Use of CT scans in selection of patients for pectusexcavatum surgery: A preliminary report

Haller, Julia A.; Kramer, Sandra S.; Lietman, Steven A.

doi:10.1016/s0022-3468(87)80585-7

Cited by 629 publications

(360 citation statements)

References 6 publications

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“…Patients were classified as having PE based on physical examination at the time of consult, which was confirmed upon review of axial imaging (Figure 1). Thoracic surgeons initially developed the HI to quantify the degree of the pectus deformity by comparing the ratio of the lateral diameter of the chest and the distance from sternum to anterior vertebral body at the point of maximal depression (Figure 2) on CT scan (9). Among thoracic surgeons, a calculated HI of >3.25 designates PE which may benefit from surgical correction.…”

Section: Methodsmentioning

confidence: 99%

Chest Wall Deformity in the Radiation Oncology Clinic

Stahl

Hong

Lester-Coll

et al. 2016

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Abstract. Background Adjuvant radiation therapy for women with breast cancer is associated with a reduction in local recurrence and, in many patients, a survival benefit (1, 2). As risk of cardiac events is correlated with the mean heart radiation dose (MHD), radiation oncological planning often focuses on techniques to reduce the MHD in women with left-sided breast cancer (3). Individual anatomic variation, including breast size, breast ptosis, tumor bed location, heart position and chest wall shape, all impact the ability of the radiation oncologist to achieve optimal MHD. In particular, pectus excavatum (PE) has been identified as a challenging situation for treatment planning in breast cancer.PE is a congenital deformity of the chest wall associated with sternal depression. It accounts for about 90% of anterior chest wall disorders and has an incidence of one in 400 to one in 1,000 births (4). PE is about four times more prevalent in males than females (5). Classically, PE has been measured on computed tomography (CT) by the Haller index (HI), which is used to determine which patients might benefit from surgical correction. PE is well recognized as a condition which may increase MHD during left-sided breast radiation, prompting the investigation of several radiotherapy techniques to address this clinical problem, including intensity-modulated radiation therapy (6), deep inspiration breath-hold technique (DIBH) (7), and lateral decubitus positioning (8).The purpose of this analysis was to determine the incidence of PE in women treated with radiation therapy for breast cancer at our Institution and to define anatomical chest wall metrics predictive of elevated MHD in patients undergoing breast radiotherapy. Patients and MethodsData source and study cohort. We retrospectively reviewed the records of 273 patients consecutively simulated for left-sided breast cancer or at our Institution between January 2013 and December 2014. The Yale Institutional Review Board approved this study (#150301553). Patients underwent 3-dimensionsal conformal planning, with either forward planned fixed gantry field-in-field technique or wedges as indicated by individual patient geometry. Cardiac segmentation included both cardiac muscle and the pericardium, starting at the branch point of the pulmonary arteries and continuing inferiorly to the cardiac apex. The MHD was recorded from the treatment planning system using heterogeneity corrections (Eclipse Version 13.6; Varian, Palo Alto, CA, USA). Contribution to MHD from supraclavicular, axillary, or boost fields was not considered in the measurement of MHD. Patients with PE who were treated with DIBH were also retrospectively re-planned on their free breathing (FB) CT scan for comparison.Variables. Patients were classified as having PE based on physical examination at the time of consult, which was confirmed upon review of axial imaging (Figure 1). Thoracic surgeons initially developed the HI to quantify the degree of the pectus deformity by 5295 This article is freely accessible onli...

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Section: Methodsmentioning

confidence: 99%

Chest Wall Deformity in the Radiation Oncology Clinic

Stahl

Hong

Lester-Coll

et al. 2016

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“…The former is the ratio between the vertebral body diameter and the distance between the xiphisternal junction and the posterior border of the vertebral body [3]. The Haller index is currently the gold standard for assessing the severity of pectus excavatum, and is based on computed tomography (CT) of the chest [4,17,18]. The index is calculated as the ratio between the maximum laterolateral distance and the minimum anteroposterior distance from the anterior portion of the vertebral body to the posterior surface of the sternum.…”

