Bronchiectasis in children is a major health issue which can be life-threatening if not diagnosed and effectively treated. In the diagnosis of bronchiectasis, an increased broncho-arterial (BA) ratio is considered a significant marker. The BA ratio is measured by evaluating BA pairs, using high-resolution computed tomography (HRCT) scans. Detecting BA pairs automatically is challenging due to the complex characteristics of BA pairs and the ambiguous appearance of the bronchi. This study proposes an effective computerized approach to detect BA pairs and assess BA ratio using HRCT scans of children and employing computer-aided techniques and novel custom-build algorithms. Attention is given to reconstructing broken bronchial walls and identifying discrete BA pairs using custom-built kernel based and patch-based algorithms for pixel-level image analysis. To detect BA pairs, the lung region is segmented in the HRCT slices and image preprocessing techniques, including noise reduction, binarizing, largest contour detection and a hole-filling algorithm, are applied. A histogram analysis method is introduced to clean the images. A kernel-based algorithm is proposed to reconstruct the pixel distribution if the bronchial wall is so that the bronchi can be detected precisely. Potential arteries are detected using balanced histogram thresholding, morphological opening and an approach based on four conditions related to the object area circularity, rectangular boundary box ratio and enclosing circle area ratio. Potential bronchi are detected through matching of object coordinates with potential arteries, hole-filling and four condition based approaches. The potential BA pairs are detected by matching the coordinates of potential bronchi with those of potential arteries as the artery and bronchus are adjacent to each other in BA pairs. Finally, from the potential BA pairs, actual BA pairs are identified using a custom-built patch algorithm. The study is conducted using 2471 HRCT slices of seven children, obtained from the Royal Darwin Hospital, Australia. The BA ratio is derived based on the ratio of diameters, major axis lengths, minor axis lengths, area, convex hull and equivalent diameter where the BA ratios are respectively 0.51–0.65, 0.49–0.59, 0.59–0.77, 0.25–0.42, 0.29–0.47, 1.5–2 and 0.50–0.65.