Range Of Skin Tones Research Articles

Abstract PR001: Radiation dose estimates via live, optical imaging are highly dependent upon patient skin tone

Abstract Introduction: New medical technologies must be tested across diverse populations to ensure efficacy for all patients. In the last decade, a novel technique for imaging in vivo radiation dose was developed to mitigate clinical radiotherapy (RT) incidents. Named Cherenkov imaging (CI), this technology captures the inherent light emission from ionizing radiation interacting with tissue during RT and allows for spatial verification of dose across a patient surface compared to their plan. Recent efforts have been made to use CI to quantitatively assess the true dose delivered across a patient’s surface in real-time, but many patient-specific factors prevent developing a direct Cherenkov-to-dose calibration until addressed. Melanin, a known absorber of light including Cherenkov wavelengths, is the most influential. Early phantom studies showed a near 45% change in emission across a range of skin tones for the same dose. Up until now, further investigation into this effect has been limited to phantoms due to a low number of in vivo CI studies and predominantly Caucasian catchment area demographics. We present a first detailed analysis of imaging patients with a wider range of skin tones and quantifying the effect that it has on dose estimation errors. Methods: A multi-institutional partnership was developed to expand patient demographics and increase diverse skin tone representation. All CI was completed with time-gated iCMOS cameras that capture the low light emission from tissue during RT. Cherenkov images were normalized by absolute planned dose and bulk tissue heterogeneities to minimize non-linear effects outside of skin tone. Patients were initially categorized by ethnicity and their skin tones were quantified by analysis of calibrated color photography. Average Cherenkov light intensity per dose was compared across various skin tones towards developing a calibration system for quantifying dose from the corrected signals. Results: In vivo Cherenkov images exhibit a nearly 220% decrease in signal across a range of skin tones, from White to Black/African American patients, greatly affecting the Cherenkov-to-dose calibration. However, a linear correlation exists between quantitative skin luminosity and dose-normalized Cherenkov emission. Thus, quantifying skin luminosity provides a method to normalize out the effect of skin tone and minimize the in vivo dose estimation errors across diverse patient demographics. Conclusion: This study addresses the critically important issue of developing optical tools that are appropriately calibrated for all skin tones. In vivo CI must be calibrated by skin tone for dosimetric assessments. We have shown that it is not only feasible to image dark skin patients, but possible to quantify the effect that a range of skin tones has on CI for a given dose. Using this information, we can develop a skin tone normalization algorithm to minimize dose estimation errors. Future work will focus on expanding our patient dataset to even darker skin tones through active recruitment efforts in the participating clinics. Citation Format: Savannah Decker, Jacqueline Andreozzi, Diego Hernandez, Daniel Alexander, Vihan Wickramasinghe, Ibrahim Oraiqat, Erli Chen, Iman Washington, Rongxiao Zhang, Lesley Jarvis, Petr Bruza, David Gladstone, Brian Pogue. Radiation dose estimates via live, optical imaging are highly dependent upon patient skin tone [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr PR001.

Answering the call to diversify the dermatology curriculum in undergraduate medical education.

Limited exposure to dermatological diseases across a range of skin tones can lead to diagnostic inaccuracies and lower diagnostic self-confidence. This study demonstrates that a short-term dermatology course is feasible and beneficial for increasing diagnostic skills across a range of skin tones, especially when skin of colour education is intentional.

The “Syringe Hickey”: An Alternative Skin Marking Method for Lumbar Puncture

BackgroundLumbar puncture is a procedure that is commonly performed in emergency departments. Despite their absence from procedure kits, emergency physicians often use skin markers to delineate landmarks for a lumbar puncture. We prefer to create a temporary indentation in the skin using the suction of a syringe. This “syringe hickey” eliminates the need for a skin marker. DiscussionWe created a photo demonstration comparing the syringe hickey to a skin marker for site marking. The syringe hickey was created using a 10-mL syringe aspirated to 5 mL on the forearm for 1 min. The syringe hickey lasted over 30 min on a range of skin tones across the Fitzpatrick Scale. The skin marker faded but the syringe hickey maintained its definition after application of ultrasound gel and sterilization with either chlorhexidine or betadine. ConclusionsThe syringe hickey is a simple skin marking technique that is resistant to antiseptic agents and ultrasound gel. The syringe hickey may be useful for other procedures that require puncture site marking.

Development of gRADient: An Inclusive Tool for Objective Measurement of Radiation Acute Skin Toxicity across Skin Tones in Breast Cancer

