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Competing Interests: Competing interests: None declared.

Background: Teleradiology has become one of the most important approaches to virtual clinical diagnosis; its importance has only grown during the coronavirus 2019 pandemic. In developing countries, asking patients to take photographs of their images using a smartphone can facilitate the process and help keep its costs down. However, the images taken by patients with smartphones often are of poor quality, and there is no regulation or standard instruction about how to use smartphones to take photographs of medical examination images effectively. These problems limit the use of smartphones in remote diagnosis and treatment., Questions/purposes: To formulate a set of guidelines for the most appropriate and effective use of smartphones to capture images (radiographs, CT images, and MR images), and to determine whether these guidelines are more effectively adopted by patients of differing ages and genders., Methods: In this prospective study, a set of step-by-step instructions was created with the goal of helping patients take better smartphone photographs of orthopaedic diagnostic images for transfer to telemedicine services. Following the advice of surgeons, experts in smartphone technology, imaging experts, and suggestions from patients, the instructions were modified based on clinical experience and finalized with the goals of simplicity, clarity, and convenience. Potentially eligible patients were older than 18 years, had no cognitive impairment, and used smart phones. Based on that, 256 participants (patients or their relatives and friends) who visited the orthopaedic department of our hospital from June to October 2020 potentially qualified for this study. A total of 11% (29) declined to participate, leaving 89% (227) for analysis here. Their mean age was 36 ± 11 years, 50% were women (113 of 227), and the patient himself/herself represented in 34% (78 of 227) of participants while relatives or friends of patients made up 66% (149 of 227) of the group. In this study, the diagnoses included spinal stenosis (47% [107 of 227]), disc herniation without spinal stenosis (31% [71 of 227]), vertebral fractures (14% [32 of 227]), and other (7% [17 of 227]). Each study participant first took photographs of their original medical images based on their own knowledge of how to use the smartphone camera function; each participant then took pictures of their original images again after receiving our instructional guidance. Three senior spine surgeons (YZ, TQL, TCM) in our hospital analyzed, in a blinded manner, the instructed and uninstructed imaging files based on image clarity (the content of the image is complete, the text information in the image is clearly visible, there is neither reflection nor shadow in the image) and image position (it is not tilted, curled, inverted, or reversed). If either of these conditions was not satisfied, the picture quality was deemed unacceptable; two of three judges' votes determined the outcome. Interobserver reliability with kappa values for the three judges were 0.89 (YZ versus TQL), 0.92 (YZ versus TCM), and 0.90 (TQL versus TCM)., Results: In this study, the overall proportion of smartphone medical images deemed satisfactory increased from 40% (91 of 227) for uninstructed participants to 86% (196 of 227) for instructed participants (risk ratio 2.15 [95% CI 1.82 to 2.55]; p<0.001). The proportion of acceptable-quality images in different age groups improved after instruction, except for in patients aged 51 years or older (3 of 17 uninstructed participants versus 8 of 17 instructed participants; RR 2.67 [95% CI 0.85 to 8.37]; p = 0.07). The proportion of acceptable-quality images in both genders improved after instruction, but there was no difference between the genders., Conclusion: We believe our guidelines for patients who wish to take smartphone photographs of their medical images will decrease image transmission cost and facilitate orthopaedic telemedicine consultations. However, it appears that patients older than 50 years are more likely to have difficulty with this approach, and if so, they may benefit from more hands-on assistance from clinic staff or younger relatives or friends. The degree to which our findings are culture-specific should be verified by other studies in other settings, but on the face of it, there is little reason to believe our findings would not generalize to a reasonable degree. Other studies in more heterogeneous populations should also evaluate factors related to levels of educational attainment and wealth differences, but in the meantime, our findings can give clinical teams an idea of which patients may need a little extra assistance., Level of Evidence: Level II, therapeutic study., Competing Interests: Each author certifies that neither he or she, nor any member of his or her immediate family, has funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request., (Copyright © 2021 by the Association of Bone and Joint Surgeons.)

Purpose: To develop and validate OCT and color fundus photography (CFP) criteria in differentiating polypoidal choroidal vasculopathy (PCV) from typical neovascular age-related macular degeneration (nAMD) in eyes with suboptimal response to anti-vascular endothelial growth factor (VEGF) monotherapy and to determine whether OCT alone can be used to guide photodynamic therapy (PDT) treatment., Design: Clinical study evaluating diagnostic accuracy., Participants: Patients with nAMD who received 3-month anti-VEGF monotherapy but had persistent activity defined as subretinal fluid or intraretinal fluid at month 3 assessments., Methods: In phase 1, international retina experts evaluated OCT and CFP of eyes with nAMD to identify the presence or absence of features due to PCV. The performance of individual and combinations of these features were compared with ICGA. In phase 2, these criteria were applied to an independent image set to assess generalizability. In a separate exercise, retinal experts drew proposed PDT treatment spots using only OCT and near-infrared (NIR) images in eyes with PCV and persistent activity. The location and size of proposed spot were compared with ICGA to determine the extent of coverage of polypoidal lesions (PLs) and branching neovascular network (BNN)., Main Outcome Measures: Sensitivity and specificity of CFP and OCT criteria to differentiate PCV from nAMD and accuracy of coverage of OCT-guided PDT compared with ICGA., Results: In eyes with persistent activity, the combination of 3 non-ICGA-based criteria (sharp-peaked pigment epithelial detachment [PED], subretinal pigment epithelium [RPE] ring-like lesion, and orange nodule) to detect PCV showed good agreement compared with ICGA, with an area under the receiver operating characteristic curve of 0.85. Validation using both an independent image set and assessors achieved an accuracy of 0.77. Compared with ICGA, the OCT-guided PDT treatment spot covered 100% of PL and 90% of the BNN., Conclusions: In nAMD eyes with persistent activity, OCT and CFP can differentiate PCV from typical nAMD, which may allow the option of adjunct PDT treatment. Furthermore, OCT alone can be used to plan adjunct PDT treatment without the need for ICGA, with consistent and complete coverage of PL., (Copyright © 2021 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Background: Data regarding teledermatology for patch testing are limited., Objectives: Compare patch test readings and final interpretation by two in-person dermatologists (IPDs) with eight teledermatologists (TDs)., Methods: Patch tested patients had photographs taken of 70 screening series of allergens at 48 hours and second readings. Eight TDs reviewed photos and graded reactions (negative, irritant, doubtful, +, ++, +++) at 48 hours and second readings; in addition, they coded a final interpretation (allergic, indeterminant, irritant, negative) for each reaction. TDs rated overall image quality and confidence level for each patient and patch test reaction, respectively. Percentage of TD-IPD agreement based on clinical significance (success, indeterminate, and failure) was calculated. Primary outcome was agreement at the second reading., Results: Data were available for 99, 101, and 66 participants at 48 hours, second reading, and final interpretation, respectively. Pooled failure (+/++/+++ vs negative) at second reading was 13.6% (range 7.9%-20.4%). Pooled failure at 48 hours and final interpretation was 5.4% (range 2.9%-6.8%) and 24.6% (range 10.2%-36.8%), respectively. Confidence in readings was statistically correlated with quality of images and disagreement., Conclusion: For patch testing, teledermatology has significant limitations including clinically significant pooled failure percentages of 13.6% for second readings and 24.6% for final interpretation., (© 2021 John Wiley & Sons A/S . Published by John Wiley & Sons Ltd.)

