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Is wound photography becoming sloppy?

2020; Wiley; Volume: 17; Issue: 1 Linguagem: Inglês

10.1111/iwj.13302

1742-481X

Douglas Queen, Keith G Harding,

Pressure Ulcer Prevention and Management

International Wound JournalVolume 17, Issue 1 p. 5-6 EDITORIALOpen Access Is wound photography becoming sloppy? Douglas Queen, Douglas Queen Editor IWJSearch for more papers by this authorKeith Harding, Keith Harding Editor-in-Chief IWJSearch for more papers by this author Douglas Queen, Douglas Queen Editor IWJSearch for more papers by this authorKeith Harding, Keith Harding Editor-in-Chief IWJSearch for more papers by this author First published: 12 January 2020 https://doi.org/10.1111/iwj.13302Citations: 2AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Wound photography has fast become the norm as part of everyday wound documentation. It remains the most significant part of wound documentation as it is the best record of change, both negative or positive. The adage of "a picture paints a thousand words" is so true in this circumstance as it is difficult, when seeing so many patients, to remember how the wound looked from visit to visit. Even the most accurate of descriptions would not suffice when compared with a photographic record. With the advent of digital cameras (both SLR and point-and-shoot), photography was made easier. While this technology made the taking and storage easier, it did not obviate the need for good photographic practices. The opposite was true in that good practices were even more important because of the convenience and efficiency in taking photographs. This is more obvious to us in our personal lives where we snap multiple photos to get "the one good one." The magic of digital is not having to develop and print or indeed use film. Oh, how that changed our lives! Then, add in the evolution of high-resolution cameras in our smart devices, especially phones. How did that impact "good practice"? Negatively for sure! We have evolved from taking one, well-framed and set-up photograph to several somewhat framed photographs to obtain "the good one" to taking 10s of photographs (sometimes high multiples) of the same person/event to get the "perfect shot. Oh, how technology has changed good practice! So, why is this important in the area of wound photography? It is of utmost importance as the photograph is often used for measurement of the wound dimensions and computation of its area as a measure of wound status with time. Like all medical photography, the standardisation of the environment is important as significant changes can produce errors in the measurement. Key components that can influence the end result are lighting and angle of capture. Rennert et al1 showed that the same wound when measured with improper (13.1 cm2) and proper techniques (20.1 cm2) resulted in a 35% underestimation of the true area. This was because of a simple change in the angle of capture. We all know the effect of poor lighting on the quality of our family snaps, so it hardly warrants explanation. The use of calibration markers can help significantly, but they do not obviate the need for some simple good practice. Newer technologies have been developed to capitalise on the quality and efficiency of smart devices for the capture of wound photographs.2 Some of these technologies capture other wound-related information and integrate directly with EMRs (Electronic Medical Records). While designed to increase quality and efficiency of capture, human interaction is still required and is often the area of failure. While such technology is easier to use and, for the most part, somewhat fool proof (ie, you do not need a photography degree or advanced knowledge); some simple best practice steps are required. Just like photographing your children or pets, where you want to capture the best image possible, some thought and preparation drives the quality of capture/image of a wound. Simple things such as awareness of lighting and angle of capture ensures good consistent image capture and therefore accurate, consistent computation of the wound parameters. Quality in, Quality out. Consistency of image and reliability of data require awareness of input. While technology can provide efficiency and guidance, it cannot replace "good practice". Just like with other medical photography, a good practice process for taking consistent wound photographs ensures accuracy of measurement. Clinicians think clinically, not technologically. By designing these technologies to think clinically, solutions will better fit our "norm." However, it is also important that, even in a more niche clinical arena, such as wound care, the technology has to integrate into practice and also with the other current technological solutions being used regularly in our care environment.3 Many associations, publications, and facilities have detailed best practice. The following are two specific examples that provide general guidance that is consistent with the majority. The American Professional Wound Care Association4 has issued a list of practical guidelines for the use of digital images when it comes to wound photography. Use the same digital camera for successive images. Use the same image resolution settings on the digital camera (several are available). Use the same light source, intensity, and angle. Have the camera at the same angle, distance, rotation, and height from the wound. Choose either pre- or post-debridement for all images in a sequence. Select the same magnification for the digital camera lens ("zoom"). Choose a naming convention and put case identification and number or date in the image (this will not be required for a full digital solution). Choose image archive software that will allow keyword searches and audio tags with images. Have the wound in the same relative position as previous images. Use "fiducial" reference markers wherever possible to achieve consistency (ie, patient code, date, scale). Sperring and Baker5 published 10 top tips for wound photography as detailed below: Use a digital camera owned by your place of work Set the time and date on the camera Get the light right Take the first photograph of patient data Make the wound the only focus Standardise the views taken of the wound Get the angle right to take a proportional image Establish the wound location for the viewer Close-up images establish detail for the viewer Securely save and store the images Consistent, critical components in both include the importance of light and angle of capture. Both are imperative to ensure the photograph is as close to reality as possible. This is especially important for any wound measurement. Today, care, for the most part, is being delivered by a more technophobic generation, but that is changing rapidly, and within only a few years, the true technological generation (ie, millennials) will be delivering the majority of the care. This will truly change the delivery of care to the benefit of all, and wound care is an important part of that change. As a poorly understood but significant hidden and growing epidemic, the change is rapidly needed and should be embraced willingly.6 Wound photographs provide a visual reference not matched by memory or the written word.7 As patient load and work stress increases, time and the memory comes under strain. Technology can provide high efficiencies in wound imaging and documentation.8, 9 However such benefits should not obviate best practice. Remember Quality In, Quality Out. REFERENCES 1Rennert BA, Golinko M, Kaplan D. Standardization of would photography using the wound electronic medical record. Adv Skin Wound Care. 2008; 22(1): 32- 38. 2Bradshaw LM, Gergar ME, Holko GA. Collaboration in wound photography competency development: a unique approach. Adv Skin Wound Care. 2011; 24(2): 85- 94. 3Queen D, Perez C. What digital wound care could mean for those suffering from wounds. Int Wound J. 2018; 15: 501- 502. 4 American Professional Wound Care Association. Proposed APWCA photographic guidelines for wounds. http://www.apwca.org/guidelines/photographic.cfm. Accessed December 20, 2019. 5Sperring B, Baker R. Ten top tips: taking high-quality digital images of wounds. Wounds Int. 2014; 5(1): 7- 8. 6Queen D, Harding K. Data-driven specialisation of wound care through artificial intelligence. Int Wound J. 2019; 16: 879- 880. 7Swann G. Photography in wound care. Nurs Times. 2010; 96(45): 9. 8Jeffcoate WJ, Musgrove AJ, Lincoln NB. Using image J to document healing in ulcers of the foot in diabetes. Int Wound J. 2017; 14: 1137- 1139. 9Armstrong D. Guest editorial: time and place-shifting the physical examination: technologies are converging to allow more detailed evaluations of the foot and wound. Int Wound J. 2007; 4: 289- 290. Citing Literature Volume17, Issue1February 2020Pages 5-6 ReferencesRelatedInformation