clinical imaging with an iphone
TRANSCRIPT
ClinicalimagingwithaniPhone
HonA/ProfAmandaOakley
WaikatoHospital,25June2015
ThispresentaDon
• Whytakeclinicalimages?• PaDentconsent• Smartphonecameras• BestpracDce• Anatomicviews• Close-upphotography• Dermatoscopy• Somehelpfulapps
Whytakeclinicalimages?
• DocumentaDon• Compareclinicalstatusatfollow-up• Referraltodermatologist• Histopathologyrequest• MulDdisciplinaryreview• PersonaleducaDon• Teaching• PublicaDon
DocumentaDon
SamsungGalaxyS4,September2014
Follow-up
drmolescope.com
Referraltodermatologist
Theoldway Thenewway
Histopathologyrequest
MulDdisciplinarymeeDng
PersonaleducaDon
Teaching
PublicaDon
PaDentconsent
ConsentoniPhone
PicSafeMedi Consent
Smartphonecameras
• Alwayswithyou• Highqualityintopendmodels
• Sensorsworkinlowlight• Easytoarchive/backup• Easytoemail/message/uploadtowebsite
iPhone6oriPhone6+
iPhone6+oriPhoneTouch
8MPiSightcamera5.5”1920-by-1080-pixelresoluEonat401ppi
5MPiSightcamera4”1920-by-1080-pixelresoluEonat401ppi
SamsungGalaxy6
• 16MP
• Workswellinlowlight
• HDRremovesshadowsandhighlights
• 5.1”display
OtherAndroids
• HTCOneM920MP
• SonyXperiaZ320.7MB
BestpracDce
• Privacy+security• Backup• Removingimagefromthephone
• Qualityimages
Privacy
• Checkprivacyse^ngs
• Avoidfull-faceimageswherepossible
• Removejewelleryandclothing
• Ta`oosareidenDfying
Security
• Lockyourscreen• TouchIDisbest• Use8+-charactermemorablepasscodesegil2tlk2U!
AutomaDcencryptedbackup
• iCloudDrive– Or,viaiTuneswhenconnected
• MyPhotoStream
• Dropbox
Sharingthepicture
Removeimagefromthephone
PicsafeMediremovesitforyou
Emailreport Onlinereport
Imagequality
• Ensureplentyoflight• Checkexposureisadequate• Suitablebackground• Avoidextraneousobjects• Ensurefocus• Lensparallelwithsubject
Under-exposed
• AvoidsidelighDng• Useflashifnecessary(forceflash)
AppleiPhone3GS,August2011
Shadowsrarelyhelpdiagnosis
AppleiPhone3GS,August2011AppleiPhone4S,November2014
Tap&dragtoadjustexposure
Useaplainma`ebackground
• Neutralblue,green,grey
• Cloth,paper,wall,photographicbackdrop
Avoidabusybackground
HTC_PO582,April2015HTC_PO582,April2015
Avoidextraneousobjects
Avoidextraneousobjects
Ensurefocus
• Lensparallelwithsubject
• Don’tgettooclose• Tapscreentoguidethecameratofocuspoint
NokiaN95,November2008
Lensnotparallelwithsubject
SonyEricssonK800i,April2009SamsungGalaxyS4,January2015
Anatomicviews
Headandneck
Minimisingshadows
Useareflectortogetridofshadow
Trunk
Trunk
Arms
Hands
Nails
Legs
Legs
Legs
Good Bad
Feet
Close-upphotography
• Withandwithoutarulerwhererelevant
• Iftooclose,backoffandzoomtoimprovedepthoffield
• HoldcamerasDllorusetripod
Close-upsofcurvedareas
• Nose,ears,lips• Useaneutral-colouredcardwithaholeinitifyourcameraisstrugglingtofocusorexposureiswrong
Close-upDps
Autoexposure/focuslock Flashon
Camera+
TokeepcamerasDll
Tripod Timer
Skinlesionofconcern
• Anatomicview
• Macroview
• Macroviewwithrule
• Dermatoscopicview
Locatethelesionprecisely
• Anatomymapper.com
• DocumentaDon
• Histopathologyrequests
Naevus
IDlabel Removehair
Dermatoscopicviews
• Smartphoneadaptersforseveraldevices– DermLiteDL1,DL1Basic,DL3,DLIIHRPro,DLIIHybrid
– OpDclar– VEOS– Handyscope
Dermatoscopicimages
• Contactwithskin• Polarisedand/ornonpolarisedviews
• ApplyfluidegsaniDser
Whyhaveadermatoscopiccamera?
• Referraltospecialist– Dermatology
– Teledermatology
– Histopathology• Forfollow-up• It’sfun!
TwoiPhonecamerasforthenon-dermoscopistorpaDent
• MoleScope • DermLiteMonitor
MoleScope
MoleScopedevice
MoleScopeiPhoneapp
RegisterpaEent Chosebodysite
Takethepictures
Overviewimage Dermoscopyimage
Annotate
Ondevice Online
Evaluatethelesion
DrMoleScope.com
AutomaDcrotaDonforfollow-up
DermliteMonitor
ReferraltodermatologyatWH
• Electronicreferralspermita`achments
• However,currently:– ImagesosenprintedinB&Worover2pages
– ProvidingadviceisDmeconsuming;it’seasiertoarrangeanappointment
• Inthefuture,we’llassessreferralsonline,whichwillhelpintriageandinadvice
Teledermatologyreferral
• NewZealandTeledermatologyprovidesanonlineadviceserviceforGPs– DrsOakley,Rademaker,Yung,Hill
• ItiscurrentlyfreetoWaikatoGPs– WechargeorganisaDonsinotherpartsofNZ
www.teledermatology.nz
CollegiumTelemedicus.org
Acknowledgements
• GratefulthankstoDavidOakley
• iPhonesupport• Anatomymapper.com• Camera+• PicSafeMedi• DrMoleScope• Dermlite