Periodic flow at airway bifurcations. II. Flow partitioning

Application of Machine Learning for Segmentation of the Pulmonary Acinus Imaged by Synchrotron X-Ray Tomography

Background: To assess the effectiveness of inhalation therapy, it is important to evaluate the lungs' structure; thus, visualization of the entire lungs at the level of the alveoli is necessary. To achieve this goal, the applied visualization technique must satisfy the following two conditions simultaneously: (1) it has to obtain images of the entire lungs, since one part of the lungs is influenced by the other parts, and (2) the images have to capture the detailed structure of the alveolus/acinus in which gas exchange occurs. However, current visualization techniques do not fulfill these two conditions simultaneously. Segmentation is a process in which each pixel of the obtained high-resolution images is simplified (i.e., the representation of an image is changed by categorizing and modifying each pixel) so that we can perform three-dimensional volume rendering. One of the bottlenecks of current approaches is that the accuracy of the segmentation of each image has to be evaluated on the outcome of the process (mainly by an expert). It is a formidable task to evaluate the astronomically large numbers of images that would be required to resolve the entire lungs in high resolution. Methods: To overcome this challenge, we propose a new approach based on machine learning (ML) techniques for the validation step. Results: We demonstrate the accuracy of the segmentation process itself by comparison with previously validated images. In this ML approach, to achieve a reasonable accuracy, millions/billions of parameters used for segmentation have to be optimized. This computationally demanding new approach is achievable only due to recent dramatic increases in computation power. Conclusion: The objective of this article is to explain the advantages of ML over the classical approach for acinar imaging.

Particle transport and deposition: basic physics of particle kinetics

The human body interacts with the environment in many different ways. The lungs interact with the external environment through breathing. The enormously large surface area of the lung with its extremely thin air-blood barrier is exposed to particles suspended in the inhaled air. The particle-lung interaction may cause deleterious effects on health if the inhaled pollutant aerosols are toxic. Conversely, this interaction can be beneficial for disease treatment if the inhaled particles are therapeutic aerosolized drugs. In either case, an accurate estimation of dose and sites of deposition in the respiratory tract is fundamental to understanding subsequent biological response, and the basic physics of particle motion and engineering knowledge needed to understand these subjects is the topic of this article. A large portion of this article deals with three fundamental areas necessary to the understanding of particle transport and deposition in the respiratory tract. These are: (i) the physical characteristics of particles, (ii) particle behavior in gas flow, and (iii) gas-flow patterns in the respiratory tract. Other areas, such as particle transport in the developing lung and in the diseased lung are also considered. The article concludes with a summary and a brief discussion of areas of future research.

Optimisations and evolution of the mammalian respiratory system : A suggestion of possible gene sharing in evolution

The respiratory system of mammalians is made of two successive branched structures with different physiological functions. The upper structure, or bronchial tree, is a fluid transportation system made of approximately 15 generations of bifurcations leading to the order of about 2(15) = 30, 000 terminal bronchioles with a diameter of approximately 0.5mm in the human lung. The branching pattern continues up to generation 23 but the structure and function of each of the subsequent structures, called acini, is different. Each acinus consists in a branched system of ducts surrounded by alveoli and plays the role of a diffusion cell where oxygen and carbon dioxide are exchanged with blood across the alveolar membrane. We show here that the bronchial tree simultaneously presents several different optimal properties. It is first energy efficient, second, it is space filling and third it is also "rapid". This physically based multi-optimality suggests that, in the course of evolution, an organ selected against one criterion could have been used later for a totally different purpose. For example, once selected for its energetic efficiency for the transport of a viscous fluid like blood, the same genetic material could have been used for its optimized rapidity. This would have allowed the emergence of atmospheric respiration made of inspiration-expiration cycles. For this phenomenon to exist, rapidity is essential as fresh air has to reach the gas exchange organs, the pulmonary acini, before the beginning of expiration. We finally show that the pulmonary acinus is optimized in the sense that the acinus morphology is directly related to the notion of a "best possible" extraction of entropic energy by a diffusion exchanger that has to feed oxygen efficiently from air to blood across a membrane of finite permeability.

Total and regional lung volume changes during high-frequency oscillatory ventilation (HFOV) of the normal lung

The effect of high-frequency oscillatory ventilation (HFOV) settings on the distribution of lung volume (V(L)) with changes in mean airway pressure (Paw), frequency (f(R)) and tidal volume (V(T)) remains controversial. We used computer tomographic (CT) imaging to quantify the distribution of V(L) during HFOV compared to static continuous positive airway pressure (CPAP). In anesthetized, supine canines, CT imaging of the entire lung was performed during CPAP and HFOV at Paw of 5, 12.5 and 20 cm H(2)O, f(R)=5, 10, 15 Hz. We found small, statistically significant decreases compared with CPAP in total and regional V(L) during HFOV that were greatest at lower f(R) and Paw. Apex and base sub-volumes underwent changes comparable to the lung overall. Increases in f(R) were accompanied by increases in Pa(O)(2). These finding provide additional insight into the impact of HFOV settings on the distribution of V(L) and suggest that there is low risk of occult regional over-distention during HFOV in normal lungs.

