138 research outputs found
Three-dimensional breast assessment by multiple stereophotogrammetry after breast reconstruction with latissimus dorsi flap
Introduction:
Numerous methods exist for the assessment of the female breast. Traditionally, a subjective approach was taken for surgical planning and evaluation of the postoperative outcome. Several objective methods have been developed to support this procedure, among which are laser scanning, MRI, mammography, ultrasound and photography. Recently, 3D imaging technology has been developed.
Material & Method:
3D breast assessment by multiple stereophotogrammetry was examined. A custom-made imaging system with eight digital cameras arranged in four camera pods was utilised. This system was used for breast capture, resulting in eight images obtained by the cameras. The merging of these images and 3D image construction was carried out by C3D software and the volume assessment of the 3D images was made using breast analysis tool (BAT) software, developed by Glasgow University.
A validation study was conducted. Nine plaster models were investigated and their volume determined by 3D stereophotogrammetry and water displacement method. Water displacement was considered to be the gold standard for comparison. The plaster models were specially made in order to represent a variety of shapes and sizes of the female breast. Each plaster model was examined 10 times by each method. Further, the volumes of the breasts of six female volunteer live models were investigated by the same two methods and the results compared. A special focus was placed on the reproducibility of the assessment. Each live model was captured with the 3D capture system three times at two different time points after retaking a special pose in a custom-made positioning frame. Altogether, each live model was captured six times, resulting in six 3D images, each of which was measured three times with BAT software.
A patient study was conducted in 44 patients after unilateral immediate breast reconstruction with Latissimus dorsi flap and no contra-lateral surgery. Each patient underwent 3D imaging with the multiple stereophotogrammetry system. During capture, the special pose in the custom-made positioning frame was taken by the patient’s leaning forward almost horizontally with the upper body for the breasts to rise off the chest wall to enable full breast coverage by the cameras. 3D images were constructed with C3D software and volumes measured with BAT. For each patient, one 3D image was constructed and measured four times with BAT software. In addition to the volume determination, a shape analysis was conducted. For this purpose, 10 landmarks were determined according to recommendations in the literature. Two landmarks, sternal notch and xiphoid, were marked, forming an imaginary midline between each other and four landmarks on each breast, i.e. the medial and lateral ends of the infra-mammary fold, and the most prominent and most inferior breast points were utilised for symmetry assessment between the right and left breasts. Each landmark was recorded four times by the operator on the 3D image and three-dimensional coordinates obtained. By assessment of the left and right breasts a breast asymmetry score was calculated.
Firstly, breast asymmetry was assessed objectively on the 3D images through the centroid size, which was determined as the square root of the sum of squared Euclidian distances from each landmark to the centroid. The centroid was the geometric mean of the landmarks. Secondly, asymmetry was assessed through breast volume by application of BAT software. Thirdly, asymmetry was examined through the landmarks themselves by investigation of the mismatch of the landmark configuration of one breast and its relabelled and matched reflection. The non-operated and reconstructed sides were compared and landmarks were recorded by the operator in three dimensions in four repeated tests. A decomposition of the total landmark asymmetry into its factors was conducted by fixation of the surface of the non-operated side and translation, rotation and scaling of the surface of the reconstructed side.
For comparison, a subjective breast assessment was conducted by six expert observers who rated the results after breast reconstruction by subjective qualitative assessment of the symmetry in 2D images of the same 44 patients in six poses. For this purpose the Harris scale was utilised, providing a score of 1 to 4 for poor to excellent symmetry.
Results:
The results revealed that differences in the obtained volumes in the plaster models were not significant. In contrast, differences in the breast volumes measured in the live models were significant. The examination of the reproducibility revealed that overall reproducibility obtained by stereophotogrammetry was better than that obtained by water displacement. No correlation between breast size and reproducibility of the measurements was found.
The results of the patient study demonstrated that the reproducibility of the landmarks was within 5 mm. There was a non-significant difference of the centroid sizes between both breasts. There was a significant difference of the volumes between the two breasts, with the non-operated side being larger than the reconstructed side. Volume was considered to be a more accurate measure for comparison of both breasts than centroid size as it was based on thousands of data points for the calculation as opposed to only four points of the centroid size. The statistical analysis of the landmark data provided a mathematical formula for determination of the breast asymmetry score. The average asymmetry score, derived by landmark assessment as the degree of mismatch between both sides, was 0.052 with scores ranging from 0.019 (lowest score) to 0.136 (highest score). The decomposition of the landmark-based asymmetry revealed that location was the most important factor contributing to breast asymmetry, ahead of intrinsic breast asymmetry, orientation and scale.
When investigating the subjective assessment, the inter-observer agreement was good or substantial. There was moderate agreement on the controls and fair to substantial intra-observer agreement.
