Lung donation is the most risky transplant procedures. With low survival rates, and poor acceptance of donated lungs, those in need of a lung transplant are at high risk of dying. One reason for poor outcomes is the lack of optimal match between donor and recipient when it comes to lung size and shape. Lungs that do not properly fit in the recipient’s chest cavity can fail to inflate fully and quickly start to deteriorate. In such patients, lung contusions can form, edema occurs in healthy lung tissue, and overall lung function declines. To improve patient outcomes after lung transplant, we describe here a developed a computational pipeline which enables donor lungs to be properly matched to recipients. This tool uses CT scans from both the donor and potential recipients to calculate how anatomically different the sets of lungs are, and therefore provide improved matches in both size and shape for the donor lungs.

Lung cancer is the leading cause of cancer deaths worldwide. In order to determine if lung nodules are cancerous, a biopsy needs to be taken. There is a need to be able to perform more of these biopsies through a transbronchial approach in order to reduce the risk of pneumothorax that is associated with transthoracic biopsies. This is particularly the case at the periphery of the lung where the bronchioles become too small for a traditional bronchoscope. The proposed biopsy tool incorporates a compact coaxial camera and illumination configuration to make it more compact than a traditional bronchoscope. It also includes a new flexible needle design that allows a biopsy to be taken adjacent to a radial ultrasound transducer. The navigation and tissue biopsy capabilities of the proposed device are demonstrated through benchtop and animal testing.

Nowadays, “personalized medicine” is starting to replace the current “one size fits all” approach. The goal is to have the right drug with the right dose for the right patient at the right time and location. Indeed, conventional pulmonary drug delivery devices still have poor efficiencies (<25%) for delivering drugs to the lung tumor sites. Major portions of the aggressive medicine deposit on healthy tissue, which causes severe side effects and induces extra health care expenses. Therefore, a new targeted pulmonary drug delivery method is proposed and evaluated using the Computational Fluid-Particle Dynamics (CFPD) method to achieve the lobe-specific delivery. By controlling the release position and velocity of the drug particles at the mouth inlet, drug deposition efficiency (DE) in a designated lobe can be increased up to 90%. Intersubject variability has also been investigated using the noninvasive in silico tool. Results indicate that the glottis constriction ratio is a key factor to influence the effectiveness of the purposed targeted drug delivery method. Although lobe-specific pulmonary drug delivery can be realized, the actuation flow rate must be lower than 2 L/min, and the glottis constriction ratio has a significant impact on the effectiveness of the targeting method. Also, a design idea using e-cigarette as the prototype is proposed as the next-generation inhaler to accommodate the operational flexibility restrictions.

Lung cancer is the second most common cancer in both men and women globally. More than one million lung cancer cases are diagnosed worldwide each year. The leading cause of cancer death is lung cancer in the United States and worldwide [1]. According to the American Cancer Society, there were an estimated 222,500 new cases of lung cancer and 155,870 deaths from lung cancer in the United States in 2017. Early detection and diagnosis, as well as accurate localization in lung intervention, are the keys to reducing the death rate from lung cancer [1].

In this paper we present a device for improving blood oxygenation in patients with Acute Respiratory Distress Syndrome (ARDS). ARDS is caused by lung-related illness or injury, and can occur in mechanically ventilated ICU patients due to volutrauma or barotrauma. In ARDS, the lower lung is closed resulting in impaired gas exchange, and the upper lung is easily overstretched resulting in injury. The application of continuous negative abdominal pressure (CNAP) assists in opening the lower lung by pulling the diaphragm towards the abdomen. The device, consisting of a rigid arch, a compliant patient interface, and a pressure sensor module, allows for the application of CNAP to a patient suffering from ARDS. An initial pig trial using the prototype device showed significant improvement in the ratio of oxygen in the blood to the fraction of inspired oxygen, PaO 2 /FiO 2 , after five minutes of −5 cmH2O pressure application. Furthermore, preliminary testing on healthy humans indicated the device was comfortable, easy to apply, and formed a consistent airtight seal. Future prototypes will focus on ease of application, rigidity, and adjustability.