<h3>Purpose/Objective(s)</h3> Existing tools for grading radiation acute skin toxicity (RAST) primarily rely on subjective interpretation of erythema and desquamation, potentially limiting validity for patients of color (POC). Yet, more objective tools like in-lab colorimetry are not readily available for use in clinical practice. We report the development and preliminary testing of a novel digital photograph-based tool (gRADient) for RAST assessment in hypofractionated whole breast irradiation (hWBI) by: (1) validating the tool against colorimetry, and (2) testing its ability to detect skin changes over the course of hWBI across a range of skin tones. <h3>Materials/Methods</h3> Women ≥18 years undergoing unilateral hWBI to 40.5-42.6 Gy, +/- boost, were prospectively enrolled at 2 facilities (N=39). ≥2 physicians rated Fitzpatrick skin phenotype. Multiple photos of the treated and untreated (control) breast were taken weekly during hWBI (N=15 photos per time point). We mapped pixel-level RBG values to 2 corresponding color spaces: 3-item L*a*b* and Prism model (12 colors, shade, and tint on an increasing 0-1 scale). 13 patients also underwent in-lab colorimetry, collected in 4 quadrants of each breast. Patient PRO-CTCAE and Skindex-16, and provider CTCAEv.5 and RTOG tools were completed weekly. Spearman's rho assessed in-lab colorimetry vs. photo-based L*a*b*, and paired t-tests evaluated changes in Prism values between the treated and control breast at the first and last assessment. <h3>Results</h3> We evaluated 1,815 photos from 30 patients who underwent ≥3 photo sessions at the time of analysis. Patient-reported race was 43% White, 40% Black, and 17% other, corresponding to Fitzpatrick skin types of I-II (44%), III-IV (20%), and V (37%). For the colorimetry cohort, all 3 values of L*a*b* were significantly correlated for in-lab colorimetry vs. photos (all p<0.005). Across all photos, there was a significant increase in red, pink, and orange hues as well as in shading [mean ∆ of differences (dod) 0.023, 0.0004, 0.023, and 0.033, respectively, all p<0.05] for Prism in the treated vs. control breast over time. In exploratory analyses, a composite of these variables detected significant changes in time across all skin types (mean dod 0.047). While RTOG and CTCAE responses correlated with color space changes, more granular variations could be detected with gRADient. Inter-patient Skindex-16 results varied widely. <h3>Conclusion</h3> In a preliminary analysis, our novel photo-based tool yielded measurements that correlated with in-lab colorimetry, supporting its validity. Moreover, gRADient detected increases in red and pink (corresponding to erythema) as well as orange hues and shading (corresponding to increased pigmentation) across a range of skin tones. Next steps include continued prospective evaluation of gRADient, with the goal of building a web-based photo application to facilitate clinical use in RAST grading and patient education.

Validation of remote atopic dermatitis severity assessment with the Eczema Area and Severity Ondex in children using caregiver-provided photos and videos.

We sought to quantify the reliability and validity of remote atopic dermatitis (AD) severity assessment using the Eczema Area and Severity Index (EASI) applied to caregiver-provided photos (p-EASI) and videos (v-EASI). Children (0-17 years) with a physician diagnosis of AD were recruited. Caregivers took photos and a video of their child's skin. A clinician scored in-person EASI on the same day, then p-EASI and v-EASI for each participant 10 days or more between ratings. Two additional clinicians scored p-EASI and v-EASI. Lin's concordance correlation coefficient (CCC) was employed to assess criterion validity using in-person EASI as the gold standard. Intraclass correlation coefficients (ICCs) were calculated to assess interrater reliability of p-EASI and v-EASI. Fifty racially and ethnically diverse children (age [mean ± SD]: 4.3 ± 4.4 years; 42% female) with a range of AD severity (EASI: 6.3 ± 6.4) and Fitzpatrick skin types (1-2: 9%; 3-4: 60%; 5-6: 31%) were enrolled and received in-person EASI assessment. Fifty had p-EASI and 49 had v-EASI by the same in-person rater, and by two additional raters. The CCC and ICC for p-EASI were 0.89, 95% CI [0.83, 0.95] and 0.81, 95% CI [0.71, 0.89], respectively. The CCC and ICC for v-EASI were 0.75, 95% CI [0.63, 0.88] and 0.69, 95% CI [0.51, 0.81], respectively. In this diverse population with a range of skin tones, p-EASI showed good criterion validity and good interrater reliability. v-EASI showed moderate to good criterion validity and moderate interrater reliability. Both may be reliable and valid options for remote AD severity assessment.

Impact of Diversity in Training Resources on Self-Confidence in Diagnosing Skin Conditions Across a Range of Skin Tones: An International Survey.

BackgroundMedical images are invaluable in facilitating recognition of clinical signs. Recent studies highlight a lack of diversity of skin tone images used within medical education. However, there is a paucity of data on the impact of this on patient care.AimsTo investigate diversity in training resources used by users of an International online teaching platform and self-confidence in diagnosing skin conditions in all skin tones.MethodsUsers of an online teaching platform (www.dftbskindeep.com) were invited to participate in a survey evaluating key points including geographical location, ethnicity, profession, specialty, years of experience, training resources and confidence in diagnosing skin conditions. Data analyses were performed using SPSS. Categorical variables were presented as proportions. Chi-squared or Fisher's exact tests were used to compare the distribution between groups as appropriate.ResultsOf 600 participants, 74% reported training resources featuring predominantly white skin. Participants were “generally uncertain” in 43% cases, “sometimes uncertain but clinically safe” (52%), and “confident across a range of skin tones” in a minority (5%). Self-confidence was associated with location [higher in Africa (29%) and Latin America (11%), (p < 0.001)]; diversity of training resources [higher with a mix (10%) or darker tones (20%) (p < 0.001)]; clinical experience [6–10 (5%) or >10 years of practice (11%) (p < 0.001)] and specialty [highest in dermatologists (53%, p < 0.001)]. Self-confidence was lowest among pediatricians, emergency medicine and pediatric emergency medicine specialists (<5%).ConclusionsThese data provide preliminary evidence that training resources used by healthcare professionals on a global scale may lack enough diversity on representation of skin images, and a lack of self-confidence in diagnosing pediatric skin conditions. Further work is needed to understand the impact on knowledge and patient care to ensure equitable healthcare for all.

