Wound Imaging

Excerpt

Medical imaging has significantly improved over the past 30 years, enhancing its clinical utility and enabling clinicians to refine therapeutic strategies. In wound care, imaging is pivotal in facilitating early and accurate diagnosis, which is crucial for optimizing patient outcomes. While imaging is often employed as an adjunct to traditional clinical evaluation, it significantly supports wound healing assessment and monitoring, mainly when clinical examination alone may fall short.

The most common initial assessment of acute or chronic wounds involves visual inspection and clinical examination. However, these methods are inherently subjective, especially when evaluating key metrics such as wound size and changes in the wound bed over time. Traditional grading systems like the Bates-Jensen wound assessment tool, pressure ulcer grade recording charts, Wagner grading scale, the wound, ischemia, and foot infection, and the site, ischemia, bacterial infection, area, and depth assessments provide useful frameworks. Still, they do not offer insights into whether healing has stalled, the depth of the wound, or the presence of infection. Clinical assessment relies on the clinician's experience, and even a well-trained eye may not accurately assess wound depth or the presence of underlying infection. This limitation underscores the importance of advanced imaging tools in wound care.

Photography, alongside more traditional imaging modalities like plain radiographs, computed tomography scans, magnetic resonance imaging, and ultrasound, offers an invaluable complement to clinical assessments. These imaging techniques are particularly useful in detecting deeper or life-threatening infections, evaluating underlying bone trauma or abnormalities, and assessing distal perfusion. Digital imaging, often through digital cameras or smartphone-based systems, has emerged as the most cost-effective and minimally invasive method for documenting wound progress. These images can be uploaded to electronic medical records and integrated with artificial intelligence to measure the wound area and perimeter (see Image. Stage 2 Pressure Ulcer). They can also be customized to provide data regarding the tissue type and used to build wound databases that support education and clinical decision-making.

Despite its advantages, most imaging techniques struggle to measure wound depth accurately, limiting their ability to assess wound volume. Specialized equipment like "time-of-flight" cameras can address this challenge by measuring the phase shift of light reflected from the wound bed to calculate depth and volume. However, these devices are expensive and logistically challenging to use. Nonetheless, digital photography remains the predominant imaging tool in wound care, providing a balance of accessibility, ease of use, and valuable clinical insights. This article explores various imaging techniques and their relevance to treating acute or chronic wounds.