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Chapman BV, Lei X, Patil P, Tripathi S, Nicklaus KM, Grossberg AJ, Shaitelman SF, Thompson AM, Hunt KK, Buchholz TA, Merchant F, Markey MK, Smith BD, Reddy JP. Quantitative 3-Dimensional Photographic Assessment of Breast Cosmesis After Whole Breast Irradiation for Early Stage Breast Cancer: A Secondary Analysis of a Randomized Clinical Trial. Adv Radiat Oncol 2020; 5:824-833. [PMID: 33083644 PMCID: PMC7557136 DOI: 10.1016/j.adro.2020.04.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose Our purpose was to use 3-dimensional (3D) surface photography to quantitatively measure breast cosmesis within the framework of a randomized clinical trial of conventionally fractionated (CF) and hypofractionated (HF) whole breast irradiation (WBI); to identify how 3D measurements are associated with patient- and physician-reported cosmesis; and to determine whether objective measures of breast symmetry varied by WBI treatment arm or transforming growth factor β 1 (TGFβ1) status. Methods and Materials From 2011 to 2014, 287 women age ≥40 with ductal carcinoma in situ or early-stage invasive breast cancer were enrolled in a multicenter trial and randomized to HF-WBI or CF-WBI with a boost. Three-dimensional surface photography was performed at 3 years posttreatment. Patient-reported cosmetic outcomes were recorded with the Breast Cancer Treatment Outcome Scale. Physician-reported cosmetic outcomes were assessed by the Radiation Therapy Oncology Group scale. Volume ratios and 6 quantitative measures of breast symmetry, termed F1-6C, were calculated using the breast contour and fiducial points assessed on 3D surface images. Associations between all metrics, patient- and physician-reported cosmesis, treatment arm, and TGFβ1 genotype were performed using the Kruskal-Wallis test and multivariable logistic regression models. Results Among 77 (39 CF-WBI and 38 HF-WBI) evaluable patients, both patient- and physician-reported cosmetic outcomes were significantly associated with the F1C vertical symmetry measure (both P < .05). Higher dichotomized F1C and volumetric symmetry measures were associated with improved patient- and physician-reported cosmesis on multivariable logistic regression (both P ≤ .05). There were no statistically significant differences in vertical symmetry or volume measures between treatment arms. Increased F6C horizontal symmetry was observed in the CF-WBI arm (P = .05). Patients with the TGFβ1 C-509T variant allele had lower F2C vertical symmetry measures (P = .02). Conclusions Quantitative 3D image-derived measures revealed comparable cosmetic outcomes with HF-WBI compared with CF-WBI. Our findings suggest that 3D surface imaging may be a more sensitive method for measuring subtle cosmetic changes than global patient- or physician-reported assessments.
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Affiliation(s)
- Bhavana V. Chapman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xiudong Lei
- Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Prithvi Patil
- Department of Engineering Technology, University of Houston, Houston, Texas
- The University of Texas Health Science Center at Houston, Houston, Texas
| | - Shikha Tripathi
- Department of Engineering Technology, University of Houston, Houston, Texas
| | - Krista M. Nicklaus
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas
| | - Aaron J. Grossberg
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon
| | - Simona F. Shaitelman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alastair M. Thompson
- Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Surgery, Division of Surgical Oncology, Baylor College of Medicine, Houston, Texas
| | - Kelly K. Hunt
- Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Thomas A. Buchholz
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Scripps MD Anderson Cancer Center, La Jolla, California
| | - Fatima Merchant
- Department of Engineering Technology, University of Houston, Houston, Texas
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas
- Department of Computer Science, University of Houston, Houston, Texas
| | - Mia K. Markey
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas
- Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Benjamin D. Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jay P. Reddy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Corresponding author: Jay P. Reddy, MD, PhD
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Tong OLH, Chamson-Reig A, Yip LCM, Brackstone M, Diop M, Carson JJL. Structured-light surface scanning system to evaluate breast morphology in standing and supine positions. Sci Rep 2020; 10:14087. [PMID: 32839488 PMCID: PMC7445296 DOI: 10.1038/s41598-020-70476-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 06/05/2020] [Indexed: 11/09/2022] Open
Abstract
Breast shapes are affected by gravitational loads and deformities. Measurements obtained in the standing position may not correlate well with measurements in the supine position, which is more representative of patient position during breast surgery. A dual color 3D surface imaging system capable of scanning patients in both supine and standing positions was developed to evaluate the effect of changes in body posture on breast morphology. The system was evaluated with breast phantoms to assess accuracy, then tested on ten subjects in three body postures to assess its effectiveness as a clinical tool. The accuracy of the system was within 0.4 mm on average across the model. For the human study, there was no effect of body posture on breast volumes (p value > 0.05), but we observed an effect of completeness of breast scans on body posture (p value < 0.05). Post-hoc tests showed that the supine position and the standing position with hands at the waist differed significantly (p value < 0.05). This study shows that the system can quantitatively evaluate the effect of subject postures, and thereby has the potential to be used to investigate peri-operative changes in breast morphology.
