David A. Gilbert

Theory and Practical Steps to Introducing a New 3D Public Health Indicator to Replace BMI Using Existing Population-Based Multidimensional Reference Measurement Sets

Body Mass Index is an aging public health indicator obesity measurement, based solely on height and weight. Despite its shortcomings, it has gained acceptance over time primarily because of its simplicity, and it has been applied not only to individuals, but also to various population groups. Calls to replace BMI with a more modern indicator within the medical community have been growing louder, but the medical community moves very slow and acceptance of a multidimensional health indicator appears to most to be far off. However, by using multinational 3D sizing studies done over the years by the clothing industry, the introduction of a 3D public health indicator as well as a multidimensional population measurement reference set can be implemented in the very near future.

Longitudinal Statistical Analysis of Weight, Volume, Surface Area and Circumferential Measurements for a Female Bariatric Population

One “rule of thumb” for evaluating a successful outcome for a gastric bypass or sleeve bariatric surgical procedure is to monitor the subject’s “% Excess Weight Loss.” In general, the desired goal is to achieve 75% “Excess Weight Loss” around 1 year after their surgical procedure. This figure is not exact. There may be a number of reasons why a particular patient may not achieve this outcome. These could range from certain medical conditions or medicinal regimes to a lack of embracing the lifestyle changes that are required to achieve the optimal outcome after surgery. Nonetheless it is a benchmark commonly used in practice today. What is not known is the relationship, if any, between weight loss and the physical changes to the individual’s body shape and their measurements, including volume and surface area as it undergoes this dramatic transition.

Categorizing the Morbidly Obese Body Shape and Estimating Body Appearance Outcome before Weight Loss Surgery Using 3D Anthropometric Data

Categorizing the physical shape of the morbidly obese has always been an inexact science. Surgeons can readily identify extreme shapes such as “android” or “gynecoid,” but will have various opinions as to the shape individuals that present between these two extremes. Yet the physical shape characteristics of a morbidly obese person is often an indicator as to the potential difficulty of the pending surgery. A new set of mathematical equations has been developed to classify “Primary Shape” and “Shape Tendency.” These were developed using linear and circumferential measurements, volume and surface data, and the height of certain measurements provided by 3D booth scanning of morbidly obese individuals. With few exceptions, it has been found that these “Shape Descriptors” remain consistent throughout the massive weight loss experience. This finding, combined with longitudinal data collected by scanning, aggregating and de-identifying thousands of individuals who underwent a bariatric surgical procedure offers a statistical approach to estimate body appearance outcome prior to actual weight loss surgery. In turn, this provides a realistic motivational tool to the morbidly obese individual and opens up avenues within the Body Image Assessment and Body Image Dissatisfaction realms of research.

3D Body Scanning - An Important Tool for Digital Archiving of Cosmetic Surgery Procedures

Background At the end of 2002, a 3D whole-body white light scanner was introduced into a cosmetic surgery practice in Norfolk, Virginia. The stated purpose was to investigate this device as an aid for evaluating body contouring procedures. For the first time, the surgeon could pre-operatively scan a patient, measure “body areas of interest,” and examine in detail the patient’s 3D body contours to help plan for the pending surgical procedure. Multiple, custom designed measurement templates were then applied to the 3D body model to extract measurements pertinent to the surgical procedure. The pre-operative 3D body model was stored. Post-operative scans of the patient would then be taken periodically, and measured with the same measurement templates. The difference in measurements, including volume and surface area document the physical changes of patient’s body resulting from the procedure. Many cosmetic surgery patients return for additional procedures over the course of years. The patient’s 3D digital archive provides the surgeon with the ability to consult previous 3D body models and evaluate the measurement changes of past procedures. These unique insights, combined with a current 3D scan and traditional medical information form a contiguous and robust foundation for assessing the pending surgical procedure. Methods Three case examples are presented. Case 1 considers multiple cosmetic procedures performed in a close succession and the 3D scans and measurement templates used for pre-operative and postoperative evaluation. Case 2 presents an example 3D body scans of sequential cosmetic surgical procedures to replace and rebuild the left and right breasts of a subject. Case 3 involves multiple cosmetic procedures performed on the same patient over a period of years. In each case, the patient’s 3D digital archive played an important role in documenting each surgical procedure and provided a platform to evaluate the contours of the patient for the pending surgery. Discussion A 3D whole-body scan is an independent entity. It represents the accurate physical appearance of the subject standing in the scan chamber as of the date and time of scan acquisition. A cosmetic surgery patient may undergo multiple procedures at once, such as breast reduction and abdominoplasty. The result of each procedure can be measured by applying separate customized measurement templates to the post-operative 3D body model. The patient may also undergo a sequence of procedures over time. Each post-operative 3D body model can be evaluated independently. The entire set of preoperative and post-operative 3D body scans form a historical 3D digital archive and can be appended to the traditional patient medical record. Conclusion The utility of a 3D whole-body scanner is in its ability to create an accurate 3D body model of the subject within the scan chamber, thereby creating a permanent 3D record once stored. A “clean” 3D scan documents the subject’s physical body. Measurements can be extracted at any time as appropriate, but the archived 3D body model is the important record. Subsequent body scans can be measured and compared to the initial body scan. Many cosmetic surgery procedures result in immediate physical changes to the body. Each post-operative scan documents these changes. Successive post-operative scans form the patient’s 3D digital archive. This archive can serve as the basis for further surgical planning, validating surgical results, or can be used as a tool for independently assessing surgical outcomes. Proceedings of 3DBODY.TECH 2017 8th International Conference and Exhibition on 3D Body Scanning and Processing Technologies, Montreal, Canada, 11-12 Oct. 2017

