Comparison between breast volume measurement using 3D surface imaging and classical techniques

Customized planning of augmentation mammaplasty with silicon implants using three-dimensional optical body scans and biomechanical modeling of soft tissue outcome

The aesthetic results of augmentation mammaplasty are essentially determined by the size and the shape of the implant as well as its position on the chest. To achieve successful aesthetic results, customized surgery planning based on a reliable visual concept of the prospective surgery outcome and quantitative methods for assessment of three-dimensional (3D) breast shape could be of considerable additional value. This report evaluates a novel method for customized planning and quantitative optimization of breast augmentation based on 3D optical body scanning of the patient's breast and computational modeling of soft tissue mechanics. This method allows a 3D photo-realistic appearance of postsurgery breasts to be simulated for different surgical scenarios. It also allows the result of a virtual simulation to be implemented using measurements derived from a computationally predicted breast model. A series of clinical studies are presented that demonstrate the feasibility and accuracy of the proposed approach for customized 3D planning of breast augmentation, including direct comparison between simulated and postsurgery results. Our experimental results show that for 89% of the breast surface, the average difference between the simulated and postsurgery breast models amounts to less than 1 mm. The presented method for customized planning of augmentation mammaplasty enables realistic prediction and quantitative optimization of postsurgery breast appearance. Based on individual 3D data and physical modeling, the described approach enables more accurate and reliable predictions of surgery outcomes than conventionally used photos of prior patients, drawings, or ad hoc data manipulation. Moreover, it provides precise quantitative data for bridging the gap between virtual simulation and real surgery.

Five methods of breast volume measurement: a comparative study of measurements of specimen volume in 30 mastectomy cases

BACKGROUND

To compare breast volume measurement techniques in terms of accuracy, convenience, and cost.

METHODS

Breast volumes of 30 patients who were scheduled to undergo total mastectomy surgery were measured preoperatively by using five different methods (mammography, anatomic [anthropometric], thermoplastic casting, the Archimedes procedure, and the Grossman-Roudner device). Specimen volume after total mastectomy was measured in each patient with the water displacement method (Archimedes). The results were compared statistically with the values obtained by the five different methods.

RESULTS

The mean mastectomy specimen volume was 623.5 (range 150-1490) mL. The breast volume values were established to be 615.7 mL (r = 0.997) with the mammographic method, 645.4 mL (r = 0.975) with the anthropometric method, 565.8 mL (r = 0.934) with the Grossman-Roudner device, 583.2 mL (r = 0.989) with the Archimedes procedure, and 544.7 mL (r = 0.94) with the casting technique. Examination of r values revealed that the most accurate method was mammography for all volume ranges, followed by the Archimedes method.

CONCLUSION

The present study demonstrated that the most accurate method of breast volume measurement is mammography, followed by the Archimedes method. However, when patient comfort, ease of application, and cost were taken into consideration, the Grossman-Roudner device and anatomic measurement were relatively less expensive, and easier methods with an acceptable degree of accuracy.

Validation of a passive stereophotogrammetry system for imaging of the breast: a geometric analysis

The overall aim of this study was to assess the accuracy, reproducibility and stability of a high resolution passive stereophotogrammetry system to image a female mannequin torso, to validate measurements made on the textured virtual surface compared with those obtained using manual techniques and to develop an approach to make objective measurements of the female breast. 3D surface imaging was carried out on a textured female torso and measurements made in accordance with the system of mammometrics. Linear errors in measurements were less than 0.5mm, system calibration produced errors of less than 1.0mm over 94% over the surface and intra-rater reliability measured by ICC=0.999. The mean difference between manual and digital curved surface distances was 1.36 mm with maximum and minimum differences of 3.15 mm and 0.02 mm, respectively. The stereophotogrammetry system has been demonstrated to perform accurately and reliably with specific reference to breast assessment.

Assessment of cosmesis after breast reconstruction surgery: a systematic review

BACKGROUND

Breast reconstruction (BR) is undertaken to improve cosmetic outcomes, but how this is optimally assessed is uncertain. This review summarises current methods for assessing cosmesis after reconstructive surgery and makes recommendations for future practice.

METHODS

A comprehensive systematic review identified all studies with 20 or more participants that evaluated the cosmetic outcome of BR. Four evaluation criteria (reporting of study inclusion criteria, type and timing of BR and timing of assessment) were used to assess study quality. Articles reporting at least three of the four criteria were considered robust and further summarised to report methods of cosmetic assessment, assessor details and the scoring systems used.

