Clinical photography in dermatology using smartphones: An overview

Artificial intelligence in dermatology: advancements and challenges in skin of color

Artificial intelligence (AI) uses algorithms and large language models in computers to simulate human-like problem-solving and decision-making. AI programs have recently acquired widespread popularity in the field of dermatology through the application of online tools in the assessment, diagnosis, and treatment of skin conditions. A literature review was conducted using PubMed and Google Scholar analyzing recent literature (from the last 10 years through October 2023) to evaluate current AI programs in use for dermatologic purposes, identifying challenges in this technology when applied to skin of color (SOC), and proposing future steps to enhance the role of AI in dermatologic practice. Challenges surrounding AI and its application to SOC stem from the underrepresentation of SOC in datasets and issues with image quality and standardization. With these existing issues, current AI programs inevitably do worse at identifying lesions in SOC. Additionally, only 30% of the programs identified in this review had data reported on their use in dermatology, specifically in SOC. Significant development of these applications is required for the accurate depiction of darker skin tone images in datasets. More research is warranted in the future to better understand the efficacy of AI in aiding diagnosis and treatment options for SOC patients.

Fotografie in der Dermatologie - ein Scoping Review: Praktiken, Skin of Color, Patientenpräferenzen und medizinisch-rechtliche Überlegungen

Die klinische Fotografie ist essentiell für die Dermatologie. Es gibt jedoch keine umfassende Aufarbeitung der Literatur zur Fotografie in der Dermatologie. Dieser Scoping Review soll die Literatur zu fotografischen Praktiken in der Dermatologie, der Fotografie stark pigmentierter Haut (Skin of Color), Patientenpräferenzen und medizinisch‐rechtlichen Überlegungen zusammenfassen. Die Datenbanken Embase, MEDLINE, PubMed und Evidence Based Medicine wurden im Einklang mit der PRISMA‐Erweiterung für Scoping Reviews durchsucht. Insgesamt wurden 33 Studien zusammengefasst. Die klinische Fotografie wird häufig für die Markierung von Biospiestellen, Beurteilung, Diagnostik, Krankheitsüberwachung, Bewertung des Ansprechens auf die Behandlung, medizinische Ausbildung, Forschung, das Einholen kollegialer Ratschläge und in der Teledermatologie eingesetzt. Obwohl es in der dermatologischen Fotografie weiterhin kaum Darstellungen von Skin of Color gibt, sind fotografische Überlegungen für dunklere Hauttypen verfügbar. Die meisten Patienten unterstützen die medizinische Fotografie. Dabei besteht der Wunsch, dass klinische Fotografien vom eigenen Arzt aufgenommen und bevorzugt klinikeigene Kameras und keine persönlichen Geräte verwendet werden. Relevante medizinisch‐rechtliche Fragestellungen umfassen Bedenken hinsichtlich des Datenschutzes, der Verwendung persönlicher Geräte und der Dokumentation der Einwilligung. Die Fotografie in der Dermatologie entwickelt sich ständig weiter und findet immer breitere Anwendung. Verbesserte Verfahren und Innovationen werden Menschen aller Hautfarben zugute kommen. Die Einhaltung der Zustimmung und des Datenschutzes muss gewährleistet werden, um die zunehmende Einfachheit der Bildaufnahme und ‐freigabe aufrechtzuerhalten.

Photography in dermatology - a scoping review: Practices, skin of color, patient preferences, and medical-legal considerations

Clinical photography is essential in dermatology. However, a comprehensive literature review of photography in dermatology is lacking. This scoping review aims to summarize the literature regarding photography practices in dermatology, photography of skin of color, patient preferences, and medical-legal considerations. A search was conducted utilizing Embase, MEDLINE, PubMed, and Evidence Based Medicine databases in accordance with the PRISMA extension for Scoping Reviews. In total, 33 studies were summarized. Clinical photography is commonly used in biopsy site marking, assessment, diagnosis, disease monitoring, evaluation of treatment response, medical education, research, seeking advice from colleagues, and teledermatology. Although dermatologic photography remains devoid of skin of color representation, photographic considerations for darker skin are available. Most patients support medical photography, with a preference for clinical photographs to be taken by their own physicians, and for use of clinic/hospital-owned cameras over personal devices. Pertinent medical-legal issues include concerns around privacy, personal device use, and documentation of consent. Photography in dermatology is continuously evolving with broader applications. Improved practices and innovations will benefit individuals of various skin tones. Management of consent and privacy must be upheld to sustain the increasing ease of image capture and sharing.