Introduction: Introduction: food intake records are a useful resource for diet assessment, as well as for self-evaluation, self-control, and self-motivation to change an eating behavior. New technologies based on mobile phones permit a different way of recording food intake. Objective: to validate and assess food photographic record (FPR) as a useful instrument in professional practice for assessing food intake. Methodology: forty nutrition professionals participated. In a first stage, food variables obtained through FPR were analyzed and correlated with data from the frequency of food consumption questionnaire (FFQ) and a 24-hour recall (24HR). In a second stage, FPR was applied again to evaluate temporal stability (FPR 1 versus FPR 2). Wilcoxon's test and Spearman's correlation test were applied. Results: a moderate and significant positive association was found for total caloric intake (TCI) and total fat between FPR and 24HR (r = 0.68, p = 0.0008, and r = 0.52, p = 0.01, respectively). In addition, a positive and moderate association was found for TCI, proteins and fats between FPR 1 and FPR 2 (r = 0.61, p = 0.0004; r = 0.60, p = 0.0005; r = 0.64, p = 0.0002, respectively). Conclusion: FPR is a valid method for professional practice to estimate dietary intake, with greater consistency with 24HR data than FFQ, and presents temporal stability for TCI, protein and fat recordings. In addition, FPR may facilitate the adoption of positive eating habits such as more conscious intakes, among other benefits.

Dermatology is a clinical and visual discipline, which makes it the quintessential medical specialty for spot diagnosis and telemedicine. The COVID-19 pandemic has led to an unprecedented worldwide renaissance of teledermatology (TD). It has helped deliver high-quality medical care, while protecting the medical personnel and vulnerable patients from potential infection. Examining a patient from a distance through digital photography has many drawbacks, including lack of physical touch, difficulties in performing full body examinations, and several legal and ethical issues. We summarize have summarized the more common pitfalls and highlight the key aspects of direct patient-to-physician TD. Basic practical advice includes the use of TD for obtaining patient history, examining patient-captured photographs for inflammatory skin disease, and skin cancer screening., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Clinical photography is an important component of the initial assessment and follow-up of patients with vitiligo in clinical practice and research settings. Standardization of this photographic process is essential to achieve useful, high-quality, and comparable photographs over time., Objective: The aim is to develop an international consensus for a core set of recommendations for standardized vitiligo clinical photography., Methods: Based an international meeting of vitiligo experts, a standard operating procedure was developed for vitiligo photography in daily practice and research settings. This protocol was subsequently reviewed by 20 vitiligo experts until agreement was reached., Results: The resulting protocol includes a set of 10 and 15 photographs for clinical practice and research purposes, respectively. The photographic series are based on anatomic units included in the Vitiligo Extent Score. Furthermore, graphic representations of standardized positioning and suggestions for guidelines to standardize the process (background color, lighting, position marking, scales, materials, instruments) for both color and ultraviolet photographs are described., Conclusions: This consensus-based protocol for vitiligo photography will harmonize imaging for both clinical practice, translational research, and clinical trials. It can improve outcome assessment, foster multicenter collaboration, and promote better communication with patients regarding outcomes of treatment., (Copyright © 2019 American Academy of Dermatology, Inc. All rights reserved.)

Background: Screening of diabetic retinopathy (DR) reduces blindness by early identification of retinopathy. This study compares DR grades derived from a two-field imaging protocol from two imaging platforms, one providing a single 60-degree horizontal field of view (FOV) and the other, a standard 45-degree FOV., Methods: Cross-sectional study which included 1257 diabetic patients aged ≥18 years attending their DR screening visit in the English National Diabetic Eye Screening Programme (NDESP). Patients with maculopathy (M1), preproliferative (R2) or proliferative DR (R3) were referred to an ophthalmologist. Patients with ungradable images (U) are examined in a slit-lamp biomicroscopy clinic. Image acquisition under mydriasis of two images per eye was carried out with the EIDON and with standard fundus cameras. Evaluation was performed by masked graders., Results: Agreement after consensus with kappa statistic was 0.89 (quadratic weights (95% CI 0.87 to 0.92)) for NDESP severity grade, 0.88 (quadratic weights (95% CI 0.82 to 0.94)) for referable disease and 0.92 (linear weights (95% CI 0.88 to 0.95)) for maculopathy. The EIDON detected clinically relevant DR features outside the 45-degree fields in two patients (0.16%): one with intraretinal microvascular abnormalities (IRMAs) and one with neovascularisation. In eight patients (0.64%), the EIDON allowed DR feature visualisation inside the 45-degree fields that were not identified in the NDESP images: three patients (0.24%) with IRMA and five patients (0.40%) with maculopathy. The rates of ungradable encounters were 12 (0.95%) and 13 (1.03%) with the EIDON and NDESP images, respectively., Conclusion: The EIDON identifies a small number of additional patients with referable disease which are not detected with standard imaging. This is due to the EIDON finding disease outside the standard FOV and greater clarity finding disease within the standard FOV., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Optic-disc photography (ODP) has proven to be very useful for optic nerve evaluation in glaucoma. In real clinical practice, however, limited patient cooperation, small pupils, or media opacities can limit the performance of ODP. The purpose of this study was to propose a deep-learning approach for increased resolution and improved legibility of ODP by contrast, color, and brightness compensation. Each high-resolution original ODP was transformed into two counterparts: (1) down-scaled 'low-resolution ODPs', and (2) 'compensated high-resolution ODPs' produced via enhancement of the visibility of the optic disc margin and surrounding retinal vessels using a customized image post-processing algorithm. Then, the differences between these two counterparts were directly learned through a super-resolution generative adversarial network (SR-GAN). Finally, by inputting the high-resolution ODPs into SR-GAN, 4-times-up-scaled and overall-color-and-brightness-transformed 'enhanced ODPs' could be obtained. General ophthalmologists were instructed (1) to assess each ODP's image quality, and (2) to note any abnormal findings, at 1-month intervals. The image quality score for the enhanced ODPs was significantly higher than that for the original ODP, and the overall optic disc hemorrhage (DH)-detection accuracy was significantly higher with the enhanced ODPs. We expect that this novel deep-learning approach will be applied to various types of ophthalmic images., Competing Interests: The authors have declared that no competing interests exist.

