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Assessment of breast changes (skin erythema) during the treatment course and clinical follow-up at 3 months
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Background:
Three-dimensional Surface Imaging (3DSI) is a well-established method to objectively monitor morphological changes in the female breast in the field of plastic surgery. In contrast, in radiation oncology we are still missing effective tools, which can objectively and reproducibly assess and document adverse events in breast cancer radi...
Context in source publication
Context 1
... of the patients receiving CF-RT or HF-RT showed signs of a skin reaction during the baseline imaging session. Details on the incidence of changes in breast appearance are displayed in Table 2. When examining the overall changes regarding breast appearance, we found localised skin erythema in 22 out of 38 cases (57.9%). ...Citations
... The resulting volume of this 3D figure is used as a measure of breast volume. However, it is important to keep in mind the limitations of this technology, which are detailed in Table 1 [26][27][28]. ...
... The resulting volume of this 3D figure is used as a measure of breast volume. However, it is important to keep in mind the limitations of this technology, which are detailed in Table 1 [26][27][28]. Table 1. ...
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.
... Signs of breast lymphoedema were quantified using multiple tools and approaches (Table 1). Breast tissue dermal thickness was measured using ultrasound (n = 12) [21-24, 35, 36, 54, 57-60, 72] and mammography (n = 3) [26][27][28]; local tissue water was measured using tissue dielectric constant (TDC) (n = 8) [19, 20, 51-53, 59, 61, 73]; breast volume was measured using three-dimensional surface imagery (3D-SI: n = 4) [37,40,56,63], magnetic resonance imaging (MRI: n = 1) [41] and anthropomorphic techniques (n = 1) [36]; extracellular fluid volume was measured using bioimpedance spectroscopy (BIS: n = 3) [54,62,74]; tissue resistance was measured using tonometry (n = 3) [55,59,62], the pitting test (n = 2) [59,61] and indentation force (n = 1) [52]; and dermal backflow/compensatory drainage pathways was visualised with indocyanine green imaging (ICG: n = 1) [73]. Additionally, clinician rating scales (n = 8) [29, 31, 33-35, 37, 47, 72] were used to identify presence of changes to the appearance, size or texture of the breast tissue. ...
... gov/ health-topics/ study-quali ty-asses sment-tools [accessed 26 October 2020]). Seven studies were rated as good quality [19,45,47,49,58,60,74], 25 rated as fair [20-24, 26, 27, 30-32, 35, 36, 42, 57, 59, 61, 63-67, 70-73] and 17 as poor [25,28,29,33,34,37,38,41,43,44,48,50,52,55,62,68,69] (Table 1). ...
Purpose
Breast lymphoedema is a possible side effect of breast conserving surgery, but it is poorly understood. This is due, in part, to difficulty assessing the breast. This systematic review described outcome measures that quantify breast lymphoedema signs and symptoms and evaluated the measurement properties for these outcome measures.
Method
Seven databases were searched using terms in four categories: breast cancer, lymphoedema and oedema, clinician reported (ClinROM) and patient reported outcome measures (PROM) and psychometric and measurement properties. Two reviewers independently reviewed studies and completed quality assessments. The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) methodology was used for studies including measurement property evidence.
Results
Fifty-six papers were included with thirteen questionnaires, eight patient-reported rating scales, seven physical measures, seven clinician-rating scales and four imaging techniques used to quantify breast lymphoedema. Based on COSMIN methodology, one ClinROM had sufficient reliability, ultrasound measuring dermal thickness. Tissue dielectric constant (TDC) measuring local tissue water had promising reliability. Four questionnaires had sufficient content validity (BLYSS, BLSQ, BrEQ and LYMQOL-Breast).
Conclusions
Ultrasound is recommended to reliably assess breast lymphoedema signs. No PROM can be recommended with confidence, but BLYSS, BLSQ, BrEQ and LYMQOL-Breast are promising. Further research is recommended to improve evidence of measurement properties for outcome measures.
Implications for Cancer Survivors
There are many approaches to assess breast lymphoedema, but currently, only ultrasound can be recommended for use, with others, such as TDC and questionnaires, showing promise. Further research is required for all approaches to improve evidence of measurement properties.
... Studies showed a high interest and positive experiences of the patients [6,[12][13][14]. Through the development of various mobile handheld 3D scanners [15,16], in addition to the pure documentation and planning of plastic surgery, the intraoperative application as in the augmented-reality evaluation of facial surgery [17] and in breast surgery and radiation treatment [18][19][20] has been described based on case reports. ...