Photography and Image Acquisition in Dermatology a Scoping Review: Techniques for High-Quality Photography

BACKGROUND

Clinical photography is essential in dermatology, in particular in the areas of surgical and cosmetic dermatology and has been evolving rapidly. However, many dermatologists desire more training in clinical photography and a comprehensive literature review of photography in dermatology is lacking.

OBJECTIVE

This scoping review aimed to summarize the literature regarding techniques for high-quality photography in dermatology.

MATERIALS AND METHODS

A literature search was conducted using Embase, MEDLINE, PubMed, and Evidence-Based Medicine databases in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews.

RESULTS

This review summarizes information from 74 studies. Camera type, resolution, lens choice, camera settings, environment and set-up, standardization, and types of clinical photography are all important factors in acquisition of high-quality photography.

CONCLUSION

Photography in dermatology is continuously evolving with broader applications. Improved practices and innovations will benefit the quality of images.

Consensus Guidelines for Teledermatology: Scoping Review

BACKGROUND

Consensus guidelines and recommendations play an important role in fostering quality, safety, and best practices, as they represent an expert interpretation of the biomedical literature and its application to practice. However, it is unclear whether the recent collective experience of implementing telemedicine and the concurrent growth in the evidence base for teledermatology have resulted in more robust guidance.

OBJECTIVE

The objective of this review was to describe the extent and nature of currently available guidance, defined as consensus guidelines and recommendations available for telemedicine in dermatology, with guidance defined as consensus or evidence-based guidelines, protocols, or recommendations.

METHODS

We conducted a single-reviewer scoping review of the literature to assess the extent and nature of available guidance, consensus guidelines, or recommendations related to teledermatology. We limited the review to published material in English since 2013, reflecting approximately the past 10 years. We conducted the review in November and December of the year 2022.

RESULTS

We identified 839 potentially eligible publications, with 9 additional records identified through organizational websites. A total of 15 publications met the inclusion and exclusion criteria. The guidelines focused on varied topics and populations about dermatology and skin diseases. However, the most frequent focus was general dermatology (8/15, 53%). Approximately half of the telemedicine guidance described in the publications was specific to dermatology practice in the context of the COVID-19 pandemic. The publications were largely published in or after the year 2020 (13/15, 87%). Geographical origin spanned several different nations, including Australia, the United States, European countries, and India.

CONCLUSIONS

We found an increase in COVID-19-specific teledermatology guidance during 2020, in addition to general teledermatology guidance during the period of the study. Primary sources of general teledermatology guidance reported in the biomedical literature are the University of Queensland's Centre for Online Health and Australasian College of Dermatologists E-Health Committee, and the American Telemedicine Association. There is strong evidence of international engagement and interest. Despite the recent increase in research reports related to telemedicine, there is a relative lack of new guidance based on COVID-19 lessons and innovations. There is a need to review recent evidence and update existing recommendations. Additionally, there is a need for guidance that addresses emerging technologies.

Assessing Acne Severity: Teledermatology Versus Face to Face Consultations During the COVID-19 Pandemic

BACKGROUND

Acne vulgaris is a common skin disorder in pilosebaceous units that is self-limited, especially in adolescents. This disease not only causes permanent physical complications but also psychosocial effects that harm the quality of life. Telemedicine has grown its popularity in recent years, especially during the COVID-19 pandemic. Store and Forward (SAF) teledermatology using digital cameras has also increased patient service satisfaction, promising diagnostic reliability, and clinical outcomes similar to face-to-face visits.

OBJECTIVE

We sought to compare the severity of acne vulgaris by teledermatology with face-to-face consultations. We also observe the capability of teledermatology in establishing the severity of acne vulgaris.

METHODS

This study is an observational analytic study with a cross-sectional design involving 105 patients with a diagnosis of acne vulgaris based on inclusion and exclusion criteria. The characteristics of age and sex were recorded. The severity of acne vulgaris was established directly by the resident and teledermatologically by the dermatologist consultant. Teledermatology was carried out based on photo documentation of five facial lesion areas; namely forehead, chin, right cheek, left cheek, and the entire face, along with photos from the history submitted by the resident. An assessment for acne vulgaris severity was carried out based on the classification from the International Consensus Conference on Acne Classification System. This classification divided acne vulgaris as mild, moderate, and severe with an ordinal measuring scale. A compatibility test was also performed to determine the comparison between teledermatology and face-to-face consultations in establishing the severity of acne vulgaris. Comparison of the severity of acne vulgaris was assessed by the kappa value.

