Image-based non-invasive assessment of suction blister wounds for clinical safety and efficacy.

Recognising the need for objective imaging-based technologies to assess wound healing in clinical studies, the suction blister wound model offers an easily accessible wound model that creates reproducible epidermal wounds that heal without scarring. This study provides a comprehensive methodology for implementing and evaluating photography-based imaging techniques utilising the suction blister wound model. Our method encompasses a protocol for capturing consistent, high-quality photographs and procedures for quantifying these images via a visual wound healing score and a computer-assisted colour analysis of wound exudation and wound redness. We employed this methodology on 16 suction blister wounds used as controls in a clinical phase-1 trial. Our method enabled us to discern and quantify subtle differences between individual wounds concerning healing progress, erythema and wound exudation. The wound healing score exhibited a high inter-rater agreement. There was a robust correlation between the spectrophotometer-measured erythema index and photography-based wound redness, as well as between dressing protein content and photography-based dressing yellowness. In conclusion, this study equips researchers conducting clinical wound studies with reproducible methods that may support future wound research and aid in the development of new treatments.

Clinical photography and documentation after traumatic dental injuries.

Clinical photographic documentation is recommended as part of the standardized clinical evaluation of traumatized patients according to the most current International Association of Dental Traumatology guidelines for the management of traumatic dental injuries (TDIs), published in 2020. The use of current technology such as mobile smartphones and the emergence of teledentistry for direct communication between dentists and with patients have increased the need to improve the knowledge and skills for contemporary clinical photographic documentation procedures at the dental office as well as at the accident site. The purpose of this review is to include findings from the available literature and discuss modern techniques, contemporary equipment, accessories and developments that can be used by both patients and dental professionals for proper clinical documentation after TDIs. Emphasis is given on the positioning and patient management based on the type and severity of the injury, and the selection of the appropriate technique. Moreover, the number and type of clinical photographs for each dental trauma scenario, the suggested timeline for optimal photographic documentation as well as legal considerations involved are also discussed.

Postoperative photography reduces incorrect wound breakdown diagnoses in tracheostomy.

PURPOSE: This study was performed to investigate the effect of including immediate postoperative photographs of a tracheostomy site on diagnoses (correct and incorrect) of wound breakdown in a pediatric patient population. MATERIALS AND METHODS: Chart review was performed of all patients from 2017 to 2019 who underwent a tracheostomy. Within this time span, the practice of the hospital changed such that postoperative photography was taken of the tracheostomy site. There were no changes in in-service training protocols over this time. Wound breakdown diagnoses were examined prior to and after the intervention. Diagnoses were categorized by severity according to the National Pressure Ulcer Advisory Board. Diagnoses were then divided into correct or incorrect based on examination by physician teams at the time of the diagnosis. RESULTS: Forty five patients underwent a tracheostomy during the study period. When comparing the two groups, there was a reduction in all wound breakdown diagnosis by 91 %, and those diagnoses which were entered into the chart after the photos were verified as correct. CONCLUSIONS: Without appropriate context as to the nature of tracheostomy wounds, many providers may incorrectly grade a healthy wound as wound degradation, which can affect care, reimbursement, and hospital ratings. We present our findings of placing an intraoperative wound photo in the patient's electronic medical record as a reference should wound concerns arise. We believe this is an easy action which can enhance patient care, decrease unnecessary work, and provide an accurate documentation of tracheostomy care pathways and results.

The use and ethical assessment of medical photos taken by physicians.

With the increased use of technology, the use of medical photography has also increased, especially for secondary purposes. Secondary use only results in a benefit for clinicians and is considered a one-way process. This, in turn, raises several potential ethical issues, despite the numerous benefits of medical photography. The descriptive cross-sectional study was conducted with 82 physicians who took medical photos, in Ankara, Turkey. The mean age of the participants was 44.7 years. Of the participants, 95.1% reported using their personal mobile phones for photographing and 84.1% reported taking medical photos for "use in clinical trainings (clinical seminars, student and patient trainings, etc.)". Among physicians who took photos for research purposes, 29.3% reported obtaining only verbal consent. In addition, 53.7% of physicians reported storing medical photos on their personal computers. It seems that there is no consensus among physicians regarding taking, storing, and using medical photos, and these results cause ethical problems.

The use of clinical photography to aid in the triage of ENT patient referrals.

