Optical imaging versus CT and plain radiography to quantify pectus severity: a systematic review and meta-analysis

Jean H. T. Daemen, Tom G. J. Loonen, Pieter W. J. Lozekoot, Jos G. Maessen, Thomas J. J. Maal, Karel W. E. Hulsewe, Yvonne L. J. Vissers, Erik R. de Loos*

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

10 Citations (Web of Science)


Background: Computed tomography (CT) and two-view chest radiographies are the most commonly used imaging techniques to quantify the severity of pectus excavatum (PE) and pectus carinatum (PC). Both modalities expose patients to ionizing radiation that should ideally be avoided, especially in pediatric patients. In an effort to diminish this exposure, three-dimensional (3D) optical surface imaging has recently been proposed as an alternative method. To assess its clinical value as a tool to determine pectus severity we conducted a systematic review in which we assessed all studies that compared 3D scan-based pectus severity measurements with those derived from CT-scans and radiographies.

Methods: Six scientific databases and three registries were searched through April 30th, 2019. Data regarding the correlation between severity measures was extracted and submitted to meta-analysis using the random-effects model and I2-test for heterogeneity.

Results: Five observational studies were included, enrolling 75 participants in total. Pooled analysis of participants with PE demonstrated a high positive correlation coefficient of 0.89 [95% confidence interval (CI): 0.81 to 0.93; P

Conclusions: 3D optical surface scanning is an attractive and promising imaging technique to determine the severity of PE without exposure to ionizing radiation. However, further research is needed to determine novel cut-off values for 3D scans to facilitate clinical decision making and help determine surgical candidacy. No evidence was found that supports nor discards the use of 3D scans to determine PC severity.

Original languageEnglish
Pages (from-to)1475-1487
Number of pages18
JournalJournal of Thoracic Disease
Issue number4
Publication statusPublished - Apr 2020


  • Three-dimensional optical surface imaging (3D optical surface imaging)
  • external Haller index (EHI)
  • pectus excavatum (PE)
  • pectus carinatum (PC)

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