Development and implementation of a web-enabled 3D consultation tool for breast augmentation surgery based on 3D-image reconstruction of 2D pictures

Three-Dimensional Printing in Breast Reconstruction: Current and Promising Applications

Three-dimensional (3D) printing is dramatically improving breast reconstruction by offering customized and precise interventions at various stages of the surgical process. In preoperative planning, 3D imaging techniques, such as computer-aided design, allow the creation of detailed breast models for surgical simulation, optimizing surgical outcomes and reducing complications. During surgery, 3D printing makes it possible to customize implants and precisely shape autologous tissue flaps with customized molds and scaffolds. This not only improves the aesthetic appearance, but also conforms to the patient's natural anatomy. In addition, 3D printed scaffolds facilitate tissue engineering, potentially favoring the development and integration of autologous adipose tissue, thus avoiding implant-related complications. Postoperatively, 3D imaging allows an accurate assessment of breast volume and symmetry, which is crucial in assessing the success of reconstruction. The technology is also a key educational tool, enhancing surgeon training through realistic anatomical models and surgical simulations. As the field evolves, the integration of 3D printing with emerging technologies such as biodegradable materials and advanced imaging promises to further refine breast reconstruction techniques and outcomes. This study aims to explore the various applications of 3D printing in breast reconstruction, addressing current challenges and future opportunities.

Use of Three-Dimensional Imaging to Assess the Effectiveness of Volume as a Critical Variable in Breast Implant Selection

BACKGROUND

In breast augmentation, breast base diameter has been recognized as an important variable in implant selection. However, breast implant volume also has a tremendous impact on the final result. Previous methods of preoperative volume determination have been limited to external devices in a bra. Computer-based three-dimensional simulation technology now allows the physician to effectively communicate with the patient preoperatively regarding volume.

METHODS

A cohort of 40 consecutive patients underwent routine breast augmentation with either anatomically shaped or round implants. Five methods of preoperative volume determination including the Crisalix three-dimensional computer imaging system (Crisalix Virtual Aesthetics, Lausanne, Switzerland), along with an associated virtual reality tool, were used to assess the preoperative desires of the patients. A postoperative questionnaire was used to assess patient satisfaction with each volume determination method.

RESULTS

Of the 40 patients, 100 percent were satisfied with their result; however, given the opportunity, 12 percent would have chosen a larger implant. The virtual reality tool and external sizers were shown to be the most effective in choosing an implant. The virtual reality tool was judged to be very helpful (62 percent), very accurate (78 percent), and important (88 percent) in helping patients choose their desired implant size.

CONCLUSION

Prioritizing volume as an implant selection variable in breast augmentation results in a very high rate of patient satisfaction.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Hybrid Implant and Grafted Fat Breast Augmentation: Designing the Pathway to a Future With Breasts Free of Silicone Breast Implants

BACKGROUND

Fat grafting in breast augmentation surgery is becoming increasingly popular, allowing surgeons to fill the gaps that implant augmentation alone cannot. However, one of the current issues surrounding fat grafting is the lack of standardization.

OBJECTIVES

The objective of this study was to validate and summarize expert-based advice to help plastic surgeons better understand the benefits of utilizing fat grating to reduce implant size in their surgical planning.

METHODS

This was a prospective study of fat grafting in 56 patients who underwent fat transfer together with silicone breast implants. A 3-dimensional planning system was used to plan the procedure and also to analyze the fat retention and resorption rates. Pictures served as a basis for a questionnaire in which both patients and physicians were asked to rate their satisfaction.

RESULTS

Patients reported a satisfaction rate of "excellent" in 83.3% of cases and "good" in 16.7%. Physician satisfaction was rated as "excellent" in 84.5% of cases, "good" in 13.3%, and "fair" in 4.2% of cases. The mean fat volume grafted per breast was 113.63 mL. The mean absorption rate was 4.53%.

CONCLUSIONS

The procedure presented consistent and reproducible results. Hybrid breast augmentation can help design a pathway for a future with breasts free of silicone. This information is particularly relevant for women who have their first breast augmentation at an early age and will probably have 2 to 5 additional surgeries in their lifetime due to the nature of current silicone breast technology.

