Use of standardized, quantitative digital photography in a multicenter Web-based study

Joseph A Molnar, Wesley K Lew, Derek A Rapp, E Stanley Gordon, Denise Voignier, Scott Rushing, William Willner, Joseph A Molnar, Wesley K Lew, Derek A Rapp, E Stanley Gordon, Denise Voignier, Scott Rushing, William Willner

Abstract

Objective: We developed a Web-based, blinded, prospective, randomized, multicenter trial, using standardized digital photography to clinically evaluate hand burn depth and accurately determine wound area with digital planimetry.

Methods: Photos in each center were taken with identical digital cameras with standardized settings on a custom backdrop developed at Wake Forest University containing a gray, white, black, and centimeter scale. The images were downloaded, transferred via the Web, and stored on servers at the principal investigator's home institution. Color adjustments to each photo were made using Adobe Photoshop 6.0 (Adobe, San Jose, Calif). In an initial pilot study, model hands marked with circles of known areas were used to determine the accuracy of the planimetry technique. Two-dimensional digital planimetry using SigmaScan Pro 5.0 (SPSS Science, Chicago, Ill) was used to calculate wound area from the digital images.

Results: Digital photography is a simple and cost-effective method for quantifying wound size when used in conjunction with digital planimetry (SigmaScan) and photo enhancement (Adobe Photoshop) programs. The accuracy of the SigmaScan program in calculating predetermined areas was within 4.7% (95% CI, 3.4%-5.9%). Dorsal hand burns of the initial 20 patients in a national study involving several centers were evaluated with this technique. Images obtained by individuals denying experience in photography proved reliable and useful for clinical evaluation and quantification of wound area.

Conclusion: Standardized digital photography may be used quantitatively in a Web-based, multicenter trial of burn care. This technique could be modified for other medical studies with visual endpoints.

Figures

Figure 1
Figure 1
To determine the accuracy of the SigmaScan planimetry, wound models with known areas were created with circles of diameter 4 cm.
Figure 2
Figure 2
For validation of the technique, images were captured with the standardized background and digital camera in the manner to be used in the clinical study.
Figure 3
Figure 3
Digital image quality of a clinical image from the prospective multicenter trial before (left figure) and after (right figure) adjustment with Adobe Photoshop.
Figure 4
Figure 4
In an example of a photo obtained in the clinical study, SigmaScan planimetry is used to determine the area of a wound by outlining the area of the wound with a mouse.

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Source: PubMed

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