Chest Modeling and Personalized Surgical Planning for Pectus Excavatum

Abstract

Abstract. Pectus excavatum is among the most common major congenital anomalies of the chest wall whose correction can be performed via minimally invasive Nuss technique that places a pectus bar to elevate the sternum anteriorly. However, the size and bending of the pectus bar are manually modeled intraoperatively by trial-and-error. The procedure requires intense pain management in the months following surgery. In response, we are developing a novel distraction device for incremental and personalized PE correction with minimal risk and pain, akin to orthodontic treatment using dental braces. To design the device, we propose in this study a personalized surgical planning framework for PE correction from clinical noncontrast CT. First, we segment the ribs and sternum via kernel graph cuts. Then costal cartilages, which have very low contrast in noncontrast CT, are modeled as 3D anatomical curves using the cosine series representation and estimated using a statistical shape model. The size and shape of the correction device are estimated through model fitting. Finally, the corrected/post-surgical chest is simulated in relation to the estimated shape of correction device. The root mean square mesh distance between the estimated cartilages and ground truth on 30 noncontrast CT scans was 1.28±0.81 mm. Our method found that the average deformation of the sterna and cartilages with the simulation of PE correction was 49.71±10.11 mm.

The True‐Blue technique: Enhanced chondral assessment of the chest wall

“…Augmented and virtual reality are also being explored, with promising implications for diagnosis and preoperative planning 17 . Artificial‐intelligence driven segmentation for costal cartilage has been shown to create 3D reconstructions accurately and efficiently, in a fraction of the time of manual segmentation 18,19 . While promising, these methods are still very new and would likely be a major leap for most providers to take.…”

Assessment and treatment of pectus deformities: a review of reverse engineering and 3D printing techniques

“…The short time, low cost, and extreme accuracy of replicas AM technologies offer are the main advantages that explain the introduction of simulation and planning as a standard for the preparation of some surgeries. Wei et al (2010), Zhao et al (2014), Zhong et al (2014), Matsuo et al (2018), Tse et al (2018), Wang et al (2020), Martinez et al (2021) exploited preoperative simulation to plan the PE correction surgery. In Wei et al (2010), Zhong et al (2014), Tse et al (2018), digital 3D models of the patient-specific anatomies were used to study the optimal geometry of the bar and the aesthetic outcome of the surgery, exploiting also finite element method tools.…”

“…To perform customized modelling of the bar without subjecting the patient to ionizing radiation with CT, (Rodrigues et al , 2014) proposed an artificial neural network network to estimate the position of the ribs from the external profile of the thorax, which is obtainable with optical instruments. Zhao et al (2014) offered the design of a bar based on an estimated model of the costal cartilages that is based on the use of statistical models; the correction device was designed and developed based on such a model.…”

The Role of Three-Dimensional Printing in the Nuss Procedure: Three-Dimensional Printed Model-Assisted Nuss Procedure

“…Traditionally, the length of the pectus bar is determined by measuring the distance between the midaxillary lines with a measuring tape and subtracting 2.5 cm [1]. Although the Nuss procedure has become the standard for surgical PE intervention [2], the size and curvature of the pectus bar are determined by trial and error with repeated insertions and flips of the pectus bar [3][4][5]. These readjustments are bothersome and potentially hazardous.…”

“…The Nuss procedure, first reported in 1998 by Nuss and associates [1], is the placement of a pectus bar to elevate the sternum anteriorly. Although the Nuss procedure has become the standard of surgical intervention for PE [2], the size and curvature of the pectus bar is determined by trial and error by repeated insertion and flipping of the pectus bar [3][4][5].…”