Comparison of still image quality between traditional 35 mm digital and GoPro cameras in a surgical setting

Efficacy of ethylene oxide-sterilized waterproof cases for handheld cameras as sterile barriers for intraoperative imaging and recording

OBJECTIVE

To evaluate the efficacy of ethylene oxide (EtOH) sterilization of 4 different waterproof camera cases and the ability of those sterilized cases to maintain a sterile barrier for intraoperative camera use.

SAMPLE

3 action cameras, 1 smartphone, and associated waterproof cases.

PROCEDURES

Cases were inoculated by immersion in medium containing Staphylococcus pseudintermedius, Escherichia coli, and Pseudomonas aeruginosa and then manually cleaned and subjected to EtOH sterilization. Cameras were disinfected, loaded into sterile cases, and sterilely operated for 2 hours. Samples were collected from cases after inoculation, EtOH sterilization, camera loading, and 1 and 2 hours of operation and from all cameras after 2 hours of operation. Procedures were repeated twice, followed by an additional challenge round wherein cameras were purposefully contaminated prior to loading. All samples underwent bacterial culture.

RESULTS

All cases were successfully sterilized, and loading of nonsterile cameras into sterile cases caused no contamination when cameras had been disinfected beforehand. Nonpathogenic environmental contaminants were recovered from 6 of 64 culture samples and 2 of 4 room samples. During the challenge round, only the postload sample for 1 case yielded E coli, suggesting sterile glove contamination; however, postload, 1-hour, and 2-hour samples for the GoPro case yielded E coli and S pseudintermedius, suggesting major contamination.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested that the evaluated cases can be safely sterilized with EtOH and used for image acquisition by aseptically prepared surgeons when cameras are disinfected prior to loading. Except for the GoPro camera, camera use did not jeopardize sterile integrity.

The iPhone, the reflex, and the vinyl record: is the smartphone taking the best intraoperative photographs?

Surgical field photography is a tough exercise: surgeons dedicate the required time for photography even during complex surgeries; the intense lighting of the operating field works against photography, and the surgeon has to utilise whatever equipment is available. We selected five complex interventions and two surgeons (one with an iPhone^® and one with a Digital Single Lens Reflex [DSLR] camera) who each took a photograph of the operating field. The source of photographs was blinded, and the image quality was scored using a 5-point Likert scale by three groups of team members with differing experiences: six senior surgeons, two junior surgeons, and four surgical residents. We evaluated the resolution (adequate for clinical interpretation), colour (appear true and natural), contrast (adequate to distinguish different structures), and overall quality. The mean ± SEM overall image quality was similar for both the smartphone and DSLR (3.7 ± 0.1 vs. 3.8 ± 0.11; p = 0.87), as were most of the scores for each image characteristic. Surgeons seek objectivity and efficiency. The smartphone is a more convenient photographic equipment and produces identical results than the DSLR. Human beings can be sensitive to image quality. The DSLR image was found to be sharper, however, this was found to be imperceptible.

UniTwain: A Cost-Effective Solution for Lean Gross Imaging

Background:

Gross imaging of surgical specimens is paramount for the accurate gross examination and diagnosis of disease. Optimized imaging workflow can facilitate consistently high-quality gross photographs, especially in high-volume, metropolitan hospitals such as ours. Most commercial medical gross imaging technology provides ergonomically well-designed hardware, remotely operated cameras, intuitive software interfaces, and automation of workflow. However, these solutions are usually cost-prohibitive and require a large sum of capital budget.

Materials and Methods:

We applied lean techniques such as value stream mapping (VSM) to design a streamlined and error-free workflow for gross imaging process. We implemented a cost-effective technology, UniTwain, combined with high-resolution webcam to achieve the ideal results.

Results:

We reduced the mean process time from 600 min to 4.0 min (99.3% decrease in duration); the median process time was reduced from 580 min to 3.0 min. The process efficiency increased from 20% to 100%. The implemented solution has a comparable durability, scalability, and archiving feasibility to commercial medical imaging systems and costs four times less. The only limitations are manual operation of the webcam and lower resolution. The webcam sensors have 8.2 megapixel (MP) resolution, approximately 12 MP less than medical imaging devices. However, we believe that this difference is not visually significant and the effect on gross diagnosis with the naked eye is minimal.

Conclusions:

To our knowledge, this is the first study that utilized UniTwain as a viable, low-cost solution to streamline the gross imaging workflow. The UniTwain combined with high-resolution webcam could be a suitable alternative for our institution that does not plan to heavily invest in medical imaging.