Three-dimensional photography

Using a Smartphone 3-Dimensional Surface Imaging Technique to Manufacture Custom 3-Dimensional-Printed Eyeglasses

Importance

Finding a suitable fit in glasses for pediatric patients with congenital and acquired craniofacial abnormalities is difficult; consequently, these children are at high risk of vision loss secondary to refractive amblyopia as they often have poor adherence to daily glasses wearing. Custom 3-dimensional (3D)-printed glasses may have an improved design and fit, but access is limited by the availability of computed tomography and magnetic resonance imaging (MRI).

Objective

To describe a method for using a commercially available smartphone 3D surface imaging (3DSI) technique to capture facial anatomy as a basis for custom glasses design.

Design, Setting, and Participants

This quality improvement study analyzes data from a case series in a primary academic center with multiple referral centers throughout the United States. The evaluation included reported fit descriptions from patients with poor glasses adherence due to craniofacial abnormalities.

Main Outcomes and Measures

Key anatomic parameters for glasses fit (face width, distance from ear bridge to nasal bridge, distance from center of pupil to center of nasal bridge, distance from lateral to medial canthus, ear vertical offset, and nasal bridge width) were compared between scans. A 3DSI scan was considered successful if these key parameters could be determined and the difference in measurements was less than 5% between MRI and 3DSI. A second outcome measure included the fit of glasses designed by the 3DSI method as reported by the patient, parent, or guardian.

Results

Measurements of key parameters for glasses fit were similar across MRI and 3DSI scans with a mean (SD) difference of 1.47 (0.79) mm between parameters (range, 0.3-4.60 mm). Among 20 patients aged 1 to 17 years with craniofacial abnormalities, all achieved a successful fit (reporting daily glasses adherence without irritation) as judged by the patient, parent, or guardian. A mean of 1.7 revisions were made from initial prototype to final frame production using 3DSI technology.

Conclusions and Relevance

This study demonstrated that smartphone-enabled 3DSI coupled with widely available 3D printing technology can produce custom frames with a successful fit for patients with craniofacial anomalies. This accessible and well-tolerated imaging process may have implications for adherence with glasses wearing among patients at risk of vision loss due to amblyopia.

Three-dimensional facial scanner in the hands of patients: validation of a novel application on iPad/iPhone for three-dimensional imaging

Background

Three-dimensional (3D) photography plays an important role in surgical planning and postoperative evaluation. Commercial 3D facial scanners are expensive, and they require patients to come to the clinics for 3D photography. To solve this problem, we developed an iPad/iPhone application to enable patients to capture 3D images of themselves on their own. This study aimed to evaluate the validity and reproducibility of this novel imaging system.

Methods

3D images were taken on 20 volunteers using the novel imaging system. Twenty-one anthropometric parameters were measured using calipers (direct measurement) and 3D photographs (3D photogrammetry). The results were compared to assess the accuracy and bias of 3D photogrammetry. The reproducibility was evaluated by testing intra- and interobserver reliabilities. Furthermore, 3D virtual models obtained by the novel imaging system and Vectra H1 camera were compared by performing heat map analysis.

Results

The 3D photogrammetric results showed excellent correlations with direct measurements. Most anthropometric parameters did not show statistically significant differences between the two methods. The 95% limits of agreement exceeded 2 mm in some parameters, especially those with large numbers, although their relative error measurements were very small. Intra- and interobserver reliabilities were high enough to ensure good reproducibility. The comparison of 3D models obtained by the novel imaging system and Vectra H1 camera showed that the mean distance and the mean RMS were 0.08 and 0.67 mm, respectively.

Conclusions

The novel 3D facial scanning system is validated to enable patients to take 3D images on their own. The imaging quality of the subnasale region needs further improvement. Future clinical applications include surgical planning, postoperative evaluation, and early diagnosis of diseases that affect facial appearance.

"Topographic Shift": a new digital approach to evaluating topographic changes of the female breast

PURPOSE

To assess precise topographic changes of the breast, objective documentation and evaluation of pre- and postoperative results are crucial. New technologies for mapping the body using digital, three-dimensional surface measurements have offered novel ways to numerically assess the female breast. Due to the lack of clear demarcation points of the breast contour, the selection of landmarks on the breast is highly dependent on the examiner, and, therefore, is prone to error when conducting before-after comparisons of the same breast. This study describes an alternative to volumetric measurements, focusing on topographic changes of the female breast, based on three-dimensional scans.