RESULTS

122 primary papers assessed cosmesis in 11,308 women with median follow-up of 28.8 months (range 18.0-42.9 months). Cosmesis was assessed by either healthcare professionals or patients in 33 (27.1%) and 37 studies (30.3%), respectively, and by both professionals and patients in 52 (42.6%). Professional assessments included 43 (40.2%) clinical, 49 (45.8%) photographic and 13 (12.1%) geometric assessments conducted by between 1 and 26 observers. Surgeons were most frequently involved in assessments (n = 71, 67.6%), but in 38 (36.1%) papers the assessor's profession was not reported. Twenty-seven (25.7%) papers used previously published assessment scale. Patients' views were assessed in 89 studies, using questionnaires (n = 63) or interviews (n = 12); 14 (15.7%) did not report how patients' views were obtained.

CONCLUSIONS

Current methods for assessing the cosmetic outcome of BR vary widely. A valid patient-centred assessment method is required to fully understand the outcomes of BR and to inform decision-making.

MRI-based breast volumetry-evaluation of three different software solutions

As lipofilling of the female breast is becoming more popular in plastic surgery, the use of MRI to assess breast volume has been employed to control postoperative results. Therefore, we sought to evaluate the accuracy of magnetic resonance imaging (MRI)-based breast volumetry software tools by comparing the measurements of silicone implant augmented breasts with the actual implant volume specified by the manufacturer. MRI-based volume analysis was performed in eight bilaterally augmented patients (46 ± 9 years) with three different software programs (Brainlab© I plan 2.6 neuronavigation software; mass analysis, version 5.3, Medis©; and OsiriX© v.3.0.2. 32-bit). The implant volumes analysed by the BrainLab© software had a mean deviation of 2.2 ± 1.7% (r = 0.99) relative to the implanted prosthesis. OsiriX© software analysis resulted in a mean deviation of 2.8 ± 3.0% (r = 0.99) and the Medis© software had a mean deviation of 3.1 ± 3.0% (r = 0.99). Overall, the volumes of all analysed breast implants correlated very well with the real implant volumes. Processing time was 10 min per breast with each system and 30 s (OsiriX©) to 5 min (BrainLab© and Medis©) per silicone implant. MRI-based volumetry is a powerful tool to calculate both native breast and silicone implant volume in situ. All software solutions performed well and the measurements were close to the actual implant sizes. The use of MRI breast volumetry may be helpful in: (1) planning reconstructive and aesthetic surgery of asymmetric breasts, (2) calculating implant size in patients with missing documentation of a previously implanted device and (3) assessing post-operative results objectively.

Acquisition and interactive 3D exploration of the internal structure of a dissected specimen

We present a system to keep track of a destructive process such as a medical specimen dissection, from data acquisition to interactive and immersive visualization, in order to build ground truth models. Acquisition is a two-step process, first involving a 3D laser scanner to get a 3D surface, and then a high resolution camera for capturing the texture. This acquisition process is repeated at each step of the dissection, depending on the expected accuracy and the specific objects to be studied. Thanks to fiducial markers, surfaces are registered on each others. Experts can then explore data using interaction hardware in an immersive 3D visualization. An interactive labeling tool is provided to the anatomist, in order to identify regions of interest on each acquired surface. 3D objects can then be reconstructed according to the selected surfaces. We aim to produce ground truths which for instance can be used to validate data acquired with MRI. The system is applied to the specific case of white fibers reconstruction in the human brain.

Computer-Aided Methods in Bespoke Breast Prosthesis Design and Fabrication

This case study presents a method of utilizing computer-aided design technologies to provide bespoke, external breast prostheses. The technique is illustrated through a case study of a mastectomy patient. Photogrammetry methods were used to capture the breast form when supported by a brassiere and the unsupported breast and defect side. Computer-aided design techniques were used to generate a digital prosthesis based upon the supported breast shape and with a fitting surface that matched the defect side. Furthermore, a two-part mould was designed and fabricated using rapid prototyping methods. A colour-matched prosthesis was then fabricated in a gel-based, platinum-cured silicone.

Correlation between scoliosis and breast asymmetries in women undergoing augmentation mammaplasty

BACKGROUND

Breast asymmetries and scoliosis influence the results of augmentation mammaplasty. Although a variety of methods have been proposed to resolve breast asymmetries, to date, no simple preoperative algorithm has been proposed for predicting the breast volume and decreasing breast asymmetries in the place of subjective or expensive evaluation. The relationship between the scoliosis and breast volume asymmetry was further analyzed statistically in this study.

