New Methods for Imaging Evaluation of Chest Wall Deformities (original) (raw)
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Journal of Pediatric Surgery, 2007
Background: Standard modalities to assist in determining the extent of chest wall developmental deformities in patients include x-ray and computed tomography (CT). The purpose of this study is to describe an optical imaging technique that provides accurate cross-sectional images of the chest, and to compare these with standard CT-derived images of chest wall abnormalities. Patients and Methods: Ten patients (5 pectus excavatum and 5 pectus carinatum) underwent imaging that included limited CT and optical cross-sectional imaging. Severity indices of the deformity using the standard Haller index (HI) were calculated from CT scans. A similar severity measurement of deformity was derived from the outline of torso cross sections (ie, from skin to skin measurements) obtained from optical images. To assess the severity of carinatum defects, a modified pectus index was derived, which measures the anterior chest protrusion from the central chord of the chest cross section. We performed regression analyses, comparing the indices obtained from CT and optical imaging methodologies. Results: Optical measures of cross-sectional deformities correlated well with standard HI (r 2 = 0.94) and even better with the modified pectus index (r 2 = 0.96). Adaptation of the HI for pectus carinatum deformity evaluation was effective, and consistent with the torso surface deformity measures. Conclusions: Torso models from optical imaging offer 3-D images of the chest wall deformity with no radiation exposure. This preliminary study showed promising results for the use of torso surface measurement as an alternative index of pectus deformities; if validated in larger studies, these measures may be useful for following chest wall abnormalities, using repeated studies in patients. D
The Korean Journal of Thoracic and Cardiovascular Surgery, 2018
Background: The nonsurgical treatment of chest wall deformity by a vacuum bell or external brace is gradual, with correction taking place over months. Monitoring the progress of nonsurgical treatment of chest wall deformity has relied on the ancient methods of measuring the depth of the excavatum and the protrusion of the carinatum. Patients, who are often adolescent, may become discouraged and abandon treatment. Methods: Optical scanning was utilized before and after the intervention to assess the effectiveness of treatment. The device measured the change in chest shape at each visit. In this pilot study, patients were included if they were willing to undergo scanning before and after treatment. Both surgical and nonsurgical treatment results were assessed. Results: Scanning was successful in 7 patients. Optical scanning allowed a visually clear, precise assessment of treatment, whether by operation, vacuum bell (for pectus excavatum), or external compression brace (for pectus carinatum). Millimeter-scale differences were identified and presented graphically to patients and families. Conclusion: Optical scanning with the digital subtraction of images obtained months apart allows a comparison of chest shape before and after treatment. For nonsurgical, gradual methods, this allows the patient to more easily appreciate progress. We speculate that this will increase adherence to these methods in adolescent patients.
Interactive CardioVascular and Thoracic Surgery
OBJECTIVES To compare a standard protocol using chest computed tomography (CT) to a non-irradiant protocol involving a low-cost portable 3D scanner and magnetic resonance imaging (MRI) for all pectus deformities based on the Haller index (HI). METHODS From April 2019 to March 2020, all children treated for pectus excavatum or carinatum at our institution were evaluated by chest CT, 3D scanning (iPad with Structure Sensor and Captevia—Rodin4D) and MRI. The main objectives were to compare the HI determined by CT or MRI to a derived index evaluated with 3D scanning, the external Haller index (EHI). The secondary objectives were to assess the inter-rater variability and the concordance between CT and MRI for the HI and the correction index. RESULTS Eleven patients were evaluated. We identified a strong correlation between the HI with MRI and the EHI (Pearson correlation coefficient = 0.900; P < 0.001), with a strong concordance between a radiologist and a non-radiologist using intra-...
The Annals of Thoracic Surgery
Background. Current approaches to quantifying the severity of pectus excavatum require internal measurements based on cross-sectional imaging. The aim of this study is to exploit a novel index evaluated on the external surface of the chest with a three-dimensional (3D) optical scanner. Methods. Fifty-one children (41 male, 10 female) between 2 and 17 years of age were evaluated with a 3D optical scanner. Pectus excavatum severity was calculated by using an ad hoc instant 3D scanner and defining an automatic procedure to generate an optical 3D correction index (CI3D). For the latter, an ideal threshold was derived from a statistical analysis, and five blind surveys were collected from pediatric specialists on chest wall deformities. The CI3D was then correlated with blind clinical assessments of PE severity.
Variations of the soft tissue thicknesses external to the ribs in Pectus Excavatum patients
Journal of Pediatric Surgery, 2013
Background: Surgical repair of pectus excavatum (PE) has become more popular due to improvements in the minimally invasive Nuss procedure. The pre-surgical assessment of PE patients requires Computerized Tomography (CT), as the malformation characteristics vary from patient to patient. Objective: This work aims to characterize soft tissue thickness (STT) external to the ribs among PE patients. It also presents a comparative analysis between the anterior chest wall surface before and after surgical correction. Methods: Through surrounding tissue segmentation in CT data, STT values were calculated at different lines along the thoracic wall, with a reference point in the intersection of coronal and median planes. The comparative analysis between the two 3D anterior chest surfaces sets a surgical correction influence area (SCIA) and a volume of interest (VOI) based on image processing algorithms, 3D surface algorithms, and registration methods. Results: There are always variations between left and right side STTs (2.54 ± 2.05 mm and 2.95 ± 2.97 mm for female and male patients, respectively). STTs are dependent on age, sex, and body mass index of each patient. On female patients, breast tissue induces additional errors in bar manual ☆ Funding: This work was supported by "Fundação para a Ciência e a Tecnologia" (FCT), Portugal, through the R&D project referenced PTDC/SAU-BEB/
Three-Dimensional Image Processing (3DIP) and Applications, 2010
The paper presents an optical three-dimensional shape measurement system and an automatic method for assessment of pectus excavatum severity based on the measurement results. The measurement system consists of four directional modules utilizing structured light projection method (namely temporal phase shifting TPS and modified Gray code projection) to capture the shape of body surface of the patients. The measurement result is a three-dimensional point cloud representing the skin surface. The system setup is described and the typical measurement parameters are given. The automated data analysis path is explained. Its main stages are: point cloud segmentation, normalization of trunk orientation, cutting the model into slices, analysis of each slice shape, selecting the proper slice for the assessment of pectus excavatum of the patient and calculating its shape parameter. The analysis does not require any initial processing (e.g. surface fitting or mesh building) as it is conducted on raw 3-D point cloud data resulting from the measurement. A new shape parameter (I 3ds ) was developed that shows correlation with CT Haller Index widely used for assessment of pectus excavatum. Preliminary clinical results are presented.
