{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T18:11:03Z","timestamp":1779387063112,"version":"3.53.1"},"reference-count":27,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T00:00:00Z","timestamp":1778889600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Foreign-body aspiration (FBA) is a common and largely preventable pediatric emergency, yet current safety standards and risk assessments rely predominantly on object size and on anecdotal descriptions and bronchoscopy findings. We propose a clinically oriented proof-of-concept workflow that combines high-resolution three-dimensional (3D) scanning and calibrated two-dimensional (2D) imaging of retrieved objects with radiomic shape descriptors and large language model (LLM) reasoning to support aspiration risk assessment and guide prevention. Methods: Objects were obtained from the Susy Safe registry and historical series from the University Clinical Centre Tuzla. Each object was digitized with 3D scanning and photographed with a ruler. Morphometric descriptors\u2014including volume, surface area, sphericity, elongation, flatness, curvature and convexity\u2014were computed from stereolithography (STL) meshes; silhouette area, perimeter and Feret diameters were extracted from 2D photographs. Normative airway dimensions from radiographic and computed tomography (CT) studies provided anatomical context. A sharp, irregular metallic object recovered from a child\u2019s laryngo-tracheal tract served as an illustrative case. Results: The object\u2019s major axis approximated the anteroposterior glottic diameter, suggesting potential traversal when longitudinally oriented, whereas its irregular shape increased the likelihood of mucosal laceration and lodging. LLM-based synthesis provided a structured narrative interpretation consistent with a high-risk profile and highlighted preventive implications. Conclusions: Combining 2D\/3D morphometry with LLM reasoning provides objective assessment of FBA hazards and may support safer product design, injury-prevention policies, and caregiver education.<\/jats:p>","DOI":"10.3390\/children13050684","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T16:46:18Z","timestamp":1779381978000},"page":"684","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Integration of 2D and 3D Imaging Descriptors with Large Language Models for Assessing Pediatric Foreign-Body Aspiration Risk"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7906-0580","authenticated-orcid":false,"given":"Dario","family":"Gregori","sequence":"first","affiliation":[{"name":"Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy"},{"name":"BIOSTAT-X Biostatistics & AI for Biomedical Discovery, Pediatric Research Institute (IRP) \u201cCitt\u00e0 della Speranza\u201d, 35127 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9396-5025","authenticated-orcid":false,"given":"Cinzia Anna Maria","family":"Papappicco","sequence":"additional","affiliation":[{"name":"Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy"},{"name":"BIOSTAT-X Biostatistics & AI for Biomedical Discovery, Pediatric Research Institute (IRP) \u201cCitt\u00e0 della Speranza\u201d, 35127 Padova, Italy"},{"name":"PhD Program in Translational Specialistic Medicine \u201cG.B. Morgagni\u201d, Curriculum \u201cNursing and Health Sciences\u201d, University of Padova, 35131 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dario","family":"Vucinic","sequence":"additional","affiliation":[{"name":"Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0924-5883","authenticated-orcid":false,"given":"Chiara","family":"Giraudo","sequence":"additional","affiliation":[{"name":"Unit of Advanced Clinical and Translational Imaging, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Paddova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1201-8702","authenticated-orcid":false,"given":"Azra","family":"Ibrisevic","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, University Clinical Center Tuzla, 75000 Tuzla, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alen","family":"Harcinovic","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, University Clinical Center Tuzla, 75000 Tuzla, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0160ekib","family":"Umihani\u0107","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, University Clinical Center Tuzla, 75000 Tuzla, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fuad","family":"Brkic","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, University Clinical Center Tuzla, 75000 Tuzla, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Solidea","family":"Baldas","sequence":"additional","affiliation":[{"name":"Protecting Children Association (Prochild) Onlus, 34129 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1771-4686","authenticated-orcid":false,"given":"Giulia","family":"Lorenzoni","sequence":"additional","affiliation":[{"name":"Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy"},{"name":"BIOSTAT-X Biostatistics & AI for Biomedical Discovery, Pediatric Research Institute (IRP) \u201cCitt\u00e0 della Speranza\u201d, 35127 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5823-1659","authenticated-orcid":false,"given":"Honoria","family":"Ocagli","sequence":"additional","affiliation":[{"name":"Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"220","DOI":"10.5455\/medarh.2018.72.220-223","article-title":"Death as a Consequence of Foreign Body Aspiration in Children","volume":"72","author":"Brkic","year":"2018","journal-title":"Med. Arch."},{"key":"ref_2","unstructured":"Centers for Disease Control and Prevention (CDC) (2025, December 10). WISQARS Web-Based Injury Statistics Query and Reporting System, Available online: https:\/\/wisqars.cdc.gov\/."},{"key":"ref_3","first-page":"265","article-title":"Foreign body injuries in children: A review","volume":"35","author":"Passali","year":"2015","journal-title":"Acta Otorhinolaryngol. Ital."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Lorenzoni, G., Vertuani, M., Basso, V., Rescigno, P., Ocagli, H., and Gregori, D. (2023). Characterization of Non-Food Foreign Bodies Aspirated by Children: A Systematic Review of the Literature. Children, 10.","DOI":"10.3390\/children10101709"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"M\u00eendru, D.E., P\u0103duraru, G., Rusu, C.D., \u021aarc\u0103, E., Azoic\u0103i, A.N., Ro\u0219u, S.T., Curp\u0103n, A.