1. Introduction
Respiratory morphology is a key component in predicting pulmonary drug delivery [
1]. In contrast to extensive studies on aerosol properties (device and formulations) and breathing conditions (patients and delivery methods), studies of the effects of the respiratory tract and variability are scarce. Generating anatomically accurate airway models is still challenging and time-consuming. It is more challenging to generate representative airway models specific to different ages, genders, races, and diseases [
2]. Furthermore, the respiratory tract is multiscale, from nose-mouth-throat, tracheobronchial, central airway, down to submicron alveoli [
3]. The smaller the airway, the more difficult it is to reconstruct from images. The respiratory tract is compliant and can be dynamic during drug delivery. The drug aerosol transport and deposition involve multiple physics, including inertial impaction, diffusion, and sedimentation. Particle transport and deposition are highly sensitive to anatomical details, such as airway curvature, and disease-induced airway remodeling. Interactions between airway morphology and other factors (aerosols, breathing, etc.) can also be important [
4].
Current methods to generate respiratory airway models include computer-aided design (CAD), segmentation of medical images, and algorithm-based morphing [
5]. The CAD-based approaches historically include Gambit and SolidWorks to generate new geometries, and HyperMorph, MAYA, and/or Blender to modify existing geometries [
6]. Zhao et al. [
7] and Talaat et al. [
8] used user-defined functions (UDFs) to control the opening/closing of the glottis and expansion-contraction of the alveoli following the tidal breathing waveforms. Wang et al. [
9] used a multi-point approach in MAYA to control the boundary motions such as the uvula flapping. Similar methods have also been applied in hydrodynamics of fish fins and aerodynamics of insect wings [
10,
11]. The segmentation method used computed tomography (CT) scans and magnetic resonance imaging (MRI) scans to reconstruct anatomically accurate, patient-specific airway models [
12]. With quick advances in both imaging and segmentation techniques, this approach has become mainstream in airway model development in recent years, starting from relatively simple geometries such as the trachea to increasingly more sophisticated structures such as the nose and deep lungs [
13,
14,
15,
16,
17]. Image segmentation has also been used to develop respiratory airway models in other species, with an emphasis on lab animals like mice, rats, rabbits, dogs, and monkeys to decrease animal usage [
18,
19,
20,
21,
22,
23,
24]. However, this approach has been limited by ethical issues, low image resolutions, and data availability to meaningfully study the shape variation effects [
25,
26].
Tongue variability among subjects during inhalation drug delivery: The tongue position can significantly affect the upper airway geometry and airflow dynamics during inhalation, which is crucial for effective drug delivery to the lungs [
27]. The variability in tongue position among subjects during inhalation drug delivery can be attributed to several factors. First, the size, shape, and position of the tongue, as well as the dimensions of the oral cavity, vary considerably among individuals. These anatomical differences can lead to differences in tongue positioning during inhalation. Second, breathing patterns, such as nasal vs. oronasal or shallow vs. deep breathing, can influence the tongue position. The coordination of the muscles involved in breathing maneuvers, including the genioglossus, hyoglossus, and styloglossus muscles, can vary among individuals and activities. Third, the posture and head position during drug delivery can also affect the positioning of the tongue and the pharyngeal morphology [
28]. Other factors contributing to tongue position variability include age, health (e.g., obesity), medical condition (e.g., obstructive sleep apnea), medication use (e.g., sedatives or muscle relaxants), and inhalation devices (DPI, MDI, and nebulizer) [
29,
30,
31]. The variability in tongue position can impact the airflow patterns, particle deposition, and overall effectiveness of inhaled drug delivery [
32]. Considering this variability is key to optimizing inhalation drug delivery techniques and devices to ensure consistent and efficient delivery to the targets within the respiratory tract.
The adjoint solver was proposed in the 1970s in the field of aerodynamics, particularly in the context of aircraft design optimization [
33]. The adjoint method has the advantage of efficiently computing the system performance with respect to shape design variables. Its earliest applications involved the design optimization of transonic airfoils and wings. By using the adjoint solver, researchers could efficiently compute the sensitivity of aerodynamic quantities (such as drag or lift) to changes in the shape of the airfoil or wing. This information was then used in optimization algorithms to iteratively modify the shape and improve the aerodynamic performance [
34,
35]. Since its inception, the adjoint solver has found applications in various other fields, including structural optimization, inverse design problems, shape optimization, and multiphase flows [
36,
37,
38,
39]. Note that the observables in the adjoint solver requires field variables, such as velocity, pressure, and temperature to compute the adjoint sensitivity, thus precluding its usage in simulations of inhalation drug delivery, where aerosols were often considered as the discrete phase [
40]. One exception is when aerosols are treated as the chemical species or probability density, the concentration or probability are field variables, and thus can be used to construct design observables for adjoint sensitivity calculation and shape optimization.
