The laser scan three-dimensional device allows a quick and reproducible measurement of the upper limb volume without requiring direct contact with the skin of patients. In addition, the technology is inexpensive, user friendly, reproducible, and extremely precise even in the presence of gibbousness and swelling. Demonstrating the procedure will be Dr.Lorenzo Lippi from our research group.
Begin by installing a free downloadable 3D laser scanning application on a tablet computer. Next, use a marker of the highest contrast color compared to the skin of the patient to mark the skin of the upper limb to be analyzed at five centimeter landmarks starting from the wrist to the elbow and from the elbow to the proximal portion of the arm. Draw circumferences around the upper limb to be analyzed at the level of each landmark and position the patient in an upright position in a room with sufficient space to move around them.
Raise the patient's upper limb anteriorly by 90 degrees and ask the patient to remain in this position without moving for the entire duration of the scan. Link a 3D laser scanner device to the tablet and open the 3D laser scanner application. Enter the credentials of the patient into the patient database and click connection and plus to enter a new patient.
When all of the patient information has been entered, click the 3D icon and use two fingers to adjust the distance and size of the cube on the screen to select the area to be examined. Click scan and start the three-dimensional scan, framing the upper limb of the patient on all of the planes of the space, rotating around the limb from all angles multiple times to optimize the quality of the acquired image. When the acquisition is complete, press done.
Then revise the form to assess any acquisition defects or missing parts as necessary. Next, select the acquisition and press the icon to enter an email and send the file. On the desktop computer, download the data sent by email and insert a USB drive with the software license for the 3D laser scanner software.
After opening the data file, view the scan and click create new patient. Under the file menu, select the patient file and select the scan. Click extract.
Select the extracted scan and click cleaning. Next, select the image and orient the image in the space using the skin landmarks to cut off any segments included in the scan on the various axes as necessary. Validate the cut figure and name the shape obtained from the scan.
Click create a new shape to orient the shape axis on the three planes of the space. Click next and wait for the generation of the final form and click end. Select the processed form and click open.
The software will provide the total volume of the processed form. Then click volume to calculate the volume of the different sections and move and select the upper and lower margin of the section from which to extract the volume. In this representative study, 30 healthy male and female adults and 30 breast cancer female patients who later developed breast cancer-related lymphedema were evaluated.
Arm volume measurements were performed using both the circumferential and 3D laser scanner methods. In both groups, both methods demonstrated high levels of inter and intraoperator reproducibility with a mean R squared of 0.99 for both techniques. Accordingly, the mean value of the 3D laser scanner volume calculations also showed a strong correlation with those from the circumferential method in both groups as confirmed by the Bland-Altman plot showing a high level of agreement and consistency between the two different measurements.
Furthermore, although differences were observed before and after complex decongestive treatment for both techniques in the breast cancer patient group, the 3D laser scanner method correlation was higher than that observed for the circumferential method. This procedure can be used in any physiological or pathological condition that require a volumetric evaluation of any part of the body. The use of this technique in a clinical setting can solve several issues related to the standardization of volumetric measurements in breast cancer-related lymphedema.
