The project is comprised of two parts: the development of skin imaging standards and the creation of a public archive of annotated/marked-up validated skin lesion images.
The many facets of skin lesion imaging standards to be addressed by the project can be grouped into five interactive Working Groups: Technology, Technique, Terminology, Metadata, and Privacy.
Technology: There are a multitude of dermatoscopes, digital cameras, and computerized imaging systems currently in use. Without standards for spatial resolution and color consistency, images acquired with different imaging systems are not directly comparable. Color consistency is likely to be a particular challenge because pigmentation is a major diagnostic feature of melanomas and the skin itself is variably pigmented. Similarly, standards for device-related image processing, image compression, and metadata collection and format will be required. Accordingly, research teams/working groups will address the following issues: a. Minimal spatial and color resolution b. Image security / encryption, and c. Image processing, compression and metadata formats.
Technique: Standardization of the techniques used to acquire images of skin lesions and the surrounding skin will be required to maximize the utility of these images for teaching, research, and public education. Techniques relevant to the standardization of individual images of skin lesions include the type of image (contact vs noncontact) and the image magnification. Techniques relevant to the standardization of images acquired during total body photography include specification of body surfaces to be included, standardized poses and a standardized approach to patient privacy in the setting of nudity.
Terminology: Standardized terms are needed to describe clinical and pathological characteristics associated with skin lesions as well as the morphological features displayed in photographic or dermoscopic images. There have been some ambitious attempts to develop a formal lexicon of agreed terms for dermatological conditions but the scope of these earlier programs did not permit their completion. The ISIC Melanoma Project will benefit from these prior efforts. Restricting the scope of the lexicon to skin lesions as opposed to rashes etc. should allow timely completion of this set of standards. The terms to be standardized will relate to clinical/pathologic as well as morphologic attributes. Examples of clinical attributes include clinical diagnoses, anatomic site, pathologic diagnoses, symptoms, and risk factors. Examples of morphologic attributes include clinical morphology, dermoscopic morphology, and pathological morphology. The project will benefit from subgroup leaders with established domain expertise.
Metadata/DICOM: There is general consensus that the metadata initiative is best advanced using the Digital Image Communication in Medicine (DICOM) standard. DICOM was originally developed for radiology but has since been adopted by many other image producing medical specialties e.g. ophthalmology. Adopting the DICOM framework for metadata involves developing an Information Object Defintion (IOD). An IOD is a specification that documents metatdata elements and logically groups and structures the elements.
The metadata group will be informed by the technology and technique groups who will identify requisite metadata items. The metadata group will be responsible for producing a specification. The metadata group will promote membership of the DICOM Working Group for dermatology (WG-19 Dermatology). The metadata group will also perform a market scan to identify existing DICOM implementation in dermatology vendor products.
Standards Development Methodology
Each working group will conduct a systematic review of the existing standards for their domain from the medical literature and the relevant standards organizations. It is anticipated that these reviews will be published in appropriate peer-reviewed journals and will serve as the basis for an initial draft of the proposed standard. An internet-based, interactive user interface, housed on this web site, will be used to further develop the proposed standards.
Proposed standards will be published on the ISDIS web site. Feedback and suggestions for revision will be actively sought from organizational stakeholders and the international dermoscopy community. Applying Delphi methodology among stakeholders and mapping our results to the standards and terminologies developed by other medical specialty associations, standards’ developers, and government agencies- we anticipate deriving sets of standards that will be broadly applicable. Many organizations are participating in standards development; a list of some organizations active in this field in the US is shown in the Standards Hub section of the HealthIT web site.