title: Uses and abuses of digital imaging in plastic surgery.
abstract: BACKGROUND
  Surgeons extensively rely on photographic communication for documenting surgical results, teaching and research, and obtaining informed consent from patients. With the advent of digital photography and widespread availability of sophisticated image manipulation software, the potential for committing digital fraud cannot be discounted.
  
  
  METHODS
  Ten 'before' and 'after' plastic surgical photographs were selected, and a number of them were digitally enhanced using a standard desktop software by a non-expert in digital photography. A panel of 10 consultant plastic surgeons was asked to judge which, if any of the images had been digitally manipulated.
  
  
  RESULTS
  Expert assessment had a sensitivity of only 12% in identifying digitally manipulated images. Furthermore, there was poor interobserver agreement with an Intraclass Correlation Coefficient of 0.39.
  
  
  CONCLUSIONS
  Digital fraud is easy to commit and difficult to detect. Furthermore, a number of inadvertent and simple image manipulation functions can also amount to misrepresentation. There may be scope for cooperation within editorial circles to set standards for the submission of digital photographs. Surgeons need also to be aware of the potential for misrepresentation of information through digital image manipulation and exercise caution in the communication of digital photographic information.
authors.affiliation: Department of Ear Nose and Throat Surgery, Charing Cross Hospital, London W6 8RF, United Kingdom.
authors.forename: S A Reza
authors.initials: SA
authors.lastname: Nouraei
authors.forename: Jim
authors.initials: J
authors.lastname: Frame
authors.forename: Charles
authors.initials: C
authors.lastname: Nduka