Digital imaging in clinical dermatology across the UK in the year 2001

A quantitative assessment of the human skin surface using polarized light digital photography and its dermatologic significance

BACKGROUND

Quantitative and objective investigations of parallel-polarized light (PPL) photography for dermatologic purposes are scarce.

OBJECTIVE

To determine the significance of quantitative analysis of PPL photography to develop objective measurement methods of skin surface characteristics.

METHOD

For PPL photography, a digital camera, a light-emitting diode illuminator, and polarizing filters were arranged and kept constant. We analyzed the PPL photography images of the glabella, the medial aspect of the forearm, and the posterior aspect of the lower leg, and measured the CIELAB values. A dermatologist evaluated the clinical severity of the actual photographed sites with respect to glossiness and dryness. These clinical severities were compared statistically with the CIELAB values.

RESULTS

According to the correlation analysis, the L* value was negatively correlated with dryness (r=-0.29869, P=0.0047) and glossiness (r=-0.35367, P=0.0185).

CONCLUSION

The method used in this study is applicable to the quantitative evaluations of other dermatologic diseases or conditions, especially in relation to skin surface changes.

Objective and quantitative evaluation of scar color using the L*a*b* color coordinates

Scar color evaluation by clinical physicians has been based on subjective judgments. The purpose of this study was to investigate the application of a novel photographic analysis to produce an objective and quantitative measurement of scar color using the L*a*b* color coordinates. Three plastic surgeons evaluated photos of 207 scars using the clinical scar assessment scale developed by Beausang et al. Scar color was subjectively classified as group 1 (perfect match), 2 (slight mismatch), 3 (obvious mismatch), or 4 (gross mismatch). Three general physicians quantified color differences between the scar and the surrounding normal skin using the L*a*b* color coordinates. The total color difference (DeltaT*) and the color differences for each coordinate (DeltaL*, Deltaa*, and Deltab*) were calculated. The measurement was performed 3 times with a 4-week interval. Group 1 contained 51 scars, group 2 had 68, group 3 had 46, and group 4 had 42. The mean (SD) total color difference values (DeltaT*) for each group were 4.4 (1.83), 9.55 (2.18), 17.76 (2.96), and 29.06 (9.45), respectively (P < 0.001). The mean of each color coordinate (DeltaL* = light to dark, and Deltaa* = green to red) also differed between the groups, except in groups 1 and 2. The mean Deltab* (blue to yellow) did not differ between the groups. The correlation coefficients for interrater reliability and test-retest consistency were satisfactory. Objective scar evaluation using the L*a*b* color coordinates is found to be a reliable method to quantify scar color. With further study, this method could be simple and effective to assess the effects of scar management.

Enterprise imaging and multi-departmental PACS

The aim of this review is to present the status of digital image acquisition and archiving outside of radiology and to describe the technical concepts and possibilities of how a "radiology" Picture Archiving and Communication System (PACS) can become a multi-departmental (MD-)PACS. First the principles of system integration technology are explained and illustrated by the description of a typical radiology system integration. Then four types of modality integration approaches are defined: the direct modality integration (Type-I), the integration via DICOM acquisition software (Type-II) the integration via specialised systems either with (Type-III) or without PACS connection (Type-IV). The last section is dedicated to the presentation of the PACS requirements of selected interdisciplinary modality types [Endoscopy, Ultrasound and Electrocardiography (ECG)] and clinical disciplines (Pathology, Dermatology, Ophthalmology and Cardiology), which are then compared with the technical possibilities of a MD-PACS.

Integrating digital image management software for improved patient care and optimal practice management

BACKGROUND

Photographic images provide vital documentation of preoperative, intraoperative, and postoperative results in the clinical dermatologic surgery practice and can document histologic findings from skin biopsies, thereby enhancing patient care. Images may be printed as part of text documents, transmitted via electronic mail, or included in electronic medical records.

OBJECTIVES

To describe existing computer software that integrates digital photography and the medical record to improve patient care and practice management.

CONCLUSIONS

A variety of computer applications are available to optimize the use of digital images in the dermatologic practice.

Overcoming the Limitations of Integrated Clinical Digital Imaging Solutions

Context.—Digital imaging is increasingly common in medicine. Vendors of anatomic pathology software have addressed this need by integrating digital image acquisition and storage into their products. While offering a number of advantages, these solutions cannot be easily adapted to accommodate the existing work flow for many pathology departments.

Objective.—To describe a novel solution that maintains the advantages of these integrated solutions but offers many additional flexibilities, making it more compatible with the work flow in most clinical departments.

Design.—This solution involves separating the image acquisition step from the image archiving process and creating dual-image storages for greater usability. Software needed to deploy this modular and scalable solution is described.

Results.—We have deployed this solution at our institution and achieved widespread acceptance and use, with minimal training required. Deployment in the surgical pathology gross specimen room, in particular, has resulted in a significant increase in the number of photographs taken and the percentage of cases documented photographically.

Conclusions.—The complete clinical digital imaging solution described herein is an effective, scalable solution for pathology imaging at a departmental level. Although developed and implemented in an anatomic pathology department, the method described is generally applicable to digital imaging in any large multiuser environment.