Integrating Augmented Reality Tools in Breast Cancer Related Lymphedema Prognostication and Diagnosis
February 6th, 2020
Breast cancer related lymphedema is frequent in breast cancer survivors, but there are not widely employed guidelines for its diagnosis and quantification. Here, we introduce a reliable and cost-effective protocol to define, quantify, and compare upper limb volume in breast cancer patients.
The laser scan three-dimensional device allows a quick and reproducible measurement of the upper limb volume without requiring direct contact with the skin of patients. In addition, the technology is inexpensive, user friendly, reproducible, and extremely precise even in the presence of gibbousness and swelling. Demonstrating the procedure will be Dr.Lorenzo Lippi from our research group.
Begin by installing a free downloadable 3D laser scanning application on a tablet computer. Next, use a marker of the highest contrast color compared to the skin of the patient to mark the skin of the upper limb to be analyzed at five centimeter landmarks starting from the wrist to the elbow and from the elbow to the proximal portion of the arm. Draw circumferences around the upper limb to be analyzed at the level of each landmark and position the patient in an upright position in a room with sufficient space to move around them.
Raise the patient's upper limb anteriorly by 90 degrees and ask the patient to remain in this position without moving for the entire duration of the scan. Link a 3D laser scanner device to the tablet and open the 3D laser scanner application. Enter the credentials of the patient into the patient database and click connection and plus to enter a new patient.
When all of the patient information has been entered, click the 3D icon and use two fingers to adjust the distance and size of the cube on the screen to select the area to be examined. Click scan and start the three-dimensional scan, framing the upper limb of the patient on all of the planes of the space, rotating around the limb from all angles multiple times to optimize the quality of the acquired image. When the acquisition is complete, press done.
Then revise the form to assess any acquisition defects or missing parts as necessary. Next, select the acquisition and press the icon to enter an email and send the file. On the desktop computer, download the data sent by email and insert a USB drive with the software license for the 3D laser scanner software.
After opening the data file, view the scan and click create new patient. Under the file menu, select the patient file and select the scan. Click extract.
Select the extracted scan and click cleaning. Next, select the image and orient the image in the space using the skin landmarks to cut off any segments included in the scan on the various axes as necessary. Validate the cut figure and name the shape obtained from the scan.
Click create a new shape to orient the shape axis on the three planes of the space. Click next and wait for the generation of the final form and click end. Select the processed form and click open.
The software will provide the total volume of the processed form. Then click volume to calculate the volume of the different sections and move and select the upper and lower margin of the section from which to extract the volume. In this representative study, 30 healthy male and female adults and 30 breast cancer female patients who later developed breast cancer-related lymphedema were evaluated.
Arm volume measurements were performed using both the circumferential and 3D laser scanner methods. In both groups, both methods demonstrated high levels of inter and intraoperator reproducibility with a mean R squared of 0.99 for both techniques. Accordingly, the mean value of the 3D laser scanner volume calculations also showed a strong correlation with those from the circumferential method in both groups as confirmed by the Bland-Altman plot showing a high level of agreement and consistency between the two different measurements.
Furthermore, although differences were observed before and after complex decongestive treatment for both techniques in the breast cancer patient group, the 3D laser scanner method correlation was higher than that observed for the circumferential method. This procedure can be used in any physiological or pathological condition that require a volumetric evaluation of any part of the body. The use of this technique in a clinical setting can solve several issues related to the standardization of volumetric measurements in breast cancer-related lymphedema.
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Overview
This article presents a reliable and cost-effective protocol for diagnosing and quantifying breast cancer-related lymphedema in survivors. It introduces a laser scan three-dimensional device for precise measurement of upper limb volume.
Key Study Components
Area of Science
- Oncology
- Medical Imaging
- Rehabilitation
Background
- Breast cancer survivors often experience lymphedema.
- There is a lack of widely accepted guidelines for its diagnosis.
- Accurate measurement of limb volume is crucial for assessment.
- Existing methods may be invasive or impractical.
Purpose of Study
- To introduce a new protocol for upper limb volume measurement.
- To enhance the accuracy and reliability of lymphedema assessment.
- To provide a cost-effective solution for clinicians.
Methods Used
- Utilization of a laser scan three-dimensional device.
- Application of a free downloadable 3D laser scanning application.
- Marking skin landmarks on the upper limb for measurement.
- Positioning patients in an upright position for optimal scanning.
Main Results
- The device allows for quick and reproducible measurements.
- It is user-friendly and inexpensive.
- Measurements remain precise even with limb swelling.
- The protocol can be easily implemented in clinical settings.
Conclusions
- The introduced protocol improves lymphedema diagnosis.
- It offers a practical solution for breast cancer survivors.
- Future studies may validate its effectiveness in broader populations.
Frequently Asked Questions
Executive Industry Relevance
Digitally assisted volumetric assessment using 3D laser scanning introduces reproducibility and precision to breast cancer-related lymphedema (BCRL) diagnosis, addressing a critical gap in early detection and monitoring. This technology-driven workflow supports predictive confidence and standardization at the interface of oncology and digital health, enabling scalable integration into discovery and translational research pipelines. Its adoption can inform risk-adjusted advancement decisions and portfolio triage in therapeutic development targeting lymphatic complications.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Enables quantitative interrogation of lymphatic dysfunction in disease-relevant cohorts.
- Supports biological de-risking by providing reproducible volumetric endpoints.
- Facilitates functional target validation for interventions addressing lymphatic pathology.
Screening & Assay Development
- Prepares validated digital phenotyping systems for downstream screening workflows.
- Standardizes volumetric measurement, enhancing assay reproducibility and comparability.
- Enables reliable evaluation of candidate interventions in preclinical and translational settings.
Translational & Preclinical Research
- Aligns digital volumetric biomarkers with disease progression and therapeutic response.
- Ensures continuity from discovery through preclinical validation by providing objective, quantitative outputs.
- Supports risk-adjusted advancement decisions based on robust, reproducible data.
Pipeline & Workflow Integration
This digitally assisted volumetric assessment method integrates from early discovery through translational research, supporting lead identification and preclinical validation in lymphatic disease models.
- Discovery Biology: Provides quantitative endpoints for hypothesis testing and pathway clarification in lymphatic dysfunction.
- Screening: Delivers standardized, reproducible volumetric outputs for assay readiness and compound evaluation.
- Analytics: Enables statistical comparison of intervention effects using precise digital measurements.
- Translational Research: Bridges discovery and preclinical work by aligning digital biomarkers with clinical endpoints.
- Enterprise Reuse: Offers a scalable, reusable digital phenotyping capability across disease models requiring volumetric assessment.
Operational & Enterprise Impact
- Scientific Value: Increases predictive confidence and reduces mechanistic ambiguity in lymphatic disease research.
- Operational Value: Enhances standardization, reproducibility, and scalability of volumetric measurements.
- Strategic Value: Improves go/no-go decisions and capital efficiency by providing robust quantitative data.
- Portfolio Impact: Supports risk-adjusted prioritization and advancement of lymphatic-targeted programs.
Implementation Considerations
- Requires expertise in digital imaging and volumetric analysis.
- Needs access to 3D laser scanning devices and compatible analytical software.
- Demands cross-team standardization of measurement protocols and data handling.
- Adaptation may be necessary for different anatomical sites or disease models.
- Practical limitations include patient positioning and potential variability in landmark placement.