Waiting lists for Ear, Nose and Throat (ENT) outpatient appointments are currently the longest that they have ever been. The Aneurin Bevan University Health Board has adopted a unique Clinical Photography ENT triage service to tackle this. General Practitioner referrals are triaged by ENT consultants, to identify those patients in whom otoscopic imaging could be used to detect a serious otological condition or to enable virtual management. They are triaged to Clinical Photography, to undergo digital imaging which is reviewed in a virtual clinic alongside the initial referral. 72 patients have completed the pathway, with 51.3% discharged without requirement for face-to-face consultant appointment. 9.7% were upgraded to urgent or 2 week waits. This intervention is predicted to help identify patients on the waiting list with potentially serious disease so that they do not wait excessively, and to reduce waiting times for outpatient appointments in ENT.

Clinical photography processes (ClinPhoto) study for photo diversity.

Although clinical photography serves an important role in the education of clinicians, there is still a disparity of darker skin tones in the photographs used for medical education. This disparity results in a skill deficit for clinicians because the differences in skin pigmentation change the appearance of visible diseases so that it is essential for students and trainees to have examples of clinical photographs on varying skin tones. To effectively address the problem, we need to understand the complex sociotechnical processes involved in clinical photography, which is more than simply the act of taking a photograph. Therefore, we conducted semi-structured interviews on clinical photography with 10 clinicians, 1 medical photographer, and 1 clinical administrator at a tertiary academic medical centre. The interviews revealed 5 deductive themes based on the questions and 19 inductive codes within those themes on how clinical photography is conducted. Analysis of the themes through a lens of critical theory showed how simple awareness of the disparity has not led to interventions for the poor representation of varying skin tones in photographs for medical education and also suggests initial next steps.

Training in bereavement communication - attitudes to guidance and training for clinical photographers.

Bereavement is one of the most emotionally intense situations healthcare staff can find themselves in and requires extensive communication training to work in. While other healthcare staff receive specific training in bereavement, clinical photographers do not receive much, if any, in the form of bereavement communication training. The lack of training can lead to clinical photographers feeling ill-prepared to communicate with bereaved parents. This paper aims to identify if clinical photographers feel there is a need for training or written guidance and what they would wish to see included within it. A questionnaire was distributed to clinical photographers via the Institute of Medical Illustrators to gather opinions, results indicate that the majority feel there is a need.

Evaluation of a simple image-based tool to quantify facial erythema in rosacea during treatment.

BACKGROUND: Facial erythema is a common symptom in rosacea. To overcome subjectivity in scoring erythema severity, objective redness quantification is desirable. This study evaluated an image-based erythema quantification tool to monitor facial erythema in rosacea patients during treatment and compared these values to clinical scores. MATERIALS AND METHODS: Twenty-one rosacea patients were treated with topical ivermectin for 16 weeks. Clinical erythema scores and clinical photographs were taken at week 0, 6, 16 and 28. Using ImageJ, RGB images were split into red, green and blue channels to measure the green/red ratio of lesional skin compared with a green sticker. With CIELAB colour space, a* (indicating colour from green to red) of a lesional and non-lesional facial site was measured, calculating ∆a*. Interobserver concordance and correlation between quantitative and clinical erythema values were determined. RESULTS: Treatment resulted in reduction of clinical erythema scores. No significant changes in red/green ratios were measured. Lesional a* and ∆a* significantly decreased from baseline to week 16 and 28 (P < .05). A weak correlation existed between clinical scores and lesional a* (Rs  = 0.37), and between clinical scores and ∆a* (Rs  = 0.30), with a clear trend towards higher a* and ∆a* for higher clinical scores. Interobserver correlation was high (R2  = 0.82). CONCLUSION: ImageJ is a simple, rapid, objective and reproducible tool to monitor erythema in rosacea patients during treatment. The photographs allow retrospective analysis, evaluation of large and small lesions, and discrimination of subtle redness differences. We recommend using lesional a* to monitor erythema of inflammatory dermatoses in clinical practice.

A CLOSE-UP guide to capturing clinical images.

Telemedicine is rapidly becoming ubiquitous as the medical profession adjusts its practice to provide optimal care to patients in the context of the COVID19 pandemic. The ability to provide accurate dermatological advice via telemedicine is dependent on the receipt of high-quality clinical images and accurate clinical context, on which clinicians receive little education during medical school and subsequent training. Clinicians can improve their capture, delivery and storage of images using the CLOSE-UP acronym, which encapsulates important considerations in the clinical photography process.

Mobile Point-of-Care Medical Photography: Legal Considerations for Health Care Providers.