LEVEL OF EVIDENCE: 4

Three-Dimensional Facial Scanning at the Fingertips of Patients and Surgeons: Accuracy and Precision Testing of iPhone X Three-Dimensional Scanner

BACKGROUND

The iPhone X (Apple, Inc., Cupertino, Calif.) is the first smartphone to be released with a high-fidelity three-dimensional scanner. At present, half of all U.S. smartphone users use an iPhone. Recent data suggest that the majority of these 230 million individuals will upgrade to the iPhone X within 2 years. This represents a profound expansion in access to three-dimensional scanning technology, not only for plastic surgeons but for their patients as well. The purpose of this study was to compare the iPhone X scanner against a popular, portable three-dimensional camera used in plastic surgery (Canfield Vectra H1; Canfield Scientific, Inc., Parsippany, N.J.).

METHODS

Sixteen human subjects underwent three-dimensional facial capture with the iPhone X and Canfield Vectra H1. Results were compared using color map analysis and surface distances between key anatomical landmarks. To assess repeatability and precision of the iPhone X three-dimensional scanner, six facial scans of a single participant were obtained and compared using color map analysis. In addition, three-dimensionally-printed facial masks (n = 3) were captured with each device and compared.

RESULTS

For the experiments, average root mean square was 0.44 mm following color map analysis and 0.46 mm for surface distance between anatomical landmarks. For repeatability and precision testing, average root mean square difference following color map analysis was 0.35 mm. For the three-dimensionally-printed facial mask comparison, average root mean square difference was 0.28 mm.

CONCLUSIONS

The iPhone X offers three-dimensional scanning that is accurate and precise to within 0.5 mm when compared to a commonly used, validated, and expensive three-dimensional camera. This represents a significant reduction in the barrier to access to three-dimensional scanning technology for both patients and surgeons.

Guidetomeasure-OT: A mobile 3D application to improve the accuracy, consistency, and efficiency of clinician-led home-based falls-risk assessments

BACKGROUND

A key falls prevention intervention delivered within occupational therapy is the home environment falls-risk assessment process. This involves the clinician visiting the patient's home and using a 2D paper-based measurement guidance booklet to ensure that all measurements are taken and recorded accurately. However, 30% of all assistive devices installed within the home are abandoned by patients, in part as a result of the inaccurate measurements being recorded as part of the home environment falls-risk assessment process. In the absence of more appropriate and effective guidance, high levels of device abandonment are likely to persist.

AIM

This study presents guidetomeasure-OT, a mobile 3D measurement guidance application designed to support occupational therapists in carrying out home environment falls-risk assessments. Furthermore, this study aims to empirically evaluate the performance of guidetomeasure-OT compared with an equivalent paper-based measurement guidance booklet.

METHODS

Thirty-five occupational therapists took part in this within-subjects repeated measures study, delivered within a living lab setting. Participants carried out the home environment falls-risk assessment process under two counterbalanced treatment conditions; using 3D guidetomeasure-OT; and using a 2D paper-based guide. Systems Usability Scale questionnaires and semi-structured interviews were completed at the end of both task. A comparative statistical analysis explored performance relating to measurement accuracy, measurement accuracy consistency, task completion time, and overall system usability, learnability, and effectiveness of guidance. Interview transcripts were analysed using inductive and deductive thematic analysis, the latter was informed by the Unified Theory of Acceptance and Use of Technology model.

RESULTS

The guidetomeasure-OT application significantly outperformed the 2D paper-based guidance in terms task efficiency (p <  0.001), learnability (p <  0.001), system usability (p <  0.001), effectiveness of guidance (p =  0.001). Regarding accuracy, in absolute terms, guidetomeasure-OT produced lower mean error differences for 11 out of 12 items and performed significantly better for six out of 12 items (p = < 0.05). In terms of SUS, guidetomeasure-OT scored 83.7 compared with 70.4 achieved by the booklet. Five high-level themes emerged from interviews: Performance Expectancy, Effort Expectancy, Social Influence, Clinical Benefits, and Augmentation of Clinical Practice. Participants reported that guidetomeasure-OT delivered clearer measurement guidance that was more realistic, intuitive, precise and usable than the paper-based equivalent. Audio instructions and animated prompts were seen as being helpful in reducing the learning overhead required to comprehend measurement guidance and maintain awareness of task progression.