Three-dimensional Surface Imaging (3DSI) has become a valuable tool for planning and documenting surgical procedures. Although surface scanners have allowed for a better understanding of breast shape, size, and asymmetry during patient consultation, its use has not been included in intraoperative assessment so far. Validation of the reliability of the intraoperative use of a portable handheld 3DSI equipment as a tool to evaluate morphological changes during breast augmentation surgery. The patients who underwent bilateral subpectoral breast augmentation through an inframammary incision were included in this study. Intraoperative 3DSI was performed with the Artec Eva device, allowing for visualization of the surgical area before incision, after use of breast sizers and implant, and after wound closure. Intraoperatively manual measurements of breast distances and volume changes due to known sizer and implant volumes were in comparison with digital measurements calculated from 3DSI of the surgical area. Bilateral breasts of 40 patients were 3D photographed before incision and after suture successfully. A further 108 implant sizer uses were digitally documented. There was no significant difference between manual tape measurement and digital breast distance measurement. Pre- to postoperative 3D volume change showed no significant difference to the known sizer and implant volume.
... However, acute skin toxicity is very common and ranges from mild erythema to skin desquamation [4][5]. Additionally, anatomical changes such as breast oedema during the course of radiotherapy is significant for conventional and hypo-fractionated treatments [6]. These require careful monitoring as they can affect the accuracy of dose delivery. ...
Purpose
To determine the accuracy of AlignRT surface deformation module in detecting and quantifying oedema in breast cancer radiotherapy.
Materials and Methods
A female torso phantom and water-equivalent boluses of different thicknesses (0.5–1.5 cm) were used. The variation of surface displacement and the percentage of surface within tolerance, as a function of bolus thickness and Region of Interest (ROI) size, were investigated. Additionally, a dynamic phantom was used to study the impact of patient breathing on the swelling estimation. Lastly, a flowchart was derived to alert physicians in the case of breast swelling.
Results
Average displacement value proved to be inversely correlated with ROI size (R² > 0.9). As such, for a ROI smaller than the bolus size (2.5x2.5 cm²), the average displacement (1.05 cm) provides an accurate estimate of the oedema thickness (within 5%). In opposition, with a clinical ROI, the 1 cm-thick bolus was largely underestimated with an average displacement value of 0.28 cm only. To limit the impact of patient breathing on surface deformation, dynamic surface captures and the use of the corrected patient position should be privileged. Using AlignRT, a clinical workflow for breast swelling follow-up was developed to help in the decision for repeat simulation and dosimetry.
Conclusion
The surface deformation module provides an accurate, simple, and radiation-free approach to detect and quantify breast oedema during the course of radiotherapy.
... We used an affordable and portable 3D camera, which was able to create a highly accurate and reliable 3D skin surface model easily. Recently, some studies reported using 3D cameras to measure various changes in the skin caused by radiotherapy 22,23 . These showed that 3D cameras are superior to conventional photographs in detailed assessment of the occurrence and development of skin changes, and in measuring and documenting RD objectively. ...
... In the future, the accuracy and reliability of predictive models may be improved by implementing an automated system that can evaluate RD grading and can generate NTCP suitable for the specific institution and treatment technique. The 3D camera can measure both RD and also various changes to the skin, such as psoriasis, swelling, and fibrosis 22 . Some studies have reported psoriasis as the only clinical factor predictive of RD 21 . ...
Predicting the radiation dose‒toxicity relationship is important for local tumor control and patients’ quality of life. We developed a first intuitive evaluation system that directly matches the three-dimensional (3D) dose distribution with the skin surface image of patients with radiation dermatitis (RD) to predict RD in patients undergoing radiotherapy. Using an RGB-D camera, 82 3D skin surface images (3DSSIs) were acquired from 19 patients who underwent radiotherapy. 3DSSI data acquired included 3D skin surface shape and optical imaging of the area where RD occurs. Surface registration between 3D skin dose (3DSD) and 3DSSI is performed using the iterative closest point algorithm, then reconstructed as a two-dimensional color image. The developed system successfully matched 3DSSI and 3DSD, and visualized the planned dose distribution onto the patient's RD image. The dose distribution pattern was consistent with the occurrence pattern of RD. This new approach facilitated the evaluation of the direct correlation between skin-dose distribution and RD and, therefore, provides a potential to predict the probability of RD and thereby decrease RD severity by enabling informed treatment decision making by physicians. However, the results need to be interpreted with caution due to the small sample size.
... It is also being used for ever more complex tasks in maxillofacial surgery [2] and is finding application for augmented reality and virtual reality [3]. Clinicians of a growing number of medical disciplines effectively apply this radiation-free and cost-efficient technology to monitor specific anatomical regions, such as the breast [4,5], face [6,7], or leg [7,8]. ...
