AN INTERACTIVE TOOL FOR WOUND IMAGE ANALYSIS

PRESENTED BY

1.S.RAJENDRA PRASAD
(IV/IV-BTECH,ECE)

DEPT OF ELECTRONICS&COMMUNICATION
 AN INTERACTIVE TOOL FOR WOUND IMAGE
ANALYSIS

ABSTRACT
The lack of non contact methods to quantify wound healing accurately is a major
obstacle in clinical practice and in drug efficacy studies. The objective of our
work is to develop an interactive image analysis tool which can be used to
quantify the healing of the wound accurately. Our method involves image
processing techniques such as median filtering, thresholding, connected
components, region growing and color coding. Wound healing can be better
judged by considering the different wound tissues individually. Each of the wound
tissue zones and the total area of the wound are computed to provide accurate
quantification of the wound healing process.
Key words: Wound image analysis, wound healing.

1 INTRODUCTION

Wound image analysis finds its application in healthcare to monitor the healing of the
wound to decide on the course of treatment. It is also used in research to study the drug
efficacy or the radiation effects. To demonstrate the effects of a new drug on wound
healing, the wound surface area is one of the important variables [3].The healing process
is a phenomenon which can be visually assessed by an observer but only in qualitative
terms. Manual wound measurement is done by tracing the wound boundary and then
calculating the area. This is an error prone and a tedious task. Various digital image
processing methods for wound healing assessment have been proposed. These techniques
require the operator to drag the mouse around the wound edge to select the region of
interest. [1] proposes a non contact wound measurement system which uses a structured
light pattern to calculate the area and volume of debrided wounds. This system suffers
from less portability, cumbersome set up, calibration for each set up, requirement of a
specialized device for this purpose etc. There have been efforts to use color image
processing for automatic and quantitative analysis of healing skin wounds [2].
Healing is assessed by measuring the amounts of various wound tissues present in the
wound area. Another approach measures healing as the shift from the black to yellow
necrotic tissue to red granulation tissue. [3] proposes a method of choosing the HSI and
the ‘rgb chromatic system’ of color representation to derive a color index to assess the
healing. [4] highlights that the commonly used area based parameters - the absolute
change and the percentage change in area are biased by differences in wound size. Hence
a linear parameter which makes use of area and perimeter measurements is proposed,
which is valid for wounds of any shape and size. But in this article, healing is considered
as progress of wound margin along the skin surface. It does not take into consideration
the possible growth of skin from within the wound region. [6] compares the various
surface measurement methods in terms of accuracy, precision, ease of use, time
consumption, cost, availability and the amount of training involved.
Wide variations in colors that are generally seen in wounds make the automatic and
accurate measurement difficult. When the wound is deep, depending on the angle at
which the camera is positioned, we may get shadows in the wound area. Before the image
is acquired, the wound is cleaned. During this process of cleaning, slight bleeding is also
possible. This oozing blood could also change the color in the wound area. Some wound
care materials could also cause some changes to the colors of the wound tissues. These
are the reasons which might cause failure of automatic methods [2 , 3] of evaluating the
wound condition. In some cases, along with the area contraction, healing process might
also involve skin growth from within the region. In such cases, measuring the area or
perimeter [4] does not give the correct result.
Volumetric wound measurements are important for deep wounds. The techniques used
for the volumetric study are filling the lesion with saline, using casts and the computer
vision based structured light technique. The first two methods need the contact of the
wound, hence not preferable. The computer vision method is good but requires a
sophisticated set up for the wound measurements. The precision of these methods is
correlated with the wound’s area/volume ratio. Small and deep wounds
can be measured with better precision than large and shallow wounds [6]. Our work is
limited to develop a tool to measure the two dimensional wound size accurately. Feature
for depth measurement is not incorporated. Hence this tool is useful for measurements
where depth information is not a critical parameter.
Wound healing is a complex process and depends on numerous factors such as health
condition of the subject, site of wound, blood supply, response to a drug by an individual
etc. Hence it is difficult to make a meaningful comparative study of healing in regular
clinical practice. However for research purposes, a wound is made on a healthy subject
and the course of healing is studied. In such cases, one needs to carefully choose the
subjects to see that the site of wound, the health conditions of the subject and the size or
shape of wound are the same among the subjects.
The precise assessment of wound needs lot more information than just the wound size.
Considering the MEASURE framework [5], key wound parameters that should be
addressed in the assessment and management of chronic wounds are Measure (length,
width, depth, and area), Exudate (quantity and quality), Appearance (wound bed,
including tissue type and amount), Suffering (pain type and level), Undermining
(presence or absence), Reevaluate (monitoring of all parameters regularly), and Edge
(condition of edge and surrounding skin). Hence, for more accurate results and to handle
all the above mentioned conditions, we provide for the user inputs, so that the
measurements give accurate results.
The objective of our work is to develop an interactive tool for accurate assessment of the
healing of the wound. This is done interactively with the help of inputs from the operator.
This makes sure that the measurements take care of the wide variations and provides
accurate results. Following the MEASURE framework, we also provide facility for the
observations of those parameters, to be entered by the operator as an optional feature.
 2 METHOD