A Survey of Measurement Templates Used for Assessing Pre-Operative Body Contours and Evaluating Cosmetic Surgery Results Using a 3D Whole-Body Scanner

Background A 3D whole-body scanner has been utilized at a cosmetic surgery practice in Norfolk, Virginia since 2002. Pre-operative and post-operative scans have been taken of many patients that have undergone various cosmetic surgical procedures. Through trial, error and analysis, various measurement templates have been designed as an aid for the surgeon to assess the pre-operative body contours and to evaluate the post-operative results of common cosmetic procedures. This paper presents measurement templates that have been found to be useful for breast augmentation, breast reduction, abdominoplasty and thigh-lift surgical procedures. Methods Manual measurements have traditionally been used to evaluate the body contours of the pre-operative patient. These are typically of linear and circumferential nature. Many of the manual measurements made by the surgeon are replicated within the scanner measurement software. These can be selected and programmed into a measurement template, which can then be applied to the patient’s 3D body model to automatically extract the desired information. The scanner measurement software can produce multidimensional measurement information such as surface area and volume. Such measurement tools were previously unavailable. There are many measurements provided by scanning software that are beneficial to enhance the pre-operative evaluation, perhaps too many. These include linear contours, the height of certain measurements and uncommon circumferential measurements. The measurement templates presented are a result of experience. Case 1 and Case 2 detail the measurement template used for evaluating breast augmentation and breast reduction procedures. Case 3 is an example of the measurement template used for evaluating an abdominoplasty procedure. The measurements utilized for abdominoplasty center around the mid-section of the body. Case 4 is an example of the template used for evaluating a thigh-lift. The measurements utilized are focused on the lower half of the body. Discussion Applying procedure-specific measurements to a pre-operative 3D body scan can help detect and quantify existing asymmetries. These asymmetries may be corrected during the surgical procedure through proper planning. Breast augmentation, reduction, abdominoplasty and thigh-lift surgical procedures have immediate impact on the body. These changes can be measured longitudinally as patients return for post-operative visits. The effects of edema (swelling) can be documented with each post-operative 3D body scan. The edema usually abates within six months and the 3D body scans thereafter can be compared with the pre-operative 3D body scan to quantify the physical changes brought about by the surgical procedure. Changes in volume can be reviewed against the weight of the actual amount of tissue removed in cases of breast reduction, thigh lift, or abdominoplasty. In the case of breast augmentation, changes in post-operative bust volume can be compared to the size of the breast implants inserted. Conclusion The measurement templates used to document the cosmetic surgical procedures discussed have evolved over time. They are in no way final or complete, but they have added considerable multidimensional insight into evaluating pre-operative body contours and documenting any pre-existing asymmetric conditions. Applying these templates to post-operative 3D body scans quantifies the physical changes brought by the surgical procedure, including the correction of detected asymmetries. Moreover, the series of pre-operative and post-operative 3D body scans form the patient’s 3D digital archive. As new measurements are added to the existing measurement templates, they can be applied to 3D body models of past surgical procedures for investigation and validation. Proceedings of 3DBODY.TECH 2017 8th International Conference and Exhibition on 3D Body Scanning and Processing Technologies, Montreal, Canada, 11-12 Oct. 2017

The Usefulness of a 3D Whole-Body Scanner for Uncommon Cosmetic Surgery Procedures

