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Huang A, Lee V, Chauhan AE, Sahoo A, Li J, Pham D, Aninwene GE, Yiu F, Lerman S, Iyer N, Moman P, Jackson N, Sturm RM. Application of intraoperative structured light scanning to enable post-operative evaluation of digital and 3D-printed penile models. J Pediatr Urol 2024:S1477-5131(24)00269-9. [PMID: 38862294 DOI: 10.1016/j.jpurol.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 04/06/2024] [Accepted: 05/15/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Penile phenotype in hypospadias is currently assessed visually or manually (e.g., ruler, goniometer) for clinical, education, and research applications. However, these methods lack precision and accuracy across raters and cannot be reevaluated retrospectively following a surgical repair. The project aim was to evaluate the precision and reliability of penile dimensions obtained from digital and three dimensional (3D) printed models created from intraoperative (OR) structured light scans (SLS) during primary pediatric penile procedures. METHODS Boys ages 1 month to 6 years underwent first- or single-stage penile surgery at a single institution were enrolled in this prospective study (IRB #20-000143). For each patient, immediately following placement of a stay suture under consistent manual tension, intra-operative dimension measurements with a ruler were obtained. A digital 3D model was created prior to penile repositioning using an Artec Space Spider scanner and Artec Studio 13 software. Following the case, two different raters completed 10 digital measurements of each generated model in Autodesk Fusion 360. These digital models were subsequently 3D printed and two different raters completed 10 manual dimension measurements of each 3D printed model using a ruler. A one-way random effects intraclass correlation coefficient (ICC) evaluated measures of agreement between and within raters, respectively. Analyses were conducted in R version 4.2. RESULTS Six scans were obtained (hypospadias: 4, circumcision: 2). Intra-rater assessments showed excellent precision across repeated digital measurements; manual measurements of 3D printed models had excellent reliability for glans width and penile length but poor to good reliability for glans height. Inter-rater reliability was good to excellent for glans width (0.77-0.95) and good for penile length (0.71-0.88). However, there was poor inter-rater reliability for glans height (0-0.14). Following training regarding glans height location, there was an improvement in precision and repeatability of manual and digital measurements. CONCLUSION Digital measurement of OR-derived 3D models resulted in excellent repeatability for each rater and improved between-rater reliability over manual measurement of 3D printed models alone, ensuring that images can be compared by various surgeons both now and in the future. SLS is promising as a novel modality to digitally generate 3D models, thereby informing phenotypic analysis for research and education. Further development of digital measurement methods to ensure consistency between raters for quantitative assessment of additional parameters and assessment of the technology within the pre-operative environment for surgical planning is planned.
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Affiliation(s)
- Alen Huang
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Victoria Lee
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Akash E Chauhan
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Astha Sahoo
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Joshua Li
- Department of Medicine Statistics Core, UCLA, Los Angeles, CA, USA
| | - Derek Pham
- Department of Medicine Statistics Core, UCLA, Los Angeles, CA, USA
| | - George E Aninwene
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Felix Yiu
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Steven Lerman
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Neha Iyer
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Precious Moman
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Nicholas Jackson
- Department of Medicine Statistics Core, UCLA, Los Angeles, CA, USA
| | - Renea M Sturm
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Thornton SM, Attaluri PK, Wirth PJ, Shaffrey EC, George RE, Carbullido MK, Rao VK. Picture Perfect: Standardizing and Safekeeping Clinical Photography in Plastic Surgery. Aesthet Surg J Open Forum 2024; 6:ojae012. [PMID: 38510270 PMCID: PMC10954060 DOI: 10.1093/asjof/ojae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
Plastic surgery relies heavily on clinical photography to document preoperative and postoperative changes, visualize surgical approaches, and evaluate outcomes. However, the contemporary landscape of plastic surgery photography faces challenges, including a lapse in standards due to the prevalence of smartphones, social media platforms, and security concerns related to data storage and cyberattacks. In this comprehensive review, the authors aim to provide plastic surgeons with practical guidelines for achieving standardized, high-quality clinical photography while navigating the evolving landscape of technology, security, and ethical considerations. We explore the security challenges associated with storing clinical photographs, emphasizing the legal obligations under the Health Insurance Portability and Accountability Act (HIPAA). We also discuss various storage options, including HIPAA-compliant cloud services, electronic medical records, and emerging technologies like blockchain and artificial intelligence. Level of Evidence 5
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Affiliation(s)
| | | | | | | | | | | | - Venkat K Rao
- Corresponding Author: Dr Venkat K. Rao, 600 Highland Avenue, Box 3236, Clinical Science Center, Madison, WI 53792, USA. E-mail:
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Ritschl LM, Classen C, Kilbertus P, Eufinger J, Storck K, Fichter AM, Wolff KD, Grill FD. Comparison of three-dimensional imaging of the nose using three different 3D-photography systems: an observational study. Head Face Med 2024; 20:7. [PMID: 38267982 PMCID: PMC10807178 DOI: 10.1186/s13005-024-00406-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/04/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND New 3D technologies for superficial soft tissue changes, especially in plastic and reconstructive surgical procedures, can improve the planning and documentation of facial surgeries. The purpose of this study was to compare and determine the applicability and feasibility of three different 3D-photography systems in clinical practice imaging the nose. METHODS A total of 16 healthy non-operated noses were included in this prospective study. A plaster model of each nose was produced, digitized, and converted to a .stl mesh (= ground truth model). Three-dimensional images of each nose were then taken using Artec Space Spider (gold standard), Planmeca ProFace®, and the Bellus3D Dental Pro application. All resulting .stl files were aligned to the ground truth model using MeshLab software, and the root mean square error (RMSE), mean surface distance (MSD), and Hausdorff distance (HD) were calculated. RESULTS The Artec Space Spider 3D-photography system showed significantly better results compared to the two other systems in regard to RMSE, MSD, and HD (each p < 0.001). There was no significant difference between Planmeca ProFace® and Bellus3D Dental Pro in terms of RMSE, MSD, and HD. Overall, all three camera systems showed a clinically acceptable deviation to the reference model (range: -1.23-1.57 mm). CONCLUSIONS The three evaluated 3D-photography systems were suitable for nose imaging in the clinical routine. While Artec Space Spider showed the highest accuracy, the Bellus3D Dental Pro app may be the most feasible option for everyday clinical use due to its portability, ease of use, and low cost. This study presents three different systems, allowing readers to extrapolate to other systems when planning to introduce 3D photography in the clinical routine.
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Affiliation(s)
- Lucas M Ritschl
- Department of Oral and Maxillofacial Surgery, School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Strasse 22, D-81675, Munich, Germany
| | - Carolina Classen
- Department of Oral and Maxillofacial Surgery, School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Strasse 22, D-81675, Munich, Germany.
- Department of Oral and Maxillofacial Surgery, Saarland University Medical Centre, 66421, Homburg, Germany.
| | - Paul Kilbertus
- Department of Oral and Maxillofacial Surgery, School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Strasse 22, D-81675, Munich, Germany
| | - Julia Eufinger
- Department of Oral and Maxillofacial Surgery, School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Strasse 22, D-81675, Munich, Germany
| | - Katharina Storck
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Strasse 22, D-81675, Munich, Germany
| | - Andreas M Fichter
- Department of Oral and Maxillofacial Surgery, School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Strasse 22, D-81675, Munich, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Strasse 22, D-81675, Munich, Germany
| | - Florian D Grill
- Department of Oral and Maxillofacial Surgery, School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Strasse 22, D-81675, Munich, Germany
- Private Practice Oral and Maxillofacial Surgery, Wolfratshausen, Germany
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Barnett SL, Choe J, Aiello C, Bradley JP. Facial Feminization Surgery: Anatomical Differences, Preoperative Planning, Techniques, and Ethical Considerations. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2070. [PMID: 38138173 PMCID: PMC10744788 DOI: 10.3390/medicina59122070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/15/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023]
Abstract
Facial Feminization Surgery (FFS) is a transformative surgical approach aimed at aligning the facial features of transgender women with their gender identity. Through a systematic analysis, this paper explores the clinical differences between male and female facial skeletons along with the craniofacial techniques employed in FFS for each region. The preoperative planning stage is highlighted, emphasizing the importance of virtual planning and AI morphing as valuable tools to be used to achieve surgical precision. Consideration is given to special circumstances, such as procedure sequencing for older patients and silicone removal. Clinical outcomes, through patient-reported outcome measures and AI-based gender-typing assessments, showcase the efficacy of FFS in achieving proper gender recognition and alleviating gender dysphoria. This comprehensive review not only offers valuable insights into the current state of knowledge regarding FFS but also emphasizes the potential of artificial intelligence in outcome evaluation and surgical planning to further advance patient care and satisfaction with FFS.
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Affiliation(s)
- Sarah L. Barnett
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Joshua Choe
- Northwell Health Division of Plastic Surgery, Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY 11042, USA; (J.C.); (C.A.)
| | - Christopher Aiello
- Northwell Health Division of Plastic Surgery, Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY 11042, USA; (J.C.); (C.A.)
| | - James P. Bradley
- Northwell Health Division of Plastic Surgery, Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY 11042, USA; (J.C.); (C.A.)