METHOD

The study was designed as an interventional prospective study of 10 female volunteers who had planned on having aesthetic breast augmentation with anatomical, textured implants. Three dimensional scans of the breasts were performed intraoperatively, first without and then with breast implants. The topographic change was determined as the mean distance between two three-dimensional layers before and after augmentation. This mean distance is defined as the Topographic Shift.

RESULTS

The mean implant volume was 283 cc (SD = 68.6 cc, range = 210-395 cc). The mean Topographic Shift was 7.4 mm (SD = 1.9 mm, range = 4.8-10.7 mm). The mean Topographic Shifts per quadrant were: I: 8.0 mm (SD = 3.3 mm); II: 9.2 mm (SD = 3.1 mm); III: 6.9 mm (SD = 3.5 mm); IV: 1.9 mm (SD = 4.3 mm).

CONCLUSION

The Topographic Shift, describing the mean distance between two three-dimensional layers (for example before and after a volume changing therapy), is a new approach that can be used for assessing topographic changes of a body area. It was found that anatomical, textured breast implants cause a topographic change, particularly on the upper breast, in quadrant II, the décolleté.

Anthropometric Analysis of the External Nose of the Egyptian Males

OBJECTIVE

The aim of this study was to describe average nasal anthropometric measurements for young Egyptian males by using the Rhinobase^® software.

MATERIALS AND METHODS

This was a cross-sectional study involving the evaluation of facial photographs. Frontal, right lateral and basal photographs for 300 healthy adult male Egyptian volunteers (n = 300) were taken; then, the photos were edited using Rhinobase^® Software and CorelDraw graphics (2017) software. Twenty anthropometric landmarks were determined. The calculated measurements of the soft tissue of the external nose included ten linear measurements and five angles.

RESULTS

The means of the linear measurements of the external nose in this study were as follows: nasal height (56.12 mm), nasal bridge length (47.0 mm), columella length (9.1 mm), alar length (29.3 mm), morphological nose width (41.0 mm), anatomical nose width (38.0 mm), nasal tip protrusion (21.0 mm), nasal tip projection using 'Goode's method' (29.36 mm), dorsum width (9.6 mm) and nasion height (2.04 mm). The means of the angular measurements of the nose were as follows: nasofacial angle (33.1°), nasofrontal angle (144.0°), nasolabial angle (104.5°), nasomental angle (127.6°) and mentocervical angle (104.7°).

CONCLUSIONS

Racial differences of the external nasal anthropometric values exist; hence, it is important to establish the average anthropometric measures for several races and ethnic groups. Measurements collected in this study can serve as a database for anthropometric average values of the external nose in healthy adult Egyptian males. Moreover, these measurements can aid in planning prior to nasal reconstruction and esthetic rhinoplasty by serving as a reference standard. Although the Rhinobase^® software is an easy, reliable and safe indirect method for nasal analysis, we should be cautious during interpretation of some edited landmarks on Rhinobase^® software pictures. In addition, inserting two rulers (in the horizontal and vertical dimension) allows accurate assessment of the linear anthropometric measurements.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Breast volumetric analysis for aesthetic planning in breast reconstruction: a literature review of techniques

BACKGROUND

Accurate volumetric analysis is an essential component of preoperative planning in both reconstructive and aesthetic breast procedures towards achieving symmetrization and patient-satisfactory outcome. Numerous comparative studies and reviews of individual techniques have been reported. However, a unifying review of all techniques comparing their accuracy, reliability, and practicality has been lacking.

METHODS

A review of the published English literature dating from 1950 to 2015 using databases, such as PubMed, Medline, Web of Science, and EMBASE, was undertaken.

RESULTS

Since Bouman's first description of water displacement method, a range of volumetric assessment techniques have been described: thermoplastic casting, direct anthropomorphic measurement, two-dimensional (2D) imaging, and computed tomography (CT)/magnetic resonance imaging (MRI) scans. However, most have been unreliable, difficult to execute and demonstrate limited practicability. Introduction of 3D surface imaging has revolutionized the field due to its ease of use, fast speed, accuracy, and reliability. However, its widespread use has been limited by its high cost and lack of high level of evidence. Recent developments have unveiled the first web-based 3D surface imaging program, 4D imaging, and 3D printing.