Background: Eyebrow and eyelash hair loss and nail damage-in addition to scalp hair loss-are important signs/symptoms of alopecia areata (AA) to patients and deserve assessment in AA clinical trials., Objectives: Our objective was to develop clinician-reported outcome (ClinRO) and patient-reported outcome (PRO) measures and accompanying photoguides to aid in the assessment of AA-related eyebrow, eyelash and nail signs/symptoms., Methods: Iterative rounds of qualitative, semi-structured interviews were conducted with US expert dermatologists and North American patients with AA. Patients with eyebrow, eyelash and nail involvement were purposefully sampled. Interview transcripts were qualitatively analyzed., Results: Dermatologists (n = 10) described eyebrow and eyelash loss as concerning for affected patients and, along with nail appearance, as deserving assessment. Dermatologist data informed the development of single item, 4-point Likert-type ClinRO and PRO measures of current eyebrow loss, eyelash loss and nail appearance and a PRO measure of eye irritation. Patients (n = 45, age 15-72 years) confirmed the importance and relevance of these signs/symptoms. Interim revision resulted in measures that were understood by and relevant to patients. Dermatologists (n = 5) and patients (n = 10, age 21-54 years) participated in the development of the eyebrow, eyelash and nail photoguides and confirmed that they included photos that appropriately represented different severity levels and were helpful to derive and standardize ratings across raters., Conclusions: The ClinRO and PRO measures for eyebrow, eyelash and nail appearance, with their accompanying photoguides and the PRO Measure for Eye Irritation provide clear and meaningful assessments of outcomes important to patients with AA.

Fungal keratitis (FK) is the most devastating and vision-threatening microbial keratitis, but clinical diagnosis a great challenge. This study aimed to develop and verify a deep learning (DL)-based corneal photograph model for diagnosing FK. Corneal photos of laboratory-confirmed microbial keratitis were consecutively collected from a single referral center. A DL framework with DenseNet architecture was used to automatically recognize FK from the photo. The diagnoses of FK via corneal photograph for comparing DL-based models were made in the Expert and NCS-Oph group through a majority decision of three non-corneal specialty ophthalmologist and three corneal specialists, respectively. The average percentage of sensitivity, specificity, positive predictive value, and negative predictive value was approximately 71, 68, 60, and 78. The sensitivity was higher than that of the NCS-Oph (52%, P < .01), whereas the specificity was lower than that of the NCS-Oph (83%, P < .01). The average accuracy of around 70% was comparable with that of the NCS-Oph. Therefore, the sensitive DL-based diagnostic model is a promising tool for improving first-line medical care at rural area in early identification of FK.

Purpose: This study assessed the feasibility and preliminary efficacy of the Photographs of Meaning Program for Adolescent and Young Adult cancer patients and survivors (POM-AYA). Methods: POM-AYA is a structured 10-week meaning-based intervention in which participants post photographs and accompanying narratives through a social media platform. Measures of depression, overall quality of life (QoL), and spiritual well-being were assessed on consent (T1), after completing the 10-week intervention (T2) and 2 months' postintervention (T3). Participants also completed a satisfaction questionnaire and follow-up semi-structured interviews. Results: Thirty AYA cancer patients and survivors (ages 17-36) were enrolled in the study. At T2, depressive symptoms were significantly lower and QoL was significantly higher compared with T1. These gains were maintained at T3. There were no significant differences in reported spiritual well-being across the study period. Overall, participants reported high rates of study satisfaction in both the survey and qualitative feedback. Conclusion: POM-AYA appears to be a potentially beneficial, widely accessible intervention in reducing depressive symptoms and increasing QoL in AYA cancer patients and survivors.

Purpose: To investigate intrarater and interrater reliability, agreement, and concurrent validity of a smartphone photography-based application compared with a universal goniometer in children with cerebral palsy., Methods: Range of motion of hip abduction, popliteal angle, and ankle dorsiflexion was measured with a universal goniometer and a photography-based application in children with cerebral palsy, Gross Motor Function Classification System levels I to V.A 2-way random-effects intraclass correlation coefficients and Bland-Altman plots, standard error of measurement, and smallest detectable change were used for analyses., Results: The application had good to excellent reliability and concurrent validity compared with a universal goniometer, while the large measurement error of both methods suggests that changes of 10° to 23° are needed to be certain that changes over time are not results of measurement error., Conclusions: A photography-based goniometer can be a reliable and valid tool when measuring range of motion in children with cerebral palsy.

Aims: To summarize the effects of centralization of diabetic fundus photograph interpretation into a virtual reading center., Methods: In 2016 Kaiser Permanente Northern California, a large, membership-based health plan with an ethnically and racially diverse population, centralized diabetic retinopathy screening into a virtual reading center. Retina screens were based on single field, 45-degree fundus photographs. We compared the accuracy of photography interpretation the year before centralization to the year after using masked reads performed by retina specialists of 1000 randomly selected screens from each time period., Results: In all, 1902 patient screens with adequate quality images were included in the primary analysis. Images from pre-centralization screens were largely read by ophthalmologists (76.2%), while screens post-centralization were mainly read by optometrists (84.6%). Despite being interpreted by readers with lower levels of professional training, the sensitivity of screening increased from 43.9% (95% CI 38.0-49.8%) to 66.0% (95% CI 60.5-71.4%)., Conclusion: A move to a centralized virtual reading center was associated with improved accuracy of diabetic retinopathy screening.