-\u0218., Ciomaga Jitaru, I.M., P\u0103dure\u021b, I.A., and Luca, A.C. (2023). Foreign Body Aspiration in Children\u2014Retrospective Study and Management Novelties. Medicina, 59.","DOI":"10.3390\/medicina59061113"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"5","DOI":"10.5847\/wjem.j.1920-8642.2016.01.001","article-title":"Airway foreign bodies: A critical review for a common pediatric emergency","volume":"7","author":"Salih","year":"2016","journal-title":"World J. Emerg. Med."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Kim, Y., Park, J.-E., and Kim, J.-H. (2022). Plain Radiographic Analysis of Laryngeal Dimensions in Young Children: Normal versus Croup. Children, 9.","DOI":"10.3390\/children9101532"},{"key":"ref_8","first-page":"239","article-title":"The normal pediatric larynx on CT and MR","volume":"18","author":"Hudgins","year":"1997","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1186\/s41747-018-0068-z","article-title":"Radiomics: The facts and the challenges of image analysis","volume":"2","author":"Rizzo","year":"2018","journal-title":"Eur. Radiol. Exp."},{"key":"ref_10","first-page":"122","article-title":"Beyond imaging: The promise of radiomics","volume":"38","author":"Avanzo","year":"2017","journal-title":"Phys. Medica Eur. J. Med. Phys."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"ckaf161.1067","DOI":"10.1093\/eurpub\/ckaf161.1067","article-title":"3D modeling of foreign bodies in pediatric injuries: A web-based public health prevention approach","volume":"35","author":"Papappicco","year":"2025","journal-title":"Eur. J. Public Health"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Safia, A., Abd Elhadi, U., Bader, R., Khater, A., Karam, M., Bishara, T., Massoud, S., Merchavy, S., and Farhat, R. (2024). Flexible versus Rigid Bronchoscopy for Tracheobronchial Foreign Body Removal in Children: A Comparative Systematic Review and Meta-Analysis. J. Clin. Med., 13.","DOI":"10.3390\/jcm13185652"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"111474","DOI":"10.1016\/j.ijporl.2023.111474","article-title":"Complication rates in rigid vs. flexible endoscopic foreign body removal in children","volume":"166","author":"Wiemers","year":"2023","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_14","first-page":"909","article-title":"Tracheobronchial foreign bodies in children. Experience at ORL clinic Tuzla, 1954\u20132004","volume":"71","year":"2007","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_15","unstructured":"Gonzalez, R.C. (2018). Digital Image Processing, Pearson India. [4th ed.]."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"9","DOI":"10.29390\/cjrt-2021-068","article-title":"Development and internal validation of an equation using anthropometric measures to predict correct endotracheal tube insertion depth","volume":"58","author":"Volsko","year":"2022","journal-title":"Can. J. Respir. Ther."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"824","DOI":"10.21037\/tp-2025-71","article-title":"Characteristics of endotracheal tube design of different brands are related to proper endotracheal tube position in pediatrics: A descriptive study","volume":"14","author":"Wankijcharoen","year":"2025","journal-title":"Transl. Pediatr."},{"key":"ref_18","unstructured":"R Core Team (2023). R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing."},{"key":"ref_19","unstructured":"(2026, March 23). GPT-5 Pro Model|OpenAI API. Available online: https:\/\/developers.openai.com\/api\/docs\/models\/gpt-5-pro."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1038\/s41591-024-03425-5","article-title":"The TRIPOD-LLM reporting guideline for studies using large language models","volume":"31","author":"Gallifant","year":"2025","journal-title":"Nat. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e53559","DOI":"10.2196\/53559","article-title":"The Temperature Feature of ChatGPT: Modifying Creativity for Clinical Research","volume":"11","author":"Davis","year":"2024","journal-title":"JMIR Hum. Factors"},{"key":"ref_22","first-page":"906","article-title":"Early Medical Assessment with Radiography Imaging Techniques\u2014An Analysis with Pediatric Foreign Body Aspiration","volume":"6","author":"Vasumathy","year":"2019","journal-title":"Int. Res. J. Eng. Technol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3398","DOI":"10.21037\/jtd.2017.06.137","article-title":"Foreign body aspiration in adult airways: Therapeutic approach","volume":"9","author":"Hewlett","year":"2017","journal-title":"J. Thorac. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1007\/s00405-025-09856-1","article-title":"Cautionary lessons from real-world testing of GPT-4.1 AI for pediatric foreign body aspiration","volume":"283","author":"Hack","year":"2026","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1038\/s41746-025-02097-w","article-title":"Automated detection of radiolucent foreign body aspiration on chest CT using deep learning","volume":"8","author":"Liu","year":"2025","journal-title":"npj Digit. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"162014","DOI":"10.1016\/j.jpedsurg.2024.162014","article-title":"The Impact of Deep Learning on Determining the Necessity of Bronchoscopy in Pediatric Foreign Body Aspiration: Can Negative Bronchoscopy Rates Be Reduced?","volume":"60","author":"Demir","year":"2025","journal-title":"J. Pediatr. Surg."},{"key":"ref_27","unstructured":"Chang, W., Cheng, J., Allaire, J.J., Sievert, C., Schloerke, B., and Xie, Y. (2026, March 01). Shiny: Web Application Framework for R, version 1.9.1; R package: Vienna, Austria, 2025. Available online: https:\/\/CRAN.R-project.org\/package=shiny."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/5\/684\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T17:27:26Z","timestamp":1779384446000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/5\/684"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,16]]},"references-count":27,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["children13050684"],"URL":"https:\/\/doi.org\/10.3390\/children13050684","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,16]]}}}