SkinAid User Manual
- Angiraa Erdenesanaa (Unlicensed)
- Gergely Szikszay-Molnár
- Gergely Csány
SkinAid 4.0 Instructions for Use (04.08.2022)
Please find older versions of Dermus SkinAid manual in the archive.
1. About SkinAid
SkinAid is a web application that allows the user to view optical and ultrasound image recordings and their associated metadata (lesion location, patient's year of birth, optional notes) that are both being anonymously stored on the Cloud. The web application allows the user to make annotations on the images. This helps in communication between the dermatologist and the colleague performing the treatment procedure. The image and the associated metadata can be shared or downloaded directly as a PDF file.
2. How to Start
The software is available at www.skinaid.app, where the user can sign in with a registered email address and a corresponding password.
2.1. How to Register
If you are a new user, you can initiate your registration by selecting the “Sign up” label either below the “Sign in” button or at the right side of the top bar.
The following information is required during registration:
Name
Affiliation (e.g. name of institution, private practice)
Specialisation (dermatologist, surgeon, general practitioner, or other)
Medical practitioner registration number (optional)
E-mail address
Password
Billing details
Confirmation of the acceptance of the “Terms and Conditions” and of the “Privacy Policy”
Please note that the “Terms and Conditions” and the “Privacy Policy” must be opened before prior to checking the boxes of acceptance.
After completing the “Sign up” page, you will receive a confirmation email from register@dermusvision.com. Please, click on the “Verify Email” link to finalize the registration.
Following a successful verification, you will receive a confirmation email from Dermus Ltd, where you will be granted access to our SkinAid platform.
2.2. How to Sign In
After successful registration, you can log in to the SkinAid interface by providing your credentials and selecting the ‘Sing In’ button.
If you have registered before but you do not remember your password, you can click on the “Forgot password?” label and follow the instructions for resetting your password.
2.3. How to add a new patient
Following a successful login, the user can access the previously added (anonymous) patient data and can edit them, optionally.
A new patient can be added using the white plus sign with a red background at the bottom right corner of the page. Patient’s information can be entered here.
Please note that no identifiable patient data is stored in the SkinAid system.
It is mandatory to give the year of birth and the gender of the patient. The note field is optional. Multiple items can be selected from a predetermined list for patient-level notes.
Please note that a "Patient ID" numbers are generated automatically, to maintain anonymity of the patients.
2.4. How to add a new lesion
A single patient's page contains a general information of the patient (patient ID, birth year, sex, patient notes), access to previously added lesions, and a shortcut to add a new lesion.
You can add a new lesion by clicking on the plus sign icon at the bottom right corner. The location of the lesion can be selected on the following body schematic. You can swipe the image left or right to switch between front and back views of the body schematic. You can also zoom in for higher precision of the selection (using mouse scroll or two-fingers zooming gesture).
The lesion location can be selected by clicking/tipping on the corresponding point of the schematic. You can modify your selection by clicking/tipping on another point (only the last selected point will be saved).
It is possible to choose from a list of notes in the text box below the image to add a lesion-level note. You can also save the selected lesion location by clicking on the “Add lesion” button. This leads to the single lesion screen of the added lesion.
On the single lesion screen, the relevant region of the body schematic with the selected lesion location, the lesion note and the lesion diagnosis are shown alongside the primary patient information (patient ID, birth year, sex). This is the screen from which single recordings of the lesion can be opened or new recordings can be added in various ways and forms.
2.5. How to add a new recording
There are three ways of adding a recording to a lesion of a patient. All of them can be started by hovering over the “Ⓥ” button on a single lesion screen.
After selecting the ‘Add new Record’ button, the page will be prompted to an interface with two options. There you can upload an existing image or capture a new one using the camera of your device.
Selecting the other button (“Import OptoFuse record”) prompts the OptoFuse record uploading interface (see Section 4.1).
2.6. How to navigate the Toolbar
At the top of the page, you can find the navigation Toolbar of the SkinAid Software as shown in the image below.
The following options are displayed at the Toolbar section:
Last edited lesion – a shortcut to the last visited lesion’s page (it appears only after the user has visited at least one single lesion page after signing in).
About – a shortcut to the About page containing information regarding Dermus Ltd. and SkinAid-relevant documentation (User manual, Terms and Conditions, Privacy Policy, Release notes).