Research into stillbirth memento photography shows the practice to be welcomed by the bereaved. The visual attributes and content of stillbirth memento photographs are yet to be rigorously analysed however, representing a significant gap in current understanding. This study seeks to address this. 51 professionally produced stillbirth memento photographs have been sampled, anonymised and analysed. Using a content analysis methodology, imagery was characterised by aesthetic and semantic properties. The results were then cross-referenced against existing stillbirth scholarship, data from an interview study with people who had experienced pregnancy loss, and against image theories. The content analysis identified four distinctive image tropes in the sample: images of mother, father and baby, with the baby being held and the parents touching; macro photography of the baby; portrait photographs of babies lying alone with little or no physical trauma evident; and images of a parent, usually the mother, cradling the baby. The analysis also identified specific attributes, present across the sample, that appeared significant and distinctive of stillbirth memento photography. These were: (1) stylistic attributes , (2) acknowledgement and validation, (3) identity construction , (4) ambiguity and (5) e mbodiment .

Aim: To evaluate the sensitivity and specificity of 1-, 2-, and 3-fields, nonmydriatic (NM), 45° color photography compared with mydriatic ophthalmoscopy for detection of diabetic retinopathy (DR)., Methods: Masked, comparative case series was performed utilizing a group of 128 diabetic patients (256 eyes) with various stages of DR who underwent both 3-fields NM color photography and ophthalmologic examination. In a blinded manner, the same optometrist who read the original 3-fields images for a patient read the 1- and 2-fields photographs on separate dates later., Results: The sensitivity and specificity of digital retinal photography compared with dilated ophthalmoscopy were, respectively: 88% and 76% for 1-field; 94% and 69% for 2-fields; and 100% and 79% for 3-fields. The proportion of agreement between fundus photography reading and exam DR diagnosis were 58% for 1-field, 58% for 2-fields, and 77% for 3-fields. Kappa and Cramer's V statistics for 1-, 2-, and 3-fields were 0.55 and 0.60, 0.52 and 0.57, and 0.72 and 0.74, respectively. Three-fields measurement of DR was most similar to the dilated ophthalmological exam overall and across all DR severity levels., Conclusions: Compared to 1- and 2-fields fundus photography, 3-fields is superior for detecting vision-threatening DR. One- and 2-fields have reasonable sensitivity for DR screening., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: The study of alcohol use frequency utilizes alcohol-related cue imagery. Although a number of alcohol-image databases currently exist, they have several limitations: Many are not publicly available, some use stock images or clip art rather than real photographs, several eliminate any photographs displaying brand information, and predominantly they contain relatively few images. The aim of this project was to develop a large, open-access database of alcohol-related cue images, containing photographs with and without brand information, taken in real-world environments, with images in a variety of orientations and dimensions., Methods: The study collected 1,650 images voluntarily from the larger community, to capture photographs with a wide range of content, environments, and relation to alcohol. All images were then rated on scales of valence, arousal, and relation to alcohol by 1,008 Amazon Mechanical Turk workers, using classical emotion validation methods based on the International Affective Picture System (IAPS). Survey respondents were screened with the Alcohol Use Disorders Identification Test (AUDIT), and Cronbach's alpha scores were calculated to determine the interrater reliability of scores across the whole sample, and within low-risk, moderate-risk, and high-risk drinkers for each rating domain. Univariate ANOVAs were run to determine differences in ratings across drinking groups., Results: All Cronbach's alpha scores indicated high interrater reliability within the whole sample, and across drinking severity groups. Tukey's HSD post hoc results indicated greater arousal and affect in response to image viewing in moderate- and high-risk drinkers, and higher relation-to-alcohol ratings in low-risk drinkers. All images had categorization tags assigned by members of the study team., Conclusions: The established imagery set includes 1,650 alcohol-related images, rated on scales of valence, arousal, and relation to alcohol, and categorized by type of alcohol depicted. The imagery database will be available for open-access download and use through Google Photos., (© 2019 by the Research Society on Alcoholism.)

Objective: To validate digitally displayed photographic portion-size estimation aids (PSEA) against a weighed meal record and compare findings with an atlas of printed photographic PSEA and actual prepared-food PSEA in a low-income country., Design: Participants served themselves water and five prepared foods, which were weighed separately before the meal and again after the meal to measure any leftovers. Participants returned the following day and completed a meal recall. They estimated the quantities of foods consumed three times using the different PSEA in a randomized order., Setting: Two urban and two rural communities in southern Malawi., Participants: Women (n 300) aged 18-45 years, equally divided by urban/rural residence and years of education (≤4 years and ≥5 years)., Results: Responses for digital and printed PSEA were highly correlated (>91 % agreement for all foods, Cohen's κw = 0·78-0·93). Overall, at the individual level, digital and actual-food PSEA had a similar level of agreement with the weighed meal record. At the group level, the proportion of participants who estimated within 20 % of the weighed grams of food consumed ranged by type of food from 30 to 45 % for digital PSEA and 40-56 % for actual-food PSEA. Digital PSEA consistently underestimated grams and nutrients across foods, whereas actual-food PSEA provided a mix of under- and overestimates that balanced each other to produce accurate mean energy and nutrient intake estimates. Results did not differ by urban and rural location or participant education level., Conclusions: Digital PSEA require further testing in low-income settings to improve accuracy of estimations.

Background: Ultraviolet (UV) light is an essential tool to assess the extent, spreading and staging of vitiligo. Different UV light set-ups are used for vitiligo photography, including the following: (i) hand-held Wood's lamps; (ii) soft boxes with UV lamps; (iii) UV flash attached to the camera; and (iv) high output UV flash., Objective: Our objective was to compare UV light set-ups for vitiligo photography regarding image quality and ease of use., Methods: Patients with vitiligo lesions with unclear borders were included. Two images were made with all four UV set-ups per patient, for a large and a small area. Image quality was scored separately by three blinded vitiligo experts on five criteria: overall quality, clearness of borders, contrast and sharpness and for larger areas the shadows. The two professional medical photographers were asked to score the ease of use for each set-up., Results: A total of 88 photos were assessed from 11 patients. For larger areas, the frequency of a 'good' or 'very good' overall quality rating was 12.1% (Wood's), 6.1% (soft boxes), 15.2% (camera flash) and 78.8% (high output flash). For smaller areas, the score 'good' or 'very good' was given to 54.5%, 3%, 66.6% and 84.8% in the same order. For the shadow criteria, each set-up scored below 40% on a 'good' or 'very good' score. The high output flash was scored as most easy to use by the photographers., Conclusion: When comparing four different UV light set-ups for vitiligo photography, we concluded that the UV set-ups strongly influenced the quality scores of the obtained images. The high output flash scored best for both small and large areas and for ease of use. For small areas, Wood's lamp and camera flash were acceptable. All set-ups scored badly for shadows, and more research is needed to find the optimal exposure to avoid shadows., (© 2019 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.)