CONCLUSIONS

This study reveals that guidetomeasure-OT enables occupational therapists to carry out significantly more accurate and efficient home environment falls-risk assessments, whilst also providing a measurement guide tool that is considered more usable compared with the paper-based measurement guide that is currently used by clinicians in practice. These results are significant as they indicate that mobile 3D visualisation technologies can be effectively deployed to improve clinical practice, particularly within the home environment falls-risk assessment context. Furthermore, the empirical findings constitute overcoming the challenges associated with the digitisation of health care and delivery of new innovative and enabling technological solutions that health providers and policy makers so urgently need to ease the ever-increasing burden on existing public resources. Future work will focus on the development and empirical evaluation of a mobile 3D application for patient self-assessment and automated assistive equipment prescription. Furthermore, broader User Experience aspects of the application design and the interaction mechanisms that are made available to the user could be considered so as to minimize the effect of cognitive overloading and optimise user performance.

3D Mammometric Changes in the Treatment of Idiopathic Gynecomastia

BACKGROUND

Three-dimensional surface imaging (3DSI) has shown promise for plastic surgeons to objectively assess changes in body contour and breast volume.

OBJECTIVES

To assess the surgical outcome after bilateral subcutaneous mastectomy (BSM) and water jet-assisted liposuction (WAL) as treatment for idiopathic gynecomastia, using 3DSI to document changes regarding nipple-areolar complex (NAC) and breast volume.

METHODS

Thirty male patients (Simon II A to B) receiving BSM and WAL were enrolled. Eight subjects received additional mastopexy and NAC reduction. Use of a Vectra 3D Imaging System^® before and 6 months after surgery provided data regarding changes of NAC placement and NAC and breast dimensions. The sum volume of intraoperatively approximated lipoaspirate before and after centrifugation and mastectomy specimens quantified using water displacement were compared with 3D-assessed differences in volume.

RESULTS

When compared to the NAC dimensions defined during surgery, patients receiving NAC reductions showed nonsignificant postoperative changes in NAC dimensions. Patients without additional mastopexy showed a significant (p < 0.001) vertical (15.7 ± 14.3%) and horizontal (17.1 ± 15.0%) reduction in NAC diameter. 3D volume changes (92.8 ± 26.4 mL) showed significant differences (p < 0.001) 6 months after surgery compared to the intraoperatively measured lipoaspirate before (182 ± 54.5 mL) and after (120 ± 34.6 mL) centrifugation.

CONCLUSION

Although it is clear that patient satisfaction must remain the prime focus of surgical body contouring, 3DSI has proven valuable to objectively demonstrate both the anticipated outcome and further findings regarding treatment of idiopathic gynecomastia.

LEVEL OF EVIDENCE IV

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 .

3D Shape-Based Body Composition Inference Model Using a Bayesian Network

Body composition can be assessed in many different ways. High-end medical equipment, such as Dual-energy X-ray Absorptiometry (DXA), Computed Tomography (CT), and Magnetic Resonance Imaging (MRI) offers high-fidelity pixel/voxel-level assessment, but is prohibitive in cost. In the case of DXA and CT, the approach exposes users to ionizing radiation. Whole-body air displacement plethysmography (BOD POD) can accurately estimate body density, but the assessment is limited to the whole-body fat percentage. Optical three-dimensional (3D) scan and reconstruction techniques, such as using depth cameras, have brought new opportunities for improving body composition assessment by intelligently analyzing body shape features. In this paper, we present a novel supervised inference model to predict pixel-level body composition and percentage of body fat using 3D geometry features and body density. First, we use body density to model a fat distribution base prediction. Then, we use a Bayesian network to infer the probability of the base prediction bias with 3D geometry features. Finally, we correct the bias using non-parametric regression. We use DXA assessment as the ground truth in model training and validation. We compare our method, in terms of pixel-level body composition assessment, with the current state-of-the-art prediction models. Our method outperforms those prediction models by 52.69% on average. We also compare our method, in terms of whole-body fat percentage assessment, with the medical-level equipment-BOD POD. Our method outperforms the BOD POD by 23.28%.

