Part III – A comparison of the available systems – one plastic surgeons personal opinion
There are currently two systems available for computerized imaging and simulation of breast augmentation surgery. Portrait 3D manufactured by AxisThree, a company funded by Siemens and started in 2002. AxisThree claims to use technology developed by Siemens in the Portrait 3D product. Other than the Portrait 3D system, I am unaware of any other products that the company produces. The other system, Vectra 3D, is manufactured by Canfield Scientific, a company specializing in medical imaging with a long history of many successful products including imaging software, which has been in existence about twenty or so years. Canfield is known for its work in standardizing medical photography, so that images can be taken with consistent lighting, positioning and exposure parameters. Their systems are well known to the dermatology pharmaceutical industry, which contracts with them to produce imaging systems for various drug studies. Both systems were released very recently in the past year.
Let’s start with the physical capture device itself. They are pictured below:
(Photos of Vectra 3D on the right, Portrait 3D on the left)
The camera system of the Vectra 3D consists of six 12 megapixel cameras arranged into three pods. The pods use mirrors to permit the imaging of subjects from the side without having to have physical extensions to mount the cameras off to the side. The Portrait 3D system has three cameras of 3 megapixels each. The cameras are mounted on extensions out to the side.
The lighting system of the Vectra 3D consists of high powered flash. This permits imaging without the use of additional lighting. The very bright flash emits much more light than the ambient room light, therefore the room light will not affect the exposure and the room lights can be left on during the imaging process. The Portrait 3D uses LED (light emitting diode) technology. On the Portrait 3D, the LED lighting system requires the user to shut off the room lights to prevent interference of the exposure by the room light.
The software for both systems is sophisticated. Both systems are pre-programmed with various implant styles (saline and silicone) and the available sizes within a style of implant. However, neither system has the Allergan 468 style anatomic saline textured implant. The software takes the captured image and “inserts” an implant under it, then re-paints the breast tissue over the implant to show the final appearance of the implant. The systems use various algorithms to make these estimations of appearance, and the surgeon is able to manipulate the final result to what he believes the final surgical result might resemble. The Vectra 3D comes with two software packages in addition to the capture software and modeling software: an analysis program which is very powerful and great for research purposes. It also has the “sculptor” software, which is the application that performs the surgical simulation. There are great “bells and whistles” to both software systems, and I think that any surgeon could be happy with either. The Portrait system is perhaps a little easier to use at the outset, but with a little training and practice, the more robust Vectra software is also very easy to use. I think that both systems can do a great job of “simulation”.
I had the opportunity to try out the Vectra 3D system on several patients prior to purchase. I found the system easy to use, added no more than perhaps five or ten minutes to the consultation process and that this time was well spent. The patients really loved seeing their images appear on the system. For the Portrait 3D system, the company has an online demo which lasts about an hour, so I had a fairly good opportunity to see what it can do. The sales representative and the Vice President of Sales then came to my office for a second demo; I thought that they were going to bring the capture (camera) system, but they showed up with a laptop only. This demo gave me further opportunity to look at the software.
The sales experience was very different between the two companies. Canfield Scientific has a much laid back approach. Maybe a little too laid back. They are easy to contact, and respond in a timely and appropriate fashion to inquiries. They are unobtrusive, in other words, they do not email or call me frequently, and rather there approach is “we will provide you with whatever information you wish, demonstrate the product, and let us know when we can help you. AxisThree takes a different approach. While the sales force seems equally knowledgeable about their product as the competition, they are much more aggressive. The approach taken was to let me know that I could be the first with their system in this county, as I am sure they told other sales prospects. They told me that if I am left out, I may not stay competitive in obtaining surgical consults, which may or may not be the truth, but I perceived it a little bit of a scare tactic to put pressure on me. When in my office, the Vice President of Sales demonstrated the software and answered all my questions. He then said to me “so what s holding you up from purchasing the system”. Again, a little high pressure for my taste. I guess if the answer was “nothing is holding me up”, then I would have purchased the system.
So what was the factor in my decision as to which system to purchase? It comes down to a couple. First, the minor factors: Canfield has been in business a lot longer than AxisThree. (20 + vs. 7 years). Canfield has a known track record in medical imaging products and I know from personal experience with them, both with camera systems and software (I use Mirror software), they are reliable, give phenomenal technical support and stand behind their products. AxisThree is funded mainly by Siemens, and has no other products that I could find. Is this a venture capital project that might not be around in a few years? I do know. However, if I am going to invest $35,000 – $40,000 in an imaging system, I don’t want to find the company gone when I need support such as hardware maintenance and software upgrades.
Now for the main reason I chose the Vectra 3D over the Portrait 3D. I was first approached by AxisThree last fall. I looked at their web site and the quality of the images. Quite frankly, I just wasn’t that impressed with the image quality. The image manipulation was great, but the images I thought looked dark and with poor detail. The skin tones looked unnatural. At this point, I really did nothing further. I figured I would wait until I found a system I liked, as this was not on my “wish list” but rather I looked at it because I was solicited by email and it looked like an interesting piece of equipment. Quite by accident, I was at the American Academy of Dermatology meeting with my wife, who is a dermatologist. I struck up a conversation with Doug Canfield, the founder of Canfield Scientific. I asked him if he was familiar with the AxisThree Portrait 3D and did he have anything like it. With great surprise, he responded “yes, but I guess I ma not doing a great job of marketing it if you haven’t hear of it!” I then looked at the Vectra 3D at their booth and was intrigued by it. They imaged by face. The images were so life-like, so perfect. So much detail that it was like looking at yourself in a 3-D mirror, (if there was such a thing!). I then took a ride to Fairfield, NJ which was not far from my home, to look at the system further and get a better demonstration. I even was introduced to the developers. Being that I have a computer hardware as well as software background and currently develop software for my own use in my practice, I found this a unique opportunity to really “biopsy” the system.
If you compare the images produced by the two systems side by side, I think that you will agree that the Vectra system produces life-like images with excellent color and tone reproduction. Due to the high resolution cameras, the images are very sharp, even after software manipulation. The images produced by the Portrait 3D on the other hand, are dark, have poor skin tone color reproduction and are not nearly as sharp.
(Sample images shown here, Vectra on the left, Portrait 3D on the right – or maybe just a link to the Portrait 3D images on their web site)
In summary, I believe that there is a place for three dimensional imaging and surgical simulation in breast augmentation. I think that the user could obtain great use from either the Vectra 3D or the Portrait 3D system, but the Vectra system produces a far superior image quality.
Disclaimer: I purchased a Vectra 3D computerized imaging system. I do not have any financial interest in its success, or any financial interest in the manufacturer of this system, Canfield Scientific of Fairfield, NJ. I am a voluntary member of the advisory board at Canfield for this system, the purpose of which is to provide feedback and assist the manufacturer in the further development of this system.