METHODS

The study enrolled 60 scoliotic patients from 780 patients undergoing augmentation mammaplasty between January 2000 and March 2008. The average follow-up period was 2 years. The inclusion criteria required hypoplastic breasts, a difference in bilateral breast volumes greater than 20 ml, and scoliosis with a Cobb angle greater than 10 degrees . The authors' surgical algorithm demonstrated an anthropomorphic equation for predicting breast volume and selecting the correct implant size.

RESULTS

Pearson regression analysis showed that the breast volume asymmetry difference was significantly correlated with the severity of scoliosis (Cobb angle) (correlation coefficient, 0.901). No correlation between the difference in pre- and postoperative nipple and inframammary levels and the severity of scoliosis was noted. Augmentation mammaplasty significantly decreased the breast asymmetry differences (volume and nipple level) (p < 0.001). The average preoperative estimated breast volume was 45.3 ml for the smaller breast and 88.4 ml for the larger breast.

CONCLUSION

This study found that the severity of scoliosis showed significant correlation with the breast volume asymmetry differences. Augmentation mammaplasty for breast asymmetries decreased not only the volume difference but also the difference in nipple levels.

Three-dimensional surface imaging for clinical trials: improved precision and reproducibility in circumference measurements of thighs and abdomens

BACKGROUND AND OBJECTIVES

Numerous body contouring and laser-assisted liposuction devices have recently obtained or are seeking FDA clearance, and assessment of efficacy of these devices is largely based upon qualitative comparisons of before and after photographs and measurable changes in patient circumference. The current standard for measuring body circumference in clinical trials involves the use of a standard measuring tape. These manual measurements introduce human error and may incorrectly support or refute a device or procedure's efficacy. A promising alternative to manual measurements is three-dimensional (3D) photography. This technology allows circumference measurements to be performed on 3D digital models. Our objective is to compare the precision and reproducibility of manual versus 3D photographic measurement of body circumference.

STUDY DESIGN/MATERIALS AND METHODS

Thirty subjects completed this IRB approved study. Each subject's thighs and abdomen were measured twice by each of two blinded investigators and twice by the 3D system.

RESULTS

For right and left thigh circumference, the variance of the replication errors [measurement 1-measurement 2] for the human investigators was 20.5% larger than the variance for the 3D photography system. For abdominal circumference, the variance for the human investigators was 231.3% larger than the variance for the 3D system.

CONCLUSIONS

3D photography is a valuable tool that enables investigators to reliably detect minute changes in body shape; consequently, 3D photography reduces the number of subjects needed to sufficiently power a clinical study. For studies involving abdominal circumference, utilizing 3D photography reduces the number of subjects needed by 1/2 to 2/3.

Postoperative evaluation platform of female breast implant surgery with breast configuration indicator

The purpose of this study is to establish an optimal module of breast configuration, under normal seating state, for postoperative evaluation of a female breast implant surgery. The analytical parameters of breast configuration, such as the breast position, size and shape, can be derived from a three-dimensional (3D), full-sized image process under non-radiation condition. This optimal module converts the breast position, size and shape to the breast configuration indicator consisting of three components or indices-the breast position, volume and breast congruence rate. In conjunction with the continuity analysis, the breast configuration indicator would allow a surgeon to practically grasp the progress during the postsurgery revisits. In addition, the module derived from the proposed computer-aided breast configuration indicator could be of great use as a tool of communication between patients and surgeons.

Magnetic resonance images and linear measurements in the surgical treatment of breast asymmetry

BACKGROUND

Objective evaluation of breast asymmetry surgical treatment should consider not only breast shape but also breast volume.

METHODS

For this study, 22 patients with primary breast asymmetry were evaluated by magnetic resonance imaging (MRI) as well as linear measurements preoperatively and 6 months postoperatively. The mean difference between the pre- and postoperative linear measurements was graduated from excellent to poor. Breast volume was estimated by MRI from axial reconstruction for three-dimensional application using the Cavalieri formula and specific software.

RESULTS

A strong correlation (r = 0.817) was found between the pre- and postoperative breast volumes, as increased or decreased by the surgical procedure. Patients with less postoperative volume differences tended to have the best ratings with linear measurements. When the same surgical procedure was performed bilaterally or when only one breast was treated by surgery, greater volume symmetry was observed.

CONCLUSIONS

Linear measurements and MRI are objective methods for evaluating postoperative symmetry, and when used in association, can help plastic surgeons to achieve favorable results in mammary asymmetry treatment.