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Affiliation(s)
- Olivia L H Tong
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor Street, London, ON, N6A 4V2, Canada.,School of Biomedical Engineering, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Astrid Chamson-Reig
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor Street, London, ON, N6A 4V2, Canada
| | - Lawrence C M Yip
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor Street, London, ON, N6A 4V2, Canada.,Department of Medical Biophysics, Western University, London, Canada
| | - Muriel Brackstone
- London Regional Cancer Program, London Health Sciences Centre, 800 Commissioners Road East, London, N6A 5W9, Canada.,Department of Surgery, Western University, London, Canada
| | - Mamadou Diop
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor Street, London, ON, N6A 4V2, Canada.,School of Biomedical Engineering, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada.,Department of Medical Biophysics, Western University, London, Canada
| | - Jeffrey J L Carson
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor Street, London, ON, N6A 4V2, Canada. .,School of Biomedical Engineering, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada. .,Department of Medical Biophysics, Western University, London, Canada. .,Department of Surgery, Western University, London, Canada.
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Natural Breast Symmetry in Preoperative Breast Cancer Patients. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2297. [PMID: 31942335 PMCID: PMC6952140 DOI: 10.1097/gox.0000000000002297] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/17/2019] [Indexed: 11/25/2022]
Abstract
Plastic surgeons aim to achieve breast symmetry during cosmetic and reconstructive breast surgery. They rely on measures of breast size, position, and projection to determine and achieve breast symmetry, but normative data on symmetry in preoperative breast reconstruction patients are scarce.
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Applications and limitations of using patient-specific 3D printed molds in autologous breast reconstruction. EUROPEAN JOURNAL OF PLASTIC SURGERY 2018; 41:571-576. [PMID: 30294071 PMCID: PMC6153881 DOI: 10.1007/s00238-018-1430-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/04/2018] [Indexed: 12/03/2022]
Abstract
Background Over the last years, several techniques have been proposed to improve the outcome of autologous breast reconstruction procedures. One of these innovations describes patient-specific, three-dimensional (3D) printed breast molds for intraoperative use based on 3D stereophotogrammetry. In this article, we want to share our preliminary experiences with producing such templates, its clinical possibilities and limitations in practice. Methods Patient-specific templates were designed based on 3D stereophotogrammetry images. The 3D template was fabricated using a 3D printer. During breast reconstruction, the autologous flap was placed inside the printed template to aid the surgeon in determining the shape and volume of the autologous flap creating the desired breast dimensions. Patients were 3D-photographed 6 to 9 months post-operatively. Results Three patients with unilateral breast reconstructions showed a width difference of 0.5 cm and mean volume difference of 211 ml between the reconstructed and contralateral breasts. In the three bilateral reconstructed patients, a mean difference in breast width and volume of respectively 0.5 cm and 16 ml was found. Conclusions Patient-specific breast templates are inexpensive and relatively easy to design, while being practical and convenient to obtain insight in the dimensions of the desired breast during reconstruction, according to the operating surgeons. Patient selection is however critical, as patients must have sufficient donor volume and/or satisfying breast shape to be able to use the template to its full potential. Level of evidence: Level IV, therapeutic study.
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Teo I, Reece GP, Huang SC, Mahajan K, Andon J, Khanal P, Sun C, Nicklaus K, Merchant F, Markey MK, Fingeret MC. Body image dissatisfaction in patients undergoing breast reconstruction: Examining the roles of breast symmetry and appearance investment. Psychooncology 2017; 27:857-863. [PMID: 29152816 DOI: 10.1002/pon.4586] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 11/03/2017] [Accepted: 11/06/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Reconstruction as part of treatment for breast cancer is aimed at mitigating body image concerns after mastectomy. Although algorithms have been developed to objectively assess breast reconstruction outcomes, associations between objectively quantified breast aesthetic appearance and patient-reported body image outcomes have not been examined. Further, the role of appearance investment in explaining a patient's body image is not well understood. We investigated the extent to which objectively quantified breast symmetry and patient-reported appearance investment were associated with body image dissatisfaction in patients undergoing cancer-related breast reconstruction. METHODS Breast cancer patients in different stages of reconstruction (n = 190) completed self-report measures of appearance investment and body image dissatisfaction. Vertical extent and horizontal extent symmetry values, which are indicators of breast symmetry, were calculated from clinical photographs. Associations among breast symmetry, appearance investment, body image dissatisfaction, and patient clinical factors were examined. Multi-variable regression was used to evaluate the extent to which symmetry and appearance investment were associated with body image dissatisfaction. RESULTS Vertical extent symmetry, but not horizontal extent symmetry, was associated with body image dissatisfaction. Decreased vertical extent symmetry (β = -.19, P < .05) and increased appearance investment (β = .45, P < .001) were significantly associated with greater body image dissatisfaction while controlling for clinical factors. CONCLUSIONS Breast symmetry and patient appearance investment both significantly contribute to an understanding of patient-reported body image satisfaction during breast reconstruction treatment.