CONCLUSIONS

Despite its importance, an accurate, reliable, and simple breast volumetric analysis tool has been elusive until the introduction of 3D surface imaging technology. However, its high cost has limited its wide usage. Novel adjunct technologies, such as web-based 3D surface imaging program, 4D imaging, and 3D printing, appear promising.

Evaluation of Facial Volume Changes after Rejuvenation Surgery Using a 3-Dimensional Camera

BACKGROUND

Surgical rejuvenation alters facial volume distribution to achieve more youthful aesthetic contours. These changes are routinely compared subjectively. The introduction of 3-dimensional (3D) stereophotogrammetry provides a novel method for measuring and comparing surgical results.

OBJECTIVES

We sought to quantify how specific facial areas are changed after rejuvenation surgery using the 3D camera.

METHODS

Patients undergoing facial rejuvenation were imaged preoperatively and postoperatively with 3D stereophotogrammetry. Images were registered using facial surface landmarks unaltered by surgery. Colorimetric 3D analysis depicting postoperative volume changes was performed utilizing the 3D imaging software and quantitative volume measurements were constructed.

RESULTS

Nine patients who underwent combined facelift procedures and fat grafting were evaluated. Median time for postoperative imaging was 4.8 months. Positive changes in facial volume occurred in the forehead, temples, and cheeks (median changes, 0.9 mL ± 4.3 SD; 0.8 mL ± 0.47 SD; and 1.4 mL ± 1.6 SD, respectively). Negative changes in volume occurred in the nasolabial folds, marionette basins, and neck/submental regions (median changes, -1.0 mL ± 0.37 SD; -0.4 mL ± 0.9 SD; and -2.0 mL ± 4.3 SD, respectively).

CONCLUSIONS

The technique of 3D stereophotogrammetry provides a tool for quantifying facial volume distribution after rejuvenation procedures. Areas of consistent volume increase include the forehead, temples, and cheeks; areas of negative volume change occur in the nasolabial folds, marionette basins, and submental/chin regions. This technology may be utilized to better understand the dynamic changes that occur with facial rejuvenation and quantify longevity of various rejuvenation techniques.

LEVEL OF EVIDENCE

4 Diagnostic.

The 3D Facial Norms Database: Part 1. A Web-Based Craniofacial Anthropometric and Image Repository for the Clinical and Research Community

With the current widespread use of three-dimensional (3D) facial surface imaging in clinical and research environments, there is a growing demand for high-quality craniofacial norms based on 3D imaging technology. The principal goal of the 3D Facial Norms (3DFN) project was to create an interactive, Web-based repository of 3D facial images and measurements. Unlike other repositories, users can gain access to both summary-level statistics and individual-level data, including 3D facial landmark coordinates, 3D-derived anthropometric measurements, 3D facial surface images, and genotypes from every individual in the dataset. The 3DFN database currently consists of 2454 male and female participants ranging in age from 3 to 40 years. The subjects were recruited at four US sites and screened for a history of craniofacial conditions. The goal of this article is to introduce readers to the 3DFN repository by providing a general overview of the project, explaining the rationale behind the creation of the database, and describing the methods used to collect the data. Sex- and age-specific summary statistics (means and standard deviations) and growth curves for every anthropometric measurement in the 3DFN dataset are provided as a supplement available online. These summary statistics and growth curves can aid clinicians in the assessment of craniofacial dysmorphology.

[Methods and importance of volume measurement in reconstructive and aesthetic breast surgery]

Volume measurement of the breast allows for better surgical planning and implant selection in breast reconstructive and symmetrization procedures. The safety and accuracy of tumor removal, in accordance with oncoplastic principles, may be improved by knowing the true breast- and breast tumor volume. The authors discuss the methods of volume measurement of the breast and describe the method based on magnetic resonance imaging digital volume measurement in details. The volume of the breast parenchyma and the tumor was determined by processing the diagnostic magnetic resonance scans, and the difference in the volume of the two breasts was measured. Surgery was planned and implant selection was made based on the measured volume details. The authors conclude that digital volume measurement proved to be a valuable tool in preoperative planning of volume reducing mammaplasty, replacement of unknown size implants and in cases when breast asymmetry is treated.

Digital anthropometric shape analysis of 110 rhinoplasty patients in the Black Sea Region in Turkey

PURPOSE

The aim of the study was to describe the average values of the nasal anthropometric measurements by using the landmark-based geometric morphometric technique in young male patients who applied for rhinoplasty in the Black Sea Region in Turkey.