Acute respiratory distress syndrome (ARDS) arising from trauma, sepsis, pneumonia or other diseases has been acknowledged to be a major clinical problem in respiratory medicine. Hypoxia and hypercapnia arising from ARDS are life-threating particularly in children and elderly people. The reported mortality rate for ARDS is high. Current methods for treating patients who have limited or no lung function are ineffective or insufficient and present additional risks to the patients. In this research, we have explored new methods of infusing phospholipid-coated oxygen microbubbles (OMBs) to the thoracic cavity in order to oxygenate patients suffering from ARDS and hypoxemia. In our previous work, OMBs have been shown to be effective in treating hypoxia in models of LPS lung injury and lung trauma in rats and rabbits. In this study, we have developed a novel thoracic cavity extrapulmonary oxygenation devices using OMBs and test this device in a benchtop test and in vivo experiment on a large animal (pig) right pneumothorax injury model.

Asthma is a chronic disease that causes fixed airflow obstruction, swelling and inflammation of the lung airways. This results in shortness of breath, wheezing and coughing [1]. 3.9 million People in South Africa are estimated to suffer from the disease and 1.5% of this total die as a result, annually [2]. The disease is the 3rd most common cause of child hospitalisation in South Africa. In developing countries, the most common and affordable treatment option for asthma would be the standard metered dosage inhaler (MDI) [3, 4]. MDI’s provide a range of medications (including airway dilators and anti-inflammatories) contained within the aerosol canisters. A large number of paediatric and geriatric patients suffering from asthma are unable to produce the necessary force required to activate the standard MDI. The study investigated fingertip pinch (action carried out when activating an MDI) strengths to determine the activation force deficit for paediatric patients [5]. In addition, patients using a standard MDI are unable to track the number of dosages remaining in the aerosol canisters [5]. The study presents a solution to the above mentioned patient limitations. A sleeve attachment was developed to reduce the required activation force of a standard MDI and track patient medication adherence. Additional features included height adjustability for varied MDI sizes (55mm to 90mm in length) and paediatric patient aesthetic appeal.

Personal protective equipment (PPE) such as respirators will form the first line of defense in the event of a public health emergency including an airborne pandemic or a bio-terror attack. The two major pathways by which virus-carrying aerosols can reach the human lungs through these PPEs are: a) the intrinsic penetration through porous layers of the PPE and b) the leakage through gaps between the PPE and a person’s face [1, 2]. The contribution from the second pathway can be significantly reduced using fit-testing i.e. by choosing the appropriately sized respirator for a specific face. Unfortunately, in case of an emergency, it would not be possible to fit-test the entire US population. In this scenario, excessive leakage can occur through the gaps. [1]. Hence, it is critical to identify the potential anatomical leak sites (gaps) and quantify the amount of aerosol leakage through surgical respirators for the average US population. At the behest of Office of Counterterrorism and Emerging Threats, the Center for Devices and Radiological Health, US Food and Drug Administration (FDA), has been developing a comprehensive risk assessment model for determining the risk to different populations in case of an “off-label” use of such PPEs, i.e. for public emergency scenarios for which these FDA cleared respirators were not intended to be used. In order to develop the risk assessment model, establishing a correlation between the respirator gaps and aerosol leakage between the face and the respirator is critical. A previous study [3] identified the gaps of N95 surgical respirators for a large population and quantified the aerosol leak using computational fluid dynamics. However, the gap surface area, which is a key parameter required for establishing the gap-aerosol leak correlation, has not been quantified before. In this study, gaps were identified and the gap surface areas were quantified for multiple head-respirator combinations under realistic conditions using imaging coupled with computer-aided design and modeling.