From mainstream media outlets to social media and everything in between, doctored photographs are appearing with growing frequency and sophistication. The resulting lack of trust is impacting law enforcement, national security, the media, e-commerce, and more. While some types of manipulations can be detected with a careful visual examination, our visual system seems unable to reliably detect other types of manipulations. The field of image forensics has emerged to help return some trust in photography. I describe the perceptual limits of detecting manipulated images, as well as representative examples of computational techniques for authenticating images.

Background: Skin picking disorder is a prevalent disorder frequently comorbid with depression and anxiety, which is underdiagnosed mainly by dermatologists. Assessment of skin picking disorder is based on instruments influenced by the awareness about skin picking disorder and comorbid symptoms. To date, there is no validated instrument for Brazilian individuals nor an instrument to evaluate the severity of skin lesions in an objective way., Objectives: Validate the Skin Picking Impact Scale for Brazilian Portuguese and create a photographic measurement to assess skin lesions., Methods: The sample was assessed through the Skin Picking Impact Scale translated into Brazilian Portuguese, the Hamilton Anxiety Scale, the Beck Depression Inventory, and the Clinical Global Impression Scale. The patients' skin lesions were photographed. Photos were evaluated regarding active excoriation, crust/bleeding, exulceration, and linear lesions., Results: There were 63 patients included. The Skin Picking Impact Scale translated into Brazilian Portuguese had good internal consistency (Cronbach's alpha=0.88), which tests of goodness-of-fit, showing a suitable model. The reliability of photographic measurement was 0.66, with a high internal consistency (Cronbach's alpha=0.87). Photographic measurement was not correlated with the Skin Picking Impact Scale, the Clinical Global Impression Scale, or comorbid symptoms., Study Limitations: Lack of a previously validated instrument to evaluate dermatillomania in the Brazilian population for comparison., Conclusion: The Skin Picking Impact Scale validated in Brazilian Portuguese is a good instrument to evaluate skin picking disorder. Photographic measurement is a consistent way of assessing skin lesions, but it does not reflect the impact of skin picking disorder on the individual's life., (Copyright © 2019. Published by Elsevier España, S.L.U.)

Purpose: Art interventions have demonstrated holistic benefits for persons living with dementia and their caregivers. In this article, we describe the results of a pilot photojournalism program for 10 unpaid caregivers of persons living with dementia, with respect to caregivers' experience in the program and their psychological well-being. Design: Caregivers participated in four sessions led by a professional photojournalist who taught principles of photography. Between the sessions, caregivers took photographs that represented what caregiving meant to them using digital cameras provided in the program. During the sessions, instruction was interspersed with discussion of caregivers' photographs. Method: Caregiver burden and depressive symptoms were measured pre- and postprogram. Qualitative exploration included sessions' observations, viewing caregivers' photographs, and recording caregivers' accompanying comments. Findings: For participants with pre- and postprogram data, caregiver burden decreased significantly ( p = .037). For caregivers with pre- and postprogram data, depressive symptoms decreased nonsignificantly ( p = .066). Clinically meaningful reductions in caregiver burden and depressive symptoms were attained. Qualitative findings highlighted caregivers' strong engagement with the project, the facilitator, and other participants, and reflection on multiple aspects of their experience. Conclusions: This intervention helped caregivers creatively communicate their experience and demonstrated efficacy in the improvement of caregivers' psychological well-being.

This article presents a steganographic method StegoNN based on neural networks. The method is able to identify a photomontage from presented signed images. Unlike other academic approaches using neural networks primarily as classifiers, the StegoNN method uses the characteristics of neural networks to create suitable attributes which are then necessary for subsequent detection of modified photographs. This also results in a fact that if an image is signed by this technique, the detection of modifications does not need any external data (database of non-modified originals) and the quality of the signature in various parts of the image also serves to identify modified (corrupted) parts of the image. The experimental study was performed on photographs from CoMoFoD Database and its results were compared with other approaches using this database based on standard metrics. The performed study showed the ability of the StegoNN method to detect corrupted parts of an image and to mark places which have been most probably image-manipulated. The usage of this method is suitable for reportage photography, but in general, for all cases where verification (provability) of authenticity and veracity of the presented image are required., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Importance: Multicolour is a new imaging technology and its sensitivity for detecting polypoidal choroidal vasculopathy (PCV) and age-related macular degeneration (AMD) has not been well described., Background: To evaluate the accuracy of multicolour imaging compared to colour fundus photography (CFP) in differentiating AMD and PCV from normal eyes, and in detecting PCV., Design: Prospective cohort study at a tertiary referral centre., Participants: Fifty consecutive patients with PCV or AMD., Methods: Standardized multimodal imaging, including CFP, multicolour imaging, and fluorescein and indocyanine green angiography, were graded by a Central Reading Center using standardized grading protocols., Main Outcomes and Measures: Sensitivity, specificity, positive and negative predictive values (PPV and NPV)., Results: Of 100 eyes, 44 had PCV, 33 had AMD, and 23 were normal. Multicolour imaging had higher specificity (73.9% vs 52.2%) and NPV (94% vs 85.7%) compared to CFP for detecting all types of AMD. For the detection of PCV, multicolour had higher sensitivity (86.4% vs 59.1%) and NPV (89.3% vs 74.3%). Polypoidal lesions were detected in 39 of 44 eyes (88.6%) using multicolour imaging, while the branching vascular network (BVN) was detected in 16 of 44 eyes (36.4%). Using BVN as a parameter, infrared imaging specificity and PPV for detecting PCV were 96.6% and 88.9%, respectively., Conclusions and Relevance: Multicolour imaging is superior to standard CFP in differentiating AMD and PCV from normal eyes, and in detecting features of PCV. Specific features seen on multicolour imaging can alert ophthalmologists to the likely presence of these diseases so that additional definitive investigations can be performed., (© 2018 Royal Australian and New Zealand College of Ophthalmologists.)

