Reliability and comparison of 3-dimensional surface imaging of the face using a hand-held and whole body surface scanner

Objective: 3-Dimensional surface (3DSI) imaging has been shown to be a useful tool for plastic surgeons in the preoperative, intraoperative and postoperative setting. And to the knowledge of the authors no data about the reproducibility and accuracy of 3-Dimensional surface imaging of the face using a whole-body scanner is available. Thus, the objective of this investigation was to assess the reproducibility of facial scans acquired using a whole-body imaging device and to compare the precision of distance measurements in the face using a hand-held surface imaging device and a whole-body surface imaging device. Furthermore, the reproducibility of the whole body scanner was investigated. Material and Methods: This investigation enrolled a total of 22 healthy volunteers with a mean age of 29.36 years. Two consecutive 3-D images of the volunteers were obtained utilizing a whole-body imaging device(WB360) and a hand-hold imaging device(Vectra H2). For the whole-body imaging predefined distances in the face were performed in each scan and compared. Furthermore, surface deviation between two consecutively captured scans was assessed. Results: For the reliability of whole-body scan, the distance with the smallest statistical significance was found to be at the nose with p = 0.998, while the biggest statistical significance was found in the midface with p = 0.658. The area with the biggest surface deviation between the superimposed scans was the neck with a RMS of 1.62 ± 1.71 mm and the area with the smallest surface deviation was the forehead with a RMS of 0.17 ± 0.05 mm. For the comparison of the both scanners our results revealed that the measured difference between the length and the standard reference did not differ statistically significant between the two investigated devices in all investigated areas of the face (p > 0.266), however the measured difference of the width and the width of the standard reference differed statistically significant in all areas of the face across the investigated devices (p < 0.032). Conclusion: The whole – body-imaging device investigated in this study can be utilized to capture the face and provides enough accuracy to compare scans. Even though not directly investigated, it can be hypothesized that the error caused by repositioning the patient between a baseline and a follow – up scan will not be too big to consider measurements performed with the whole – body-imaging device as impractical. Both, measurements obtained from scans acquired using the hand held imaging device and the whole – body-imaging device differed significantly from the standard reference. Users should be aware of deviations when obtaining 3DSI using the presented imaging devices but should not refrain from using them, as the absolute differences might be too small to play a role in both, clinical and research, setting

Portable Three-Dimensional imaging to monitor small volume enhancement in face, vulva and hand: a comparative study

Multiple handheld 3-dimentional systems are available on the market but data regarding their use in detecting small volumes are limited. The aim of this study was to compare different portable 3D technologies in detecting small volumetric enhancement on a mannequin model and a series of patients. Five portable 3D systems (Artec Eva, Crisalix, Go!Scan, LifeViz Mini, and Vectra H1) were tested in a controlled environment with standardised volumes and in a clinical setting with patients undergoing small volume fat grafting to face, vulva and hand. Accuracy was assessed with absolute and relative technical error measurement (TEM and rTEM); precision with intra- and inter-observer reliability (rp and ICC), and usability in clinical practice with the following parameters: portability, suitability of use in operating theatre/clinic, ease of use of hardware and software, speed of capture, image quality, patient comfort, and cost. All tested devices presented overall good accuracy in detecting small volumetric changes ranging from 0.5 to 4 cc. Structured-light laser scanners (Artec Eva and Go!Scan) showed high accuracy but their use in clinical practice was limited by longer capture time, multiple wiring, and complex software for analysis. Crisalix was considered the most user-friendly, less bothering for patients, and truly portable but its use was limited to the face because the software does not include vulva and hand. 3D technologies exploiting the principle of passive stereophotogrammetry such as LifeViz Mini and Vectra H1 were the most versatile for assessing accurately multiple body areas, representing overall the best long-term value-for-money. 3D portable technology is a non-invasive, accurate, and reproducible method to assess the volumetric outcome after facial, vulval and hand injectables. The choice of the 3D system should be based on the clinical need and resources available