Handheld Optical System for Pectus Excavatum Assessment
Applied Sciences, 2021
Disruptive 3D technologies, such as reverse engineering (RE) and additive manufacturing (AM), when applied in the medical field enable the development of new methods for personalized and non-invasive treatments When referring to the monitoring of pectus excavatum, one of the most common thoracic malformations, 3D acquisition of the patient chest proved to be a straightforward method for assessing and measuring chest deformation Unfortunately, such systems are usually available in a dedicated facility, can be operated only by specialized doctors with the support of engineers and can be used only with patients on site It is therefore impossible to perform any routine check-up when the patient is unable to reach the outpatient clinic The COVID19 pandemic situation has placed even greater restrictions on patient mobility, worsening this problem To deal with this issue, a new low-cost portable optical scanner for monitoring pectus excavatum is proposed in this work The scanner, named Tho...
Medical & Biological Engineering & Computing, 2010
In our previous study, we developed a computerized technique that measured degree of chest-wall deformity in funnel chest patients using several image processing techniques, such as, active contour model. It could calculate quantitative indices for chest-wall deformity using patient's CT image. However, the algorithm contained manual initialization processes that required clinicians to obtain additional training processes to understand engineering contents and be familiar with the technique. In this study, we suggested a fully automatic algorithm that can measure the degree of chest-wall deformity by automating initialization processes. The initialization processes to segment CT images were automated by applying various image processing techniques such as histogram analysis, point detection, and object recognition. In order to evaluate the performance of the proposed algorithm, both the previous algorithm (semi-automatic) and newly suggested algorithm (fully automatic) were applied to preoperative CT images of 61 funnel chest patients to calculate several indices that represented chest-wall deformity quantitatively and to measure their processing time of our algorithm using a computer. The time required for initialization processes was 28.12 s using the semi-automatic algorithm and 0.07 s using the fully automatic algorithm (99.75% speed enhancement) and the time required for whole index calculation process was 61.12 s in semi-automatic algorithm and 30.09 s in fully automatic algorithm (50.76% speed enhancement). In most indices, calculation results of the two algorithms showed no significant difference between each other. The proposed algorithm could calculate chest-wall deformity more accurately with relatively shorter processing time than our previous method. Applying this algorithm is expected to facilitate more efficient diagnosis and evaluation processes of funnel chest patients for clinical doctors.
The Comparison Of Measurements On Chest X-Ray For Patients With Pectus Deformity
The Internet Journal of Thoracic and Cardiovascular Surgery
Purpose: Various parameters have been proposed to measure of severity of pectus deformities. We performed some different measurements on the chest x-ray for the patients who underwent an operation for pectus deformity to determine a reasonable parameter for preoperative and postoperative assessment. Methods: A hundred patients, who don't have scoliosis and kyphosis, were selected for this study. Fifty of these patients had a pectus excavatum and remaining 50 had a pectus carinatum deformity. The measurements on poster-anterior (PA) and lateral (L) chest X-rays were performed preoperatively and postoperatively and compared statistically. Results: Only the parameters, which are measured on, lateral chest x-ray for patients in both groups are statistically meaningful. Conclusions: The three parameters (lateral dimension of cardiac silhouette, sternovertebral distance, the lateral transverse dimension of chest), which are measured on lateral chest x-ray, can be used for preoperative and postoperative assessment of both groups of patients.
Chest fast MRI: An Imaging alternative on pre-operative evaluation of Pectus Excavatum
Journal of Pediatric Surgery
Background: Standard imaging methods in evaluating chest wall deformities, such as Pectus Excavatum (PE) in paediatric and adolescent patients, include baseline 2-view chest radiography and chest CT scan. Only few studies to date investigated the value of fast MRIin the pre operative assessment of patient affected by PE. Objective: To evaluate the efficacy of chest fast MRI in pre-operative management of patient affected by PE. To obtain the Haller Index (HI) and Asymmetry Index (AI) from chest fast MRI protecting patients from radiation exposure. Materials and Methods: We analyzed the data of 42 consecutive patients with severe PE who underwent minimally invasive repair between March 2007 and March 2010. All 42 patients received chest fast MRI, but only the first 5 in view of the results, were studied also with chest ultrafast CT scan. In both examinations, data at the deepest point of the depression were collected. Results: Severity indices of the deformity using HI and AI, collected from CT scan and fast MRI in the first 5 patients, were comparable. In the remaining 37 fast chest MRI offered good images of the chest wall deformities with no radiation exposure, detailing anatomical information such as displacement and rotation of the heart or great vessels anomalies. Conclusion: This study suggests the use of chest MRI in pre operative workup for patients with PE to obtain severity indices (Haller Index and Asymmetry Index avoiding radiation exposure to paediatric patients.