Medical photographs have been used for decades to document clinical findings. The ease with which medical photographs can be captured and integrated into the electronic health record (EHR) has increased as digital cameras obviated the need for the film development process. Today, cameras integrated into smartphones allow for high-resolution images to be instantly uploaded and integrated into the EHR. With major EHR vendors offering mobile smartphone applications for the conduct of point-of-care medical photography, health care providers and institutions need to be aware of legal questions that arise in the conduct of medical photography. Namely, (1) what are the requirements for consent when taking medical photographs, and how may photographs be used after consent is obtained, (2) are medical photographs admissible as evidence in court, and (3) how should a provider respond to a request by a patient or parent requesting that a photograph be deleted from the medical record? Herein, we review relevant laws and legal cases in the context of accepted standards of medical practice pertaining to point-of-care medical photography. This review is intended to aid health care providers and institutions seeking to develop or revise policies regarding using a mobile application at their clinical practice.

The clinical photographers' perspective of emotionally challenging situations.

A clinical photographer's role can cover a broad range of disciplines within the health care setting and throughout a patient's care pathway. This in turn can result in the photographer being exposed to scenarios and conditions which can be extremely traumatic. At the time this study took place, formal training for clinical photographers on the management of these situations or the emotional well-being of the photographer did not exist. To explore clinical photographers' experiences and management of these situations, the author circulated a questionnaire which was completed by 216 participants. The results showed individuals find a range of situations emotionally challenging and this varies from person to person based on factors such as experiences they have had in their personal life and time within the profession.

Late fusion of deep and shallow features to improve discrimination of actinic keratosis from normal skin using clinical photography.

BACKGROUND: Actinic keratosis (AK) is a common premalignant skin lesion that can potentially progress to squamous cell carcinoma. Appropriate long-term management of AK requires close patient monitoring in addition to therapeutic interventions. Computer-aided diagnostic systems based on clinical photography might evolve in the future into valuable adjuncts to AK patient management. The present study proposes a late fusion approach of color-texture features (shallow features) and deep features extracted from pre-trained convolutional neural networks (CNN) to boost AK detection accuracy on clinical photographs. MATERIALS AND METHODS: System uses a sliding rectangular window of 50 × 50 pixels and a classifier that assigns the window region to either the AK or the healthy skin class. 6010 and 13 915 cropped regions of interest (ROI) of 50 × 50 pixels of AK and healthy skin, respectively, from 22 patients were used for system implementation. Different support vector machine (SVM) classifiers employing shallow or deep features and their late fusion using the max rule at decision level were compared with the McNemar test and Yule's Q-statistic. RESULTS: Support vector machine classifiers based on deep and shallow features exhibited overall competitive performances with complementary improvements in detection accuracy. Late fusion yielded significant improvement (6%) in both sensitivity (87%) and specificity (86%) compared to single classifier performance. CONCLUSION: The parallel improvement of sensitivity and specificity is encouraging, demonstrating the potential use of our system in evaluating AK burden. The latter might be of value in future clinical studies for the comparison of field-directed treatment interventions.

Clinical photography in severe idiopathic scoliosis candidate for surgery: is it a useful tool to differentiate among Lenke patterns?

PURPOSE: Clinical photography has proven to be reliable for posture assessment in adolescents and young adults with idiopathic scoliosis. This paper attempts to elucidate whether clinical photography is capable of distinguishing the distinctive characteristics in trunk deformity of the different Lenke patterns in patients with severe scoliosis candidate for surgery. METHODS: One hundred and seventy-three patients (82% women), average age of 20.8 years and average largest curve magnitude of 58.7° were included. PA standing full-spine X-rays and digital photographs from the back of the trunk were measured. RADIOLOGICAL MEASUREMENTS: It is used to measure magnitude of the proximal thoracic (PTC), main thoracic (MTC) and thoracolumbar/lumbar (TL/LC) curves, T1 tilt and the clavicle-rib intersection angle. PHOTOGRAPHIC MEASUREMENTS: It is used to measure shoulder height angle, axilla height angle, waist height angle (WHA), right and left waist angles and trunk areas. STATISTICAL ANALYSIS: One-way ANOVA to test mean differences among Lenke types for radiological and photographic measurements was performed. ROC curve analysis was conducted to find out cutoff values in photographic measurements to differentiate among curve patterns. RESULTS: Most radiological and photographic measurements differ among curve patterns. On ROC curve analysis, solid cutoff values were found for WHA (AUC = 0.8), left waist angle (AUC = 0.81), right waist angle (AUC = 0.81) and the difference between left and right waist angles (AUC = 0.86) to differentiate between types 1 and 2 and the other three types (3, 5 and 6). CONCLUSIONS: Clinical photography is a valid method for assessing trunk asymmetry in severe idiopathic scoliosis. Specifically, for waist area measurements, robust cutoff values can be determined to discriminate among different curve patterns according to Lenke classification. These slides can be retrieved under Electronic Supplementary Material.