Enhancement of autologous fat graft survival by recipient site preparation

Fat grafting has emerged as a very powerful tool, largely used in plastic surgery for a multitude of indications, including correction of contour abnormalities, breast reconstruction, and cosmetic procedures. However, the variability in terms of volumetric stability of the grafted fat and the lack of methods to measure outcomes in a reliable, easy and reproducible manner represent relevant limitations. To improve outcomes, the majority of the investigations has focused on three of the four steps of the fat grafting process, namely harvesting, processing, and re-injection. The preparation of the recipient site has instead received less attention, despite several reports suggesting an ability of determining higher fat survival rates, mainly through induction of cell proliferation, neo-vascularization and neo-adipogenesis. It is therefore of utmost clinical relevance to determine whether the preparation of the recipient site prior to fat grafting leads to more favorable results. The aim of the present work is to collect and review all existing pre-clinical and clinical evidence regarding all methods to prepare the recipient site, to introduce a new preparation technique and to validate a new three-dimensional method to assess outcomes objectively. Four publications are included. The first manuscript provides a comprehensive overview of the different techniques to prepare the recipient site for fat grafting as they were investigated in pre-clinical studies, including external volume expansion, implantation of alloplastic material, administration of cell-proliferation factors, ischemia, and microneedling. The resulting outcomes are analyzed and the underlying mechanisms of action clarified. The second paper reviews all clinical studies investigating the most used preparation technique, external volume expansion, examining different indications, treatment protocols, outcomes, and complications. The third article presents an innovative and simple intraoperative external expansion system which applies a strong cycling negative pressure of -550 mmHg to enhance small-volume autologous fat grafting (40–80 mL) and discusses its background and its mechanism of action. In particular, this article examines our experience with recipient sites in the breast characterized by restrictive cicatrix or pre-irradiated tissues. Finally, the fourth study validates the use of a novel, inexpensive and handheld three-dimensional scanning process to perform an easy and precise measurement of breast volumes and surfaces, extremely useful to evaluate fat grafting outcomes, especially in case of small volume transplantation

A structured-light surface scanning system to evaluate breast morphology in standing and supine positions

Objective and accurate surface measurements of the human breast are important for surgical planning and outcome assessment. Breast shapes are affected by gravitational loads and deformities, and the measurements obtained in the standing position may not correlate well with measurements in supine position, which is more representative of breast surgery. To evaluate the effect of changes in body posture on breast morphology, a dual color 3D surface imaging system capable of scanning patients in both the supine and standing positions was developed. System performance was established by assessing the surface coverage and accuracy between a CAD breast model and 3D surface scans of a 3D print of the CAD model. The modular nature of the system offers the potential to add additional surface scanners with unique colors to increase coverage without sacrificing speed. The human pilot study shows that the system can quantitatively evaluate the effect of subject postures in individuals with smaller breasts, and thereby has the potential to be used to investigate changes in breast morphologies

Evaluation of Intraoperative Volumetric Assessment of Breast Volume Using 3D Handheld Stereo Photogrammetric Device.

Methods for assessing three-dimensional (3D) breast volume are becoming increasingly popular in breast surgery. However, the precision of intraoperative volumetric assessment is still unclear. Until now, only non-validated scanning systems have been used for intraoperative volumetric analyses. This study aimed to assess the feasibility, handling, and accuracy of a commercially available, validated, and portable device for intraoperative 3D volumetric evaluation. All patients who underwent breast surgery from 2020 to 2022 were identified from our institutional database. Intraoperative 3D volumetric assessments of 103 patients were included in this study. Standardized 3D volumetric measurements were obtained 3 months postoperatively to compare the intraoperatively generated volumetric assessment. All of the study participants were women with a mean age of 48.3 ± 14.7 years (range: 20-89). The mean time for intraoperative volumetric assessment was 8.7 ± 2.6 min. The postoperative 3D volumetric assessment, with a mean volume of 507.11 ± 206.29 cc, showed no significant difference from the intraoperative volumetric measurements of 504.24 ± 276.61 cc (p = 0.68). The mean absolute volume difference between the intraoperative simulations and postoperative results was 27.1 cc. Intraoperative 3D volumetric assessment using the VECTRA H2 imaging system seems to be a feasible, reliable, and accurate method for measuring breast volume. Based on this finding, we plan to investigate whether volumetric objective evaluations will help to improve breast symmetry in the future