Biofluid Mechanics of the Pulmonary System

Presents an overview of leading areas of discovery in bio-fluid mechanics related to the pulmonary system, with particular reference to the airways. Areas briefly reviewed include airway gas dynamics, impedance studies, collapsible-tube studies, and airway liquid studies. Emphasis is placed on promising further directions, such as analysis of interacting fluid-mechanical or fluid-structure phenomena, multi-scale modeling across widely varying length and time scales, and integration of advanced simulations into respiratory investigation and pulmonary medicine.

High-frequency oscillatory ventilation: Mechanisms of gas exchange and lung mechanics

OBJECTIVE

Overview of the mechanisms governing gas transport, mechanical factors influencing the transmission of pressure and flow to the lung, and the measurement of lung mechanics during high-frequency oscillatory ventilation (HFOV) in acute respiratory distress syndrome.

DATA SOURCES AND STUDY SELECTION

Studies indexed in PubMed illustrating key concepts relevant to the manuscript objectives. Pressure transmission during HFOV in the adult lung was simulated using a published theoretical model.

DATA SYNTHESIS

Gas transport during HFOV is complex and involves a range of different mechanisms, including bulk convection, turbulence, asymmetric velocity profiles, pendelluft, cardiogenic mixing, laminar flow with Taylor dispersion, collateral ventilation, and molecular diffusion. Except for molecular diffusion, each mechanism involves generation of convective fluid motion, and is influenced by the mechanical characteristics of the intubated respiratory system and the ventilatory settings. These factors have important consequences for the damping of the oscillatory pressure waveform and the drop in mean pressure from the airway opening to the lung. New techniques enabling partitioning of airway and tissue properties are being developed for measurement of lung mechanics during HFOV.

CONCLUSIONS

Awareness of the different mechanisms governing gas transport and the prevailing lung mechanics during HFOV represents essential background for the physician planning to use this mode of ventilation in the adult patient. Monitoring of lung volume, respiratory mechanics, and ventilation homogeneity may facilitate individual optimization of HFOV ventilatory settings in the future.

Tracheal and central bronchial aerodynamics using virtual bronchoscopy and computational fluid dynamics

Virtual bronchoscopy reconstructions of the airway noninvasively provide useful morphologic information of structural abnormalities such as stenoses and masses. In this paper, we show how virtual bronchoscopy can be used to perform aerodynamic calculations in anatomically realistic models. Pressure and flow patterns in a human airway were computed noninvasively. These showed decreased pressure and increased shear stress in the region of a stenosis.

Interplay between geometry and flow distribution in an airway tree

Uniform flow distribution in a symmetric volume can be realized through a symmetric branched tree. It is shown here, however, by 3D numerical simulation of the Navier-Stokes equations, that the flow partitioning can be highly sensitive to deviations from exact symmetry if inertial effects are present. The flow asymmetry is quantified and found to depend on the Reynolds number. Moreover, for a given Reynolds number, we show that the flow distribution depends on the aspect ratio of the branching elements as well as their angular arrangement. Our results indicate that physiological variability should be severely restricted in order to ensure adequate fluid distribution through a tree.

Respiratory fluid mechanics and transport processes

The field of respiratory flow and transport has experienced significant research activity over the past several years. Important contributions to the knowledge base come from pulmonary and critical care medicine, surgery, physiology, environmental health sciences, biophysics, and engineering. Several disciplines within engineering have strong and historical ties to respiration including mechanical, chemical, civil/environmental, aerospace and, of course, biomedical engineering. This review draws from a wide variety of scientific literature that reflects the diverse constituency and audience that respiratory science has developed. The subject areas covered include nasal flow and transport, airway gas flow, alternative modes of ventilation, nonrespiratory gas transport, aerosol transport, airway stability, mucus transport, pulmonary acoustics, surfactant dynamics and delivery, and pleural liquid flow. Within each area are a number of subtopics whose exploration can provide the opportunity of both depth and breadth for the interested reader.

Fluid flow through ramified structures

We investigate the fluid flow through two-dimensional ramified structures by direct simulation of the Navier-Stokes equations. We show that for trees with n generations, the flow distribution strongly depends on the Reynolds number Re. Specifically, for a tree without loops the flow becomes highly heterogeneous at high Re. For a tree with loops, on the other hand, the flow distribution tends to be more uniform at increased Re conditions. We show that these apparently contradictory behaviors have the same origin, namely, the effect of inertia on the momentum transport in the channels of the ramified geometry. In order to simulate the propagation of the flow imbalance throughout the tree without loops, we develop a simple model that incorporates the basic fluid dynamics features of the system. For large trees, the results of the model indicate that the distribution of flow at the outlet branches can be described by a self-affine landscape. Finally, we argue that the nonuniform partitioning of flow found for the structure without loops may contribute to the morphogenesis and functioning of the bronchial tree.