Macroscopic study of surgical samples sent to the histopathology lab provides the first diagnostic approach. Obtaining quality photographs of these pieces facilitates proper case documentation for publication, sharing, teaching and research.This device has been originally designed for enucleated eyes but it could be used for a wide diversity of human or animal samples including thyroids, pituitary glands, prostates… It can be coupled to any smartphone camera.The Black and White Box is an affordable and easy option for taking gross pathology photographs of high quality. In this work we provide full instructions on how to make it., (© 2019 Wiley Periodicals, Inc.)

Background: Tracking of dietary intake is key to enhancing weight loss. Mobile apps may be useful for tracking food intake and can provide feedback about calories and nutritional value. Recent technological developments have enabled image recognition to identify foods and track food intake., Objective: We aimed to determine the effectiveness of using photography as a feature of a smartphone weight loss app to track food intake in adults who were overweight or obese., Methods: We analyzed data from individuals (age, 18-65 years; body mass index≥25 kg/m 2 ; ≥4 days of logged food intake; and ≥2 weigh-ins) who used a mobile-based weight loss app. In a retrospective study, we compared those who used the photo feature (n=9871) and those who did not use the feature (n=113,916). Linear regression analyses were used to assess use of the photo feature in relation to percent weight loss., Results: Weight loss was greater in the group using the photo feature (Δ=0.14%; 95% CI 0.06-0.22; P<.001). The photo feature group used the weight loss app for a longer duration (+3.5 days; 95% CI 2.61-4.37; P<.001) and logged their food intake on more days (+6.1 days; 95% CI 5.40-6.77; P<.001) than the nonusers. Mediation analysis showed that the weight loss effect was absent when controlling for either duration or number of logged days in the program., Conclusions: This study was the first to examine the effect of a food photo feature to track food intake on weight loss in a free-living setting. Use of photo recognition was associated with greater weight loss, which was mediated by the duration of app use and number of logged days in the program., (©Daniela Ben Neriah, Allan Geliebter. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 29.05.2019.)

Background: Once-daily topical oxymetazoline cream 1·0% significantly reduced persistent facial erythema of rosacea in trials requiring live, static patient assessments., Objectives: To evaluate critically the methodology of clinical trials that require live, static patient assessments by determining whether assessment of erythema is different when reference to the baseline photograph is allowed., Methods: In two identically designed, randomized, phase III trials, adults with persistent facial erythema of rosacea applied oxymetazoline or vehicle once daily. This phase IV study evaluated standardized digital facial photographs from the phase III trials to record ≥ 1-grade Clinician Erythema Assessment (CEA) improvement at 1, 3, 6, 9 and 12 h postdose., Results: Among 835 patients (oxymetazoline n = 415, vehicle n = 420), significantly greater proportions of patients treated with oxymetazoline vs. vehicle achieved ≥ 1-grade CEA improvement. For the comparison between phase IV study results and the original phase III analysis, when reference to baseline photographs was allowed while evaluating post-treatment photographs, the results for oxymetazoline were similar to results of the phase III trials (up to 85.7%), but a significantly lower proportion of vehicle recipients achieved ≥ 1-grade CEA improvement (up to 29.7% [phase 4] vs. 52.3% [phase 3]; P<0.001). In the phase IV study, up to 80·2% of patients treated with oxymetazoline achieved at least moderate erythema improvement vs. up to 22·9% of patients treated with vehicle. The association between patients' satisfaction with facial skin redness and percentage of erythema improvement was statistically significant., Conclusions: Assessment of study photographs, with comparison to baseline, confirmed significant erythema reduction with oxymetazoline on the first day of application. Compared with the phase III trial results, significantly fewer vehicle recipients attained ≥ 1-grade CEA improvement, suggesting a mitigated vehicle effect. This methodology may improve the accuracy of clinical trials evaluating erythema severity., (© 2018 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.)

Background: Teleophthalmology is an evidence-based method for diabetic eye screening. It is unclear whether the type of eye care provider performing teleophthalmology interpretation produces significant variability., Introduction: We assessed grading variability between an optometrist, general ophthalmologist, and retinal specialist using images from an urban, diabetic retinopathy teleophthalmology program., Methods: Three readers evaluated digital retinal images in 100 cases (178 eyes from 90 patients with type 2 diabetes). Fisher's exact test, percent agreement, and the observed proportion of positive (P pos ) or negative agreement (P neg ) were used to assess variability., Results: Among cases deemed gradable by all three readers (n = 65), there was substantial agreement on absence of any retinopathy (88% ± 4.6%, P neg  = 0.91-0.95), presence of moderate nonproliferative or worse retinopathy (87% ± 3.9%, P pos  = 0.67-1.00), and presence of macular edema (99% ± 0.9%, P pos  = 0.67-1.00). There was limited agreement regarding presence of referable nondiabetic eye pathology (61% ± 11%, P pos  = 0.21-0.59) and early, nonroutine referral for a follow-up clinical eye exam (66% ± 8.1%, P pos  = 0.19-0.54). Among all cases (n = 100), there was acceptable agreement regarding which had gradable images (77% ± 5.0%, P pos  = 0.50-0.90)., Discussion: Inclusion of multiple types of eye care providers as teleophthalmology readers is unlikely to produce significant variability in the assessment of diabetic retinopathy among high-quality images. Greater variability was found regarding image gradability, nondiabetic eye pathology, and recommended clinical referral times., Conclusions: Our results suggest that more extensive training and uniform referral standards are needed to improve consensus on image gradability, referable nondiabetic eye pathology, and recommended clinical referral times.

Background: Color fundus photography have been extensively used to explore the link between retinal morphology changes associated with various disease i.e. Diabetic Retinopathy, Glaucoma. The development of multimodal imaging system that integrates Infrared Scanning Laser Ophthalmoscope (IR-SLO) and Optical Coherence Tomography (OCT) could help in studying these diseases at an early stage. The aim of this study was to test the agreement between the retinal vasculature parameters from the Infrared images obtained from optical coherence tomography and color fundus imaging., Methods: The IR and Color retinal images were obtained from 16 volunteer participants and seven retinal vessel parameters, i.e. Fractal Dimension (FD), Average Angle (ABA), Total Angle Count (TAC), Tortuosity (ST), Vessel/Background ratio (VBR), Central Retinal Arteriolar Equivalent (CRAE) and Central Retinal Venular Equivalent (CRVE) were extracted from these retinal images using Retinal Image Vasculature Assessment software (RIVAS) and Integrative Vessel Analysis (IVAN)., Results: The Bland Altman plot was used to investigate the agreement between the two modalities. The paired sample t-test was used to assess the presence of fixed bias and the slope of Least Square Regression (LSR) line for the presence of proportional bias. The paired sample t-test showed that there was no statistically significant difference between Color and IR based on retinal vessel features (all p values > 0.05). LSR also revealed no statistically significant difference in the retinal vessel features between Color and IR., Conclusion: This study has revealed that there is a fair agreement between Color and IR images based on retinal vessel features. This research has shown that it is possible to use IR images of the retina to measure the retinal vasculature parameters which has the advantage of being flash-less, can be used even if there is opacity due to cataract, and can be performed along with OCT on the same device.

