High-resolution computed tomography (HRCT) has been used to examine airway narrowing. We developed an automated computed tomographic image analysis algorithm (computed tomographic airway morphometry; CTAM) to measure airway lumen area (Ai ), airway wall area (Awa), and airway angle of orientation. Tubes of varying size were embedded in Styrofoam and then scanned at angles between 0 degrees and 50 degrees to assess the accuracy of measurements made with CTAM. Two excised pig lungs were fixed in inflation, sectioned, and scanned. Ai and Awa were measured planimetrically from the cut surfaces to optimize CTAM measurement parameters. In CTAM, Ai was defined according to an airway-size-dependent threshold value, and total Awa was determined through a score-guided erosion method. Results were compared with measurements made through a previously validated method (manual method). CTAM provided accurate measurements of the tubes' Ai values at all angles; Awa was overestimated in direct relation to airway size. The manual method underestimated Ai and overestimated Awa in a manner directly related to airway size as well as to airway angle of orientation. In the excised lung, the mean errors of Ai and Awa measurements made with CTAM were 0.52 +/- 0.24 mm(2) and 0.17 +/- 0.32 mm(2) (mean +/- SEM), respectively. Ai errors with the manual method were similar, but Awa was overestimated to a greater degree (6.3 +/- 0.38 mm(2); p < 0.01) and the error was proportional to Awa (r = 0.64; p < 0.01). CTAM allows accurate measurements of airway dimensions and angle of orientation.