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Lopez X, Panton J, Nagarkar P, Preston S, Abramowitz J, Amirlak B. Initial Assessment of VECTRA Three-Dimensional Imaging to Accurately Simulate Breast Volume Changes in Transfeminine Patients: A Mannequin Study. Aesthet Surg J Open Forum 2023; 5:ojad015. [PMID: 37325787 PMCID: PMC10265444 DOI: 10.1093/asjof/ojad015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Methods that aim to accurately measure and predict breast development can be utilized in gender-affirming treatment planning, patient education, and research. OBJECTIVES The authors sought to evaluate whether three-dimensional (3D) stereophotogrammetry accurately measures transfeminine breast volume changes on a masculine frame when simulating anticipated changes in soft tissue after gender-affirming surgical therapy. Then, we describe the innovative application of this imaging modality in a transgender patient to illustrate the potential role of 3D imaging in gender-affirming surgical care. METHODS A 3D VECTRA scanner (Canfield, Fairfield, NJ) was used to measure anthropometric breast measurements. Postoperative changes in breast volume were simulated on a cardiopulmonary resuscitation mannequin using 450 cc MENTOR breast implants (Mentor Worldwide LLC, Irvine, CA). To demonstrate the ability of the VECTRA to accurately simulate transfeminizing augmentation in practice, we describe its use in a 30-year-old transgender female with a 2-year history of gender-affirming hormone therapy, presenting for gender-affirming surgical care. RESULTS In the mannequin, mean breast volumes were 382 cc on the right (range 375-388 cc), and 360 cc on the left (range 351-366 cc). The average calculated difference in volume between the 2 sides was 22 cc (range 17-31 cc). There were no instances where the left side was calculated to be larger than the right or where the calculated size was smaller than the actual implant size. CONCLUSIONS The VECTRA 3D camera is a reliable and reproducible tool for preoperative assessment, surgical planning, and simulating breast volume changes after gender-affirming surgery.
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Affiliation(s)
| | | | | | | | | | - Bardia Amirlak
- Corresponding Author: Dr Bardia Amirlak, 1801 Inwood Road, 5th Floor, Dallas, TX 75390, USA. E-mail:
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Ashraf DC, Miller A, Ahmad M, Smith LD, Grob SR, Winn BJ, Kersten RC, Vagefi MR. Augmentation of telemedicine post-operative follow-up after oculofacial plastic surgery with a self-guided patient tool. Orbit 2022:1-11. [PMID: 35920583 DOI: 10.1080/01676830.2022.2104325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSE This study evaluates a web-based tool designed to augment telemedicine post-operative visits after periocular surgery. METHODS Adult, English-speaking patients undergoing periocular surgery with telemedicine follow-up were studied prospectively in this interventional case series. Participants submitted visual acuity measurements and photographs via a web-based tool prior to routine telemedicine post-operative visits. An after-visit survey assessed patient perceptions. Surgeons rated photographs and live video for quality and blurriness; external raters also evaluated photographs. Images were analyzed for facial centration, resolution, and algorithmically detected blur. Complications were recorded and graded for severity and relation to telemedicine. RESULTS Seventy-nine patients were recruited. Surgeons requested an in-person assessment for six patients (7.6%) due to inadequate evaluation by telemedicine. Surgeons rated patient-provided photographs to be of higher quality than live video at the time of the post-operative visit (p < 0.001). Image blur and resolution had moderate and weak correlation with photograph quality, respectively. A photograph blur detection algorithm demonstrated sensitivity of 85.5% and specificity of 75.1%. One patient experienced a wound dehiscence with a possible relationship to inadequate evaluation during telemedicine follow-up. Patients rated the telemedicine experience and their comfort with the structure of the visit highly. CONCLUSIONS Augmented telemedicine follow-up after oculofacial plastic surgery is associated with high patient satisfaction, rare conversion to clinic evaluation, and few related post-operative complications. Automated detection of image resolution and blur may play a role in screening photographs for subsequent iterations of the web-based tool.
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Affiliation(s)
- Davin C Ashraf
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Amanda Miller
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Meleha Ahmad
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Loreley D Smith
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Seanna R Grob
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Bryan J Winn
- Department of Ophthalmology, University of California, San Francisco, California, USA.,Ophthalmology Section, Surgical Service, San Francisco Veterans' Affairs Health Care System, San Francisco, California, USA
| | - Robert C Kersten
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco, California, USA
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