Utilizing Pre- and Postoperative CT to Validate an Instrument for Quantifying Pectus Excavatum Severity
An instrument that objectively quantifies a condition’s severity and its improvement after treatment is of great use. This is also the case for pectus excavatum (PE), a congenital chest wall deformity, for which several severity indices have been introduc
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Pediatric Thoracic Surgery Beijing, Children’s Hospital, Capital Medical University, Beijing, China [email protected], [email protected] 2 Modeling, Simulation and Visualization Engineering, Old Dominion University, Norfolk, USA {nkida001,mobei001,rdmckenz}@odu.edu 3 Ocean Lakes High School, Virginia Beach, USA [email protected] Clinical Surgery/Pediatrics, Children’s Hospital of The King’s Daughters and EVMS, Norfolk, USA [email protected]
Abstract. An instrument that objectively quantifies a condition’s severity and its improvement after treatment is of great use. This is also the case for pectus excavatum (PE), a congenital chest wall deformity, for which several severity indices have been introduced. This work describes a system that utilizes chest surface scans generated from CT-data or optical scanning to provide a gauge and visualization of chest wall deviations. A validation experiment is conducted to evaluate the fidelity of such an instrument utilizing pre- and postoperative CT scans. Statistical analysis shows the ability of the instrument to accurately recog‐ nize changes in the chest surface profile. Keywords: Pectus excavatum · Registration · Validation
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Introduction
Pectus excavatum (PE), also called sunken or funnel chest, is a congenital chest wall deformity characterized by a deep depression of the sternum and accounts for about 90 % of congenital chest wall abnormalities in children [1]. PE occurs approximately once in every 400 births and is often accompanied by other problems such as scoliosis and breathing issues [2]. A surgical intervention is generally recommended for a patient with a Haller Index (HI) larger than 3.25. Haller index (HI), introduced in 1987 and considered a gold standard for assessing Pectus Excavatum (PE) severity, is evaluated with computed tomography (CT) [3]. For less severe cases, conservative treatments that involve gradual changes of the chest wall have been developed [4, 5].
© Springer Science+Business Media Singapore 2016 L. Zhang et al. (Eds.): AsiaSim 2016/SCS AutumnSim 2016, Part III, CCIS 645, pp. 451–456, 2016. DOI: 10.1007/978-981-10-2669-0_48
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In addition to HI, several indices have been introduced to quantify PE deformity and severity using chest CT scans [6]. However, such scans are not widely available postoperatively due to the intent to limit ionizing radiation exposure and avoid asso‐ ciated costs. This makes obtaining the aforementioned indices, including HI, very challenging for assessing post-treatment improvements for both surgical and conser‐ vative interventions. While some have proposed the use of rudimentary techniques for external measure‐ ments of the chest such as chest cyrtometry with a metric tape [7] or simple linear measurements using cylindrical rulers, others explored the use of optical scanning for creating an external profile of the chest surface to quantify the deformation. While the optical scanning approach is very beneficial, the systems used were stationary and rela‐ tively expensive. Furth
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