Three-dimensional Surface Imaging for Clinical Decision Making in Pectus Excavatum

Area of Science:

• Medical Imaging
• Thoracic Surgery
• Pediatric Surgery

Background:

• Pectus excavatum evaluation traditionally uses computed tomography (CT) or radiographs, involving radiation exposure.
• Conventional Haller and correction indices rely on internal measurements, making them unsuitable for 3D surface imaging.
• Lack of established cut-off values for external 3D imaging indices hinders surgical candidacy assessment.

Purpose of the Study:

• To establish cut-off values for external 3D imaging indices in pectus excavatum.
• To validate 3D surface imaging as a radiation-free alternative for surgical decision-making.

Main Methods:

• Prospective cohort study including patients with suspected pectus excavatum.
• Acquisition of 3D surface images alongside CT (adults) or radiographs (pediatrics).
• Calculation of external Haller and external correction indices; ROC curve analysis to determine optimal cut-off values.

Main Results:

• Optimal cut-off for external Haller index: ≥1.83 (PPV 0.90-0.97, NPV 0.72-0.81).
• Optimal cut-off for external correction index: ≥15.2% (PPV 0.86, NPV 0.93).
• Both indices demonstrated high accuracy in predicting surgical candidacy.

Conclusions:

• External Haller index (≥1.83) and external correction index (≥15.2%) derived from 3D imaging are accurate, radiation-free tools.
• These indices facilitate surgical decision-making for pectus excavatum.
• 3D surface imaging provides a valuable alternative to radiation-based methods.