Patients – a shortcut to the home screen containing the list of patients and their data.
Single patient – a shortcut to the single patient screen of the current patient (appears only when staying under the patient level (on single lesion or single recording screens).
Single lesion – a shortcut to the single lesion screen of the current lesion (appears only when staying under the lesion level (on single recording screens).
Settings – a shortcut to the User related Settings page.
Logout button.
3. Recording-level User Interactions
On the screen of a single recording, you can find several tools for record analysis by hovering over the “Ⓥ”button at the bottom right corner of the page.
The following tools can be found on the interface:
Segmentation
Annotation
Record Notes
Download images
Thickness Measurement
Record Information
3.1. Segmentation
This function allows users to map a manual segmentation on the ultrasound image.
The segmentations can be outlined by polygon shapes superimposed on the existing ultrasound image. The polygons can be drawn with various colors, each representing a different skin structure.
The corresponding colors and their structure types are shown at the top of the screen above the ultrasound image. In the cases of multimodal (optical + ultrasound image) recordings, the segmentation will be done on the ultrasound image.
To add and customize a new polygon shape representing segmentation, the following steps are required:
Select the structure listed with ‘radio buttons’.
Add a new polygon by long clicking anywhere on the image and select “Add new polygon”. This adds a rectangle with 4 nodes.
Modify the shape of the polygon by holding and moving its nods one-by-one.
Move the whole polygon without modifying its shape by holding and moving the mouse at any point within the polygon.
To add a new node to the polygon, long click (for over 2 seconds) on the relevant line of the polygon (for over 2 seconds) and select “Add new point”.
To delete a node of the polygon, long click on the relevant node of the polygon (for over 2 seconds) and select “Delete point”.
3.2. Annotation
A dermatologist can mark out lesion borders or any other structures on a given image by using the annotation functionality of the SkinAid software.
Using the annotation functionality, you can highlight any points or structures of interest on the image (up to 7 points). You may also use this for highlighting the borders of a lesion as shown in the example below. Points are selected by single clicks at desired locations on the image. The green circles around the dots are intended to highlight the marked points more prominently. Point selections can be withdrawn by using the “Undo” button.
It is possible to zoom into the image by scrolling the wheel of your mouse for more precise marking. Click on ‘Save Annotation’ to save your image plot. When the Annotation is ready, the pdf report can be either sent to an email address or be downloaded directly.
3.3. Record notes
With this command, notes can be selected from a predefined drop-down list (See Figure 1).
Multiple predefined text items can be selected in a single note.
Each note will have its own time stamp and will be ordered according to the most recent date of creation.
3.4. Download images
By selecting this option, the image(s) will be downloaded automatically. The image file name will contain patient ID, lesion ID and recording ID information. For OptoFuse recordings, both ultrasound and optical images will be automatically downloaded in separate files.
3.5. Thickness measurement
This option allows users to make a distance measurement by selecting two points on the ultrasound image. Only vertical measurement is possible currently, which means that the output of the measurement will be the vertical (depth) projection (component) of the distance between the two points, making thickness measurements of skin layers with a parallel orientation to the surface easier.
If a measurement was made, its point selection and results will be automatically saved as a record note (see Section 3.3). The record note contains the following values [mm]:
x1 – lateral coordinate of point 1 (first selected)
y1 – vertical (depth) coordinate of point 1 (first selected)
x2 – lateral coordinate of point 2 (second selected)
y2 – vertical (depth) coordinate of point 2 (second selected)
dx – lateral projection of the distance between the two points
dy – vertical (depth) projection of the distance between the two points
d – true distance between the two points
3.6. Record information
Record information is automatically created and can be viewed via selecting this button after a lesion segmentation was performed on the ultrasound (US) image of the record. In such case, the following information are calculated and displayed as “lesion measurements” in [mm]:
US lesion axis ratio,
US lesion compactness,
US lesion PA ratio.
4. OptoFuse Recording
OptoFuse Recording is an optical-ultrasound image set with one optical image and multiple ultrasound images of the same skin area. In order to get a reliable fusion of the images, a specific physical marker (also presented on the images below) shall be used when recording optical and ultrasound images.
4.1. Importing OptoFuse Image
The “Import OptoFuse record” screen can be reached as described above, in Section 2.5.