MATERIALS AND METHODS

The study group consisted of 110 healthy male patients all were born in the Black Sea Region, Turkey. The landmark-based geometric morphometric technique was used to analyze the nasal shapes as described in the literature. The mean age was 29 years (ranging from 23 to 35). All patients underwent primary rhinoplasty in our clinic between 2006 and 2011 years. All data were obtained from standardized digital photographic images. Anterior and worm's eye view photos of the patients were analyzed by using standard anthropometric measurement methods.

RESULTS

The mean total length and nasal bridge length of the noses were 58.90 and 57.35 mm, respectively. The mean nasal bridge width and the morphologic nose width were 32.65 and 35.50mm, respectively. The average width of the anatomic nose was 26.25 mm. The mean length and width of the ala were 22.72 and 4.73 mm, respectively. The mean length and width of the columella were 11.35 and 5.20mm, respectively. The mean frontonasal angle was 137.88° and the mean nasolabial angle was 87.34°.

CONCLUSION

Black Sea nose was characterized by being considerably longer than average in nasal length and columellar height. Also nasolabial angle was found to be more acute than average when compared to other noses.

Reconstruction of unicoronal plagiocephaly with a hypercorrection surgical technique

Object

Successful surgical repair of unicoronal plagiocephaly remains a challenge for craniofacial surgeons. Many of the surgical techniques directed at correcting the stigmata associated with this craniofacial deformity (for example, ipsilateral supraorbital rim elevation [vertical dystopia], ipsilateral temporal constriction, C-shaped deformity of the face, and so on) are not long lasting and often result in deficient correction and the need for secondary revision surgery. The authors posit that the cause of this relapse was intrinsic deficiencies of the current surgical techniques. The aim of this study was to determine if correction of unilateral coronal plagiocephaly with a novel hypercorrection surgical technique could prevent the relapse of the characteristics associated with unicoronal plagiocephaly.

Methods

The authors performed a retrospective analysis of 40 consecutive patients who underwent surgical repair of unicoronal plagiocephaly at their institution between 1999 and 2009. In all cases, the senior author (S.R.B.) used a hypercorrection technique for surgical reconstruction. Hypercorrection consisted of significant overcorrection of the affected ipsilateral frontal and anterior temporal areas in the sagittal and coronal planes. Demographic, perioperative, and follow-up data were collected for comparison. The postsurgical appearance of the forehead was documented clinically and photographically and then evaluated and scored by 2 independent graders using the expanded Whitaker scoring system. A relapse was defined as a recurrence of preoperative features that required secondary surgical correction.

Results

The mean age of the patients at the time of the operation was 13 months (range 8–28 months). The mean follow-up duration was 57 months (range 3 months to 9.8 years). The postsurgical hypercorrection appearance persisted on average 6–8 months but gradually dissipated and normalized. No patients exhibited a relapse of unicoronal plagiocephalic characteristics that required surgical correction. In all cases the aesthetic results were excellent. Only 3 patients required reoperation for the management of persistent calvarial bone defects (2 cases) and removal of a symptomatic granuloma (1 case).

Conclusions

Our study demonstrates that patients who undergo unicoronal plagiocephaly repair with a hypercorrection surgical technique avoid long-term relapse. Our results suggest that the surgical technique used in the correction of unilateral coronal synostosis is strongly associated with the prevention of postsurgical relapse and that the use of this novel method decreases the need for surgical revision.

The role of anthropometric measurements in nasal surgery and research: a systematic review

BACKGROUND

Anthropometric measurements of the nose provide objective data about the size and shape of the nose. Data of average nasal anthropometric values for various ethnic groups is promoted to be of great importance in planning aesthetic nasal surgery, but there may be fundamental problems with this approach.

OBJECTIVE OF REVIEW

To collate existing knowledge on nasal anthropometry and, determine its value to the nasal surgeon, in planning aesthetic nasal surgery and in research.

SEARCH STRATEGY

A structured search of PubMed was performed from 1 January 1973 to 31 December 2009 focussing on nasal anthropometry. The MeSH keywords used were nasal/nose, anthropometry/history/methods/measurements, aesthetic, surgery, nose, otorhinolaryngologic surgical procedures.