Wound images are acquired using a CCD camera, with a white piece of paper of known
area along with the wound for the purpose of calibration for size and color. For
calibration, the reference object in the image is clicked and the area of the reference
object in the image is entered in square millimeters. This is used to calibrate the image
for size and color.The image is median filtered to eliminate the hair on the skin, or any
such noise. For some images, a threshold can be directly applied. In some images the
different tissues need to be measured separately. Hence, the operator needs to decide on
the method for wound assessment. This decision does not need high expertise. For direct
threshold option, the image is thresholded, the threshold being adjusted by the operator
by just moving across the slider with the mouse. As the user moves the slider by dragging
the mouse, the region which is selected by the threshold grows and is marked black, thus
giving the feedback to the user, so that he can adjust the slider until he gets the wound
marked black. The size of the region which is marked as black can be found out as the
count of pixels with black color. For more accuracy, the user can go for a second option,
to mark the different regions of the wound tissues individually. The operator is required
to click on any one point of the wound tissue and mark it as slough, granulation tissue or
necrotic tissue by checking the corresponding option provided. A slider is provided
which can be used for growing the region. As the slider is moved, the region grows which
is displayed by coloring the growing region with red color. The operator thus gets a
feedback of what is seen by the tool as the specified wound tissue namely slough,
granulation tissue, or the necrotic tissue. All these three tissues present in the wound
region are marked with the same procedure, individually. There is a provision to add
regions of the same tissue types in case they are scattered in the wound area. These three
measurements provide with a good quantification of the wound healing.
Figure 1a shows a wound image which can be properly analyzed by just a simple
threshold. Figure 1b shows the result of this operation.
Fig. 1a Fig. 1b Fig. 2a Fig. 2b
This can be handled better by marking the different tissues individually. The figure 2b
shows the image where the slough is marked as red by clicking on it and using slider to
grow the region. Many a time it is seen that the wound tissues can be conveniently
thresholded after being color coded. Hence an option to color code the image is also
provided.
Fig. 3a Fig. 3b

Figure 3a shows the wound image where the depth of the wound causes a shadow in the
wound region. Figure 3b shows that color coding helps in the analysis.
The user can also provide the system with the different observations suggested by the
MEASURE framework, to make the measurement more accurate.

3 CONCLUSION

This tool proves very helpful for the measurement of wound images. It is simple, easy to
use and does not require any special hardware. There is no restriction that the image
needs to be acquired at a particular angle to the wound. This is vital because not always
the subject can be positioned to satisfy this requirement. It also provides for the
documentation of the condition of the wound during the course of treatment in the
clinical practice. It handles wide variety of wound images by providing with different
options for processing. The unique feature of our tool is to provide the feedback to the
user as to what it sees as the wound by coloring that region uniquely. Another feature is
to provide an option for the user to decide on the kind of accuracy he needs in the
measurements. More accurate measurements need more user inputs.
 4 SUGGESTIONS FOR FUTURE WORK

[7] suggests that the skin lesion can be easily segmented out if the imaging is
done using the blue band of the visible spectrum. SIAscope can be used for the imaging
in the blue band to provide better quality imaging. Some way of incorporating the depth
measurement has to be tried out, keeping the set up and the other requirements minimum.
Applicability of Euclidean Distance Measure (EDM) for measurement of the wound
healing could be tried to see if it provides a valid measure for the amount of growth still
needed for the wound to be covered. If a series of deep images are acquired at the same
angle, the dark band representing the shadow could also give some measure of the depth

of the wound

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