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Affiliation(s)
- Irene Teo
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
| | - Gregory P Reece
- Department of Plastic Surgery, MD Anderson Cancer Center, Houston TX, USA
| | - Sheng-Cheng Huang
- Department of Biomedical Engineering, University of Texas, Austin TX, USA
| | - Kanika Mahajan
- Department of Behavioral Sciences, MD Anderson Cancer Center, Houston TX, USA
| | - Johnny Andon
- Department of Engineering Technology, University of Houston, Houston TX, USA
| | - Pujjal Khanal
- Department of Engineering Technology, University of Houston, Houston TX, USA
| | - Clement Sun
- Department of Biomedical Engineering, University of Texas, Austin TX, USA
| | - Krista Nicklaus
- Department of Biomedical Engineering, University of Texas, Austin TX, USA
| | - Fatima Merchant
- Department of Engineering Technology, University of Houston, Houston TX, USA
| | - Mia K Markey
- Department of Biomedical Engineering, University of Texas, Austin TX, USA
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Seoud L, Ramsay J, Parent S, Cheriet F. A novel fully automatic measurement of apparent breast volume from trunk surface mesh. Med Eng Phys 2017; 41:46-54. [PMID: 28126421 DOI: 10.1016/j.medengphy.2017.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 09/26/2016] [Accepted: 01/01/2017] [Indexed: 11/30/2022]
Abstract
This paper presents a novel method for assessing apparent breast volume from trunk surface mesh without any manual intervention. The proposed method requires a closed and smooth triangular mesh of the trunk. It comprises four main steps: automatic nipple localization, automatic breasts delineation, chest-wall interpolation and volume computation. The mean curvature is computed for each vertex using a quadratic fitting approach and used as an indicator to determine the convex fold of the breasts. The delineation is modeled as an ellipse in the frontal plane and all the vertices inside it are removed. The remaining ones are used to interpolate the chest wall with radial basis functions. The voxels inside the resulting mesh without breasts are then subtracted from the original voxelized volume to generate the breasts volume. The validation is conducted on 30 adolescent female for each of which an MRI and a trunk surface (TS) acquisitions were available. Three breast volumes are considered: the anatomical volumes (AV) manually segmented on the MRI, the external volumes computed with the proposed method first in prone position (EVP) using the trunk mesh extracted from the MRI, and second, in standing position (EVS) using the TS's mesh. Significant correlations (R> 0.77) are found between each two of the three volumes. AVs are much larger than both EVS and EPS. In fact, the manual segmentation using MRI slices allows for a direct visualization of the breast posterior delineation. Computed automatically, EVS and EPS are highly similar, indicating that the proposed method is robust to changes from prone to standing position. No significant difference between the regressions on the left and right breasts is noted. Fully-automatic 3D breast volumetry from trunk surface mesh is feasible and provides measurements that are highly correlated to manual MRI volumetry and robust to changes in posture.
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Affiliation(s)
| | - Joyce Ramsay
- Sainte Justine University Hospital Research Center, Montreal, Canada
| | - Stefan Parent
- Sainte Justine University Hospital Research Center, Montreal, Canada
| | - Farida Cheriet
- Department of Computer and Software Engineering, Polytechnique Montreal, Canada; Sainte Justine University Hospital Research Center, Montreal, Canada
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Zhao L, Cheong A, Reece GP, Fingeret MC, Shah SK, Merchant FA. Inferior Breast-Chest Contour Detection in 3-D Images of the Female Torso. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2016; 4:4300410. [PMID: 32519998 PMCID: PMC7228683 DOI: 10.1109/jtehm.2016.2614518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 08/15/2016] [Accepted: 09/12/2016] [Indexed: 11/21/2022]
Abstract
Stereophotogrammetry is finding increased use in clinical breast surgery, both for breast reconstruction after oncological procedures and cosmetic augmentation and reduction. The ability to visualize and quantify morphological features of the breast facilitates pre-operative planning and post-operative outcome assessment. The contour outlining the lower half of the breast is important for the quantitative assessment of breast aesthetics. Based on this inferior breast contour, relevant morphological measures, such as breast symmetry, volume, and ptosis, can be determined. In this paper, we present an approach for automatically detecting the inferior contour of the breast in 3D images. Our approach employs surface curvature analysis and is able to detect the breast contour with high accuracy, achieving an average error of 1.64 mm and a dice coefficient in the range of 0.72–0.87 when compared with the manually annotated contour (ground truth). In addition, the detected contour is used to facilitate the detection of the lowest visible point on the breast, which is an important landmark for breast morphometric analysis.
