Patrick M. Poston, BS, Sonali S

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The Correction Index: Setting the Standard for Recommending Operative Repair of Pectus Excavatum Patrick M. Poston, BS, Sonali S. Patel, MD, PhD, Maheen Rajput, MD, Nicholas O. Rossi, MD, Mohammed S. Ghanamah, MD, James E. Davis, MD, Joseph W. Turek, MD, PhD The Annals of Thoracic Surgery Volume 97, Issue 4, Pages 1176-1180 (April 2014) DOI: 10.1016/j.athoracsur.2013.12.050 Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Illustration of pectus indices calculated from the computed tomography axial image with the greatest sternal depression. The Haller index (HI) is measured by dividing the transverse diameter of the chest wall (line A) by the distance between the posterior aspect of the sternum and the anterior portion of the vertebra (line B): HI = A/B. To assess a correction index (CI), a virtual correction of the pectus is first performed by drawing a horizontal line across the posterior aspect of the corrected sternum (dashed line). The CI is then calculated by measuring the distance between the posterior aspect of the corrected sternum and anterior aspect of the vertebra (line C). This number is subtracted by the distance between the posterior aspect of the sternum at the site of deepest depression and the anterior vertebra (line B). This difference is divided by the first measurement and multiplied by 100 to represent the percent of chest depression: CI = [(C – B)/C] × 100. To assess an ideal chest index (ICI), a virtual correction of the pectus is first performed by drawing a horizontal line across the posterior aspect of the corrected sternum (dashed line). The ICI is calculated by measuring the transverse diameter of the chest wall (line A) and dividing this value by the distance between the posterior aspect of the corrected sternum and anterior aspect of the vertebra (line C): ICI = A/C. The Annals of Thoracic Surgery 2014 97, 1176-1180DOI: (10.1016/j.athoracsur.2013.12.050) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Regression analysis of the Haller index vs the correction index from the standard subset (±1 standard deviation of the ideal chest index variable) of pectus excavatum patients as measured on computed tomography axial images. The dashed lines show the 95% confidence interval. The Annals of Thoracic Surgery 2014 97, 1176-1180DOI: (10.1016/j.athoracsur.2013.12.050) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 An axial computed tomography scan shows an ideal chest index outlier from our series with broad chest dimensions in relation to the anterior-posterior diameter. The calculated Haller index is 4.40 and the calculated correction index is 12%. The Annals of Thoracic Surgery 2014 97, 1176-1180DOI: (10.1016/j.athoracsur.2013.12.050) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 An axial computed tomography scan shows an ideal chest index outlier from our series with a narrow chest. The calculated correction index is 33% and the calculated Haller index is 2.60. The Annals of Thoracic Surgery 2014 97, 1176-1180DOI: (10.1016/j.athoracsur.2013.12.050) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions