disorders are an important cause of respiratory morbidity in children, but no methods are currently available to measure these lesions or the airway lumen accurately. A new measurement technique is described here.
Methods:
The magnification power of a paediatric videobronchoscope was defined and a simple and user friendly computer based program (Image J) was used to develop an objective technique (colour histogram mode technique, CHMT) for measurement of the airway lumen.
Results:
In vivo intra-observer and inter-observer repeatability coefficients for repeated area measurements from 28 images using the Bland-Altman method were 0.9 mm2 and 1.6 mm2, respectively. The average intraclass correlation coefficient for repeated measurements of area was 0.93. In vitro validation measurements using a 2 mm diameter tube resolved radii measurements to within 0.1 mm (coefficient of variability 8%). An "acceptable result" was defined in 92% of 734 images completed with the CHMT alone and 8% with its modification. The success rate for two of three images being within 10% of each other's area was 100%. Measurements of cricoid cross sectional areas from 116 patients compared with expected airway areas for age derived from endotracheal tube sizes were comparable.
Conclusions:
The CHMT method of identifying and measuring airway dimensions is objective, accurate, and versatile and, as such, is important to the future development of flexible videobronchoscopy.