Section: Diagnosis and Stratification Of Pectus Deformitiesmentioning

confidence: 99%

Advances in the management of pectus deformities in children

Swergold¹,

Sridharan²,

Loukas³

et al. 2013

OJPed

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Pectus excavatum (PE) and pectus carinatum (PC) are relatively common deformities involving the anterior chest wall, occurring in 1:1000 and 1:1500 live births, respectively. While the etiology remains an enigma, the association of pectus deformities with other skeletal abnormalities suggests that connective tissue disease may play a role in their pathogenesis. Clinical features of these deformities vary with severity, as determined by the Haller index and Backer ratio, but frequently include cardiac and respiratory abnormalities. Importantly, there exist profound psychosocial implications for children afflicted with these deformities, including but not limited to feelings of embarrassment and maladaptive social behaviors. These debilitating characteristics have prompted the development of novel medical and surgical corrective techniques. The correction of pectus deformities reduces the incidence of physiological complications secondary to chest wall malformation, while simultaneously improving body image and psychosocial development in the affected pediatric population. The Ravitch (open) and Nuss (minimally invasive) procedures remain the most frequently employed methods of pectus deformity repair, with no difference in overall complication rates, though individual complication rates vary with treatment. The Nuss procedure is associated with a higher rate of recurrence due to bar migration, hemothorax, and pneumothorax. Postoperative pain management is markedly more difficult in patients who have undergone Nuss repair. Patients undergoing the Ravitch procedure require less postoperative analgesia, but have longer operation times and a larger surgical scar. The cosmetic results of the Nuss procedure and its minimally invasive nature make it preferable to the Ravitch repair. Newer treatment modalities, including the vacuum bell, magnetic mini-mover procedure (3MP), and dynamic compression bracing (DCB) appear promising, and may ultimately provide effective methods of noninvasive repair. However, these modalities suffer from a lack of extensive published evidence, and the limited number of studies currently published fail to adequately define their long-term effectiveness.

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“…For children with pectus excavatum (PE), Haller et al 3) reported a reliable method for measuring chest wall deformity in the transverse plane, using X-ray computed tomography (CT). In addition to this method, Lawson et al 4) recently began measuring the asymmetry of the chest wall in children with pectus excavatum.…”

Section: Introductionmentioning

confidence: 99%

Reliability of Two Protocols for Measuring Chest Wall Dimensions in the Transverse Plane in Individuals with Severe Motor and Intellectual Disabilities

et al. 2011

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Abstract.[Purpose] The present study aimed to estimate the reliability of two protocols for measuring chest wall dimensions in the transverse plane in individuals (18 males, 12 females) aged 2 years 6 months to 58 years (mean age 34.7 ± 17.6) with Severe Motor and Intellectual Disabilities (SMID). [Subjects and Methods] For diagnosing pneumonia in individuals with SMID, 30 X-ray computed tomograms were taken at the level of the xiphisternal junction, scanned, and saved on a personal computer. Five therapists examined these images. Anteroposterior (AP) and laterolateral (LL) diameters were measured using two protocols. The largest AP and LL diameters were measured along the gravity line (protocol 1) and along the line where the middle point of the sternum connects with the spinous process of the vertebra (protocol 2). Intraclass correlation coefficients (ICCs) were calculated to estimate the intrarater and interrater reliability of each protocol.[Results] ICCs were >0.85 in protocols 1 and 2 for all measurements, showing these protocols are highly reliable for measuring chest wall dimensions in the transverse plane. [Conclusions] Measurements using these protocols are easy and cheap, and can be performed retrospectively, providing an effective way for evaluating chest wall deformity in individuals with SMID.

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Use of CT scans in selection of patients for pectusexcavatum surgery: A preliminary report

Cited by 629 publications

References 6 publications

Chest Wall Deformity in the Radiation Oncology Clinic

Chest Wall Deformity in the Radiation Oncology Clinic

Advances in the management of pectus deformities in children

Reliability of Two Protocols for Measuring Chest Wall Dimensions in the Transverse Plane in Individuals with Severe Motor and Intellectual Disabilities

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