Development of a Checklist Tool to Assess the Quality of Skin Lesion Images Acquired by Consumers Using Sequential Mobile Teledermoscopy

Abstract

<b><i>Background:</i></b> Mobile teledermoscopy is an emerging technology that involves imaging and digitally sending dermoscopic images of skin lesions to a clinician for assessment. High-quality, consistent images are required for accurate telediagnoses when monitoring lesions over time. To date there are no tools to assess the quality of sequential images taken by consumers using mobile teledermoscopy. The purpose of this study was to develop a tool to assess the quality of images acquired by consumers. <b><i>Methods:</i></b> Participants imaged skin lesions that they felt were concerning at baseline, 1-, and 2-months. A checklist to assess the quality of consumer sequential imaging of skin lesions was developed based on the International Skin Imaging Collaboration guidelines. A scale was implemented to grade the quality of the images: 0 (low) to 18 (very high). Intra- and inter-reliability of the checklist was assessed using Bland-Altman analysis. Using this checklist, the consistency with which 85 sets of images were scored by 2 evaluators were compared using Kappa statistics. Items with a low Kappa value <0.4 were removed. <b><i>Results:</i></b> After reliability testing, 5 of the items were removed due to low Kappa values (<0.4) and the final checklist included 13 items surveying: lesion selection; image orientation; lighting; field of view; focus and depth of view. Participants had a mean age of 41 years (range 19–73), and 67% were female. Most participants (84%, <i>n</i> = 71/85) were able to select and image the correct lesion over time for both the dermoscopic and overview images. Younger participants (<40 years old) scored significantly higher (8.1 ± 2.1) on the imaging checklist compared to older participants (7.1 ± 2.4; <i>p</i> = 0.037). Participants had most difficulty with consistent image orientation. <b><i>Conclusions:</i></b> This checklist could be used as a triage tool to filter images acquired by consumers prior to telediagnosis evaluation, which would improve the efficiency and accuracy of teledermatology and teledermoscopy processes. It may also be used to provide feedback to the consumers to improve image acquisition over time.

Direct-to-Patient Mobile Teledermoscopy: Prospective Observational Study

“…In one discordant case, a history of vitiligo could have differentiated from postinflammatory hypopigmentation. A recent study developed a checklist for mobile teledermoscopy image quality [ 7 ], which could be shared with patients to improve image quality. Because the teledermatologist had a lower threshold for biopsies, a follow-up office visit should be pursued when a procedure is recommended.…”

To Refer or Not to Refer in Teledermoscopy: Retrospective Study

“…In the future, an algorithm could be created into the TDsc system that assesses the photo quality and provides real-time, direct feedback to the GP if improvements are necessary. Showing instructions in the Ksyos TDsc system (eg, image quality checklist, guidelines on taking dermoscopic photos) could support GPs in filling in the TDsc consultation completely and ensure photos of sufficient quality and correct type (overview, detailed, dermoscopic) [ 21 , 22 ].…”

The role of mobile teledermoscopy in skin cancer triage and management during the COVID-19 pandemic

“…20 Teledermoscopy is limited by the quality of images that can be captured by the consumer with limited expertise . 40 Due to the shifting demand towards consumer-led image acquisition, Koh et al developed a checklist tool for consumers that was adapted from the International Skin Imaging Collaboration guidelines to aid patients in obtaining consistent high-quality images to improve the accuracy of telediagnoses. This includes guidance on optimal lighting, background colour, the field of view, and image orientation.…”