Does abdominoplasty with liposuction of the love handles yield a shorter scar? An analysis with abdominal 3D laser scanning

The aim of this study was to evaluate the combination of abdominoplasty with liposuction of both flanks with regards to length of scar, complications, and patient's satisfaction. A retrospective analysis of 35 patients who underwent esthetic abdominoplasty at our institution between 2002 and 2004 was performed. Thirteen patients underwent abdominoplasty with liposuction of both flanks, 22 patients underwent conventional abdominoplasty. Liposuction of the flanks did not increase the rate of complications of the abdominoplasty procedures. We found a tendency toward shorter scars in patients who underwent abdominoplasty combined with liposuction of the flanks. Implementation of 3-dimensional laser surface scanning to objectify the postoperative outcomes, documented a comparable degree of flatness of the achieved body contouring in both procedures. 3-dimensional laser surface scanning can be a valuable tool to objectify assessment of postoperative results.

[Breast volume assessment based on 3D surface geometry: verification of the method using MR imaging]

Differences in breast volume and contour are subjectively estimated by surgeons. 3D surface imaging using 3D scanners provides objective breast volume quantification, but precision and accuracy of the method requires verification. Breast volumes of five test individuals were assessed using a 3D surface scanner. Magnetic resonance imaging (MRI) reference volumes were obtained to verify and compare the 3D scan measurements. The anatomical thorax wall curvature was segmented using MRI data and compared to the interpolated curvature of the posterior breast volume delimitation of 3D scan data. MRI showed higher measurement precision, mean deviation (expressed as percentage of volume) of 1.10+/-0.34% compared to 1.63+/-0.53% for the 3D scanner. Mean MRI [right (left) breasts: 638 (629)+/-143 (138) cc] and 3D scan [right (left) breasts: 493 (497)+/-112 (116) cc] breast volumes significantly correlated [right (left) breasts: r=0.982 (0.977), p=0.003 (0.004)]. The posterior thorax wall of the 3D scan model showed high agreement with the MRI thorax wall curvature [mean positive (negative) deviation: 0.33 (-0.17)+/-0.37 cm]. High correspondence and correlation of 3D scan data with MRI-based verifications support 3D surface imaging as sufficiently precise and accurate for breast volume measurements.

The stable status evaluation for female breast implant surgery by calculating related physics parameters

Cosmetic doctor utilizes the position, size and shapes of female's breast to judge whether the breast is under steady-state condition after breast implant plastic surgery. Since, doctor evaluates the breast condition with the subjective discrimination (such as vision, sense of touch) without using the objective physical parameters auxiliary. This study uses the 3D optics scanner editing 3D image to obtain full-scale 3D female breasts image. The CAD system converts the breast position, size and shapes, as the length of the curve between UBL (upper breast line) and NBL (nipple base line), the length of the curve between NBL and LBL (lower breast line), breast volume and breasts congruence rate. The stability after the breast implant plastic surgery is one of the important successful indexes of plastic surgery, so with the continuity analysis the breast curve length, volume and congruence rate can let the doctor really grasp the stability of the breast after plastic surgery.

Three-dimensional and thermal surface imaging produces reliable measures of joint shape and temperature: a potential tool for quantifying arthritis

Introduction

The assessment of joints with active arthritis is a core component of widely used outcome measures. However, substantial variability exists within and across examiners in assessment of these active joint counts. Swelling and temperature changes, two qualities estimated during active joint counts, are amenable to quantification using noncontact digital imaging technologies. We sought to explore the ability of three dimensional (3D) and thermal imaging to reliably measure joint shape and temperature.

Methods

A Minolta 910 Vivid non-contact 3D laser scanner and a Meditherm med2000 Pro Infrared camera were used to create digital representations of wrist and metacarpalphalangeal (MCP) joints. Specialized software generated 3 quantitative measures for each joint region: 1) Volume; 2) Surface Distribution Index (SDI), a marker of joint shape representing the standard deviation of vertical distances from points on the skin surface to a fixed reference plane; 3) Heat Distribution Index (HDI), representing the standard error of temperatures. Seven wrists and 6 MCP regions from 5 subjects with arthritis were used to develop and validate 3D image acquisition and processing techniques. HDI values from 18 wrist and 9 MCP regions were obtained from 17 patients with active arthritis and compared to data from 10 wrist and MCP regions from 5 controls. Standard deviation (SD), coefficient of variation (CV), and intraclass correlation coefficients (ICC) were calculated for each quantitative measure to establish their reliability. CVs for volume and SDI were <1.3% and ICCs were greater than 0.99.

Results

Thermal measures were less reliable than 3D measures. However, significant differences were observed between control and arthritis HDI values. Two case studies of arthritic joints demonstrated quantifiable changes in swelling and temperature corresponding with changes in symptoms and physical exam findings.

Conclusion

3D and thermal imaging provide reliable measures of joint volume, shape, and thermal patterns. Further refinement may lead to the use of these technologies to improve the assessment of disease activity in arthritis.