title: A Multimodality Imaging and Software System for Combining an Anatomical and Physiological Assessment of Skin and Underlying Tissue Conditions.
abstract: OBJECTIVE
  The timely and accurate assessment of skin and underlying tissue is crucial for making informed decisions relating to wound development and existing wounds. The study objective was to determine within- and between-reader agreement of Scout Visual-to-Thermal Overlay (WoundVision LLC, Indianapolis, Indiana) placement (moving the wound edge trace from the visual image onto the wound edge signature of the infrared image).
  
  
  METHODS
  For establishing within- and between-reader agreement of the Scout Visual-to-Thermal Overlay feature, 5 different readers overlaid a wound edge trace from the visual image and placed it onto the congruent thermal representation of the wound on a thermal image 3 independent times. Forty different wound image pairs were evaluated by each reader. All readers were trained by the same trainer on the operation of the Scout prior to using the software features. The Scout Visual-to-Thermal Overlay feature allows clinicians to use an anatomical measurement of the wound on the visual image (area and perimeter) to extract a congruent physiological measurement of the wound on the thermal image (thermal intensity variation data) by taking the wound edge trace from the visual image and overlaying it onto the corresponding thermal signature of the same wound edge.
  
  
  RESULTS
  The results are very similar both within- and between-readers. The coefficient of variation (CV) for the mean PV both within- and between-readers averages less than 1%, 0.89 and 0.77 respectively. When converted into degrees Celsius across all 5 readers and all 3 wound replicates, the average temperature differential is 0.28° C (). The largest difference observed was 0.63° C and the smallest difference observed was 0.04° C.
  
  
  CONCLUSIONS
  The Scout software's Visual-to-Thermal Overlay procedure, as implemented in this study, is very precise. This study demonstrates that the thermal signature of wounds may be delineated repeatedly by the same operator and reproducibly by different operators. Thus, clinicians can integrate a criterion standard visual (anatomical) assessment with a congruent physiological assessment to provide them with knowledge relating to the presence or absence of blood flow, perfusion, and metabolic activity in the wound, periwound, and wound site.
authors.affiliation: Diane Langemo, PhD, RN, FAAN, is President, Langemo & Associates, and Adjunct Professor, University of North Dakota, Grand Forks, North Dakota. James G. Spahn, MD, FACS, is Founder, Chairman of the Board, and Chief Executive Officer, WoundVision LLC; and Founder, Chairman of the Board, EHOB Inc, Indianapolis, Indiana. Dr Langemo has disclosed that she is a consultatnt to WoundVision; received payment for manuscript writing from WoundVision; received payment for expert testimony from multiple US law firms; and has received grant money from DermaSciences. Dr Spahn has disclosed that he is the managing partner and owner of WoundVision, LLC, and Chief Executive Officer and board member and employee of EHOB, Inc; his brother, Tom Spahn, MD, is an employee of WoundVision, LLC; and his son, J. D. Spahn, is a partner and owner of WoundVision, LLC. Submitted May 27, 2015; accepted in revised form November 12, 2015.
authors.forename: Diane
authors.initials: D
authors.lastname: Langemo
authors.forename: James G
authors.initials: JG
authors.lastname: Spahn
mesh_terms: D006801:Humans; D007091:Image Processing, Computer-Assisted; D064847:Multimodal Imaging; D015588:Observer Variation; D015203:Reproducibility of Results; D012881:Skin Temperature; D012883:Skin Ulcer / Q000473:pathology* / Q000503:physiopathology*