Right limb circumference, cm 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Right Limb Volume at First Visit, mls Today's Volume, mls Absolute volume change

since first visit, mls 0 Not known

Left limb circumference, cm Wrist/Ankle end

Shoulder/Hip end Left Limb 0 Not known

Comparing both of today's limb volumes Volume difference between both limbs today, mls Volume difference between both limbs today, using smaller volume as the reference volume, %

Not known Not known

RIGHT LIMB Hand/Foot Circumference Circumference, cm Equivalent radius, cm 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Wrist/Ankle End

Shoulder/Hip End

0 0 0

0 0 0 TOTAL VOLUME =

LEFT LIMB Wrist/Ankle End Circumference, cm Equivalent radius, cm 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL VOLUME =

Shoulder/Hip End

Volume of frustum, ml 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0

Volume of frustum, ml 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Take your circumferential readings at 4cm intervals up the limb, starting at the wrist/ankle. Put the appropriate circumference measurements (in centimetres) for the limb in question into the yellow boxes, starting at the top of the relevant column. Only use the number of cells in the column that you need for your measurements. Do not leave any gaps between the measurements in a column. Simply ignore any cells at the bottom that you do not use. Volumes are automatically recalaculated as you continue to put more data in. Therefore ignore all the results until you have put all the relevant data in. If you know the original limb volume before treatment was started then you can put this information in too. This allows you to see the volume loss/gain since treatment first started. If you put in volume data for both limbs then some basic comparative data is generated. When you have finished with the calculator simply close it without saving anything. PLEASE NOTE: This calculator provides a reasonable ESTIMATE of limb volume. If you wish to see the theory behind the calculations then click on the appropriate tab below. If you want to look at the precise formulae used in the calculator then you must unlock the workbook (Password = Lymphoedema) and reveal the hidden text in the calculator by highlighting the whole spreadsheet and turning all the text black. If you think the mathematics could benefit from further refinement then I would love to hear from you and/or see a copy of your modified calculator. john.chambers@khh.org.uk

This limb volume calculator makes the following assumptions: 1. Our limbs can be viewed simplistically as a stack of partial cones (a.k.a. frustums) with circular tops and 2. If we measure the circumference (C) of the limb every 4cm along its length, then the height of each frustrum is 3. You can calculate the radius (R ) of a circle of circumference (C ) using the formula C = 2Pi xR A single frustrum is shown below:

The volume of a frustrum is Pi x ((R x R) + (R x r) + (r x r)) x h / 3 Whilst assumptions 1 and 2 are reasonably acceptable, they are both fundamentally incorrect because: 1. We typically measure the 4cm spaces between each measured circumference on the surface of the skin, making these 4cm spaces the angulated slant lengths of the hypothetical frustrums rather than their true heights as measured along their central longitudinal axes. 2. The cross sections of our limbs often deviate significantly from a circle. It is possible to calculate the true frustrum height (h) from the slant length (S) and both radii (R and r) using Pythagoras's theorem: h^2 + (R - r)^2 = S^2 I incorporated this formula into my first limb volume calculator, but I found that many of the frustums generated from real field data were mathematical impossibilities. This is because the circumferences of two non-circular cross sections separated by an arbitrary slant height of 4cm can differ by far more than two pure circles separated by a fixed slant height of 4cm. This calculator therefore pretends that the slant height (S) is the same as the true frustrum height (h), which seems to be a reasonable compromise. If you wish to increase the accuracy of your limb volume calculations then you can place the limb on a lymphoedema measuring board to mark the 4cm measuring points on the skin rather than running a tape measure up the skin of the patient. We do not use a lymphoedema measuring board at