Optimising breast reconstruction. A clinical study on autologous breast reconstruction

Denne avhandlingen omhandler metoder for å optimalisere utfallet av brystrekonstruksjon ved bruk av kroppseget vev. Det første delarbeidet beskriver en kirurgisk teknikk som kombinerer to lapper fra henholdsvis buken (DIEP og TRAM lapper) og ytre deler av brystkassen (LICAP lapp) for å oppnå større volum og penere fasong på det rekonstruerte brystet hos kvinner med lite overskuddsvev på buken. LICAP lapp til brystrekonstruksjon er tidligere beskrevet, men en ny design på lappen resulterte i et bedre estetisk resultat enn med tidligere brukt teknikk. Det andre delarbeidet beskriver verdien termografi for å kartlegge lokalisasjonen av blodkar under huden (perforanter) til i planlegging av brystrekonstruksjon ved bruk av lapper fra øvre del av ryggen (TDAP lapp). Samme visualiseringsteknikk ble også funnet nyttig under og etter kirurgisk behandling for å overvåke blodforsyningen i det rekonstruerte brystet. Termografi er gunstig ved at en unngår potensielt farlige og mer arbeidskrevende teknikker som baseres på røntgenstråling eller intravenøse kontrastmidler, som ellers er hyppig brukt. Tidligere studier av intravenøs væskebehandling ved større kirurgi har vist at altfor liberal væsketilførsel kan øke risikoen for komplikasjoner og forlenge sykehusoppholdet. I det tredje delarbeidet ble to forskjellige strategier for intraoperativ væskebehandling sammenlignet, i forbindelse med mikrokirurgisk brystrekonstruksjon ved abdominale lapper. Resultatene viste at en restriktiv intravenøs væskebehandling i kombinasjon med bruk av noradrenalin og propofol, for å motvirke blodtrykksfall og gi økt blodforsyning til det transplantert vevet, var forenlig med færre komplikasjoner og kortere sykeleie. Spesielt forekom komplikasjoner relatert til det transplanterte vevet i betydelig mindre grad i pasientgruppen med lavere total intraoperativ væskevolum. Kombinasjon av lappeplastikker ved mikrokirurgisk brystrekonstruksjon, termografi for å sikre adekvat blodforsyning og en restriktiv intraoperativ væsketerapi er faktorer som kan bidra til er bedre resultat og mindre risiko ved avansert rekonstruktiv brystkirurgi.Breast reconstruction using the patient’s own tissue is common, but the surgical procedures can be complex. This project evaluated new methods to reduce the risks for complications and improve overall outcome after such surgery. In patients with limited surplus tissue on the lower abdomen, larger breast volume and improved aesthetic outcome was achieved when an abdominal free tissue transplant was combined with a local flap from the axillary area. Registration of heat radiation from the skin surface proved a valuable and safe technique to ensure proper flap design before tissue transplantation and to monitor flap blood perfusion during and after surgery, enabling swift correction of compromised flap perfusion. On assessment of intraoperative fluid management, a restricted fluid infusion combined with vasoactive drugs to ensure adequate blood pressure was correlated with less postoperative complications and shorter hospital stay as compared to a more liberal fluid management

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

Noncontact Three-Dimensional Diffuse Optical Imaging of Deep Tissue Blood Flow Distribution

The present invention provides for three-dimensional reflectance diffuse optical imaging of deep tissue blood flow distribution that removes the need for probe-tissue contact, thereby allowing for such technology to be applied to sensitive, vulnerable, damaged, or reconstructive tissue. The systems utilize noncontact application and detection of near-infrared light through optical lens and detection through a linear array or two-dimensional array of avalanche photodiodes or a two-dimensional array of detectors provided by charge-coupled-device (CCD). Both further feature a finite-element-method (FEM) based facilitation to provide for three-dimensional flow image reconstruction in deep tissues with arbitrary geometries