The objective of this study is to evaluate the feasibility of using adjoint solver to study the morphology sensitivity to inhalation dosimetry of inhaled vapor or nanomedicine to the mouth-tongue morphology. A CFD with wall adsorption (physiology-based pharmacokinetics, PBPK) was employed and two chemical species, Acetaldehyde and Benzene, were considered. Specific aims included:
Develop an adjoint-based CFD-PBPK model for vapors and nanomedicines.
Evaluate the sensitivity of the filtration efficiency to the airway shape.
Optimize the airway shape for prescribed species-specific filtration efficiencies.
4. Discussion
In this study, we explored the adjoint-CFD approach in studying the effects of mouth-tongue shape on the dosimetry of orally inhaled vapors. A practical method to study the influences of morphological variations on aerosol transport and deposition can open a new door to understanding drug bioavailability and bioequivalence among different subjects and between health and disease [
58,
59,
60,
61]. Despite large intersubject and intrasubject variability in respiratory anatomy, their effects on inhalation dosimetry have been historically less studied than other parameters, such as the flow rate and particle size. This has been attributed to challenges in varying the airway morphology while still keeping it physiologically realistic and representative. The results of this study demonstrate that the adjoint solver can provide a practical approach to examining the impacts of morphological factors. The adjoint sensitivity identified the most important factors affecting the vapor dosimetry, allowing exploration of mouth-tongue shape variations to minimize or maximize the vapor uptake in the upper airway (
Figure 9,
Figure 10 and
Figure 11). Instead of remodeling the airway geometry and solving the problem multiple times, the adjoint solver computes the observable gradient with respect to mesh points (shape sensitivity) by solving an additional set of equations (adjoint equations) only once. The structural modification can be a consequence of node displacements in a specific domain for a prescribed observable target, as shown in
Figure 4,
Figure 5 and
Figure 6). This makes the adjoint solver particularly powerful for inhalation dosimetry predictions, where the airway variability is tremendous, significantly reducing the computational cost compared to sensitivity analysis with individually modified airway models. Furthermore, detailed mechanisms for transport and deposition can also be explored after shape morphing by examining the shape variations and subsequent variations in flow/vapor dynamics (
Figure 7,
Figure 8 and
Figure 9)
Due to the automatic morphing capacity, this approach can be more user-friendly than other morphing methods based on CAD, image segmentation, mathematical algorithms (e.g., statistical shape modeling), or manual remodeling (e.g., Hypermesh, MAYA, Blender) [
62]. Note that the statistical shape modeling needs a training database of airway shape models, which are difficult to obtain per se, let alone consistent shapes with desired variability. The HyperMorph modifies a shape by enclosing the region using a lattice and moving individual lattice points [
63]. Even though it provides controlled shape remodeling, HyperMorph is labor-intensive and can generate unrealistic or unintended shapes due to the spline function [
64]. By comparison, the adjoint solver does not need a training dataset and is automatic and controllable. It is also noted that the adjoint solver is optimization-orientated with a final output of static, optimized shapes; it is not suitable for dynamic shape variations as seen in fluid-structure interactions [
65,
66,
67].
This study can be further improved by enhancing several simplifications, such as steady flow, oral airway only, rigid wall, and single observable. Inhalation dosimetry of chemical vapors and nanomedicines is sensitive to breathing maneuvers and can vary in different regions of the respiratory tract. An airway model extending beyond the oral airway can provide more realistic predictions of pulmonary dosimetry of orally inhaled aerosols. Including more bifurcations of the lung can even provide local or regional dosimetry in the lungs per se, providing granular information on bioavailability. Formulating and solving adjoint equations can be mathematically complex, and adapting existing simulation codes to include adjoint solvers can be challenging. Recall that the adjoint solver must use instantaneous field variables to constitute the observables (or objective function) for optimization. As a result, only a limited number of field variables are available, like pressure, velocity, temperature, and chemical species in the latest Fluent 23. Many field variables, as well as all discrete-phase variables, are still not available to be used for optimization. The level of geometry remodeling is also limited and susceptible to negative cells. In this study, the feasible control of the exiting mass flux is limited to “-1.2 – 2%” for Acetaldehyde and is even one order of magnitude lower for Benzene, “-0.12 – 1.5%, as shown in Figures 4&5.