RESULTS

There is published literature on the average values of the nasal dimensions for various ethnic groups, to aid surgeons in planning improvements of the face. However the large overlap of anthropometric data between racial groups and the lack of any scientific basis for the concept of race means that the published data for racial groups is of little use in planning nasal surgery. Nasal anthropometry, however, helps to answer important clinical questions in research. It has established the role of primary rhinoplasty in patients with cleft lip nasal deformity. It serves as an objective tool to investigate whether reconstructive nasal septoplasty in the paediatric population has any deleterious effect on nasal growth. Anthropometry also helps in the characterisation of dysmorphic syndromes.

CONCLUSIONS

The published anthropometric data for racial groups is of little use in planning nasal surgery. Anthropometric measurements of the nose may help to answer important clinical questions in research on the effects of surgery on nasal and facial development.

3D digital stereophotogrammetry: a practical guide to facial image acquisition

The use of 3D surface imaging technology is becoming increasingly common in craniofacial clinics and research centers. Due to fast capture speeds and ease of use, 3D digital stereophotogrammetry is quickly becoming the preferred facial surface imaging modality. These systems can serve as an unparalleled tool for craniofacial surgeons, proving an objective digital archive of the patient's face without exposure to radiation. Acquiring consistent high-quality 3D facial captures requires planning and knowledge of the limitations of these devices. Currently, there are few resources available to help new users of this technology with the challenges they will inevitably confront. To address this deficit, this report will highlight a number of common issues that can interfere with the 3D capture process and offer practical solutions to optimize image quality.

Implementing a superimposition and measurement model for 3D sagittal analysis of therapy-induced changes in facial soft tissue: a pilot study

AIM

3D digital surface photogrammetry is an objective means of documenting the quantitative evaluation of facial morphology. However, there are no standardized superimposition and measurement systems for surveying soft tissue changes. The aim of this study was to present a superimposition and measurement model for three-dimensional analysis of therapy-induced sagittal changes in facial soft tissue and to ascertain its applicability based on the reproducibility of 3D landmark positions.

PATIENTS AND METHOD

Twenty-nine children were examined (eight with cleft lip and palate, six with cleft palate, eight with Class III malocclusion and seven healthy controls, between 4.1 and 6.4 years). The mean time between examinations was 8.2 months for the patients and 8 months for the control group. Data was acquired with the DSP 400((c))imaging system. A mathematical model with seven superimposition points was developed. Two 3D images, one at the beginning and the other at the end of the examination, were generated. Both images were superimposed ten times. Ten landmarks for evaluating the soft tissue changes were geometrically defined on the superimposition image, put in place ten times, and measured. The landmarks' reproducibility was calculated via statistical intraoperator analysis. Measurement error was identified using the root mean square error (RMSE).

RESULTS

The superimposition points were easy to locate and the landmarks well definable. All midface landmarks proved to be highly reproducible with an RMSE under 0.50 mm. The lower face landmarks demonstrated good reproducibility with an RMSE under 1 mm. The midface landmarks' precision fell below the range of accuracy, while the lower face landmarks' precision fell within the optoelectronic scanner device's range of accuracy (0.50-1 mm).

CONCLUSIONS

As an accurate, non-invasive, millisecond-fast, non-ionizing and ad infinitum repeatable procedure, 3D digital surface photogrammetry is very well suited for clinical and scientific application in orthodontics. We developed a reliable superimposition and measurement model with 3D digital surface photogrammetry. This new capturing and measurement system provides a simple means of determining 3D changes in facial soft tissue. Our landmarks proved to be highly reproducible for the midface while revealing good reproducibility for the lower face.

Picture perfect? Reliability of craniofacial anthropometry using three-dimensional digital stereophotogrammetry

BACKGROUND

Quantification of facial characteristics is important for research in dysmorphology, otolaryngology, oral and maxillofacial, and plastic surgical disciplines, among others. Three-dimensional surface imaging systems offer a quick and practical method for quantifying craniofacial variation and appear to be highly reliable. However, some sources of measurement error have not yet been thoroughly evaluated.

METHODS

The authors assessed the reliability of using stereophotogrammetry for measuring craniofacial characteristics in 40 individuals, including 20 without craniofacial conditions and 20 with 22q11.2 deletion syndrome. The authors recruited staff and relatives of staff, and individuals with a laboratory-confirmed 22q11.2 deletion. Thirty anthropometric measurements were obtained on participants and on three-dimensional images.