Background A 3D whole-body scanner appears to be best suited for measuring and documenting cosmetic surgical procedures that result in significant changes to the body. These procedures include breast augmentation, breast reduction and abdominoplasty. It is less useful for measuring changes resulting from procedures such as lipoplasty, which do not immediately result in pronounced changes of body contours. This paper presents examples of 3D whole-body scanning for less common cosmetic surgery procedures, and explores the usefulness of the 3D scanner as an aid for evaluating the pre-operative condition and as a tool for measuring and documenting post-operative changes of these surgeries. Methods A 3D whole-body scanner has been deployed for use in a cosmetic surgery practice in Norfolk, Virginia since 2002. Over the course of time, pre-operative and post-operative body scans from a wide range of cosmetic procedures have been collected. The 3D body scanner has shown its utility in capturing accurate whole-body models of subjects that underwent various surgical procedures. The scanner’s measurement capabilities appear to be more effective for certain procedures and less useful for others. Case 1 examines circumferential pannulectomy. Case 2 examines a gluteal implant procedure. Case 3 examines a brachioplasty procedure. Case 4 examines chest contouring procedures. Discussion A general purpose, 3D whole-body scanner has certain limitations. It lacks definition for some regions of the body. This type of scanner is of little use for facial, hand or foot procedures, as these are outside the scanner’s coverage area. In the case of a pannulectomy or gluteal implants, changes to the body are significant and the measurements are meaningful. The scanner provides less utility for procedures involving release of recessed body parts or removal of small growths. In these cases, pre-operative and post-operative measurements show little difference. The fixed position of the subject in the scan chamber limits the coverage for procedures related to the arms and neck. The 3D body scanner excels in coverage of the male chest region and is useful in chest contouring and gynecomastia procedures. The body scanner also has excellent coverage of the back side of the patient, including the buttocks region. Summary A 3D whole-body scanner has its place as a tool to document the pre-operative subject’s body and measure overall dimensions. This has its own benefit as part of a 3D digital archive. In certain procedures, these body models and measurements can assist the surgeon in evaluating the subject’s pre-operative body contours and act as an aid for planning the pending surgery. Post-operative measurements faithfully document the results of these surgeries. The 3D whole-body scanner is not as effective in measuring procedures that result in less pronounced changes to the body, such as lipoplasty, removal of small growths, or procedures that are beyond the coverage area of the scanner. A table at the end of this paper enumerates the type of cosmetic surgeries performed, and the surgeon’s opinion as to the usefulness of the 3D scanner as an aid for pre-operative body contour evaluation or as a tool to measure and document post-operative surgical results. Proceedings of 3DBODY.TECH 2017 8th International Conference and Exhibition on 3D Body Scanning and Processing Technologies, Montreal, Canada, 11-12 Oct. 2017

New Tools for Body Image Analysis: A Modern Framework Using 3D Body Scanning

Body Image Analysis (BIA) is an important area of research. It attempts to assess how the subject perceives their physical appearance, which can often differ substantially with the actual appearance of their body. One practical application is its use in qualifying bariatric patients prior to undertaking a weight loss surgery procedure. The psychologist plays as important a part in approving the weight loss surgery as the surgeon. The psychologist must undercover disorders such as binge eating and other behavioral distortions that may jeopardize successful surgical results or complicate surgical recovery. The early visual tools used for BIA were developed in the 1970s and early 1980s and have remained relatively stagnant. This paper discusses replacing the traditional 2D paper diagrams in use today with realistic 3D body scanning images. It also provides architectural framework options to incorporate and expand the use of a 3D body scanner within a weight loss surgery clinic or conduct BIA within a cloud based environment without the use of an on-site 3D body scanner.

The Cycle of the Shape Descriptor Suite: When do People Become Overweight

An enormous amount of anthropometric data has been collected over the last decade from using 3D body scanners to measure morbidly obese subjects prior to bariatric surgery. Even more anthropometric data has been collected by scanning these individuals post-operatively on a periodic basis. A set of shape descriptors and new adiposity indices were developed. These have been previously described and presented 1,2 . The shape descriptors mathematically classify the shape of the obese. The adiposity indicators use volume and surface units to define the degree of obesity by determining the amount of “space” occupied versus traditional weight and height and they are general in nature. When these formulas are combined and applied to scan images covering individuals ranging from visually thin to somewhat obese, an interesting phenomenon occurs. Thin individuals, regardless of gender, have similar shape descriptor values. As these formulas are applied to scans of individuals who appear slightly overweight to noticeably overweight, the shape descriptors begin to mathematically differentiate physical shapes and the ratio of torso volume and torso surface area rapidly changes. This paper investigates how the 3D adiposity indicators and the shape descriptors interact to detect the onset of excess weight that can lead to the obese condition.

Lost in Translation? Coping with Multiple Scanner Vendors in a Commercial Environment

Changes in scanning technology and the emergence of additional scanner providers are, on the whole, a healthy sign for the industry. It gives users of scanning technology the choice of vendors, and minimizes the possibilities of becoming captive to a particular scanner manufacturer. However, with choice comes challenges in integrating a new scanner vendor into the existing production scanner network. Each vendor has their own measurement software with specific capabilities and it is not reasonable to operate multiple software measurement platforms in a production environment. By using a data modeling program that accepts multiple 3D formats, one can convert the various vendor scanner outputs into a common file format. A data utility program then converts these files to a format to be measured and processed on a commercial basis. In all conversions there are distortions. Quantifying this distortion is possible, but at best it can only be considered to be within an estimation range. The question is whether this distortion during the conversion process is significant.

Integrating a 3D Body Scanner into an Active Bariatric Surgery Clinic - Practical Experiences, History, Tips and Pitfalls

In late 2005, a 3D whole body scanner began to be used to measure morbidly obese (bariatric) patients prior to surgery. This scanner was located in a cosmetic surgeon’s office. The volume of scans for these bariatric patients soon began to overwhelm the cosmetic surgery practice’s staff. In early 2007, a 3D scanner was placed directly into the bariatric surgery clinic. Protocols were written to streamline and define the bariatric clinic’s staff involvement and to seamlessly integrate the scanner into the clinic’s daily operations. Meaningful reports were designed and a mechanism was created to distribute them to the patients. A billing system was also introduced. Since that time, improvements to scanner technology has led to several scanner replacements, with only slight changes to the overall protocol framework.