Author Contributions
Conceptualization, X.S. and J.X.; methodology, M.T. X.S., and J.X.; software, M.T. and J.X.; validation, X.S. and J.X.; formal analysis, M.T. X.S., and J.X.; investigation, M.T., X.S. and J.X.; data curation, M.T.; writing—original draft preparation, J.X.; writing—review and editing, M.T. and X.S.; visualization, M.T. and J.X.; supervision, J.X. All authors have read and agreed to the published version of the manuscript.
Figure 1.
The adjoint-CFD solver with three phases: flow solution, adjoint solution, and design.
Figure 1.
The adjoint-CFD solver with three phases: flow solution, adjoint solution, and design.
Figure 2.
Models: (a) geometry model of mouth-tongue throat, (b) computational mesh, and (3) mass transfer at the airway wall with mucus, tissue, and blood.
Figure 2.
Models: (a) geometry model of mouth-tongue throat, (b) computational mesh, and (3) mass transfer at the airway wall with mucus, tissue, and blood.
Figure 3.
Vapor concentration in the core flows and on the wall surfaces for (a) acetaldehyde and (b) benzene. Different concentration ranges were used to highlight the concentration variation.
Figure 3.
Vapor concentration in the core flows and on the wall surfaces for (a) acetaldehyde and (b) benzene. Different concentration ranges were used to highlight the concentration variation.
Figure 4.
Adjoint shape sensitivity at log10 scale: (a) Acetaldehyde, and (b) Benzene.
Figure 4.
Adjoint shape sensitivity at log10 scale: (a) Acetaldehyde, and (b) Benzene.
Figure 5.
Comparison between original and adjoint-modified airway models with four different observable targets in terms of 3D morphology and dimension variation: (a) Acetaldehyde, and (b) Benzene.
Figure 5.
Comparison between original and adjoint-modified airway models with four different observable targets in terms of 3D morphology and dimension variation: (a) Acetaldehyde, and (b) Benzene.
Figure 6.
Comparison of the 2D contours between original and adjoint-modified airway geometries with four different observable targets: (a) Acetaldehyde, and (b) Benzene.
Figure 6.
Comparison of the 2D contours between original and adjoint-modified airway geometries with four different observable targets: (a) Acetaldehyde, and (b) Benzene.
Figure 7.
Airflow fields in modified airway models with different targets in Acetaldehyde exit mass flux: (a) -1.2%, (b) -0.6%, (c) control, (d) +1%, and (e) +2%.
Figure 7.
Airflow fields in modified airway models with different targets in Acetaldehyde exit mass flux: (a) -1.2%, (b) -0.6%, (c) control, (d) +1%, and (e) +2%.
Figure 8.
Iso-surfaces of Q-criterion in modified airway models with different targets in Acetaldehyde exit mass flux: (a) -1.2%, (b) -0.6%, (c) control, (d) +1%, and (e) +2%.
Figure 8.
Iso-surfaces of Q-criterion in modified airway models with different targets in Acetaldehyde exit mass flux: (a) -1.2%, (b) -0.6%, (c) control, (d) +1%, and (e) +2%.
Figure 9.
Vapor transport in modified airway models with different targets for the exit mass flux relative to the control case: (a) Acetaldehyde, and (b) Benzene.
Figure 9.
Vapor transport in modified airway models with different targets for the exit mass flux relative to the control case: (a) Acetaldehyde, and (b) Benzene.
Figure 10.
Vapor concentration distributions on the wall surfaces in modified airway models: (a) Acetaldehyde, and (b) Benzene.
Figure 10.
Vapor concentration distributions on the wall surfaces in modified airway models: (a) Acetaldehyde, and (b) Benzene.
Figure 11.
Correlation between flow resistance and observable: (a) Acetaldehyde, (b) Benzene, and (c) pressure drop vs. observable.
Figure 11.
Correlation between flow resistance and observable: (a) Acetaldehyde, (b) Benzene, and (c) pressure drop vs. observable.
Table 1.
Trasport properties of chemical vaoprs.
Table 1.
Trasport properties of chemical vaoprs.
|
Da (cm2/s) |
λma |
Dm (cm2/s) |
λtm |
Dt (cm2/s) |
Acetaldehyde |
8.0×10-2
|
3.2×102
|
8.0×10-6
|
5.9×10-1
|
2.64×10-6
|
Benzene |
8.8×10-2
|
4.4 |
9.8×10-6
|
4.1 |
3.23×10-6
|