RESULTS

Intrarater and interrater reliability for most interlandmark distances on three-dimensional images had intraclass correlation coefficients greater than 95 percent, mean absolute differences of less than 1 mm, relative error measurement less than 5, and technical error of measurement less than 1 mm. The Pearson correlation coefficients of greater than 0.9 for most distances suggest high intermethod reliability between direct and image-based measurements. Three-dimensional image-based measurements were systematically larger for the head length and width, forehead, and skull base widths, and upper and lower facial widths.

CONCLUSIONS

This study provides further evidence of the high reliability of three-dimensional imaging systems for several craniofacial measurements, including landmarks and interlandmark distances not included in previous studies. The authors also discuss possible errors introduced with palpable landmarks and when working with less compliant participants, such as children. The authors offer guidelines for establishing protocols that can be tailored to each population and research question to maximize the accuracy of image-based measurements.

Three-dimensional imaging for virtual assessment and treatment simulation in orthognathic surgery

Conventional two-dimensional imaging for assessing and treatment planning orthognathic surgery has limitations. Three-dimensional imaging offers the ability to more accurately portray maxillofacial anatomy. Three-dimensional CT-based models can be generated for assessment of the dentofacial deformity. Interactive software can simulate surgical moves and algorithms can predict the three-dimensional soft tissue changes that will occur. This will inevitably effect diagnosis and treatment planning for orthognathic surgery in the future.

Validity and reliability of craniofacial anthropometric measurement of 3D digital photogrammetric images

BACKGROUND

Direct anthropometry performed during a patient examination is the standard technique for quantifying craniofacial dysmorphology, as well as for surgical planning and outcome assessment. Several new technologies have been designed to computerize anthropometric measurements, including three-dimensional (3D) digital photogrammetry. These digital systems have the advantage of acquiring patient craniofacial surface images quickly and noninvasively. Before morphometry using digital photogrammetry can be applied in clinical and research practice, it must be assessed against direct anthropometry.

OBJECTIVE

To evaluate the validity and reliability of facial anthropometric linear distances imaged by 3D digital photogrammetry with respect to direct anthropometry. DESIGN, SETTING, PARTICIPANTS, MEASURES: Standard craniofacial distances were directly measured twice on 20 normal adult volunteers. Craniofacial surfaces were also imaged using the 3dMDface digital photogrammetry system, and distances were digitally measured twice for each subject. Validity measures of accuracy and bias (for direct versus digital measurements) and reproducibility measures of precision and test-retest reliability (for repeated sets of digital measurements) were computed.

RESULTS

Seventeen of the 18 direct measurements correlated highly with digital values (mean r = 0.88). The correlation for one measurement (upper prolabial width) was not statistically significant. The overall precision of all 17 digital measurements was less than 1 mm, and the reliability was high (mean r = 0.91).

CONCLUSIONS

Craniofacial anthropometry using the 3dMDface System is valid and reliable. Digital measurements of upper prolabial width may require direct marking, prior to imaging, to improve landmark identification.

Assessment of breast aesthetics

A good aesthetic outcome is an important endpoint of breast cancer treatment. Subjective ratings, direct physical measurements, measurements on photographs, and assessment by three-dimensional imaging are reviewed and future directions in aesthetic outcome measurements are discussed. Qualitative, subjective scales have frequently been used to assess aesthetic outcomes following breast cancer treatment. However, none of these scales has achieved widespread use because they are typically vague and have low intraobserver and interobserver agreement. Anthropometry is not routinely performed because conducting the large studies needed to validate anthropometric measures (i.e., studies in which several observers measure the same subjects multiple times) is impractical. Quantitative measures based on digital/digitized photographs have yielded acceptable results but have some limitations. Three-dimensional imaging has the potential to enable consistent, objective assessment of breast appearance, including properties (e.g., volume) that are not available from two-dimensional images. However, further work is needed to define three-dimensional measures of aesthetic properties and how they should be interpreted.