Accurate nonrigid 3D human body surface reconstruction using commodity depth sensors

In the last decade, 3D modeling techniques enjoyed a booming development in both hardware and software. High-end hardware generates high fidelity results, but the cost is prohibitive, whereas consumer-level devices generate plausible results for entertainment purposes but are not appropriate for medical uses. We present a cost-effective and easy-to-use 3D body reconstruction system using consumer-grade depth sensors, which provides reconstructed body shapes with a high degree of accuracy and reliability appropriate for medical applications. Our surface registration framework integrates the articulated motion assumption, global loop closure constraint, and a general as-rigid-as-possible deformation model. To enhance the reconstruction quality, we propose a novel approach to accurately infer skeletal joints from anatomical data using multimodality registration. We further propose a supervised predictive model to infer the skeletal joints for arbitrary subjects independent from anatomical data reference. A rigorous validation test has been conducted on real subjects to evaluate the reconstruction accuracy and repeatability. Our system has the potential to make accurate body surface scanning systems readily available for medical professionals and the general public. The system can be used to obtain additional health data derived from 3D body shapes, such as the percentage of body fat.

Weighted regularized statistical shape space projection for breast 3D model reconstruction

The use of 3D imaging has increased as a practical and useful tool for plastic and aesthetic surgery planning. Specifically, the possibility of representing the patient breast anatomy in a 3D shape and simulate aesthetic or plastic procedures is a great tool for communication between surgeon and patient during surgery planning. For the purpose of obtaining the specific 3D model of the breast of a patient, model-based reconstruction methods can be used. In particular, 3D morphable models (3DMM) are a robust and widely used method to perform 3D reconstruction. However, if additional prior information (i.e., known landmarks) is combined with the 3DMM statistical model, shape constraints can be imposed to improve the 3DMM fitting accuracy. In this paper, we present a framework to fit a 3DMM of the breast to two possible inputs: 2D photos and 3D point clouds (scans). Our method consists in a Weighted Regularized (WR) projection into the shape space. The contribution of each point in the 3DMM shape is weighted allowing to assign more relevance to those points that we want to impose as constraints. Our method is applied at multiple stages of the 3D reconstruction process. Firstly, it can be used to obtain a 3DMM initialization from a sparse set of 3D points. Additionally, we embed our method in the 3DMM fitting process in which more reliable or already known 3D points or regions of points, can be weighted in order to preserve their shape information. The proposed method has been tested in two different input settings: scans and 2D pictures assessing both reconstruction frameworks with very positive results.

A Regression Model for Predicting Shape Deformation after Breast Conserving Surgery

Breast cancer treatments can have a negative impact on breast aesthetics, in case when surgery is intended to intersect tumor. For many years mastectomy was the only surgical option, but more recently breast conserving surgery (BCS) has been promoted as a liable alternative to treat cancer while preserving most part of the breast. However, there is still a significant number of BCS intervened patients who are unpleasant with the result of the treatment, which leads to self-image issues and emotional overloads. Surgeons recognize the value of a tool to predict the breast shape after BCS to facilitate surgeon/patient communication and allow more educated decisions; however, no such tool is available that is suited for clinical usage. These tools could serve as a way of visually sensing the aesthetic consequences of the treatment. In this research, it is intended to propose a methodology for predict the deformation after BCS by using machine learning techniques. Nonetheless, there is no appropriate dataset containing breast data before and after surgery in order to train a learning model. Therefore, an in-house semi-synthetic dataset is proposed to fulfill the requirement of this research. Using the proposed dataset, several learning methodologies were investigated, and promising outcomes are obtained.

Magnetic Resonance Imaging Versus 3-Dimensional Laser Scanning for Breast Volume Assessment After Breast Reconstruction

BACKGROUND

There are several methods available for measuring breast volume in the clinical setting, but the comparability and accuracy of different methods is not well described. The ideal breast volume measurement technique should be low cost, comfortable for the patient, have no ionizing radiation and be non-invasive.

