Smartphones have overcome the limitations of image quality seen in older devices and opened a new field of telemedicine called "mobile teledermatology". Technological advances and the need to reduce health service costs will strongly promote the development of telemedicine. For this reason, we evaluated the concordance between store-and-forward mobile teledermatology and the classical face-to-face dermatological visit. We also measured the time taken to submit a teleconsultation using a smartphone. Before conventional face-to-face visit, a final-year resident of the three-year course for general practitioners collected medical history, took digital images of skin diseases with a smartphone and, measuring the time required to complete this operation, transmitted them to an expert teledermatologist. In 391 patients we obtained a concordance between face-to-face and store-and-forward diagnosis of 91.05% (Cohen κ coefficient = 0.906). On average only few minutes needs to be added to a normal visit to transmit the cases to an expert teledermatologist.
Monitoring wound healing remains a medical challenge for dermatologists. Due to lack of physicians in some remote regions, teledermatology is required in this field. Standardized and reproducible measures are necessary to ensure a proper follow-up. Such qualities could apply to evaluation of wound dressings.We suggest here with the two first ever published examples that three-dimensional (3D) multispectral imaging could fulfill the expected properties for ulcer follow-up: reproducibility in different lights and conditions, automatized measurements of the involved area and depth, color recognition and fastness of acquisition. Each of those qualities should require no size or color calibrations before each acquisition.To this purpose, we used a preliminary prototype developed with the EIT health POC/Headstart funding granted to Tridimeo in December 2017. This camera uses a spectrally coded light exposure and reconstructs a 3D projection of the subject. Technical features of the device permit reproducibility of pictures whatever light conditions are. Native data were then treated with TRIDIMEO proprietary software and then read using MeshLab software. 1 Scale and reproducibility of measures assessments were performed previous to acquisitions in the development laboratory and then certified by repeated acquisition of a bent grid sheet (Figure 1). The patients were selected from wound database of Dermatology Department, Saint-Etienne University Hospital, Saint-Etienne, France. Acquisitions were performed in March 2019 in the same unit.
| C A S E 1An 84-year-old woman with chronic loss of substance of pejorative evolution on lateral side of left leg consulted in our unit. The wound measured 3.0 and 2.0 cm of vertical and horizontal axis, respectively.Wound bed was covered by yellowish fibrin and idiopathic subcutaenous calcinosis was exposed (Figure 2). Photography and publication consent by both patient herself and her daughter were obtained before image acquisition.After having defined best angle and distances that were respectively about 60° and 30 cm between objective and wound, acquisition was fast and only performed once. The exposure time was of the order of 0.1 second, and the 3D model was available about 1 second after the exposure. A realistic projection was produced as for colors and measures ( Figure 3A). Differences between in vivo and on-screen measures were estimated at 1.6%. Different light sources (artificial white, red, or sunlight) were used with no significant differences detectable on images production.The brightest/highly reflective zones gave aberrant dots on the three-dimensional reconstruction. Either adjacent skin, inflammatory edge, wound bed and calcinosis could be identified by dermatologist. Multispectral analysis permitted recognition of fibrin ( Figure 3B).
| C A S E 2A 71-year-old woman was admitted for a spontaneous right buttock necrosis of 15 cm of diameter. A necrotizing hematoma was diagnosed in the context of end-stage renal insufficiency and of dose increase of vitamin K antagoni...
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