RESULTS

Acne vulgaris was found more common in women (n=71, 67.6%) and those aged 18 to 22 years (n=55, 52.4%). Most of the subjects have moderate severity based on face-to-face consultations and teledermatology examination (n=52 (49.5%) and n=50 (47.6%), respectively). The value of the capability test between teledermatology and face-to-face consultations in comparing the severity of acne vulgaris is 0.611, which means the capability is considered good.

CONCLUSION

In this study, the teledermatology examination shows good conformity when compared with face-to-face consultations in assessing severity of acne vulgaris.

Current Status of using Scale Bar on Clinical Images and Methods to Insert it

Clinical images are of utmost importance for the majority of dermatological research and publications. The rich collection of clinical images in medical journals may help in formulating machine learning programs in the future or facilitate image-based meta-analysis. However, the presence of a scale bar in those images is required for measuring the lesion from an image. We audited recent issues of three widely circulated Indian dermatology journals and found that among 345 clinical images, 2.61% had a scale with the unit. With this background, in this article, we provided three methods for capturing and processing clinical images with scale. This article would help dermatologists to think about incorporating a scale bar in the image for the progress of science.

Usefulness of Smartphones in Dermatology: A US-Based Review

(1) Background: As smartphones have become more widely used, they have become an appealing tool for health-related functions. For dermatology alone, hundreds of applications (apps) are available to download for both patients and providers. (2) Methods: The Google Play Store and Apple App Store were searched from the United States using dermatology-related terms. Apps were categorized based on description, and the number of reviews, download cost, target audience, and use of AI were recorded. The top apps from each category by number of reviews were reported. Additionally, literature on the benefits and limitations of using smartphones for dermatology were reviewed. (3) Results: A total of 632 apps were included in the study: 395 (62.5%) were marketed towards patients, 203 (32.1%) towards providers, and 34 (5.4%) towards both; 265 (41.9%) were available only on the Google Play Store, 146 (23.1%) only on the Apple App Store, and 221 (35.0%) were available on both; and 595 (94.1%) were free to download and 37 (5.9%) had a cost to download, ranging from USD 0.99 to USD 349.99 (median USD 37.49). A total of 99 apps (15.7%) reported the use of artificial intelligence. (4) Conclusions: Although there are many benefits of using smartphones for dermatology, lack of regulation and high-quality evidence supporting the efficacy and accuracy of apps hinders their potential.

Imtidad: A Reference Architecture and a Case Study on Developing Distributed AI Services for Skin Disease Diagnosis over Cloud, Fog and Edge

Several factors are motivating the development of preventive, personalized, connected, virtual, and ubiquitous healthcare services. These factors include declining public health, increase in chronic diseases, an ageing population, rising healthcare costs, the need to bring intelligence near the user for privacy, security, performance, and costs reasons, as well as COVID-19. Motivated by these drivers, this paper proposes, implements, and evaluates a reference architecture called Imtidad that provides Distributed Artificial Intelligence (AI) as a Service (DAIaaS) over cloud, fog, and edge using a service catalog case study containing 22 AI skin disease diagnosis services. These services belong to four service classes that are distinguished based on software platforms (containerized gRPC, gRPC, Android, and Android Nearby) and are executed on a range of hardware platforms (Google Cloud, HP Pavilion Laptop, NVIDIA Jetson nano, Raspberry Pi Model B, Samsung Galaxy S9, and Samsung Galaxy Note 4) and four network types (Fiber, Cellular, Wi-Fi, and Bluetooth). The AI models for the diagnosis include two standard Deep Neural Networks and two Tiny AI deep models to enable their execution at the edge, trained and tested using 10,015 real-life dermatoscopic images. The services are evaluated using several benchmarks including model service value, response time, energy consumption, and network transfer time. A DL service on a local smartphone provides the best service in terms of both energy and speed, followed by a Raspberry Pi edge device and a laptop in fog. The services are designed to enable different use cases, such as patient diagnosis at home or sending diagnosis requests to travelling medical professionals through a fog device or cloud. This is the pioneering work that provides a reference architecture and such a detailed implementation and treatment of DAIaaS services, and is also expected to have an extensive impact on developing smart distributed service infrastructures for healthcare and other sectors.

Preferences Towards Electronically Exchanging Digital Images With Healthcare Providers Among US Adults

Background: The rapid expansion of telemedicine, including teledermatology, during the COVID-19 pandemic has required both providers and patients alike to adapt to this digital transition. However, patient attitudes towards electronically shared images with their providers are poorly understood. To address this gap, we assessed digital image sharing preferences and associated determinants in a nationally representative sample.