METHODS

Prospective cohort study comparing a 3-dimensional (3D) laser scanner versus noncontrast magnetic resonance imaging (MRI) for breast volume assessment. Subjects were women undergoing breast reconstruction with autologous fat graft. Both types of scan were performed the day before fat grafting and at 6 months postoperatively. Pearson correlations and Bland-Altman tests were performed to compare the assessment methods.

RESULTS

Eighteen patients underwent preoperative breast MRI and 3D laser scanning. Eighteen patients also underwent assessment 6 months after surgery. The total number of breasts scanned for comparison was 36, with a total of 72 comparisons for analysis. There was a strong linear association between the 2 methods using a Pearson correlation (r = 0.79; P <0.001), and Bland-Altman showed a high level of agreement between the 2 methods.

CONCLUSIONS

The 3D laser scanning, with an established protocol, was found to be equivalent to non-contrast MRI for the assessment of breast volume. Given the convenience of laser scanning and potential for lower cost compared with MRI, this technique should be considered for quantifying outcomes after complex breast reconstruction when the equipment is available.

Fall Prevention Self-Assessments Via Mobile 3D Visualization Technologies: Community Dwelling Older Adults' Perceptions of Opportunities and Challenges

BACKGROUND

In the field of occupational therapy, the assistive equipment provision process (AEPP) is a prominent preventive strategy used to promote independent living and to identify and alleviate fall risk factors via the provision of assistive equipment within the home environment. Current practice involves the use of paper-based forms that include 2D measurement guidance diagrams that aim to communicate the precise points and dimensions that must be measured in order to make AEPP assessments. There are, however, issues such as "poor fit" of equipment due to inaccurate measurements taken and recorded, resulting in more than 50% of equipment installed within the home being abandoned by patients. This paper presents a novel 3D measurement aid prototype (3D-MAP) that provides enhanced measurement and assessment guidance to patients via the use of 3D visualization technologies.

OBJECTIVE

The purpose of this study was to explore the perceptions of older adults with regard to the barriers and opportunities of using the 3D-MAP application as a tool that enables patient self-delivery of the AEPP.

METHODS

Thirty-three community-dwelling older adults participated in interactive sessions with a bespoke 3D-MAP application utilizing the retrospective think-aloud protocol and semistructured focus group discussions. The system usability scale (SUS) questionnaire was used to evaluate the application's usability. Thematic template analysis was carried out on the SUS item discussions, think-aloud, and semistructured focus group data.

RESULTS

The quantitative SUS results revealed that the application may be described as having "marginal-high" and "good" levels of usability, along with strong agreement with items relating to the usability (P=.004) and learnability (P<.001) of the application. Four high-level themes emerged from think-aloud and focus groups discussions: (1) perceived usefulness (PU), (2) perceived ease of use (PEOU), (3) application use (AU) and (4) self-assessment (SA). The application was seen as a useful tool to enhance visualization of measurement guidance and also to promote independent living, ownership of care, and potentially reduce waiting times. Several design and functionality recommendations emerged from the study, such as a need to manipulate the view and position of the 3D furniture models, and a need for clearer visual prompts and alternative keyboard interface for measurement entry.

CONCLUSIONS

Participants perceived the 3D-MAP application as a useful tool that has the potential to make significant improvements to the AEPP, not only in terms of accuracy of measurement, but also by potentially enabling older adult patients to carry out the data collection element of the AEPP themselves. Further research is needed to further adapt the 3D-MAP application in line with the study outcomes and to establish its clinical utility with regards to effectiveness, efficiency, accuracy, and reliability of measurements that are recorded using the application and to compare it with 2D measurement guidance leaflets.

Correlation of Prediction and Actual Outcome of Three-Dimensional Simulation in Breast Augmentation Using a Cloud-Based Program

BACKGROUND

Breast augmentation is among the most frequently performed cosmetic plastic surgeries. Providing patients with "realistic" 3D simulations of breast augmentation outcomes is becoming increasingly common. Until recently, such programs were costly and required significant equipment, training, and office space. New simple user-friendly cloud-based programs have been developed, but to date there remains a paucity of objective evidence comparing these 3D simulations with the post-operative outcomes.

