![]() This study aims to compare an in-vivo assessment of bruises to the features seen using four different imaging modalities, namely conventional, cross polarized, infra-red and ultra-violet. Quantitative comparisons of maximum diameters of bruises on images taken in alternate light sources including conventional, IR and UV in a pigskin model 23 and in non-embalmed and embalmed cadavers 24 have been carried out lately using Fiji 25 distribution of ImageJ software. The greatest contrast was noted with conventional, and cross polarized light, and reduced performance on darker skin. (2013) 5, 17 compared the general appearance of bruises on white (conventional), cross polarized, IR, and UV images. 22Ĭomparison of bruise images using different modalities in live humans, is sparse. ImageJ has been widely used for almost 30 years 20 to facilitate a more objective analysis 21 of medical images of different skin problems. The most consistent electronic measurements of children's bruises were ImageJ segmented conventional images. (2013) 19) and photoshop measurement, to the current standard practice, ie in vivo measurements, in both conventional and cross polarized images. (2017), 18 who compared a range of suggested measurement techniques, including ImageJ segmentation, the circle technique (proposed by Bennett et al. This has been investigated by Harris et al. In addition to the method of imaging, the measurement technique used can influence the accuracy and reliability of bruise measurements. This is of particular importance in identifying bruises in cases of suspected physical abuse, as the clinical examination may occur some considerable period of time after the abuse has occurred. (2015) 16 found that UV imaging is significantly better than physical examination in identifying hematomas when injuries are older than 1 week, and that it can be used to identify trauma up to 31 weeks after it has occurred. 13 It seems that when visual signs begin to disappear, UV images may be able to reveal old injuries, or at least support the identification of suspected injuries. ![]() The shallow penetration of ultraviolet (UV) light into human skin results in less scatter of the reflected rays, and therefore in greater surface detail, and because of its shorter wavelengths, it offers greater resolution. ![]() 12 This could be of particular value when imaging bruises on children with dark skin, as the level of penetration of IR waves, may cancel out the effect of the higher level of melanin in the epidermal layer of skin, 5 thus making the bruises easier to see. The longer wavelengths of infrared (IR) imaging may provide additional information about injuries below the surface of the skin, as they can penetrate relatively deeper in the skin, up to 3 mm, 11 and have been demonstrated to be of benefit, in combination with color images, when analyzing traumatic injuries. (2011), 10 found that clinicians preferred cross polarized imaging when assessing images of bruises for boundary, color, size, shape and absence of light reflectance. ![]() 5 Cross polarized filters also enhance visual detail, and improve the definition of bruise margins, as the wavelength of reflected light is lengthened when it penetrates the skin's surface, heightening the bruise color and contrast. Cross polarized filters have been proposed to reduce this, by removing both the glare from reflected light in images, and the shine that sweat and oil in the skin produce. 5, 6, 7, 8Ĭonventional images are sometimes impaired by spurious light reflectance from the skin, caused by electronic flash. 4 In order to visualize a bruise in the most effective way, different photographic imaging methods have been suggested, including cross polarized, infrared (IR) and ultraviolet (UV) imaging. These changes may affect the absorbance and fluorescence properties of the skin. 3 The appearance of a bruise varies according to the amount of hemoglobin visible in the indurated area followed by bio-degradational products resulting from the healing process. Certain patterns of bruising are more characteristic of abusive than unintentional injury 2 Crucial to any assessment of bruising that may indicate child abuse is an accurate recording of the bruising found.Īt present, clinical recording relies on digital imaging techniques. Bruising is the most common manifestation of physical child abuse 1 and may indicate significant underlying injuries.
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