Higher resolution digital cameras and affordable "chip" printers are now easy to find. Shareware computer based image archive programs and relatively large image storage systems are now considered "Off the shelf" technology. Image-morph and image-analysis algorithms are even included in most standard graphics packages. This combination of software and more integrated pc based hardware may add useful tools to the documentation for wound healing. The relatively recent advent of image acquisition capabilities within cell phones and palm computers (with built in image e-mail capabilities) will undoubtedly play a role in medical case documentation and more than likely reimbursement for distributed health care services.

One important aspect of this process will be a standardized approach to documenting aspects of wound care and healing over time. It is very often the case that the images of wounds are obtained without a standardized approach and are therefore less useful than they might otherwise have been. These images are often not easily available for case comparisons, evaluation of treatment, method research or education.

We propose a set of ten practical guidelines for case documentation that should provide images that more accurately, reliably and reproducibly document the process of wound care and wound healing over time.

Practical Guidelines for digital images documenting wound care/healing over time:

01- Use the same digital camera for successive images.
02- Use the same image resolution settings on the digital camera (several are available).
03- Use the same light source, intensity and angle.
04- Have the camera at the same angle, distance, rotation and height from the wound.
05- Choose either pre or post debridement for all images in a sequence.
06- Select the same magnification for the digital camera lens ("zoom")
07- Choose a naming convention and put case identification, number or date in the image.
08- Choose image archive software that will allow key word searches and audio tags with images.
09- Have the wound in the same relative position as previous images.
10- Use "fiducial" reference markers wherever possible to achieve consistency (i.e. patient code, date, scale).

Commentary:

• Different digital cameras often have unique image structure or acquisition features, multiple resolution choices and frequently different file formats for saving images. These differences can be minimized by using the same camera for successive images.
  
  
• Digital cameras are very sensitive to light. A "Flash" is usually not required and may obscure essential detail in the glare of moist surfaces
  
  
• The position of the camera has several degrees of "freedom" (in/out, up/down, right/left, forward tilt /backward tilt, in/out). This position should be repeatable from image to image. The same applies to the position of the wound relative to the camera.
  
  
• If image enhancement or image "Morphing" is to be performed then post-debridement images may be suitable for color band enhancement or comparison.
  
  
• An archive software program that will include "albums and galleries" with individual audio tags and keyword searches will allow more thorough case and process evaluation while facilitating their use for educational or research projects.
  
  
• Many digital cameras have zoom capabilities. This must be taken into consideration when taking images for later comparison. The same relative "zoom" will permit more reliable comparison of wound healing over time.
  
  
• Portable label makers are a convenient way to embed case numbers and ruled measurement references into the images. The label can be attached to small cut pieces of cardboard or placed in the background of the image.