Table 1.

Imaging specifics for chest CT evaluation of airway disease in older people.

MDCT	CT scans to better assess the airways (from the trachea to the most distal visible bronchi) are multidetector CT scans (MDCT), widely spread in Western countries. MDCT scans allow generating 2D multiplanar and 3D reconstructions of the airways.
Patient positioning	Can be challenging in those with musculoskeletal problems. Rotation of the gantry can be helpful in obtaining axial scans even in severe dorsal kyphosis.
Patient Dose	Moderate radiation doses are acceptable at inspiratory CT scan (<10 mSv). Expiratory CT may be performed with lower radiation exposure (tube current ≤ 50 mAs) [43].
Motion artifacts	MDCT takes only a few seconds to scan the entire chest, reducing or avoiding motion artifacts even in breathless patients.
Intravenous contrast media	Routinely not recommended. Required in known or suspected airway neoplasms, paratracheal masses causing airway obstruction, and in suspected pulmonary embolism. In case of contrast administration, glomerular filtration rate should always be performed, as normal values of creatinine in the blood for the adult population are not consistent with a good renal function in older population.
Breathing instructions	Fundamental to avoid motion artifacts and misleading diagnoses of airway disease. Issues in accurately following breathing instructions are more common than in younger adults, because of ear loss, dyspnea, cough, weakness of chest wall muscles, or cognitive impairment. A better compliance in following breathing instructions can be obtained by showing the procedure to the patient as well as by careful coaching the patient before and during the examination. Coaching consists of making the old patient comfortable with the instructions, ensuring him that the instructions will be repeated during the examination and he does not have to remember everything, and giving him the chance to try the protocol more times as needed [55].

(MDCT= Multidetector Computed Tomography; 2D= two dimensional; 3D= three dimensional; mSv= millisievert; mAs= milliamper/second)