The current state-of-the-art in image-based modeling allows derivation of patient-specific models of the lung, lobes, airways, and pulmonary vascular trees. The application of traditional engineering analyses of fluid and structural mechanics to image-based subject-specific models has the potential to provide new insight into structure-function relationships in the individual via functional interpretation that complements imaging and experimental studies. Three major issues that are encountered in studies of airflow through the bronchial airways are the representation of airway geometry, the imposition of physiological boundary conditions, and the treatment of turbulence. Here we review some efforts to resolve each of these issues, with particular focus on image-based models that have been developed to simulate airflow from the mouth to the terminal bronchiole, and subjected to physiologically meaningful boundary conditions via image registration and soft-tissue mechanics models. THE LUNG UNDERGOES large nonlinear deformations during normal breathing. It couples several distinct subsystems, multiple scales of interest, and multiple functions of interest. The lung is typified by heterogeneity in ventilation, perfusion, and structure. While this makes this organ system more difficult to study experimentally and/or via imaging than muscle or bone, it presents exciting challenges for research into the development and application of robust and validated computational models of the lung. The application of traditional engineering analyses of fluid and structural mechanics to image-based subjectspecific models has the potential to provide new insight into structure-function relationships in the individual.One motivation for understanding the characteristics of flow within the airways is because airflow can theoretically induce physiologically significant shear on the bronchial epithelium (1), which could be important in mechanotransduction and remodeling of the airway wall when flow is abnormal. A further motivation is that the characteristics of airway flow determine particle (either noxious or therapeutic) transport and its deposition. The lungs are increasingly recognized as a potential route for delivery of systemic drugs such as insulin (2) because this avoids the hepatic metabolic pathway and may better simulate the physiological response to a food bolus. Penetration and deposition of particles within the airways depends on airway size and branching patterns, which vary between species (3) and with age. Variation in individual airway geometry therefore makes subject-specific models essential for the study of pulmonary airflow and drug delivery. Furthermore, it has been demonstrated that a strong interaction exists between lung geometry and gas properties (4,5), which has major implications in determining gas delivery to and clearance from the lung periphery during ventilation imaging via x-ray computed tomography (CT) using xenon gas (6-8) as a contrast agent, or magnetic resonance imaging (MRI) using hyperpolari...