title: The effect of decreasing digital image resolution on teledermatology diagnosis.
abstract: OBJECTIVE
  To determine the effect of degraded digital image resolution (as viewed on a monitor) on the accuracy and confidence of dermatologic interpretation.
  
  
  METHODS
  Eight dermatologists interpreted 180 clinical cases divided into three Logical Competitor Sets (LCS) (pigmented lesions, non-pigmented lesions, and inflammatory dermatoses). Each case was digitized at three different resolutions. The images were randomized and divided into (9) 60-image sessions. The physicians were completely blinded concerning the image resolution. After 60 seconds per image, the viewer recorded a diagnosis and level of confidence. The resultant ROC curves compared the effect of LCS, level of clinical difficulty, and resolution of the digital image. One-way analysis of variance (ANOVA) compared the curves.
  
  
  RESULTS
  The areas beneath the ROC curves did not demonstrate any consistently significant difference between the digital image resolutions for all LCS and levels of difficulty. The only significant effect observed was amongst pigmented lesions (LCS-A) where the ROC curve area was significantly smaller in the easy images at high resolution compared to low and medium resolutions. For all other ROC curve comparisons within LCS-A, at all other levels of difficulty, as well as within the other LCS at all levels of difficulty, none of the differences was significant.
  
  
  CONCLUSIONS
  A 720 x 500 pixel image can be considered equivalent to a 1490 x 1000 pixel image for most store-and-forward teledermatology consultations.
authors.affiliation: Department of Military and Emergency Medicine and Dermatology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Vidmar
authors.forename: D
authors.initials: D
authors.lastname: Cruess
authors.forename: P
authors.initials: P
authors.lastname: Hsieh
authors.forename: Q
authors.initials: Q
authors.lastname: Dolecek
authors.forename: H
authors.initials: H
authors.lastname: Pak
authors.forename: M
authors.initials: M
authors.lastname: Gwynn
authors.forename: K
authors.initials: K
authors.lastname: Maggio
authors.forename: A
authors.initials: A
authors.lastname: Montemorano
authors.forename: J
authors.initials: J
authors.lastname: Powers
authors.forename: D
authors.initials: D
authors.lastname: Richards
authors.forename: L
authors.initials: L
authors.lastname: Sperling
authors.forename: H
authors.initials: H
authors.lastname: Wong
authors.forename: J
authors.initials: J
authors.lastname: Yeager
mesh_terms: D000704:Analysis of Variance; D003880:Dermatology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D012372:ROC Curve; D019114:Remote Consultation; D012871:Skin Diseases / Q000175:diagnosis*