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