Methods: We analyzed pooled data from the Health Information National Trends Survey 4, Cycle 3 and 4. Digital image sharing preferences were compared by patient characteristics and beliefs via chi-square at a significance level of p<0.05, using sampling and jackknife replicate weights to develop nationally representative sample estimates and account for the complex survey design. P-values were adjusted for multiple comparisons when appropriate.

Results: Among 6437 adults, 53.5% reported reluctance in electronically shared images and videos with providers. Greater aversion was observed among adults aged 75 or above (70.9%), retired (67.3%), and those with lower education (65.1%), lower annual income (60.9%), limited English proficiency (63.3%), distrust in health information from doctors (75.4%), and fair or poor health (60.4%).

Conclusion: Patient hesitancy towards digital image sharing may present challenges for teledermatology adoption. Greater efforts may be needed to address the age and socioeconomic digital divide, multilingual telemedicine tools, and patient-physician dynamics to ensure vulnerable groups receive needed teledermatologic care.

Computational Audiology: New Approaches to Advance Hearing Health Care in the Digital Age

The global digital transformation enables computational audiology for advanced clinical applications that can reduce the global burden of hearing loss. In this article, we describe emerging hearing-related artificial intelligence applications and argue for their potential to improve access, precision, and efficiency of hearing health care services. Also, we raise awareness of risks that must be addressed to enable a safe digital transformation in audiology. We envision a future where computational audiology is implemented via interoperable systems using shared data and where health care providers adopt expanded roles within a network of distributed expertise. This effort should take place in a health care system where privacy, responsibility of each stakeholder, and patients' safety and autonomy are all guarded by design.

Study of patients' satisfaction toward photographing their skin lesions for educational purposes

BACKGROUND

Medical images have been widely used for various aims, especially for the educational purposes. Patient confidentiality and consent should be deemed crucial. In this study, we sought to assess patients' satisfaction with taking medical photos of their skin lesions and giving their physicians consent to use them for educational purposes.

MATERIALS AND METHODS

This multi-method study included quantitative and qualitative phases and was performed from April to November 2018 in the Dermatology Department of Shiraz Faghihi Hospital in South Iran. Demographic information was analyzed using the descriptive statistics. To resolve the simultaneous effect of demographic variables on patient satisfaction, we conducted linear regression. All the tests were analyzed at the 0.05 significance level.

RESULTS

In this study, all the patients except one (99.5%) preferred that only a physician who had a direct role in their care can access their digital photos. Of 200 patients, 134 patients (62.33%) preferred the utilization of hospital cameras in photographing their skin lesions (P = 0.002). On the other hand, 131 patients (49.81%) did not gave consent about using a personal phone camera for photographing their skin lesions (P = 0.001). In the qualitative phase, two major themes (trusting attending physician and paying attention to patient confidentiality) and five sub-themes (considering their physicians as professional people who always do the right thing, allowing physicians to use their images for educational purposes, covering patient's face, using hospital cameras, and obtaining informed consent from patients) were derived from qualitative semi-structured interviews.

CONCLUSION

The results showed that there is a need for developing international and national photography guidelines in the era of technology development.

Development of a Checklist Tool to Assess the Quality of Skin Lesion Images Acquired by Consumers Using Sequential Mobile Teledermoscopy

BACKGROUND

Mobile teledermoscopy is an emerging technology that involves imaging and digitally sending dermoscopic images of skin lesions to a clinician for assessment. High-quality, consistent images are required for accurate telediagnoses when monitoring lesions over time. To date there are no tools to assess the quality of sequential images taken by consumers using mobile teledermoscopy. The purpose of this study was to develop a tool to assess the quality of images acquired by consumers.

METHODS

Participants imaged skin lesions that they felt were concerning at baseline, 1-, and 2-months. A checklist to assess the quality of consumer sequential imaging of skin lesions was developed based on the International Skin Imaging Collaboration guidelines. A scale was implemented to grade the quality of the images: 0 (low) to 18 (very high). Intra- and inter-reliability of the checklist was assessed using Bland-Altman analysis. Using this checklist, the consistency with which 85 sets of images were scored by 2 evaluators were compared using Kappa statistics. Items with a low Kappa value <0.4 were removed.