New aspects of breast volume measurement using 3-dimensional surface imaging

Precise and objective calculation of breast volume is helpful to evaluate the aesthetic result of breast surgery, but traditional methods are unsatisfactory. Three-dimensional (3D) scanning of the body surface allows reproducible and objective assessment of the complex breast region but requires further investigation before clinical application. The main goal of this study was to investigate the precision and accuracy of breast volume measurement using 3D body scanning. Five independent observers standardized the 3D scanning method using 2 dummy models (n = 200) and examined its applicability with 6 test subjects and 10 clinical patients (n = 2220). Breast volume measurements obtained with the 3D-scanner technology were compared with reference measurements obtained from test subjects through nuclear magnetic resonance imaging. The mean deviation of the breast volume measurements of 1 test subject by all observers, expressed as percentage of volume, was 2.86 +/- 0.98, significantly higher than the deviation for the dummy models, 1.65 +/- 0.42 (P < 0.001). With respect to all clinical patients, the mean measurement precision obtained preoperatively was less precise than that obtained postoperatively (3.31 +/- 1.02 versus 1.66 +/- 0.49, respectively). Interobserver differences in measurement precision were not statistically significant. The mean breast volumes obtained by nuclear magnetic resonance imaging (441.42 +/- 137.05 mL) and 3D scanning (452.51 +/- 141.88 mL) significantly correlated (r = 0.995, P < 0.001). Breast volume measurement with 3D surface imaging represents a sufficiently precise and accurate method to guarantee objective and exact recording.

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

Quantification of the complex breast region can be helpful in breast surgery, which is shaped by subjective influences. However, there is no generally recognized method for breast volume calculation. Three-dimensional (3D) body surface imaging represents a new alternative for breast volume computation. The aim of this work was to compare breast volume calculation with 3D scanning and three classic methods, focusing on relative advantages, disadvantages, and reproducibility. Repeated breast volume calculations of both breasts in six patients (n=12) were performed using a 3D laser scanner, nuclear magnetic resonance imaging (MRI), thermoplastic castings, and anthropomorphic measurements. Mean volumes (cc) and mean measurement deviations were calculated, and regression analyses were performed. MRI showed the highest measurement precision, with a mean deviation (expressed as a percentage of mean breast volume) of 1.56+/-0.52% compared with 2.27+/-0.99% for the 3D scanner, 7.97+/-3.53% for thermoplastic castings, and 6.26+/-1.56% for the anthropomorphic measurements. Breast volume calculations using MRI showed the best agreement with 3D scanning measurement (r=0.990), followed by anthropomorphic measurement (r=0.947), and thermoplastic castings (r=0.727). Compared with three classical methods of breast volume calculation, 3D scanning provides acceptable accuracy for breast volume measurements, better spatial interpretation of the anatomical area to be operated on (due to lack of chest deformation), non-invasiveness, and good patient tolerance. After this preliminary study and further development, we believe that 3D body surface scanning could provide better preoperative planning and postoperative control in everyday clinical practice.

Three-Dimensional Surface Imaging: Limitations and Considerations From the Anthropometric Perspective

The use of three-dimensional (3D) surface imaging for clinical measurement purposes has increased considerably as the technology has become more affordable. Like any measurement technique, 3D surface-based anthropometry is subject to a number of limitations and methodological caveats and thus should not be applied without sufficient consideration of its potential strengths and weaknesses. In this brief report, the authors consider 3D surface imaging from the anthropometric perspective, specifically focusing on issues related to the capture of reliable quantitative information from the head and face.

Validating Three-Dimensional Imaging of the Breast

The potential to extrapolate accurate data from 3-dimensional (3D) images of the breast is enormous and will greatly improve our ability to qualitatively determine differences in shape, size, and contour. The validity of these calculated measurements is important and needs to be determined before any meaningful data can be evaluated. PART I: Premastectomy 3D images (3dMD patient) were obtained on 19 breasts (14 patients). The volume of the mastectomy specimen was determined intraoperatively using water displacement. Two independent raters then calculated breast volumes using the 3D images and software, and these were compared with the intraoperative volume. Inter- and intrarater reliability was determined. Part II: Surface measurements (nipple to notch) were then evaluated on 20 breasts (10 patients) by comparing the 3D image determined distance to the known measurements. PART I: The average breast volume was 500 mL, compared with 489 mL for rater 1 and 490 mL for rater 2. The relative difference between the measured volume and the calculated volume for rater 1 and rater 2 was about -2%, with a standard deviation of +/- 13% to 16%. The coefficient of reproducibility for each reader was excellent, at 0.80 for rater 1 and 0.92 for rater 2. The level of agreement between the readers was also high at 0.975. Part II: The average nipple to notch measurement for each patient was 27.1 cm, compared the calculated average of 25.1 cm for rater 1 and 26.1 cm for rater 2. The mean relative difference between the measured and calculated distances for raters 1 and 2 was about -6%, with a standard deviation of +/- 6% to 7%. The level of agreement between readers was high, at 0.975. The ability to objectively determine breast volume and surface measurements using 3D imaging technology is now available with consistent and reproducible accuracy. Measurements are typically underestimated, with more variability when calculating volumes. Although inherent subjectivity will always exist when evaluating breast measurements, 3D technology provides invaluable information, particularly in the longitudinal evaluation of results.