OBJECTIVES

To determine the aesthetic similarity between pre-operative 3D simulation generated by Crisalix and real post-operative outcomes.

METHODS

A retrospective review of 20 patients receiving bilateral breast augmentation was conducted comparing 6-month post-operative outcomes with 3D simulation using Crisalix software. Similarities between post-operative and simulated images were measured by three attending plastic surgeons and ten plastic surgery residents using a series of parameters.

RESULTS

Assessment reveals similarity between the 3D simulation and 6-month post-operative images for overall appearance, breast height, breast width, breast volume, breast projection, and nipple correction. Crisalix software generated more representative simulations for symmetric breasts than for tuberous or ptotic breasts. Comparison of overall aesthetic outcome to simulation showed that the post-operative outcome was more appealing for the symmetric and tuberous breasts and less appealing for the ptotic breasts.

CONCLUSIONS

Our data suggest that Crisalix offers a good overall 3D simulated image of post-operative breast augmentation outcomes. Improvements to the simulation of the post-operative outcomes for ptotic and tuberous breasts would result in greater predictive capabilities of Crisalix. Collectively, Crisalix offers good predictive simulations for symmetric breasts.

LEVEL OF EVIDENCE IV

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 http://www.springer.com/00266 .

Breast tissue stiffness estimation for surgical guidance using gravity-induced excitation

Tissue stiffness interrogation is fundamental in breast cancer diagnosis and treatment. Furthermore, biomechanical models for predicting breast deformations have been created for several breast cancer applications. Within these applications, constitutive mechanical properties must be defined and the accuracy of this estimation directly impacts the overall performance of the model. In this study, we present an image-derived computational framework to obtain quantitative, patient specific stiffness properties for application in image-guided breast cancer surgery and interventions. The method uses two MR acquisitions of the breast in different supine gravity-loaded configurations to fit mechanical properties to a biomechanical breast model. A reproducibility assessment of the method was performed in a test-retest study using healthy volunteers and was further characterized in simulation. In five human data sets, the within subject coefficient of variation ranged from 10.7% to 27% and the intraclass correlation coefficient ranged from 0.91-0.944 for assessment of fibroglandular and adipose tissue stiffness. In simulation, fibroglandular content and deformation magnitude were shown to have significant effects on the shape and convexity of the objective function defined by image similarity. These observations provide an important step forward in characterizing the use of nonrigid image registration methodologies in conjunction with biomechanical models to estimate tissue stiffness. In addition, the results suggest that stiffness estimation methods using gravity-induced excitation can reliably and feasibly be implemented in breast cancer surgery/intervention workflows.

A Preliminary Assessment of the Predictability of Fat Grafting to Correct Silicone Breast Implant-Related Complications

BACKGROUND

Fat grafting in breast augmentation surgery is becoming increasingly popular and is allowing surgeons to fill the gaps that implant augmentation alone cannot. However, one current issue surrounding fat grafting is resorption.

OBJECTIVES

In this prospective study, the authors present their experience of fat grafting and resorption in 26 patients who had fat transfer to correct deformities or asymmetries following primary breast enlargement surgery.

METHODS

The fat utilized was harvested and processed using the Puregraft system. Fat grafting was performed until the problem was visually corrected, followed by an additional 30% overcorrection. Photographs were taken preoperatively and 1 year postoperatively, and analyzed utilizing cloud-based 3-dimensional imaging software to measure the breast volumes and calculate 1-year resorption rates. Both patients and physicians were asked to rate their satisfaction.

RESULTS

The total volume of fat transferred ranged from 160 cc to 360 cc, with an average of 280 cc per procedure. The absolute volume of tissue resorption showed considerable variation (median, 42.6 mL; range, 5.5-62 mL). However, there was a very close correlation between the volume resorbed and the volume implanted: the more volume injected, the more volume absorbed. When expressed as a percentage of implanted tissue, the resorption rate was 27.5 ± 0.8% (mean ± standard deviation) with a very narrow range (25.7%-28.9%). Patients and physicians reported a satisfaction rate of "excellent" in 83.3% and 75% of cases, respectively.

CONCLUSIONS

At 1 year, 25.7% to 28.9% of the injected fat had been resorbed in a predictable, reproducible, and effective manner.

