Quantitative comparison between the laser scanner three-dimensional method and the circumferential method for evaluation of arm volume in patients with lymphedema

Nicola Cau, Manuela Galli, Veronica Cimolin, Alida Grossi, Ivan Battarin, Greta Puleo, Augusta Balzarini, and Augusto Caraceni. Journal Vascular Surgery: Venous and Lymphatic Disorders 2018;6:96-103

Click to read the abstract

Quantitative comparison between the laser scanner three-dimensional method and the circumferential method for evaluation of arm volume in patients with lymphedema

Nicola Cau, Manuela Galli, Veronica Cimolin,  Alida Grossi, Ivan Battarin,  Greta Puleo, Augusta Balzarini, and Augusto Caraceni. Journal Vascular Surgery: Venous and Lymphatic Disorders 2018;6:96-103

Objective: Several methods are used to evaluate arm volumes. The most commonly used methods are water displacement and the circumferential method (CM), but these techniques have some limitation in application in clinical settings and accuracy. Recently, the laser scanner three-dimensional (LS3D) method was successfully proposed as a valid method for volume measurements of the upper limb in healthy individuals. The aim of the study was to compare, in terms of intraobserver and interobserver reliability, the CM and LS3D method to measure the upper limb in a group of women with upper limb lymphedema.

Methods: There were 200 women with upper limb lymphedema (mean age, 64 6 9 years; body mass index, 24.72 6 2.94 kg/m2) involved in this study. Arm measurements were obtained with both the CM and LS3D method. Statistical analysis was conducted to compare the CM and LS3D method.

Results: Both the CM and LS3D method have a satisfactory level of agreement, but we found some statistically significant differences in terms of some measurements (both circumferential and volume measurements).

Conclusions: The data obtained in this study indicate that the LS3D method could represent a reliable, valid method to measure arm circumferences and volumes in arms with lymphedema, suitable for daily clinical use. It combines precision, reproducibility, and ease of use with the possibility of measuring geometric parameters and shape information of scanned limbs.

Main findings

  • The upper limb circumferences were measured with a normal tape measure (1-mm sensibility). The participants were in standing position, with arms stretched at the shoulder level with the palm of the hand down. Measurements were made corresponding to marks made on the skin using a dermatologic pen from the ulnar styloid process of the wrist to 20 cm proximal to the lateral epicondyle (corresponding to the inferior extremity of the deltoid muscle) with 4-cm intervals. To uniquely define the arm and the upper arm, one additional point was detected corresponding to the olecranon, indicated as the middle point. Approximately 9 – 10 points along the arm.
  • LS3D method measurements. A hand-held LS3D system (O&P Scan Rodin4D, Pessac, France; laser peak power, 1 MW; wavelength, 670 nm; class I laser product) was used. Resolution of this scanner model is 0.1 mm, and the absolute accuracy is 0.75 mm.
  • Bilateral arm volumes of 200 women with unilateral lymphedema were assessed to compare segmental circumference measurements with three-dimensional laser measurements. There seemed to be good correlation between the two methods, with a good level of agreement for both arms of the patients.
  • The authors found the three dimensional laser volume measurement technique a good alternative to segmental circumference tape measurements to assess the volume of the limb with lymphedema and to compare it with the volume of the normal arm.