An innovative system for 3 D clinical photography in the resource limited settings
Background: Kaposi's sarcoma (KS) is the most frequently occurring cancer in Mozambique among men and the second most frequently occurring cancer among women. Effective therapeutic treatments for KS are poorly understood in this area. There is an unmet need to develop a simple but accurate tool for improved monitoring and diagnosis in a resource limited setting. Standardized clinical photographs have been considered to be an essential part of the evaluation. Methods: When a therapeutic response is achieved, nodular KS often exhibits a reduction of the thickness without a change in the base area of the lesion. To evaluate the vertical space along with other characters of a KS lesion, we have created an innovative imaging system with a consumer light field camera attached to a miniature "photography studio" adaptor. The image file can be further processed by computational methods for quantification. Results: With this novel imaging system, each high quality 3D image was consistently obtained with a single camera shot at bedside by minimally trained personnel. After computational processing, all focused photos and measurable 3D parameters were obtained. More than 80 KS image sets were processed in a semi automated fashion. Conclusions: In this proof of concept study, the feasibility to use a simple, low cost and user friendly system has been established for future clinical study to monitor KS therapeutic response. This 3D imaging system can be also applied to obtain standardized clinical photographs for other diseases. Background It cannot be over emphasized that high quality images are critical for clinical decisions. The current trend of establishing electronic health record (EHR) in the resource rich settings and mobile device based health care system to reach patients in the resource limited settings makes standardization and acquisition of high quality clinical photography an imperative issue. Standardization of clinical images is not only crucial for disease diagnosis, patient follow up, clinical communication and medical education, but also for computer aided clinical management. While nearly all of the radiological imaging systems, e.g. plain X ray, CT, MRI and ultrasound, have standard guidelines for obtaining and interpreting images, there is little consensus or effort in clinical photography except for a few areas, Correspondence: carsonjc@cofc.edu; ytliu@ucsd.edu Equal contributors University of California San Diego, La Jolla, CA, California College of Charleston, Charleston, SC, USA Full list of author information is available at the end of the article (c) 2014 Baghdadchi et al. licensee BioMed Ce Creative Commons Attribution License (http: distribution, and reproduction in any medium Domain Dedication waiver (http:/creativecom article, unless otherwise stated. such as presenting the outcome of a plastic surgery. In fact, many diseases can be diagnosed by their characteristic presentations before any further confirmation tests. Several medical journals, such as the New England Journal of Medicine (Images in Clinical Medicine and Image Challenge) [1] Journal of American Medical Association (Clinical Challenge) [2] British Medical Journal (Picture Quiz) etc. frequently publish typical diseases that may be diagnosed through the analysis of a single clear and informative image. In 1989, The AIDS Clinical Trial Group (ACTG) proposed a KS staging system using a three tiered system that classified the extent of tumor (T) involvement, the status of a patient's immune system (I) assessed by CD4 cell count, and the severity of their systemic illness (S) as "good risk" or "poor risk" [3] The ACTG staging system and variants that are used to assess KS therapeutic response may include lesion counts, assessment of lesion color, nodularity, ulceration and associated edema, ntral Ltd. This is an Open Access article distributed under the terms of the /creativecommons.org/licenses/by/4.0) which permits unrestricted use, provided the original work is properly credited. The Creative Commons Public mons.org/publicdomain/zero/1.0/ applies to the data made available in this Baghdadchi et al. Journal of Translational Medicine 2014, 12:169 Page 2 of 8 http:/www.translational medicine.com/content/12/1/169 measurement of sum of the product of the diameters of 5 marker lesions, and evaluation for oral KS and secondary effects of KS [3 6] The color and degree of nodularity of KS lesions are difficult to quantify, but often provide important information about response to treatment [3] While conventional photography is probably the single most useful technique for imaging KS, it does not provide enough information about tumor nodularity and other important characteristics. In contrast to what many would think, obtaining highquality clinical photography is not trivial [7 9] The suggestion of using professional clinical photographers in the professional studio settings to control the surrounding environment for light, angle etc. is not overstated for producing clear and informative photographs. However, a photographer cannot focus on a relevant lesion unless he or she has been told by an experienced clinician. Therefore, it would be difficult to generate informative images without knowing where to focus. To overcome this dilemma and to ease the technical hurdles, we have developed an innovative approach by taking advantage of the light field photography in conjunction with a design of a miniaturized "photography studio" to control environment and standardize the image presentation. Here we present a proof of concept approach for developing a 3D image based system to monitor therapeutic response of Kaposi's sarcoma in Mozambique. While this system is developed for clinical photography, applications exist for other areas that require collecting evidence by non professional personnel in field, including applications for veterinary, agriculture, and even crime investigation. Figure 1 Design and Assembly of the miniature photography studio (A C) and was 3D printed (D) The adapter can be attached to a Lytro cam Methods