Bewertung von Präzision und Genauigkeit der digitalen Oberflächenphotogrammetrie mit dem DSP 400 System / Assessment of Precision and Accuracy of Digital Surface Photogrammetry with the DSP 400 System

The objective of the present study was to evaluate the precision and accuracy of facial anthropometric measurements obtained through digital 3-D surface photogrammetry with the DSP 400 system in comparison to traditional 2-D photogrammetry. Fifty plaster casts of cleft infants were imaged and 21 standard anthropometric measurements were obtained. For precision assessment the measurements were performed twice in a subsample. Accuracy was determined by comparison of direct measurements and indirect 2-D and 3-D image measurements. Precision of digital surface photogrammetry was almost as good as direct anthropometry and clearly better than 2-D photogrammetry. Measurements derived from 3-D images showed better congruence to direct measurements than from 2-D photos. Digital surface photogrammetry with the DSP 400 system is sufficiently precise and accurate for craniofacial anthropometric examinations.

Digital three-dimensional photogrammetry: evaluation of anthropometric precision and accuracy using a Genex 3D camera system

OBJECTIVE

To determine the precision and accuracy of facial anthropometric measurements obtained through digital three-dimensional (3D) photogrammetry.

DESIGN

Nineteen standard craniofacial measurements were repeatedly obtained on 20 subjects by two independent observers, using calipers and 3D photos (obtained with a Genex 3D camera system), both with and without facial landmarks labeled. Four different precision estimates were then calculated and compared statistically across techniques. In addition, mean measurements from 3D photos were compared statistically with those from direct anthropometry.

RESULTS

In terms of measurement precision, the 3D photos were clearly better than direct anthropometry. In almost all cases, the 3D photo with landmarks labeled had the highest overall precision. In addition, labeling landmarks prior to taking measurements improved precision, regardless of method. Good congruence was observed between means derived from the 3D photos and direct anthropometry. Statistically significant differences were noted for seven measurements; however, the magnitude of these differences was often clinically insignificant (< 2 mm).

CONCLUSIONS

Digital 3D photogrammetry with the Genex camera system is sufficiently precise and accurate for the anthropometric needs of most medical and craniofacial research designs.

Symmetrical breast reconstruction: is there a role for three-dimensional digital photography?

Clinical applications of three-dimensional digital photography include assessments of breast volume and contour. It was hypothesized that knowledge of preoperative and postoperative breast volumes might facilitate obtaining symmetry after reconstructions with autologous tissue or implants. Breast reconstruction was performed for 382 women during a 4-year period. Of those women, 334 completed all phases of the reconstruction and underwent symmetry analysis. Reconstructive procedures included the use of pedicle transverse rectus abdominis musculocutaneous flaps, free transverse rectus abdominis musculocutaneous flaps, deep inferior epigastric perforator flaps, superior gluteal artery perforator flaps, or latissimus dorsi flaps or expanders/implants. Three-dimensional digital photographic images were obtained for 33 women, whereas the remaining 301 women were not digitally photographed. The differences in symmetry after the initial reconstruction and after the secondary procedures were compared for all women and for the groups with and without three-dimensional photographic images. For the group with three-dimensional imaging, initial volume symmetry was obtained for 73 percent, initial contour symmetry was obtained for 27 percent, secondary procedures were necessary for 70 percent, final volume symmetry was obtained for 88 percent, and final contour symmetry was obtained for 79 percent. For the group without three-dimensional photographic images, initial volume symmetry was obtained for 57 percent, initial contour symmetry was obtained for 34 percent, secondary procedures were necessary for 50 percent, final volume symmetry was obtained for 80 percent, and final contour symmetry was obtained for 71 percent. The results demonstrated that there was no significant difference in final contour and volume symmetry between women who had or did not have three-dimensional digital photographic images taken. However, the results demonstrated that autologous tissue reconstructions resulted in improved contour and volume symmetry, compared with implant reconstructions.