When comparing the objective and subjective assessments, it was found that the relationship between the two scores was highly significant.
Conclusion:
We concluded that 3D breast assessment by multiple stereophotogrammetry was reliable for a comparative analysis and provided objective data to breast volume, shape and symmetry. A breast asymmetry score was developed, enabling an objective measurement of breast asymmetry after breast reconstruction. 3D breast assessment served as an objective method for comparison to subjective breast assessment
Enhanced Liposuction
Liposuction began as a simple, minimally invasive method of reducing the amount of localized fat in a region. Today it is a sophisticated and complex process, with many variations in purpose and technique. In this book, a global slate of expert surgeons offers a detailed description of various minimally invasive and non-invasive options for contouring the face, neck, and body. Chapters detail the evolution and utilization of various energy-based devices and combination treatments. They also describe procedure limitations and treatment of complications. Finally, they discuss indications for various approaches with case study descriptions so readers might be assisted with treating patients in their everyday practice
Textbook on Scar Management
This text book is open access under a CC BY 4.0 license. Written by a group of international experts in the field and the result of over ten years of collaboration, it allows students and readers to gain to gain a detailed understanding of scar and wound treatment – a topic still dispersed among various disciplines. The content is divided into three parts for easy reference. The first part focuses on the fundamentals of scar management, including assessment and evaluation procedures, classification, tools for accurate measurement of all scar-related elements (volume density, color, vascularization), descriptions of the different evaluation scales. It also features chapters on the best practices in electronic-file storage for clinical reevaluation and telemedicine procedures for safe remote evaluation. The second section offers a comprehensive review of treatment and evidence-based technologies, presenting a consensus of the various available guidelines (silicone, surgery, chemical injections, mechanical tools for scar stabilization, lasers). The third part evaluates the full range of emerging technologies offered to physicians as alternative or complementary solutions for wound healing (mechanical, chemical, anti-proliferation). Textbook on Scar Management will appeal to trainees, fellows, residents and physicians dealing with scar management in plastic surgery, dermatology, surgery and oncology, as well as to nurses and general practitioners ; Comprehensive reference covering the complete field of wounds and scar management: semiology, classifications and scoring Highly educational contents for trainees as well as professionals in plastic surgery, dermatology, surgery, oncology as well as nurses and general practitioners Fast access to information through key points, take home messages, highlights, and a wealth of clinical cases Book didactic contents enhanced by supplementary material and video
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Patterns of injury and violence in Yaoundé Cameroon: an analysis of hospital data.
BackgroundInjuries are quickly becoming a leading cause of death globally, disproportionately affecting sub-Saharan Africa, where reports on the epidemiology of injuries are extremely limited. Reports on the patterns and frequency of injuries are available from Cameroon are also scarce. This study explores the patterns of trauma seen at the emergency ward of the busiest trauma center in Cameroon's capital city.Materials and methodsAdministrative records from January 1, 2007, through December 31, 2007, were retrospectively reviewed; information on age, gender, mechanism of injury, and outcome was abstracted for all trauma patients presenting to the emergency ward. Univariate analysis was performed to assess patterns of injuries in terms of mechanism, date, age, and gender. Bivariate analysis was used to explore potential relationships between demographic variables and mechanism of injury.ResultsA total of 6,234 injured people were seen at the Central Hospital of Yaoundé's emergency ward during the year 2007. Males comprised 71% of those injured, and the mean age of injured patients was 29 years (SD = 14.9). Nearly 60% of the injuries were due to road traffic accidents, 46% of which involved a pedestrian. Intentional injuries were the second most common mechanism of injury (22.5%), 55% of which involved unarmed assault. Patients injured in falls were more likely to be admitted to the hospital (p < 0.001), whereas patients suffering intentional injuries and bites were less likely to be hospitalized (p < 0.001). Males were significantly more likely to be admitted than females (p < 0.001)DiscussionPatterns in terms of age, gender, and mechanism of injury are similar to reports from other countries from the same geographic region, but the magnitude of cases reported is high for a single institution in an African city the size of Yaoundé. As the burden of disease is predicted to increase dramatically in sub-Saharan Africa, immediate efforts in prevention and treatment in Cameroon are strongly warranted
Textbook on Scar Management