In clinical settings, doctors classify pulmonary disorders into two main categories, obstructive lung disease and restrictive lung disease. The former is characterized by the airway obstruction which is associated with several disorders like chronic bronchitis, asthma, bronchiectasis, and emphysema [1]. The latter is caused by different conditions where one of the triggers is tied to the spine deformity. In general, a pulmonary function test (PFT) [2] is used to evaluate and diagnose lung function, and physicians depend on the test results to identify the disease patterns of the patients (obstructive or restrictive lung disease). In the PFT, some parameters including total lung capacity (TLC), vital capacity (VC), and residual volume (RV) can infer the lung volume and lung capacity. Other parameters, such as forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1), are often employed to assess the pulmonary mechanics. Scoliosis is an abnormal lateral curvature of the spine which involves not only the curvature from side to side but also an axial rotation of the vertebrae. Restrictive lung disease often happens in scoliosis patients, especially with severe spine deformity. Spine deformity if left untreated may lead to progression of the spinal curve, respiratory complications, and the reduction of life expectancy due to the decrease in thoracic volume for lung expansion. However, the relationship between thoracic volume and pulmonary function is not broadly discussed, and anatomic abnormalities in spine deformity (ex: scoliosis, kyphosis, and osteoporosis) can affect thoracic volume. Adequate thoracic volume is needed to promote pulmonary function. Previous literature has shown that the deformity of the thoracic rib cage will have detrimental effects on the respiratory function in adolescent idiopathic scoliosis patients [3–4]. In this paper, we aim to correlate thoracic volume and the parameters in PFTs in adult scoliosis patients 25–35 years after receiving treatments during their adolescence, either with physical bracing or spinal fusion surgery.

Understanding the characteristic of airflow, and the amount of particle deposition in different sections of respiratory system provides information for treatment procedures and processes. Results of preliminary numerical investigations for development of a system of image transfer and simulation to identify patient specific respiratory problem are presented. The system is a non-intrusive approach for evaluation of central airway diseases which could also be used for development of methods for reviving and recovery of damaged lung, especially at the onset of respiratory problems.

Low contrast imaging is of vital clinical importance and thus an important aspect of CT image quality. For example, soft plaque imaging, ground glass lung opacities, and soft tissue differentiation all depend upon excellent low contrast resolution. A primary factor in determining low contrast resolution is noise.

Computed tomography (CT) guided percutaneous lung biopsies are conducted to retrieve samples of suspected cancerous tissue for diagnosis. This paper details the design and development of Robopsy™, an economical, patient-mounted, tele-robotic, radiolucent, needle guidance and insertion system which facilitates faster more accurate lesion targeting.

Delivery of drugs to the lungs as aerosols is regarded as an excellent route for local or systemic administration of drugs. Aerosols have been used traditionally for treating illnesses of the respiratory tract (e.g. asthma), but new perspectives and needs on inhalation therapy have recently emerged (e.g. insulin). The percentage of drug that reaches the targeted region, the so-called respirable fraction (RF), is in average only 30% of the dose provided to the patient. Thus, the development of more efficient formulations and devices remains an important issue.

Failure of the cardiac or respiratory system is a common problem in the pediatric and neonatal intensive care unit. When conventional management fails to improve the child’s condition, extracorporeal life support such as extracorporeal membrane oxygenation (ECMO) can serve to provide life-saving temporary heart and lung support [1]. Renal failure often complicates care of these critically ill children on ECMO, leading to accumulation of fluid and volume overload that can worsen their heart and lung disease. Restrictive fluid management has been demonstrated to improve patient outcomes in acute lung injury.

The flexible bronchoscope, used both to directly visualize and biopsy lesions, is an important tool for diagnosing lung cancer [1]. Presented here is a conceptual design for a device that increases the depth to which the scope can be fed into the lungs. This allows doctors to find and accurately diagnose more cases of lung cancer first occurring deeper in the lungs.