Whole-body three-dimensional surface imaging (3DSI) offers the ability to monitor morphologic changes in multiple areas without the need to individually scan every anatomical region of interest. One area of application is the digital quantification of leg volume. Certain types of morphology do not permit complete circumferential scan of the leg surface. A workflow capable of precisely estimating the missing data is therefore required. We thus aimed to describe and apply a novel workflow to collect bilateral leg volume measurements from whole-body 3D surface scans regardless of leg morphology and to assess workflow precision. For each study participant, whole-body 3DSI was conducted twice successively in a single session with subject repositioning between scans. Paired samples of bilateral leg volume were calculated from the 3D surface data, with workflow variations for complete and limited leg surface visibility. Workflow precision was assessed by calculating the relative percent differences between repeated leg volumes. A total of 82 subjects were included in this study. The mean relative differences between paired left and right leg volumes were 0.73 ± 0.62% and 0.82 ± 0.65%. The workflow variations for completely and partially visible leg surfaces yielded similarly low values. The workflow examined in this study provides a precise method to digitally monitor leg volume regardless of leg morphology. It could aid in objectively comparing medical treatment options of the leg in a clinical setting. Whole-body scans acquired using the described 3DSI routine may allow simultaneous assessment of other changes in body morphology after further validation.
... Since disease-free tissue is free of nanoparticles and thus invisible to MPI, this requires a second co-registered imaging modality. Since only the surface location is needed, this could be readily supplied by a 3D optical surface scanner 97,98 prior to insertion www.nature.com/scientificreports/ in the MPI. The results in Fig. 11 show this registered with 2D optical images as opposed to 3D. ...
Breast-conserving surgery (BCS) is a commonly utilized treatment for early stage breast cancers but has relatively high reexcision rates due to post-surgical identification of positive margins. A fast, specific, sensitive, easy-to-use tool for assessing margins intraoperatively could reduce the need for additional surgeries, and while many techniques have been explored, the clinical need is still unmet. We assess the potential of Magnetic Particle Imaging (MPI) for intraoperative margin assessment in BCS, using a passively or actively tumor-targeted iron oxide agent and two hardware devices: a hand-held Magnetic Particle detector for identifying residual tumor in the breast, and a small-bore MPI scanner for quickly imaging the tumor distribution in the excised specimen. Here, we present both hardware systems and demonstrate proof-of-concept detection and imaging of clinically relevant phantoms.
... software. Using a portable Artec Eva Scanner, three-dimensional surface images (3D-SI) were recorded for the analysis of breast volumes, and changes in skin appearances for patients receiving radiation treatment [24]. Since both the breast volume and shape symmetry correlated strongly with the subjective assessment scores, the 3D-SI technique was proven to be fast and reliable in determining the breast aesthetic outcome [25]. ...
... Volumetric analysis can be used to document changes in breast morphology and is described in several studies. [10][11][12][13] However, there are a few studies available directly comparing 3D breast volume with MRI measured volume of the breast, which is the best objective standard for breast volume. Kovacs et al. have a limited study population of 12 breasts in 6 patients. ...
Three-dimensional (3D) camera systems are increasingly used for computerized volume calculations. In this study we investigate whether the Vectra XT 3D imaging system is a reliable tool for determination of breast volume in clinical practice. It is compared with the current gold standard in literature, magnetic resonance imaging (MRI), and current clinical practice (plastic surgeon's clinical estimation).
Methods:
Breast volumes of 29 patients (53 breasts) were evaluated. 3D images were acquired by Vectra XT 3D imaging system. Pre-existing breast MRI images were collected. Both imaging techniques were used for volume analyses, calculated by two independent investigators. Breast volume estimations were done by plastic surgeons during outpatient consultations. All volume measurements were compared using paired samples t-test, intra-class correlation coefficient, Pearson's correlation, and Bland-Altman analysis.
Results:
Two 3D breast volume measurements showed an excellent reliability (intra-class correlation coefficient: 0.991), which was comparable to the reliability of MRI measurements (intra-class correlation coefficient: 0.990). Mean (SD) breast volume measured with 3D breast volume was 454 cm3 (157) and with MRI was 687 cm3 (312). These volumes were significantly different, but a linear association could be found: y(MRI) = 1.58 × (3D) - 40. Three-dimensional breast volume was not significantly different from volume estimation made by plastic surgeons (472 cm3 (69), P = 0.323).
Conclusions:
The 3D imaging system measures lower volumes for breasts than MRI. However, 3D measurements show a linear association with MRI and have excellent reliability, making them an objective and reproducible measuring method suitable for clinical practice.
... As these conventional 3D scanning systems are immovable workstations, there has been interest in using handheld structured-light scanners to objectively assess breast morphology. Examples of handheld scanning systems are the Artec Eva Scanner (Artec 3D Inc., Luxembourg, Luxembourg), the iSense (3D Systems, Rock Hill, SC, USA), and the Kinect Recording System (Microsoft, Redmond, WA, USA) [10][11][12][13][14][15][16] . Although it is convenient to use handheld devices for breast surface imaging, validation studies reported measurement errors of 2.5 mm and breast volume error of 10% 14,17 . ...
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.