Smartphone use by government dermatology practitioners in Kuwait: a self-reported questionnaire based cross-sectional study.

BACKGROUND: The potential for smartphones to revolutionize the way that medical doctors practice has become a reality, particularly in specialities where visual examination is a principal step in assessing a medical case, like dermatology. Smartphones as devices hold similar capabilities to personal computers and laptops and could play an important role in supporting medical practitioners in clinical practice at the point of care and beyond. This study aimed to assess the role of smartphone technology use in dermatology practice in Kuwait, together with the potential of digital photography and users' concerns. METHODS: This cross-sectional survey involved a population of dermatology practitioners of all levels working in 11 dermatology centers distributed across six health regions in Kuwait. A validated self-reported questionnaire was used to collect data from the participants about their smartphone use. Quantitative analytical methods were undertaken to analyse the questionnaire responses. RESULTS: A total of 210 dermatologists were approached in their workplaces. Of these, 101 (48%) responded to the survey questionnaire, with a mean age of 39.1 years (±10.7 SD) and equal representation from both genders. All the respondents were using smartphone technology, wherein 94.1% used it to access medical information through various Internet search engines. The most prevalent applications used were medical and drug reference applications (69.3 and 66.3%, respectively). In all, 65% of the dermatologists were using smartphones to take clinical photographs of patients for special purposes, and this type of usage was significantly higher (p < 0.05) among females and those older than 40. CONCLUSION: This study concludes that smartphone technology has an impactful role in dermatology practice, and many of its functions can be employed to achieve better practice and better patient care. Recommendations are suggested for clinicians using smartphones in dermatology practice.

Fundamentals of Enterprise Photodocumentation: Connecting the Clinical and Technical-a Review of Key Concepts.

Photodocumentation is an invaluable tool in many specialties, including dermatology, facial plastic and reconstructive surgery, and wound management. As digital cameras and camera-enabled smartphones have become omnipresent in our society, they have brought photodocumentation to all corners of healthcare organizations including the emergency department as well as family medicine and pediatrics. Simultaneously, enterprise imaging programs have evolved enabling access to all medical images for all providers throughout these organizations. Through their unique perspective, enterprise imaging teams have an opportunity to guide development of high quality, ethical programs that are compliant with legal and regulatory requirements. Clinical and technical standards for photodocumentation are not fully evolved and thus establishing an enterprise photodocumentation program will require communication and education. Development of such a program requires an understanding of the clinical, ethical, and technical issues around photodocumentation. This article explores how photodocumentation is utilized, the patient's experience, current quality concerns, tools and technical issues around image acquisition, and the topics of informed consent, privacy, security, and lifecycle and health information management.

Diagnostic accuracy of intraoral photographic orthodontic records.

OBJECTIVE: The aims of this study were (1) to investigate how relevant intraoral photographs are to contemporary orthodontic diagnosis and (2) to assess orthodontists' ability to accurately diagnose angle classification and dental midlines using standardized intraoral photographs. METHODS: Study participants were orthodontists who completed a survey regarding photography protocols and their use of intraoral photographs for diagnosis. Each participant was randomized to complete 1 visual diagnostic task regarding either angle classification or midlines. Accuracy was compared across groups and camera angulations. RESULTS: In all, 80% of 192 respondents reported using photographs and clinic notes to plan orthodontic treatment; 50% also included dental casts. For the angle task, accuracy judging molar and canine classification was 79.9% and 51.3%, respectively with ideal standardized photographs. As camera angulation deviated, accuracy decreased significantly (P < 0.0001). For the midline task, accuracy judging the direction of deviation decreased with a small camera angulation change yet increased with a large change (P < 0.001). CONCLUSIONS: When using ideal intraoral photographs alone to diagnose angle classification and midline relationships, accuracy is not likely to be greater than 80%. As camera angulation becomes less ideal, by 15 degrees when judging angle classification or 4 degrees when judging midlines, accuracy is likely to significantly decrease. CLINICAL SIGNIFICANCE: For the clinician who wants to have the most accurate and complete records, our results suggest that intra-oral photos alone may not be adequate when it comes to judging occlusal relationships such as angle classification and esthetic parameters like midlines. When using ideal intraoral photographs to diagnose angle classification and midline relationships, accuracy is not likely to be greater than 80%. As camera angulation becomes less ideal, by as little as 15 degrees when judging angle classification or 4 degrees when judging midlines, accuracy is likely to decrease significantly. Understanding these limitations will allow clinicians to improve both their clinical photography technique and their diagnostic skills.

Graduated colour tape measure: Development and demonstration of this tool in a case series of neonatal skin injuries.