LEVEL OF EVIDENCE

4 Therapeutic.

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.

Supervised recursive segmentation of volumetric CT images for 3D reconstruction of lung and vessel tree

Three dimensional reconstruction of lung and vessel tree has great significance to 3D observation and quantitative analysis for lung diseases. This paper presents non-sheltered 3D models of lung and vessel tree based on a supervised semi-3D lung tissues segmentation method. A recursive strategy based on geometric active contour is proposed instead of the "coarse-to-fine" framework in existing literature to extract lung tissues from the volumetric CT slices. In this model, the segmentation of the current slice is supervised by the result of the previous one slice due to the slight changes between adjacent slice of lung tissues. Through this mechanism, lung tissues in all the slices are segmented fast and accurately. The serious problems of left and right lungs fusion, caused by partial volume effects, and segmentation of pleural nodules can be settled meanwhile during the semi-3D process. The proposed scheme is evaluated by fifteen scans, from eight healthy participants and seven participants suffering from early-stage lung tumors. The results validate the good performance of the proposed method compared with the "coarse-to-fine" framework. The segmented datasets are utilized to reconstruct the non-sheltered 3D models of lung and vessel tree.

Comparison of three-dimensional surface-imaging systems

BACKGROUND

In recent decades, three-dimensional (3D) surface-imaging technologies have gained popularity worldwide, but because most published articles that mention them are technical, clinicians often have difficulties gaining a proper understanding of them. This article aims to provide the reader with relevant information on 3D surface-imaging systems. In it, we compare the most recent technologies to reveal their differences.

METHODS

We have accessed five international companies with the latest technologies in 3D surface-imaging systems: 3dMD, Axisthree, Canfield, Crisalix and Dimensional Imaging (Di3D; in alphabetical order). We evaluated their technical equipment, independent validation studies and corporate backgrounds.

RESULTS

The fastest capturing devices are the 3dMD and Di3D systems, capable of capturing images within 1.5 and 1 ms, respectively. All companies provide software for tissue modifications. Additionally, 3dMD, Canfield and Di3D can fuse computed tomography (CT)/cone-beam computed tomography (CBCT) images into their 3D surface-imaging data. 3dMD and Di3D provide 4D capture systems, which allow capturing the movement of a 3D surface over time. Crisalix greatly differs from the other four systems as it is purely web based and realised via cloud computing.

CONCLUSION

3D surface-imaging systems are becoming important in today's plastic surgical set-ups, taking surgeons to a new level of communication with patients, surgical planning and outcome evaluation. Technologies used in 3D surface-imaging systems and their intended field of application vary within the companies evaluated. Potential users should define their requirements and assignment of 3D surface-imaging systems in their clinical as research environment before making the final decision for purchase.

Three-dimensional simulated images in breast augmentation surgery: an investigation of patients' satisfaction and the correlation between prediction and actual outcome

BACKGROUND

Breast augmentation is one of the most commonly performed operations. Three-dimensional outcome simulation can be used to predict and demonstrate for the patient what the planned operation aims to achieve in terms of size and shape. However, there are still few studies in the literature that look at how close the simulation is to the actual postoperative result and how patients perceive the accuracy and usefulness of the simulation.

METHODS

A prospective series of 150 patients underwent breast augmentation following consultation with the aid of three-dimensional simulation images. These patients were evaluated with a questionnaire 6 months postoperatively. A retrospective chart review of 52 patients whose three-dimensional simulations were compared with the postoperative photographs were evaluated and graded by an independent panel of investigators.

RESULTS

The independent panel graded the overall similarity of the three-dimensional simulations to the actual breasts with a total average score ± SD of 7.5 ± 0.80 (range, 4.5 to 8.9) using a visual analogue scale ranging from 1 to 10. The highest average score was given to projection, breast width, and height (7.8); the lowest average score was given to intermammary distance (7.0). Eighty-six percent of patients felt the simulated image was very accurate in predicting the actual result of their breasts.

CONCLUSIONS

Patients prefer a center that offers three-dimensional imaging technology; they feel that the simulation is very accurate and helps them very much in choosing the implant; if they could go back in time, they would choose the same implant again.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.