To import an OptoFuse recording to the software the following steps are required:
Import optical Image by clicking on the ‘Upload’ sign.
Import ultrasound image set folder by clicking on the ‘Upload’ sign.
Add ultrasound image depth in millimeters.
Add ultrasound image width in millimeters.
After providing all the necessary data, upload the files by selecting the‘Upload OptoFuse Record’ button at the bottom of the webpage.
4.2. Handling Imported Records
After a successful import, the OptoFuse Recording will be displayed on the screen as shown in the image below.
It is possible to scroll between the imported ultrasound images by moving your mouse pointer above the ultrasound image vertically, while holding down the left mouse button for selection.
The red line on the optical image indicates the spatial position of the ultrasound image slice that is on display.
If you click on the ‘Show Segmentation’ button, the results of lesion segmentation will be demonstrated in detail (on the ultrasound image). The segmentation will be computed for all of the ultrasound images.
The results of segmentation can be converted into a depth map of the lesion which will be displayed on the optical image window after selecting the ‘Show Depth Map’ button. The map shows the depth dimension of the lesion projected onto the surface of the skin as derived from segmentation results of the ultrasound images.
On the ultrasound image window, you can zoom into the images by scrolling the wheel of your mouse. Simultaneously, the red line follows the zooming command on the optical image window, indicating the relative position of the ultrasound image slice on the optical image of the surface of the skin.
It is also possible to add notes to the recording by hovering over the “Ⓥ” button and selecting the ‘Notepad’ symbol on the right side of the screen as shown in the image below.
By clicking on the ‘PDF report’ you can create a report in ‘.pdf’ format. When the report is ready, the report can be either sent to an email address or be downloaded directly.
4.3. PDF report Generation
A report is created in PDF format, which can either be downloaded directly or forwarded to an email address.
Implementation
The report is generated in PDF format after clicking on the “PDF report” button for an optical-ultrasound (OptoFuse) recording or for a different type of saved annotation (containing a single image).
There are two options to access the generated report, using the “Send or Download the report” pop-up window, which appears after pressing the “PDF report” button.
The user can type in an email address and send the report to that address by pressing the “Send” button.
The user gets notified with an error message if the given email address was incorrect.
If an existing email address was given, an email entitled “Report” is received on that address, containing the following sentence with a link clicking on which a new page is opened and the PDF report file gets downloaded automatically: “You can download the report here.“
The email also contains the following sentence: “Please note that the current report is not a standalone medical report, it can only serve as an attachment to an existing medical report.“
The user can download the PDF report directly by pressing the “Download” button.
If a report of the same recording is generated previously, a message in the “Send or download the report” pop-up window will show the following notification:
“The report is already generated previously“.
Content of the PDF report
The file name of the report contains the following information:
Report
Patient ID
Lesion ID
Recording ID
Time stamp
The report contains the following:
Dermus company logo
SkinAid website address
Title: “Report”
Patient ID (non-identifiable)
Patient gender
SkinAid website address
Title: “Report”
Patient ID (non-identifiable)
Patient gender
Patient birth year
Diagnosis
Patient note
Lesion note
Record notes
Schematic image of lesion location
Images (see below)
Report ID
Warnings (see below)
Images of the PDF reportIn the case of an annotated image:
image of lesion with annotation superimposed
In the case of an Opto-Fuse recording:
Image pairs of optical and corresponding ultrasound images with ultrasound image slice marker on the optical image
The number of the image pair is displayed together with the total number of image pairs of the report
In the cases of showing “depth map” when generating the report:
The optical images contain the depth map and the corresponding colorbar appears above the optical images
In the cases of showing “segmentation” when generating the report:
The ultrasound images contain the segmentation overlay and the corresponding legend appears above the ultrasound images
In the case of an annotated single optical-ultrasound image pair – if not less than 2 points are selected on the ultrasound image during the annotation:
axial thickness of the annotated area, with the following description: “The height difference between the two farthest annotation points is in millimeters”
Warnings of the PDF report
“The current report is not a standalone medical report, it can only serve as an attachment to an existing medical report.”
“Marker-based optical-ultrasound fusion is currently under evaluation, do not use it for clinical purposes without a permit from the relevant Authorities.”
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