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Author Notes:

Email: joelconkle@gmail.com; jconkle@emory.edu

The specific roles of these authors are articulated in the ‘author contributions’ section.

Jennifer Breiman, RN; Carma Graham, MS; Ashton Hughes, BA; Kate Keirsey, MS; and Terrell Williams, MPH were research specialists for the study who helped to develop the study manual, collected high quality anthropometry and 3D scans, and provided recommendations for further improvement of the 3D imaging system.

JB and TW also contributed to literature review on the use of manual measurements and 3D imaging for child anthropometry.

Guidance from the 2015 Standards for Reporting Diagnostic Accuracy Studies (STARD) helped to ensure completeness and transparency in reporting our study. Kenneth H. Brown, MD, The Bill and Melinda Gates Foundation, championed development of the 3D imaging system and assisted in the study design and interpretation.

The funder’s project officer contributed to study design and interpretation of the data, and had no role in collection, management or analysis of data, and no role in preparation, review, or approval of the manuscript and the decision to submit the manuscript for publication.

Competing interests: Dr. Eugene Alexander is employed by BST, Inc. and has a patent pending related to the study subject matter: Determining Anthropometric Measurements of a Non-Stationary Subject.

All other authors do not have affiliations with or financial involvement with any organization or entity with a financial interest in the subject matter or materials discussed in the manuscript.

We were able to adhere to PLOS ONE policy on sharing data, but could not share the data acquisition software code due to commercial interests of BST, Inc.

Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.


Research Funding:

The Bill and Melinda Gates Foundation (OPP1132308 to RM) funded the study.

The funder provided support in the form of salaries for authors PS, EA, UR and RM.

Accuracy and reliability of a low-cost, handheld 3D imaging system for child anthropometry.

Journal Title:



Volume 13, Number 10


, Pages e0205320-e0205320

Type of Work:

Article | Final Publisher PDF


The usefulness of anthropometry to define childhood malnutrition is undermined by poor measurement quality, which led to calls for new measurement approaches. We evaluated the ability of a 3D imaging system to correctly measure child stature (length or height), head circumference and arm circumference. In 2016-7 we recruited and measured children at 20 facilities in and around metro Atlanta, Georgia, USA; including at daycare, higher education, religious, and medical facilities. We selected recruitment sites to reflect a generally representative population of Atlanta and to oversample newborns and children under two years of age. Using convenience sampling, a total of 474 children 0-5 years of age who were apparently healthy and who were present at the time of data collection were included in the analysis. Two anthropometrists each took repeated manual measures and repeated 3D scans of each child. We evaluated the reliability and accuracy of 3D scan-derived measurements against manual measurements. The mean child age was 26 months, and 48% of children were female. Based on reported race and ethnicity, the sample was 42% Black, 28% White, 8% Asian, 21% multiple races, other or race not reported; and 16% Hispanic. Measurement reliability of repeated 3D scans was within 1 mm of manual measurement reliability for stature, head circumference and arm circumference. We found systematic bias when analyzing accuracy-on average 3D imaging overestimated stature and head circumference by 6 mm and 3 mm respectively, and underestimated arm circumference by 2 mm. The 3D imaging system used in this study is reliable, low-cost, portable, and can handle movement; making it ideal for use in routine nutritional assessment. However, additional research, particularly on accuracy, and further development of the scanning and processing software is needed before making policy and clinical practice recommendations on the routine use of 3D imaging for child anthropometry.

Copyright information:

This is an Open Access work distributed under the terms of the Creative Commons Universal : Public Domain Dedication License (http://creativecommons.org/publicdomain/zero/1.0/).

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