title: An Automatic Assessment System of Diabetic Foot Ulcers Based on Wound Area Determination, Color Segmentation, and Healing Score Evaluation.
abstract: BACKGROUND
  For individuals with type 2 diabetes, foot ulcers represent a significant health issue. The aim of this study is to design and evaluate a wound assessment system to help wound clinics assess patients with foot ulcers in a way that complements their current visual examination and manual measurements of their foot ulcers.
  
  
  METHODS
  The physical components of the system consist of an image capture box, a smartphone for wound image capture and a laptop for analyzing the wound image. The wound image assessment algorithms calculate the overall wound area, color segmented wound areas, and a healing score, to provide a quantitative assessment of the wound healing status both for a single wound image and comparisons of subsequent images to an initial wound image.
  
  
  RESULTS
  The system was evaluated by assessing foot ulcers for 12 patients in the Wound Clinic at University of Massachusetts Medical School. As performance measures, the Matthews correlation coefficient (MCC) value for the wound area determination algorithm tested on 32 foot ulcer images was .68. The clinical validity of our healing score algorithm relative to the experienced clinicians was measured by Krippendorff's alpha coefficient (KAC) and ranged from .42 to .81.
  
  
  CONCLUSIONS
  Our system provides a promising real-time method for wound assessment based on image analysis. Clinical comparisons indicate that the optimized mean-shift-based algorithm is well suited for wound area determination. Clinical evaluation of our healing score algorithm shows its potential to provide clinicians with a quantitative method for evaluating wound healing status.
authors.affiliation: Electrical and Computer Engineering Department, Worcester Polytechnic Institute, Worcester, MA, USA lwang1@wpi.edu.
authors.forename: Lei
authors.initials: L
authors.lastname: Wang
authors.affiliation: Electrical and Computer Engineering Department, Worcester Polytechnic Institute, Worcester, MA, USA.
authors.forename: Peder C
authors.initials: PC
authors.lastname: Pedersen
authors.affiliation: School of Business, Worcester Polytechnic Institute, Worcester, MA, USA.
authors.forename: Diane M
authors.initials: DM
authors.lastname: Strong
authors.affiliation: School of Business, Worcester Polytechnic Institute, Worcester, MA, USA.
authors.forename: Bengisu
authors.initials: B
authors.lastname: Tulu
authors.affiliation: Computer Science Department, Worcester Polytechnic Institute, Worcester, MA, USA.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Agu
authors.affiliation: Plastic Surgery Department, UMASS Medical School, Worcester, MA, USA.
authors.forename: Ron
authors.initials: R
authors.lastname: Ignotz
authors.affiliation: Computer Science Department, Worcester Polytechnic Institute, Worcester, MA, USA.
authors.forename: Qian
authors.initials: Q
authors.lastname: He
mesh_terms: D000328:Adult; D000465:Algorithms; D001331:Automation; D003116:Color; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D017719:Diabetic Foot / Q000473:pathology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008297:Male; D012720:Severity of Illness Index; D000068997:Smartphone; D017216:Telemedicine / Q000295:instrumentation / Q000379:methods*; D014945:Wound Healing
keywords: clinical validation of wound assessment; diabetic foot ulcer; healing score; tele-medicine; wound image analysis