This text book is open access under a CC BY 4.0 license. Written by a group of international experts in the field and the result of over ten years of collaboration, it allows students and readers to gain to gain a detailed understanding of scar and wound treatment – a topic still dispersed among various disciplines. The content is divided into three parts for easy reference. The first part focuses on the fundamentals of scar management, including assessment and evaluation procedures, classification, tools for accurate measurement of all scar-related elements (volume density, color, vascularization), descriptions of the different evaluation scales. It also features chapters on the best practices in electronic-file storage for clinical reevaluation and telemedicine procedures for safe remote evaluation. The second section offers a comprehensive review of treatment and evidence-based technologies, presenting a consensus of the various available guidelines (silicone, surgery, chemical injections, mechanical tools for scar stabilization, lasers). The third part evaluates the full range of emerging technologies offered to physicians as alternative or complementary solutions for wound healing (mechanical, chemical, anti-proliferation). Textbook on Scar Management will appeal to trainees, fellows, residents and physicians dealing with scar management in plastic surgery, dermatology, surgery and oncology, as well as to nurses and general practitioners ; Comprehensive reference covering the complete field of wounds and scar management: semiology, classifications and scoring Highly educational contents for trainees as well as professionals in plastic surgery, dermatology, surgery, oncology as well as nurses and general practitioners Fast access to information through key points, take home messages, highlights, and a wealth of clinical cases Book didactic contents enhanced by supplementary material and video
Evaluation of image receptor angulation during mediolateral oblique positioning for optimised pressure and area distribution in mammography
BackgroundMammography is the gold standard diagnostic tool for the screening and diagnosis of breast cancer; however, it is associated with pain and discomfort. The pain and discomfort are mostly due to positioning and the compression applied during the procedure. Currently there are variations in the way clients are positioned for mammography and the amount of compression applied during the procedure. In addition, there are sparse guidelines and published literature on mammographic positioning and the application of compression. It is suggested that for the medio lateral oblique (MLO) position, for an effective compression force balance and increased breast footprint, the sternal angle and the image receptor (IR) be parallel to each other. This aim of this research is to evaluate the angle of IR during MLO positioning for optimised pressure and area distribution; this in turn may help reduce pain and discomfort associated with the procedure.MethodThe experimental work described in this report is in two phases. Phase one was an anthropomorphic phantom study to establish a structured and reproducible method of using the angle of the sternum to measure the correct angle of the IR for MLO projection. An inclinometer was used to measure the sternal angle of phantom model used. Six sets of compressions were made on the breast phantom with the IR at different angles ranging from 400 to 700 at 50 angle increments. Contact pressure and contact area footprint readings between breast phantom/paddle interface and breast phantom/IR interface were recorded using Xsensor pressure mapping system. Pressure uniformity (PU) and area uniformity (AU) between phantom breast/paddle interface and phantom breast phantom/IR interface were then calculated.Phase two was a human study with participants to investigate contact pressure and area balance on MLO compressions using two angles. A digital inclinometer was used to measure the angle at which the sternum for each participant. This angle was referred to as the ‘experimental angle’. The other angle was a ‘reference angle’ of 450. Compression at the ‘experimental angle’ may result into a better distribution of pressure through the breast and juxtathoracic structures, this may reduce the pain associated with the procedure. In addition to this, compression at this angle may increase breast surface area. The hypotheses set out to ascertain if there is no significant difference between contact pressure distribution when the IR is positioned parallel to the sternal angle (experimental angle) and it is positioned at a reference angle.An Xsensor pressure mapping system was used to record and analyse pressure distribution and surface area for compressions at the ‘experimental angle’ and the ‘reference angle’ (450). Pressure and area balance between the IR and compression paddle on both of these angles were compared and T-test conducted to accept or reject the hypotheses set out. In addition, participants were asked to score their pain experience after each compression, that is, compression at the ‘reference angle’ and the ‘experimental angle’. ResultsThe results from phase one indicated there was greater balance of pressure between breast/IR interface and breast/paddle interface at IR angle 600 compared the rest of IR angles investigated. PU of zero indicated equal distribution of pressure from the IR and the paddle. IR angled at 600 recorded a PU value of 0.21 which was the closest to zero from the PU recorded for the various angles. AU of zero indicates equal distribution of area footprint from the IR and the paddle. IR at 600 (Sternal angle for phantom model) produced the greatest area footprint balance compared to the other angles with AU of 0.05. An IR angled at 600, being parallel to the sternal angle of the phantom model which was recorded at 600 on the inclinometer, was the angle which produced the greatest balance of pressure and area footprint.The results from human study indicated there was no significant difference between contact pressure and area distribution when the IR is positioned parallel to the experimental angle or positioned at a reference angle.ConclusionFor the phantom study it has been shown that positioning the IR parallel to the angle of the sternum produces a more balanced contact pressure distribution and improved breast surface area footprint. The human study demonstrated no statistically significant difference between pressure and area balance on the reference angle and the experimental angle.For pain experienced score, although there was a 95% chance that the actual pain score for the compression on the reference angle fell within 3.81 and 5.76. and that of the experimental angle fell within 3.02 and 4.79, there was no statistically significant difference between pain experienced from compression on both angles
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