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Affiliation(s)
- Lijuan Zhao
- Department of Computer ScienceUniversity of HoustonHoustonTX77204USA
| | - Audrey Cheong
- Department of Electrical and Computer EngineeringUniversity of HoustonHoustonTX77204USA
| | - Gregory P Reece
- Department of Plastic SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTX77030USA
| | - Michelle C Fingeret
- Department of Behavioral ScienceThe University of Texas MD Anderson Cancer CenterHoustonTX77030USA
| | - Shishir K Shah
- Department of Computer ScienceUniversity of HoustonHoustonTX77204USA
| | - Fatima A Merchant
- Departments of Engineering TechnologyElectrical and Computer Engineering, and Computer ScienceUniversity of HoustonHoustonTX77204USA
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3D surface imaging of the human female torso in upright to supine positions. Med Eng Phys 2015; 37:375-83. [PMID: 25703742 PMCID: PMC4380553 DOI: 10.1016/j.medengphy.2015.01.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 01/09/2015] [Accepted: 01/18/2015] [Indexed: 11/20/2022]
Abstract
Three-dimensional (3D) surface imaging of breasts is usually done with the patient in an upright position, which does not permit comparison of changes in breast morphology with changes in position of the torso. In theory, these limitations may be eliminated if the 3D camera system could remain fixed relative to the woman’s torso as she is tilted from 0 to 90 degrees. We mounted a 3dMDtorso imaging system onto a bariatric tilt table to image breasts at different tilt angles. The images were validated using a rigid plastic mannequin and the metrics compared to breast metrics obtained from 5 subjects with diverse morphology. The differences between distances between the same fiducial marks differed between the supine and upright positions by less than one percent for the mannequin, whereas the differences for distances between the same fiducial marks on the breasts of the 5 subjects differed significantly and could be correlated with body mass index and brassiere cup size for each position change. We show that a tilt table - 3D imaging system can be used to determine quantitative changes in the morphology of ptotic breasts when the subject is tilted to various angles.
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Kawale MM, Reece GP, Crosby MA, Beahm EK, Fingeret MC, Markey MK, Merchant FA. Automated Identification of Fiducial Points on 3D Torso Images. Biomed Eng Comput Biol 2013; 5:57-68. [PMID: 25288903 PMCID: PMC4147764 DOI: 10.4137/becb.s11800] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Breast reconstruction is an important part of the breast cancer treatment process for many women. Recently, 2D and 3D images have been used by plastic surgeons for evaluating surgical outcomes. Distances between different fiducial points are frequently used as quantitative measures for characterizing breast morphology. Fiducial points can be directly marked on subjects for direct anthropometry, or can be manually marked on images. This paper introduces novel algorithms to automate the identification of fiducial points in 3D images. Automating the process will make measurements of breast morphology more reliable, reducing the inter- and intra-observer bias. Algorithms to identify three fiducial points, the nipples, sternal notch, and umbilicus, are described. The algorithms used for localization of these fiducial points are formulated using a combination of surface curvature and 2D color information. Comparison of the 3D co-ordinates of automatically detected fiducial points and those identified manually, and geodesic distances between the fiducial points are used to validate algorithm performance. The algorithms reliably identified the location of all three of the fiducial points. We dedicate this article to our late colleague and friend, Dr. Elisabeth K. Beahm. Elisabeth was both a talented plastic surgeon and physician-scientist; we deeply miss her insight and her fellowship.
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Affiliation(s)
- Manas M Kawale
- Department of Computer Science, University of Houston, Houston, TX, USA
| | - Gregory P Reece
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Melissa A Crosby
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elisabeth K Beahm
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michelle C Fingeret
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mia K Markey
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, USA. ; Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Fatima A Merchant
- Department of Computer Science, University of Houston, Houston, TX, USA. ; Department of Engineering Technology, University of Houston, Houston, TX, USA
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Souéid A, Khanna A. A free 'app' for plastic surgery: the smartphone spirit level. Ann R Coll Surg Engl 2012. [PMID: 23131245 PMCID: PMC3954300 DOI: 10.1308/003588412x13373405387096k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- A Souéid
- Sandwell and West Birmingham Hospitals NHS Trust, UK.
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