EFFECTS OF SKIN TONE AND AMBIENT LIGHTING ON ACCURACY OF CONTACTLESS MEASUREMENT OF HEART RATE AND PULSE TRANSIT TIME: AN INVESTIGATION TOWARD IMAGE-BASED BLOOD PRESSURE ESTIMATION

Abstract Objective: Image-based photoplethysmography (iPPG) using video of the skin offers potential for contactless blood pressure (BP) estimation from the pulse transit time (PTT). Optical properties of human skin and ambient lighting are likely to affect accuracy of image-based PTT (iPPT) and are investigated here. Design and method: Twelve healthy volunteers (6 female, 27 ± 6 years) with a range of skin tones (Fitzpatrick skin scores of 5 to 27) were recruited. For each subject, the experiment was performed in standard fluorescent room lighting (100 lux) and repeated at five other levels of light intensity (40–310 lux). Two-minute videos were acquired from each subject's face and palm of the left hand; simultaneous electrocardiogram (ECG) and non-invasive finger BP were also measured. In each frame, two regions of interest (ROIs) were selected from the subject's face and hand, and the average of green colour intensity for each ROI were calculated as iPPG. The iPPG signal was band-pass filtered between 0.66–3 Hz, (corresponding to a 40–180 bpm heart rate (HR) range). HR was calculated as the dominant peak in the Fourier spectrum of filtered iPPG. Beat-to-beat values of iPTT were calculated between the corresponding feet of the iPPG pulsations. Results: The absolute error between average HR (errHR) determined from ECG and that calculated from iPPG in both ROIs was significantly correlated with room lumen (RL) and skin score (SC) (errHR = – 0.08 × RL + 0.67 × SC + 12, p &lt; 0.05). The minimum HR error was in standard room lighting (errHR = 3.9 ± 8.9 bpm). Using average iPTT in room lighting as the reference, the percentage error (iPTT%err) between reference iPTT and iPTT in other lighting conditions significantly decreased with lower lighting conditions but was not significantly changed with skin tone score (iPTT%err = -0.09 × RL + 55, p &lt; 0.05). Conclusions: Skin tone and ambient lighting intensity affects accuracy of contactless HR measurement. Only light intensity affects accuracy of iPTT measurement. It is likely that errors in contactless BP estimation are minimised in standard room lighting conditions but increase in dimmer conditions.

Ten Little Fingers and Ten Little Toes (review)

Reviewed by: Ten Little Fingers and Ten Little Toes Jeanette Hulick Fox, Mem Ten Little Fingers and Ten Little Toes; illus. by Helen Oxenbury. Harcourt, 200840p ISBN 978-0-15-206057-2 $16.00 Ad 6-24 mos. A multicultural assortment of babies parades across the pages of this picture book, each of them with the requisite "ten little fingers and ten little toes," despite whatever cultural or racial differences they may possess. Each iteration of the nursery-rhyme-like text begins with a pairing of babies ("There was one little baby who was born far away// And another who was born on the very next day"), always united by their shared number of digits. The last baby described is the narrator's own, who not only has ten little fingers and toes, but also "three little kisses on the tip of its nose," inviting some sweet parent/child snuggling. The story is pleasant enough, but it's rather banal, and its length and viewpoint are likelier to please adults than little ones. Oxenbury's watercolor babies, however, retain their usual cozy and individual charm. A range of skin tones and dress (or undress) is depicted, and little ones will likely enjoy looking at the attractive, smiling baby faces. Global Babies (with basic text and bright photos of babies around the world) or Oxenbury's classic board-book collection (All Fall Down, Tickle Tickle, both BCCB 11/87, etc.) offer more engaging texts with a similar multicultural appeal, but this would be fine for a parent-baby lap session or a baby storytime. Copyright © 2009 The Board of Trustees of the University of Illinois

COLOUR-MATCHING IN HAND AND FINGER PROSTHESES: THE ASIAN PERSPECTIVE

The wide range of skin tones in the Asian population presents a challenge when colour-matching hand and finger prostheses. It requires that the prostheses be custom-made to better match the wide variations. We have developed a finger and hand prosthesis using a multi-layered moulding technique incorporating a colour-matching procedure capable of reproducing the colour tones and life-like appearance of the skin. Between 1990–1994, we have fitted these prostheses to a total of 109 patients. In evaluating the colour-match of their prostheses, 84% of the patients fitted with hand prostheses and 78% of those fitted with finger prostheses had a good to excellent match. This paper discusses some of the challenges we face in colour-matching hand and finger prostheses in the Asian population.