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Bottom line: Consider low dose CT in children with concern for aspiration events
Pediatric foreign body aspiration can be a challenge. The patient obvious airway obstruction is clear, but what to do in patients who choked and are stable? Old convention used bilateral decubitus chest X-rays for evaluation for air trapping, and if positive consider scoping. More recent literature suggests that low dose CT may be more optimal for assessment of foreign body. It has similar (and in some cases less) total radiation exposure for children, shortens length of stay, and can prevent the unnecessary bronchoscopy of patients- removing the risks of the procedure and the sedation. For patients in community EDs, this may also prevent unnecessary and costly transfers.
References
Jones H, Alshammasi R, Ryan S, Bowden L, Moran A, Smyth AE, Heffernan CB. Ultra-low dose CT for suspected paediatric foreign body aspiration: comparison with conventional radiograph. J Laryngol Otol. 2025 Dec;139(12):1190-1195. PMID: 40878584.