RESULTS

After reliability testing, 5 of the items were removed due to low Kappa values (<0.4) and the final checklist included 13 items surveying: lesion selection; image orientation; lighting; field of view; focus and depth of view. Participants had a mean age of 41 years (range 19-73), and 67% were female. Most participants (84%, n = 71/85) were able to select and image the correct lesion over time for both the dermoscopic and overview images. Younger participants (<40 years old) scored significantly higher (8.1 ± 2.1) on the imaging checklist compared to older participants (7.1 ± 2.4; p = 0.037). Participants had most difficulty with consistent image orientation.

CONCLUSIONS

This checklist could be used as a triage tool to filter images acquired by consumers prior to telediagnosis evaluation, which would improve the efficiency and accuracy of teledermatology and teledermoscopy processes. It may also be used to provide feedback to the consumers to improve image acquisition over time.

Use of Mobile Applications in Dermatology

Smartphones and applications related to the same are ubiquitous now. As dermatologists, we have a wide array of smartphone apps at our disposal which we can use to improve our practice in all aspects—clinical, academic, research, and administrative. This article provides an overview of available apps, tips on using apps—both general and specific for dermatology, as well as discusses the scientific validity of some of these apps and the future of smartphone apps in the context of dermatology.

The Internet of Things: Impact and Implications for Health Care Delivery

The Internet of Things (IoT) is a system of wireless, interrelated, and connected digital devices that can collect, send, and store data over a network without requiring human-to-human or human-to-computer interaction. The IoT promises many benefits to streamlining and enhancing health care delivery to proactively predict health issues and diagnose, treat, and monitor patients both in and out of the hospital. Worldwide, government leaders and decision makers are implementing policies to deliver health care services using technology and more so in response to the novel COVID-19 pandemic. It is now becoming increasingly important to understand how established and emerging IoT technologies can support health systems to deliver safe and effective care. The aim of this viewpoint paper is to provide an overview of the current IoT technology in health care, outline how IoT devices are improving health service delivery, and outline how IoT technology can affect and disrupt global health care in the next decade. The potential of IoT-based health care is expanded upon to theorize how IoT can improve the accessibility of preventative public health services and transition our current secondary and tertiary health care to be a more proactive, continuous, and coordinated system. Finally, this paper will deal with the potential issues that IoT-based health care generates, barriers to market adoption from health care professionals and patients alike, confidence and acceptability, privacy and security, interoperability, standardization and remuneration, data storage, and control and ownership. Corresponding enablers of IoT in current health care will rely on policy support, cybersecurity-focused guidelines, careful strategic planning, and transparent policies within health care organizations. IoT-based health care has great potential to improve the efficiency of the health system and improve population health.

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.

The Efficiency of WhatsApp in Teleconsultation of Finger Vascularity in Hand Surgery

Background Teleconsultation over the smartphone is now widely used in modern medicine in the management of burns, flap cover, upper extremity trauma, and in the assessment of the feasibility of reimplantation in amputated fingers. The development of the WhatsApp application has enhanced the smartphone's efficiency remarkably to transmit images in clinical and academic settings with its failsafe and encrypted technology. In hand surgery, a teleconsultation technology must communicate details of finger vascularity effectively. However, there is a paucity of evidence on the functionality of these modern teleconsultation technologies in Hand Surgery. Here, the authors have estimated the efficiency of the WhatsApp teleconsultation in the assessment of finger vascularity. Materials and Methods In two phases, the authors transmitted clinical photographs of vascular and avascular fingers to experienced hand surgeons over the WhatsApp and asked them to assess the finger vascularity. The efficiency of the WhatsApp teleconsultation in assessing the details of finger vascularity was estimated from their responses. Results Despite 81.06% of the hand surgeons rating the vascular fingers on the transmitted photographs correctly, only 44.95% detected the avascular digits accurately; that is, 55.05% of the surgeons failed to diagnose the avascularity of fingers. This suggests serious implications in a clinical setting. The intra- and the inter-rater reliability values were 0.232 and 0.6086 (with 95% confidence interval), respectively, which indicated poor reliability of the WhatsApp teleconsultation regarding the assessment of finger vascularity. Conclusion The authors, therefore, conclude that WhatsApp is inadequate in teleconsultation given the value of vascularity details of the fingers in making a diagnosis in hand surgery.

[Clinical photography by smartphone in plastic surgery and protection of personal data: Development of a secured platform and application on 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.

Use of Smartphones for Early Detection of Melanoma: Systematic Review

Background

The early diagnosis of melanoma is associated with decreased mortality. The smartphone, with its apps and the possibility of sending photographs to a dermatologist, could improve the early diagnosis of melanoma.