Background: Despite existing guidelines and methods for standardized clinical photography in dermatology and plastic surgery, human skin exhibits exquisite site-specific morphologies and functions, and each body region can exhibit an individual pathologic phenotype. The aim of this work was to develop a standardized, representative and reproducible documentation of the multilocular hidradenitis suppurativa/acne inversa (HS) lesions, a disease mostly occurring in skin folds., Method: Optimal body positions for medical photography of candidate areas for HS involvement were evaluated. Pictures of volunteers were taken, and indicative scientific graphics were designed., Results: Due to the variability of HS lesions and the fact of their localization in skin folds, a standardized, reproducible photographic documentation of HS candidate skin areas (50 cm from the skin surface) is proposed. The photographic series includes: (1) right armpit, (2) left armpit, (3) right groin, (4) left groin, (5) genital area, (6) anal area and anal fold, (7) right buttock, (8) left buttock, (9) chest area, (10) mons pubis, (11) right submammary area (females), (12) left submammary area (females). The protocol is accompanied with indicative scientific graphics for photography-proper positioning of the relevant body parts for documentation of potentially flat skin areas. In addition, former proposals for technical standardization of photography in dermatology, regarding instrumentation, environmental lighting and background colour, have to be respected., Conclusion: Standardized photography of candidate skin areas for HS involvement will allow longitudinal intraindividual and interindividual evaluation of the disease course as well as prospective and retrospective comparative studies., (© 2018 S. Karger AG, Basel.)

We proposed a new efficient image denoising scheme, which mainly leads to four important contributions whose approaches are different from existing ones. The first is to show the equivalence between the group-based sparse representation and the Schatten-p norm minimization problem, so that the sparsity of the coefficients for each group can be measured by estimating the underlying singular values. The second is that we construct the proximal operator for sparse optimization in ℓp space with p ∈ (0, 1] by using fixed-point iteration and obtained a new solution of Schatten-p norm minimization problem, which is more rigorous and accurate than current available results. The third is that we analyze the suitable setting of power p for each noise level σ = 20, 30, 50, 60, 75, 100, respectively. We find that the optimal value of p is inversely proportional to the noise level except for high level of noise, where the best values of p are 1 and 0.95, when the noise levels are respectively 75 and 100. Last we measure the structural similarity between two image patches and extends previous deterministic annealing-based solution to sparsity optimization problem through incorporating the idea of dictionary learning. Experimental results demonstrate that for every given noise level, the proposed Spatially Adaptive Fixed Point Iteration (SAFPI) algorithm attains the best denoising performance on the value of Peak Signal-to-Noise Ratio (PSNR) and structure similarity (SSIM), being able to retain the image structure information, which outperforms many state-of-the-art denoising methods such as Block-matching and 3D filtering (BM3D), Weighted Nuclear Norm Minimization (WNNM) and Weighted Schatten p-Norm Minimization (WSNM)., Competing Interests: The authors have declared that no competing interests exist.

Background: In the past, measurement of upper limb lymphedema was done by water displacement (WD), which is frequently cited as the gold standard. For various reasons, however, the use of WD is restricted in clinical settings. A more precise and easy-to-use method would be favorable. The high precision of three-dimensional (3D) imaging in comparison to WD has already been reported for healthy subjects. The aim of this study is to determine the validity and reliability of 3D imaging by comparing it to the WD method in women with unilateral upper limb lymphedema. Methods and Results: Thirty-nine women with unilateral breast cancer-related lymphedema (BCRL) were included, of which 37 completed two volume measurement techniques (3D and WD) on the BCRL and contralateral healthy arm. Slightly larger volumes were measured by the WD method in healthy arms (+9.8 mL; p  = 0.058) and also in BCRL arms (+18.5 mL; p  < 0.001). All measurements were performed twice by the same researcher to evaluate reliability. There was no significant difference between the two measurements for healthy arms ( p  = 0.323) or BCRL arms ( p  = 0.807) in 3D imaging. Bland-Altman plots showed a high limit of agreement between the single measurements. 3D imaging had a high intrarater reliability (Intraclass Correlation Coefficient = 0.999). Conclusion: Results show that 3D imaging is an innovative method for measuring upper limb volume in BCRL patients. Even though image processing is time consuming, 3D imaging combines high reproducibility with high precision. By software automation, this technique could easily be integrated into clinical routine. It is for this reason that we would recommend implementing the Vectra 3D imaging technique for measurement of BCRL.

Purposes: Conventionally, lower limb circumference is measured using a measuring tape; however, a measuring tape may not provide sufficient precision to measure the magnitude of the lymphedema. We report the use of three-dimensional photography (VECTRA ® ) for the evaluation of lymphedema in patients after lymphovenous anastomosis (LVA). Methods: We calculated the percent error in measuring lower limb circumference with a measuring tape. We performed VECTRA before and after LVA and measured the change in volume. Because of the limitation of photographic range, the measurement of the entire lower limb was difficult using this approach. We were limited to thigh measurements. Results: The ratio of error was calculated using the largest and smallest mean measurements. The largest measurement errors, 4.3%-5.8%, were observed for the measurement of thigh circumferences, whereas the smallest measurement errors, 2.3%-2.9%, were observed in the foot and lower leg areas. The change in volume postoperatively measured using VECTRA decreased by an average of 35.1 cc. Conclusions: The evaluation with a measuring tape for the foot and lower leg region was useful because a lesser content of soft tissue was not influenced to the error by power. Contrarily, VECTRA was useful for measuring the thigh region because of the higher quantity of soft tissue, and the combination of both reduced the error.