AIM: This study proposed to (1) develop a metric graduated colour tool and (2) demonstrate the effectiveness of the tool for use in the assessment of neonatal skin injuries. MATERIALS/METHODS: Findings from wound literature informed the metric graduated colour tool's development. Tool development included consideration of colours, size (comparative to neonatal skin injuries), cost, materials, feasibility and suitability for the neonatal clinical setting. Assessment of the tool's applicability with clinical images was then tested using digital cameras with specific evaluation of image sharpness and colour. Further evaluation was conducted within a case series of neonatal skin injuries. RESULTS: The metric graduated colour tool comprised of 15 colours, measures 60 mm, displays metric dimensions, and offers a discernible reference for clinical images and injury/wound bed comparison. Images collected appeared enhanced with clear wound edges compared to previous methods. Four neonates who acquired skin injuries were included in the case series for which the tool provided reliable metric and colour comparison of epidermal stripping, extravasation, birth injury, and pressure injury. When used to compare injury assessments for series subjects measurements of both increased and decreased severity were obtained. CONCLUSION: A metric and colour tool can be used in conjunction with digital photographs to enhance objective assessment of neonatal skin injuries/wounds. The metric and colour tool provides the foundation for vital skin injury assessment and documentation essentials including injury bed colour, size and consideration of depth of damage.

Patient perceptions regarding the use of smart devices for medical photography: results of a patient-based survey.

AIM: To assess patient perceptions regarding medical photography and the use of smart devices, namely mobile phones and tablets for medical photography. METHODS: A questionnaire-based survey was conducted among 280 consecutive adult patients who presented to the oculoplastics clinic at a tertiary eye care centre. The responses were tabulated and analysed. RESULTS: Of the 280 patients surveyed, 68% felt that medical photography had a positive impact on their understanding of their illnesses and 72% felt that the use of smartphones for medical photography was acceptable. Respondents below the age of 40 years were more likely to approve of the use of mobile phones for photography as compared to those over 40. Most patients (74%) preferred a doctor to be the person photographing them. While a majority approved of doctors and trainee physicians having access to their photographs, they felt non-physician healthcare personnel should not have access to clinical photographs. Also, 72% of the respondents felt that the patient's consent should be taken before using their photographs. It was noted that patient identification and breach of confidentiality could be some of the potential issues with using smart devices as cameras in the clinic. CONCLUSIONS: Clinical photography in general and, specifically, using smart devices for clinical photographs have gained acceptance among patients. The outcomes of this study may be utilized to create policy guidelines for the use of smart devices as photography tools in the clinics. The findings of this survey can also help to create standardized, uniform patient consent forms for clinical photography.

[Clinical photography by smartphone in plastic surgery and protection of personal data: Development of a secured platform and application on 979 patients]. / Photographie clinique par smartphone en chirurgie plastique et protection des données personnelles : développement d'une plateforme sécurisée et application sur 979 patients.

BACKGROUND: The clinical photography in plastic and reconstructive surgery has known a numerical breakthrough. The storage of online data, massive means of analysis such as facial recognitions algorithms poses a serious issue when it comes to the protection of personal data. We will assess a platform's benefits in connection with the computerized medical record, which will allow keeping the photos filed and centralized in a smart and secure manner. METHOD: We interviewed 300 plastic surgeons about the role of smartphone in their clinical practice. Concomitantly, we developed an innovative platform called Surgeon©, a secure way to index, file and send photographs with a smartphone on our hospital's server. Each photographic sequence was qualified using a specific form. We then collected prospectively, between May 1st 2017 and March 30th 2018, the number of patients photographed, the number of sequences and photographs taken and the average number of sequences per patient. RESULTS: Out of 86 French plastic surgeons surveyed, 81% say that they could not go on with their daily practice today without their smartphone. Photographs taken were stored in their smartphones (50%) or synced with virtual storage (25.6%). A majority (80.2%) would use a dedicated secured smartphone application. Our application allowed us to photograph 979 patients, or 2345 sequences and 8112 photographs, with an average of 2.28 sequences per patient. CONCLUSION: Thanks to its ergonomics and security, this platform can be set up in a hospital ward and beyond.

Cross-sectional survey research investigating how medical students use clinical photographs to support their learning.

This study explored students' use of clinical photographs within seven medical schools in England. The design used was cross-sectional survey research. The data collection method was a self-completion online survey. A total of 283 students participated in the study. The proportion of students using clinical photographs was 87%, p = .217. The medical subject discipline in which clinical photographs were considered by students as most useful were dermatology (71%). The proportion for those 'Very' or 'Quite' likely to access an image library made available through their medical school was 92%. The main barrier to using existing photographic resources was awareness.