Objective

The aim of our review was to report the evidence on (1) the diagnostic performance of automated smartphone apps and store-and-forward teledermatology via a smartphone in the early detection of melanoma, (2) the impact on the patient’s medical-care course, and (3) the feasibility criteria (focusing on the modalities of picture taking, transfer of data, and time to get a reply).

Methods

We conducted a systematic search of PubMed for the period from January 1, 2007 (launch of the first smartphone) to November 1, 2017.

Results

The results of the 25 studies included 13 concentrated on store-and-forward teledermatology, and 12 analyzed automated smartphone apps. Store-and-forward teledermatology opens several new perspectives, such as it accelerates the care course (less than 10 days vs 80 days), and the related procedures were assessed in primary care populations. However, the concordance between the conclusion of a teledermatologist and the conclusion of a dermatologist who conducts a face-to-face examination depended on the study (the kappa coefficient range was .20 to .84, median κ=.60). The use of a dermoscope may improve the concordance (the kappa coefficient range was .29 to .87, median κ=.74). Regarding automated smartphone apps, the major concerns are the lack of assessment in clinical practice conditions, the lack of assessment in primary care populations, and their low sensitivity, ranging from 7% to 87% (median 69%). In this literature review, up to 20% of the photographs transmitted were of insufficient quality. The modalities of picture taking and encryption of the data were only partially reported.

Conclusions

The use of store-and-forward teledermatology could improve access to a dermatology consultation by optimizing the care course. Our review confirmed the absence of evidence of the safety and efficacy of automated smartphone medical apps. Further research is required to determine quality criteria, as there was major variability among the studies.

Workflow Challenges of Enterprise Imaging: HIMSS-SIIM Collaborative White Paper

With the advent of digital cameras, there has been an explosion in the number of medical specialties using images to diagnose or document disease and guide interventions. In many specialties, these images are not added to the patient's electronic medical record and are not distributed so that other providers caring for the patient can view them. As hospitals begin to develop enterprise imaging strategies, they have found that there are multiple challenges preventing the implementation of systems to manage image capture, image upload, and image management. This HIMSS-SIIM white paper will describe the key workflow challenges related to enterprise imaging and offer suggestions for potential solutions to these challenges.

Image-based teleconsultation using smartphones or tablets: qualitative assessment of medical experts

Background

Mobile health has promising potential in improving healthcare delivery by facilitating access to expert advice. Enabling experts to review images on their smartphone or tablet may save valuable time. This study aims at assessing whether images viewed by medical specialists on handheld devices such as smartphones and tablets are perceived to be of comparable quality as when viewed on a computer screen.

Methods

This was a prospective study comparing the perceived quality of 18 images on three different display devices (smartphone, tablet and computer) by 27 participants (4 burn surgeons and 23 emergency medicine specialists). The images, presented in random order, covered clinical (dermatological conditions, burns, ECGs and X-rays) and non-clinical subjects and their perceived quality was assessed using a 7-point Likert scale. Differences in devices' quality ratings were analysed using linear regression models for clustered data adjusting for image type and participants’ characteristics (age, gender and medical specialty).

Results

Overall, the images were rated good or very good in most instances and more so for the smartphone (83.1%, mean score 5.7) and tablet (78.2%, mean 5.5) than for a standard computer (70.6%, mean 5.2). Both handheld devices had significantly higher ratings than the computer screen, even after controlling for image type and participants' characteristics. Nearly all experts expressed that they would be comfortable using smartphones (n=25) or tablets (n=26) for image-based teleconsultation.

Conclusion

This study suggests that handheld devices could be a substitute for computer screens for teleconsultation by physicians working in emergency settings.

Clinical Photography for Periorbital and Facial Aesthetic Practice

External cutaneous photography involves photographic documentation, which helps in treatment planning, documentation of facial features, teaching, publishing and pre- and post-procedural comparisons. The key is not simply documenting, but documenting it the right way and ensuring that photography is standardised and reproducible. In this review, basic photography techniques, standardised and reproducible angles such as frontal, oblique and lateral views and specific photographic angles for conditions such as facial rejuvenation are discussed. Use of photography accessories and a few tips on how to click good photographs in the examination room and how to achieve consistency in standardised photography are also presented. External photography in ophthalmic and facial plastic surgery like any other speciality too has standardised guidelines. Even small variations cause a drastic change in the photos and it's clinical and research value. Unless stringent criteria are met, the photographs lose their relevance and impact.