Integration of 2D and 3D Imaging Descriptors with Large Language Models for Assessing Pediatric Foreign-Body Aspiration Risk

Highlights What are the main findings? Quantitative 2D and 3D morphometric descriptors, combined with LLM-based interpretation, enable a structured and informed assessment of pediatric foreign-body aspiration risk. Object morphology, including shape, sharpness, and orientation, substantially influences both where an aspirated foreign body lodges in the pediatric airway and the severity of the resulting injury, beyond traditional size-based criteria. What are the implications of the main findings? For practicing pediatricians, incorporating shape-related metrics into hazard assessment may complement existing size-based safety standards and improve the bedside identification of high-risk objects. The proposed framework offers a basis for developing interpretable tools to support prevention strategies, product design, caregiver education, and clinical risk assessment. Abstract 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—including volume, surface area, sphericity, elongation, flatness, curvature and convexity—were 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’s laryngo-tracheal tract served as an illustrative case. Results: The object’s 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.