Proposed Workflow and Standardization of Pre- and Post-Operative Images Using a Novel Dynamic Imaging Capture System
While two-dimensional (2D) and three-dimensional (3D) photography are the most commonly used imaging modalities in plastic surgery, there are many factors, such as positioning, lighting, and distance, that must be controlled in order to obtain comparable pre- and post-operative images. Furthermore, traditional modalities lack the ability to assess form, functionality, and skin elasticity. Here, we introduce a novel method of dynamic imaging capture in combination with a proposed standardized workflow for the comparison of pre- and post-operative images.
Methods/Technique: We employed a dynamic imaging capture system (oVio 360®) to capture before and after images of patients seeking surgical intervention at a specific plastic surgery practice since 2011. The system is comprised of an overhead camera that provides patients direct feedback on centering the head for imaging in combination with an imaging camera that rotates 360° in a horizontal plane around the patient. Two LED ring lights and two LED strip lights ensure consistent lighting on the patient superiorly and anteriorly, respectively. The camera records 360 stills in 12 seconds, at a rate of 30 frames per second, transcoded into video format with a final output file at 2048x2048 resolution. From each video, presentation quality still images can be obtained.
We have devised a standardized workflow when imaging patients. For assessment of the face, the patient is instructed to be imaged in five ways: 1) neutral expression; 2) smiling; 3) head tilted 45° upwards; 4) head tilted 45° downward: and, (5) alternatively flexing and relaxing the platysma for the duration of the image capture. This allows the physician to evaluate facial nerve function, symmetry and skin laxity, among other features. When assessing the body, the patient is instructed to be imaged in four ways: 1) place hands at their sides; 2) place hands behind their head; 3) place hands behind their back; and, 4) pressing the hands together flexing the pectoral muscles, allowing for visualization of breast implant position. Of note, care must be placed to ensure that patient is wearing a black robe, and that no make-up is present.
The dynamic imaging system is employed during the initial consultation and subsequent follow ups. First, a nurse obtains a scan of the area of interest following our standardized workflow. Then, the physician obtains a history and performs a physical exam. The images are reviewed with the patient and a treatment plan is developed. The patient is also shown images of patients with similar complexion and undergoing similar procedures in the consultation room, in addition to images which display phases of healing, bruising, and swelling in similar operations. While the patient is supine, the pre-operative video is played in the operating room to inform the surgeon of patient’s anatomy. As an added value, the surgeon is able to share the images with consulting surgeons virtually to aid in the care of the patient. Post-operative imaging can also be viewed remotely allowing the surgeon to have a comprehensive digital medical record of the complete clinical picture if the patient is seen in follow-up for concerns or problems. Lastly, the system allows the surgeon to review the before images of every patient to help improve the surgeon’s skills and understand the impact of every technology.
Results/Complications: We find the dynamic imaging system to be an effective way of making meaningful comparisons between pre- and post-operative images. In contrast with still capture, dynamic imaging captures form, functionality, and elasticity in the human body. By having fixed lighting, distance to patient, and standardized workflow of patient gestures, we are able to reduce unwanted differences in imaging and enhanced identification of subtle results. The use of dynamic imaging improves communication with patients by allowing for discussion of post-operative results based on other patients’ images. Additionally, dynamic imaging captures patient treatment over time, assessing healing and recovery.
Conclusion: Dynamic imaging represents a novel way of comparing pre- and post-operative images. In combination with a standardized flow of patient positions and gestures, it represents an effective way of accurately depicting skin elasticity, muscle movement, skin tone, and texture that cannot be accomplished by still capture alone. Importantly, it provides a standardized and reliable way of comparing pre- and post-operative images. Future studies will assess provider and patient satisfaction to determine the effectiveness of this system. Additionally, the implementation of this system in telehealth visits may serve as an effective way of evaluating patients in areas with less access to medical providers.