Experimental analysis of flow calculations based on HRCT imaging of individual bifurcations

Flow simulations in airways and arteries allow the non-invasive study of transport and deposition processes in these vessel systems. Individual vessel geometries as input for such simulations are highly desirable. Computed tomography (CT) permits the acquisition of binary data to reconstruct such geometries. To prove the suitability of this reconstruction method, we compared measured with simulated velocities within model bifurcations. Particle image velocimetry was applied to measure flow velocities. Numerical simulations of these velocities were carried out by using the CT data of the same models as input to flow calculations (CFD). Within the resolution limits good agreement between measured and simulated velocities was found. For the smallest bifurcation (tube diameter: 2 mm) the agreement was less, indicating a methodical limitation by the actual resolution of the CT-scan technique. The study showed that a combination of CT and CFD can be considered as an appropriate step towards realistic simulations of particle transportation and deposition in individual geometries of the respiratory or cardiovascular systems.

Numerical modeling of steady inspiratory airflow through a three-generation model of the human central airways

Two-dimensional steady inspiratory airflow through a three-generation model of the human central airways is numerically investigated, with dimensions corresponding to those encountered in the fifth to seventh generations of the Weibel's model. Wall curvatures are added at the outer walls of the junctions for physiological purposes. Computations are carried out for Reynolds numbers in the mother branch ranging from 200 to 1200, which correspond to mouth air breathing at flow rates ranging from 0.27 to 1.63 liters per second. The difficulty of generating grids in a so complex configuration is overcome using a nonoverlapping multiblock technique. Simulations demonstrate the existence of separation regions whose number, location, and size strongly depend on the Reynolds number. Consequently, four different flow configurations are detected. Velocity profiles downstream of the bifurcations are shown to be highly skewed, thus leading to an important unbalance in the flow distribution between the medial and lateral branches of the model. These results confirm the observations of Snyder et al. and Tsuda et al. and suggest that a resistance model of flow partitioning based on Kirchhoff's laws is inadequate to simulate the flow behavior accurately within the airways. When plotted in a Moody diagram, airway resistance throughout the model is shown to fit with a linear relation of slope -0.61. This is qualitatively in good agreement with the experimental investigations of Pedley et al, and Slutsky et al.

Lung morphology of cursorial and non-cursorial mammals: lagomorphs as a case study for a pneumatic stabilization hypothesis

Gross lung morphology is examined in representative species from four genera within the order Lagomorpha (Lepus californicus, Sylvilagus nuttalli, Oryctolagus cuniculus, Ochotona princeps), and compared with a representative rodent out-group (Spermophilus richardonsii). Examination of pulmonary morphology reveals several correlations between the thoracic morphology and locomotor behavior. Lepus, the most cursorial species, exhibits a distinct suite of characteristics: 1) tissue of the right cranial lobe interposed between the heart and sternum; 2) well-defined grooves in the lung tissue for both the aorta and ribs; 3) a fibrous pericardial attachment to the sternum; 4) relatively large heart and lung mass. Sylvilagus, a sprinter, exhibits these features to a lesser degree, whereas Oryctolagus and Ochotona, non-cursorial species, lack most of these features. This same suite of pulmonary features is also observed in a wide range of unrelated cursorial taxa (including selected Artiodactlya, Perissodactyla, Carnivora). Corrosion casts of the internal airways demonstrate that the cursorial and non-cursorial taxa examined here have similar branching patterns despite their variable external morphologies. The juxtaposition of pulmonary lobes, heart, and ribs leads to the hypothesis that the lungs themselves provide mechanical support of the heart and visceral mass during locomotion. Analyses of cineradiographic and pneumotachographic data obtained from Oryctolagus tend to support a pneumatic stabilization hypothesis: the lungs themselves, intimately associated with the chest walls and positively pressurized during landing, may provide some mechanical support to the viscera. This mechanism may be important in stabilizing the relatively large hearts of the most cursorial species during running.

Mammalian locomotor-respiratory integration: implications for diaphragmatic and pulmonary design

Diaphragmatic function and intrapulmonary respiratory flow in running mammals were found to differ substantially from the corresponding conditions known in resting mammals. In trotting dogs, orbital oscillations of the diaphragm were driven by inertial displacements of the viscera induced by locomotion. In turn, oscillations of the visceral mass drove pulmonary ventilation independent of diaphragmatic contractions, which primarily served to modulate visceral kinetics. Visceral displacements and loading of the anterior chest wall by the forelimbs are among the factors that contribute to an asynchronous ventilation of the lungs and interlobar gas recycling. Basic features of mammalian respiratory design, including the structure of the diaphragm and lobation of the lungs, appear to reflect the mechanical requirements of locomotor-respiratory integration.