Validity of Three-Dimensional Scanning to Measure Cranial

Deformation in a Preterm Infant: A Feasibility Study

Trisha A. Renner, PT, DPT; Betsy Donahoe-Fillmore, PT, PhD; Kaylee Arnold, SPT; Bailee Bonanno, SPT;
Carlie Currier, SPT; Amia Gaines, SPT; Monica Lough, SPT; Elizabeth Luttrull, SPT; Ethan Sullivan, SPT

Background Results
Positional plagiocephaly and other cranial deformities are common The CI and CVAI measures show ICC values >0.90 (Table 1, Table 2).
among infants and the incidence increases with prematurity. Multiple The ANOVA of cranial measures was significant (p<0.001) with
anthropometric measurements quantify cranial deformation in clinical Bonferroni post hoc testing showing the plagiocephalometry CVAI
settings. Common clinical measurements by physical therapists provide measures were significantly different (p<0.001) from all other measures.
objective data (calipers and plagiocephalometry) or a cranial
circumference mold (plagiocephalometry). Three-dimensional (3D) scans
are utilized by interdisciplinary team members to determine the need for
Discussion
Cranial measures taken with the 3D Body Scan Scanner® and the
a cranial remolding orthosis (CRO). This equipment is clinically
Structure Sensor are strongly correlated with the reference standards of
accessible, affordable, and compatible with most tablets and mobile
cranial calipers and plagiocephalometry. Plagiocephalometry CVAI
applications. The utilization of a portable 3D scanner by physical
Body Structure Sensor® (Left), Structure Sensor (Right) measures are calculated on a line 40° from the midsagittal plane. This
therapists in a clinical setting could track cranial deformation objectively,
differs from the 30° or lateral eyebrow visual landmark utilized with
visually, and inform caregiver education and referrals.
Table 1. ICC for Cranial Vault Asymmetry Index (CVAI)* Measures calipers and 3D scanning. A consistent degree diagonal measure from the
Plagio- Structure Body Scan midsagittal plane between tools is suggested.
Purpose Calipers
cephalometry Sensor Scanner®
The purpose of this feasibility study was to investigate the validity of the Calipers 1.00 0.948 0.981 0.992
Multiple scans are needed to obtain information from the Structure
Body Scan Scanner® and Structure Sensor to measure cranial Sensor secondary to infant movement. A stockinet or thin cap to contain
Plagio-
deformation in a preterm infant. 1.00 0.924 0.937 hair can alter 3D scans. Computer processing software on a shared
cephalometry
computer presents many challenges to efficiency in the clinical setting.
Subject Structure Sensor 1.00 0.949 Routine updates are needed to ensure software accessibility.
An 8 month-old female (adjusted age of 5 months) born at 26 weeks Body Scan
1.00
gestation with history of 119 day NICU hospitalization with cranial Scanner® Clinical Relevance
(brachycephalic) deformation participated prior to CRO. *CVAI= Portable 3D scanning shows promise to be an efficient and cost-effective
method to objectively measure and visualize cranial deformation in
Materials & Methods Table 2. ICC for Cranial Index (CI)* Measures
clinical settings. Further research in infants with varying cranial
The participant underwent cranial measurements with 3D infrared deformation is needed.
Plagio- Structure Body Scan
scanning using the Body Scan Scanner® (TechMed 3D, Montreal, ON, Calipers
cephalometry Sensor Scanner®
Canada) and the Structure Sensor (occipital, San Francisco, CA). Cranial Acknowledgement
Calipers 1.00 0.957 0.978 0.991 Mary I. Fisher, PT, PhD
measurements were calculated using the MSoft 3.0 (TechMed 3D,
Montreal. ON, Canada). The reference standards were cranial calipers Plagio-
1.00 0.932 0.945
cephalometry Contact Information
and plagiocephalometry. All measurements were taken twice and
repeated at 2 weeks and 1 month from the initial measurements. Structure Sensor 1.00 0.956 rennert2@udayton.edu
Intraclass correlation coefficients were calculated for the four measures
of cranial index (CI) and cranial vault asymmetry index (CVAI). Body Scan
1.00
Scanner®
Repeated measures ANOVA was used to examine mean differences
*CI=
between measures.

Table 3. Means (SD) Cranial Measures

Plagio- Structure Body Scan
Calipers
cephalometry Sensor Scanner®
CVAI CI (%) CVAI CI (%) CVAI CI (%) CVAI CI (%)

1.38 91.27 2.53 90.61 1.75 91.23 1.87 90.59

±1.34 ±1.93 ±3.91* ±2.12 ±1.75 ±2.37 ±1.67 ±2.35
Structure Sensor Anterior (Left), Superior (Center), Lateral (Right) *Significance α ≤ 0.05 Plagiocephalometry (Left), Superior Cranial View (Right)