Background Context: Posture changes are a major consequence of idiopathic scoliosis (IS). Posture changes can lead to psychosocial and physical impairments in adolescents with IS. Therefore, it is important to assess posture, but the test-retest reliability of posture measurements still remains unknown in this population., Purpose: The primary objective of the present study was to determine the test-retest reliability of 25 head and trunk posture indices using the Clinical Photographic Postural Assessment Tool (CPPAT) in adolescents with IS. The secondary objective was to determine the standard error of measurement and the minimal detectable change., Study Design/setting: This is a prospective test-retest reliability study carried out at two tertiary university hospital centers., Patients Sample: Forty-one adolescents with IS, aged 10-16 years old with curves 10°-45° and treated by medical intervention, were recruited., Methods: Two posture assessments were done using the CPPAT 5-10 days apart following a standardized procedure. Photographs were analyzed with the CPPAT software by digitizing reference landmarks placed on the participant by a physiotherapist evaluator. Generalizability theory was used to obtain a coefficient of dependability, standard error of measurement, and the minimal detectable change at 90% confidence interval., Results: Fourteen of 25 posture indices had a good reliability (ϕ≥0.78), 10 had moderate reliability (ϕ=0.55-0.74), and 1 had poor reliability (ϕ=0.45). The most reliable posture indices were waist angle asymmetry (ϕ=0.93), right waist angle (ϕ=0.91), and frontal trunk list (ϕ=0.92). Right sagittal trunk list was the least reliable posture index (ϕ=0.45). The MDC 90 values ranged from 2.6 to 10.3° for angular measurements and from 8.4 to 35.1 mm for linear measurements., Conclusions: The present study demonstrates that most posture indices, especially the trunk posture indices, are reproducible in time among adolescents with IS and provides reference values. Clinicians and researchers can use these reference values to assess change in posture over time attributable to treatment effectiveness., (Copyright © 2018 Elsevier Inc. All rights reserved.)

The present study provides normative measures for a new stimulus set of images consisting of 225 everyday objects, each depicted both as a photograph and a matched clipart image generated directly from the photograph (450 images total). The clipart images preserve the same scale, shape, orientation, and general color features as the corresponding photographs. Various norms (modal name and verb agreement measures, picture-name agreement, familiarity, visual complexity, and image agreement) were collected separately for each image type and in two different contexts: online (using Mechanical Turk) and in the laboratory. We discuss similarities and differences in the normative measures according to both image type and experimental context. The full set of norms is provided in the supplemental materials.

Background: There is a lack of evidence-based quantitative clinical methods to adequately assess posture. Our team developed a clinical photographic posture assessment tool (CPPAT) and implemented this tool in clinical practice to standardize posture assessment. The objectives were to determine the level of acceptance of the CPPAT and to document predictors as well as facilitators of and barriers to the acceptance of this tool by clinicians doing posture re-education., Methods: This is a prospective study focussing on technology acceptance. Thirty-two clinician participants (physical therapists and sport therapists) received a 3-5 h training workshop explaining how to use the CPPAT. Over a three-month trial, they recorded time-on-task for a complete posture evaluation (photo - and photo-processing). Subsequently, participants rated their acceptance of the tool and commented on facilitators and barriers of the clinical method., Results: Twenty-three clinician participants completed the trial. They took 22 (mean) ± 10 min (SD) for photo acquisition and 36 min ± 19 min for photo-processing. Acceptance of the CPPAT was high. Perceived ease of use was an indirect predictor of intention to use, mediated by perceived usefulness. Analysis time was an indirect predictor, mediated by perceived usefulness, and a marginally significant direct predictor. Principal facilitators were objective measurements, visualization, utility, and ease of use. Barriers were time to do a complete analysis of posture, quality of human-computer interaction, non-automation of posture index calculation and photo transfer, and lack of versatility., Conclusion: The CPPAT is perceived as useful and easy to use by clinicians and may facilitate the quantitative analysis of posture. Adapting the user-interface and functionality to quantify posture may facilitate a wider adoption of the tool.

Plastic surgery relies on photography for both clinical practice and research. The Photographic Standards in Plastic Surgery laid the foundation for standardized photography in plastic surgery. Despite these advancements, the current literature lacks guidelines for genital photography, thus resulting in a discordance of documentation. The authors propose photographic standards for the male and female genitalia to establish homogeneity in which information can be accurately exchanged. All medical photographs include a sky-blue background, proper lighting, removal of distractors, consistent camera framing, and standard camera angles. We propose the following guidelines to standardize genital photography. In the anterior upright position, feet are shoulder-width apart, and arms are placed posteriorly. The frame is bounded superiorly by the xiphoid-umbilicus midpoint and inferiorly by the patella. For circumferential documentation, frontal 180 degree capture via 45 degree intervals is often sufficient. Images in standard lithotomy position should be captured at both parallel and 45 degrees above the horizontal. Images of the phallus should include both the flaccid and erect states. Despite the increasing incidence of genital procedures, there lacks a standardized methodology in which to document the genitalia, resulting in a substantial heterogeneity in the current literature. Our standardized techniques for genital photography set forth to establish a uniform language that promotes more effective communication with both the patient as well as with colleagues. The proposed photography guidelines provide optimal visualization and standard documentation of the genitalia, allowing for accurate education, meaningful collaborations, and advancement in genital surgery.

I would like to thank Anne Katz, PhD, RN, FAAN, for her thoughtful editorial in the July 2018 issue of Oncology Nursing Forum. At least twice, that I am aware of, someone has used my slides without my permission. The first time happened about 10 years ago. I gave an educational program on the fundamentals of hereditary cancer syndromes at a regional conference for oncology nurses. I provided a detailed outline for note-taking and a list of references and resources. On one slide, there was a picture of my entire extended family at our cabin in a remote area of the Ozarks in Missouri, as well as several other photos that I had taken of my daughters and dog. Only I had access to those photos.&nbsp.

Standardized reliable medical photographic documentation should be made by every plastic surgeon for valid comparisons of preoperative and post-operative illustrations. However, photographic documentation in aesthetic surgery has also an important medico-legal impact as if not performed accurately it can result in severe legal ramifications. Therefore, we evaluated and redefined the existing photographic standards for abdominal contouring procedures and abdominoplasty/lipectomy further, to achieve consistent detailed photographs without any corresponding distortion or distraction. The results of the modification in standardized photographic documentation in aesthetic abdominoplasty and lipectomy are based on the basic principles of photography in plastic and aesthetic surgery and are presented in this article.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .