Figure 4 - available from: Forensic Science Medicine and Pathology
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Examples of gray scale converted images under different light source illuminations as indicated by the text under each image (R72 = using R72 filter on camera; RM90 = using RM90 filter on camera)
Source publication
Alternate light sources such as ultraviolet, narrow band, and infrared have been used in an attempt to reveal the presence of bruising that is not otherwise apparent (inapparent). The following study evaluates the ability of alternate light sources to enhance visibility of bruises by employing an objective assessment of digital photography images i...
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p class="Body">Although some smartphone applications are designed for total body photography (TBP), few offer the specificity that enables self- as well as dermatologist-, detection of new lesions, or change in lesion color or in size as little as 1mm, on an ongoing basis. The aim of this study is to assess the sensitivity of a novel TBP applicatio...
Citations
... Previous studies have raised concerns regarding the specificity of ALS in detecting bruising [29,35,36]. The chart review by Holbrook and Jackson [7] showcased an impressive capability of ALS to detect bruises, identifying bruising in 98% of reported cases of strangulation, wherein 93% displayed no apparent injuries under CWL examination. ...
The ability to analyze blunt-force trauma is crucial for deciphering valuable clues concerning mechanisms of injury and as evidence for medico-legal investigations. The use of alternate light sources (ALS) has been studied over the past decade, and is proposed to outperform conventional white light (CWL) during bruise assessments. In response to the growing interest of the technology worldwide, a systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) to address the ability of ALS to detect and visualize bruising. From an initial 4055 records identified, ten studies met the eligibly criteria and were selected for this review. Evaluation also included a novel framework, referred to as SPICOT, to further systematically assess both scientific evidence and risk of bias in forensic literature. Analysis reveals that narrowband wavelengths within in the infrared or ultraviolet spectral ranges do not significantly outperform CWL in visualizing or detecting bruising. However, wavelengths within the visible spectrum, particularly 415 nm combined with longpass or bandpass yellow filters, are more effective. However, the majority of selected studies only address the sensitivity of ALS, and therefore, results may only be considered valid when the location of a bruise is known. Further investigation is required to understand the specificity of ALS, in particular how the use of topical cosmetic products, previous wounds/scar-tissue, tattoos, moles and freckles may affect detection. The ethical concern regarding the interpretation of enhanced visualized trauma should also be considered in prospect discussions prior to implementing ALS into routine practice. Nevertheless, this review finds that narrowband ALS within the visible spectrum demonstrates potential for improved injury documentation, outperforming CWL in the detection and visualization of bruising.
... The PC muscle, which lies in a relatively deep position, is not exposed to as much UV light as the more residual blood in the compression, therefore, the effect on myoglobin is not significant. There are also vessels that are not squeezed out as much as gels, despite the distortion of the retraction 17 . Thrombosis is thus another factor involved in NBE. ...
Early pressure injury (PI) progression is associated with multi-circulatory disorders and they interplay with each other, resulting in a lack of a satisfactory diagnostic method. We generated early PI and blanchable erythema hairless rat models. Transparent disc method and capillary refilling time test (CRTT) results were recorded with ultraviolet camera to capture the dynamics changes, and the blanching index and refilling index were set for comprehensive analysis. The deteriorated areas of early PI showed non-blanchable erythema (NBE) and an increase in erythema at 0.5 and 6 h with the transparent disc method. CRTT showed a marked refilling delay at 12 h. The comprehensive analysis of blanching index and refilling index showed a significant change in erythema from NBE at 0.5 h and ischemia progressing to hemorrhage at 18 h. There was also a marked difference in the deteriorating and improving areas within the same erythema. Pathological analysis showed inflammatory cell infiltration, with marked edema accompanied by increased hemorrhage and tissue necrosis. Furthermore, small arteries and veins with thrombosis and microthrombi were observed. Consistent ischemia after decompression and subsequent hemorrhage are important indicators, and comprehensive analysis can help increase the positive diagnosis rate over that for other circulatory disorders alone.
... (25) Olds et al. also demonstrated in forensic studies that symptoms of subcutaneous bleeding, which are not visible under white light, can be observed under UV light. (26) Each sequence of images in our experiment included 11 effective images. A total of 220 (11 × 20) samples were obtained from the 20 experiments. ...
... The findings of that study implied bruises in skin with dark pigmentation would be best seen by an observer wearing orange goggles using an ALS producing 450-510 nm illumination. Data supporting those results were obtained using a digital camera with a mounted filter in front of the lens, followed by image processing and analysis to measure the size of the bruise [27]. The validity of the simulated bruise model had been previously demonstrated [28], but the model of pigmented skin was not validated against human subjects. ...
Detection and documentation of bruises on survivors of intimate partner violence (IPV) can provide valuable evidence to support investigation and subsequent prosecution of these crimes. Detection of bruises in persons with darker skin tones is often difficult, contributing to disparities in health and criminal justice responses to IPV. The purpose of this secondary data analysis was to determine whether use of an alternate light source (ALS) increased the predictive probability of successfully detecting bruises on diverse skin tones following a history of physical trauma. In this study, data were analyzed from a convenience sample of 157 subjects inclusive of six skin tones (very light, light, intermediate, tan, brown, dark) with induced bruises. Bruises were assessed under white light and an ALS 21 times over four weeks using 10 different ALS wavelength and goggle color combinations. Data analyzed included 31,841 skin observations obtained over 2897 participant assessments. Multilevel modeling was used to account for the correlation among the repeated measurements for each bruise. Across all categories of skin pigmentation, ALS wavelengths 415 nm and 450 nm viewed through a yellow filter had the most frequent detections of bruises (415 nm: n=2,777, 11.2%; 450 nm: n=2,747, 11.1%) and greater predictive probability of a positive finding (415 nm: 0.90-0.99; 450 nm: 0.85-0.99) than white light (n=2,487; 10%; 0.81-0.90). These two ALS wavelengths were the only combinations that provided greater probability of detection than white light on groups with darker skin (brown or dark), whereas additional ALS wavelengths/filters worked equally well on groups with lighter skin. Findings suggest use of an ALS in clinical assessments of patients of color who report IPV may help reduce health and criminal justice-related disparities.
... Within the field of forensic medicine and pathology, one of the applications most commonly associated with multispectral photography is the detection and visualization of latent bruises and injuries [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43]. Some articles have reported the usefulness of multispectral photography for the detection and documentation of occult bruises in children [30,35,37,42,43] and adults [32,35,37,41]. ...
... Overall, these findings seem consistent with the scientific literature. However, debate about the validity of UV, NIR, and narrowband light sources, especially for diagnosing latent and subtle bruising, appears ongoing [36,[38][39][40]. To gain a deeper understanding of the validity of different light sources, further analysis is necessary. ...
Multispectral photography offers a wide range of applications for forensic investigations. It is commonly used to detect latent evidence and to enhance the visibility of findings. Additionally, three-dimensional (3D) full-body documentation has become much easier and more affordable in recent years. However, the benefits of performing 3D imaging beyond the visible (VIS) spectrum are not well known, and the technique has not been widely used in forensic medical investigations. A multicamera setup was used to employ multispectral photogrammetry between 365 and 960 nm in postmortem investigations. The multicamera setup included four modified digital cameras, ultraviolet (UV) and near-infrared (NIR) light sources and supplemental lens filters. Full-body documentation was performed in conjunction with the use of a medical X-ray computed tomography (CT) scanner to automate the imaging procedure. Textured 3D models based on multispectral datasets from four example cases were reconstructed successfully. The level of detail and overall quality of the 3D reconstructions varied depending on the spectral range of the image data. Generally, the NIR datasets showed enhanced visibility of vein patterns and specific injuries, whereas the UV-induced datasets highlighted foreign substances on the skin. Three-dimensional multispectral full-body imaging enables the detection of latent evidence that is invisible to the naked eye and allows visualization, documentation and analysis of evidence beyond the VIS spectrum.
... Previous forensic research has proven that ultraviolet (UV) light sources can enhance the visibility of bruises (intradermal haemorrhage) that are invisible or barely visible under white light. 8 The principle underlying this effect is the absorption of UV light by haemoglobin (Hb). This approach is widely applied in forensic cases for the identification of intradermal hematomas. ...
... UV light has been used for the forensic identification of intradermal haemorrhages, that is, UV light enhances the visibility of bruises, which are invisible or barely visible under white light. 8 The emission of the UV light source that we used in this study peaked at 405 nm, which was also within the high absorption range of Hb. In this study, we clearly identified increased intradermal bleeding visually at 36 hours through UV photography (Figure 3). ...
Early pressure injury (PI) can result in either spontaneous healing (SH) or deterioration into ulcer (DU). However, determining whether PI will progress into SH or DU on the basis of non‐blanchable erythema only is difficult. In this study, we constructed two animal PI models to mimic SH and DU injuries and observed haemorrhage by using ultraviolet (UV) photography to develop potential clinical indicators for predicting the progression of early PI. Macroscopy, UV photography, and skin temperature observations were obtained. In the SH group, macroscopic observation showed the erythema was obvious at 0.5 hours after decompression and faded gradually had almost disappeared at 72 hours. In the DU group, the erythema persisted, and an erosion appeared at 24 hours after decompression and expanded at 36 hours. The erythema developed into an obvious ulcer at 48 hours and enlarged at 72 hours. The obvious ulcer found at 48 hours through macroscopic observation was clearly visible at 36 hours with UV photography, and a significant difference in grey values between the two groups was found at as early as 18 hours (P < .05). This study provided evidence showing that UV photography can predict the different progression stages of early PI. Additionally, when combined with the transparent disc method, UV photography also can be used to identify the circulatory disorders of early PI, such as haemorrhage or hyperaemia and even congestion.
... To determine whether the BVS and AVS instruments capture the construct being measured, we examined their association with other injury characteristics expected to also be associated with visibility. Other studies have used bruise size as a measure of an injury's visibility in digital images (Olds et al., 2016(Olds et al., , 2017Trefan et al., 2018). Ultimately, we found the size of the bruise or area of absorption was significantly associated with its visibility score under both light sources. ...
Background:
Documentation of injuries associated with abuse and assault has pivotal impacts on clinical and legal outcomes. Before this study, no reliable and valid tools to consistently document the clinical visibility of bruises existed. The purpose of this study was to systematically evaluate reliability and validity of the Bruise Visibility Scale for documenting bruises visualized in normal (white) light and the Absorption Visibility Scale for documenting bruises visualized using an alternate light source (ALS).
Methods:
Bruises were induced using a paintball on the upper arms of 157 participants stratified into six skin color categories. Bruises were visualized 21 times over 4 weeks under white light and 10 ALS wavelength/goggle color combinations. Bruise size was measured using a metric ruler; bruise color was measured using a spectrophotometer. Interrater reliability was calculated using kappa and intraclass correlations coefficients. Construct validity was evaluated using generalized linear mixed modeling of associations between bruise size and color with both visibility scales.
Results:
Interrater agreement for bruise detection was over 90% for all but two ALS wavelength/goggle combinations. Kappa values indicated adequate interrater agreement under white light (κ = 0.76) and ALS (κ = 0.78). The visibility scale intraclass correlation coefficients were .91 for normal light and .93 for ALS. Statistical modeling showed greater bruise size was associated with higher visibility using either scale, and greater contrast in color or lightness was associated with higher Bruise Visibility Scale values.
Implications for practice:
Both visibility scales showed satisfactory reliability and validity. Forensic nurses can use the scales to consistently document bruises.
... The few available studies have found use of an ALS enhanced bruise observation, but researchers were unable to control for the potential effects of false positives either through study design (21,24,25) or execution (23). Confounding factors, such as preexisting skin conditions and topical products, could mimic bruising by producing absorption under alternate light (21,26,27). Additionally, none of the research to date has examined how skin color impacts detection of bruising using an ALS. ...
... For example, we noted several instances of scars, tattoos, hyperpigmented areas, nevi, acne, and other lesions that demonstrated absorption under alternate light but distinguishable from bruising under direct white light assessment. In addition, washing the skin before ALS application, as we did, may remove topical products (i.e., cosmetics and sunscreen) known to cause light absorption (26,27). Performing follow-up assessments in clinical practice may also capture changes in absorption over time more consistent with a healing bruise. ...
Bruises are often difficult to detect on victims of violence, potentially impacting investigation and prosecution. The purpose of our randomized controlled trial was to measure the effectiveness of an alternate light source (ALS) within visible and long ultraviolet spectrums at improving bruise detection compared to white light over time. We also examined the effects of skin color, age, gender, localized fat, and injury mechanism on bruise detection. Participants included 157 healthy adults with balanced sampling across six skin color categories. Bruises were created under the controlled application of a paintball pellet and dropped weight to one upper and lower arm, respectively. Using a crossover design, both bruises were examined 21 times over 4 weeks. Ten different wavelength (350-535 nm) and filter (yellow, orange, red) combinations were used. Multilevel models were used to analyze 2903 examinations on both upper and lower arms. Results in multivariable models showed after controlling for other covariates 415 and 450 nm using a yellow filter had greater odds of detecting evidence of bruising than white light (Upper Arm: 415 nm: OR = 5.34, 95% CI: 4.35-6.56; 450 nm: OR = 4.08, 95% CI: 3.36-4.96). Under either light source, being female and having more localized fat had increased odds of detecting bruises created by the dropped weight (female: OR = 2.96, 95% CI: 2.37-3.70; fat: OR = 1.21, 95% CI: 1.09-1.34). Our results support ALS as an appropriate tool to enhance concurrent physical assessment of bruises in the presence of known history of injury. Future development and evaluation of clinical practice guidelines for ALS application are needed.
... Research on simulated fresh bruises also found significant enhancement in visualization compared to white light across bandwidths between 350 and 510 nm. 20 More research is needed to determine whether time is a factor in which wavelength and filters are most effective in detecting bruises on a larger, diverse sample. There are several limitations to our pilot study. ...
... Finally, we did not compare the overall clarity of bruise visualization between the two sources of light due to a lack of existing reliable metrics. Using photographic analysis to quantify the enhanced visibility of faint bruises, such as those used by Olds et al., 20 may increase the support for the clinical utility of the ALS. ...
Introduction:
Cutaneous bruises are often hard to detect particularly on individuals with a darker complexion. Researchers and federal agencies have recommended the use of alternate light to aide in the assessment of subtle injury. However, studies are limited in their evaluation of wavelength performance during the first few days of bruise healing. The purpose of this pilot study was to examine whether an alternate light source (ALS) improves detection of bruises when compared to normal light typical of clinical practice during the first three days following induction.
Methods:
A sample of eight healthy adults between 22 and 36 years of age with diverse skin color were recruited for this study. One bruise was induced on each participant by dropping a 4-oz (113g) steel ball through a 5-ft (1.5 m) vertical pipe onto the anterior surface of the forearm. Using the ALS, bruises were assessed under 14 different combinations of ultraviolet and short narrowband visible wavelengths and filters along with overhead fluorescent "examination" lighting. Participants were examined 3 to 4 times per day at approximately 4-h intervals for three consecutive days post induction.
Results:
Repeated bruise assessments on 8 subjects resulted in 59 bruise assessments and 885 total observations under the different wavelengths and filters combinations. A bruise was detectable in 46 (78%) of the assessments, with bruise ages ranging from 30 min to 57 h. Twenty (34%) bruises not detectable under normal light were visible with ASL. Multilevel modeling revealed a strong association between time and detection for shorter wavelengths, such as 365 nm (ultraviolet) and 450 nm.
Conclusion:
The results of our study suggest alternate light is more likely to detect faint bruises than normal lighting during the first three days post injury. However, more research is needed to determine which wavelengths and filter combinations are most effective during that time frame.
... It has been demonstrated that alternate light source (narrow band visible light) illumination has the potential to increase the visibility of bruises of the skin [5,6]. Studies of simulated bruises in pigskin [7] and histologically proven bruises in human cadavers [8] indicated that alternate light sources using narrow band violet light produced the maximal enhancement of bruises. However, these investigations were limited to evaluating fair (Caucasoid-type) non-pigmented skin. ...
... The absorption of light by melanin increases as the wavelength of light shortens (towards the blue to ultra-violet part of the spectrum) [11]. Thus, it was hypothesized that while alternate light source illumination using violet light has been shown to be optimal for enhancing bruises in light skin [7], light at a longer wavelength (such as blue-green) may be more effective in heavily pigmented skin by virtue of its ability to penetrate melanin better than short wavelength light. It was also hypothesized that recording of fluorescence in the infra-red region of the spectrum would prove effective for demonstrating bruises in the presence of a dense melanin barrier. ...
... Previous work had been conducted using pigskin as a model for human skin [7]. Although pigs can appear dark, this is attributed to the color of their hair. ...
The purpose of this study was to evaluate the ability of alternate light source illumination to enhance bruises in pigmented skin. Previous work was limited to simulating bruises in non-pigmented (Caucasoid type) skin by injecting blood into pigskin. In this study, it was investigated if adding a layer of melanin to the surface of the skin would simulate pigmented skin. The study included evaluating the use of a filter that transmitted infrared light (wavelength greater than 720 nm) in place of the recommended visible light filters for the alternate light sources. The results obtained using pigskin with a layer of melanin were almost the same as results using the naturally pigmented goat ear. This indicated adding a layer of melanin could be used as a model for pigmented skin in this simulation of fresh bruising. Comparing the pigskin without melanin with pigskin with melanin revealed that the optimal light source to enhance the appearance of bruising, simulated by injection of blood, changed from violet to blue-green. Using the infrared transmitting filter resulted in greater enhancement than using the alternate light sources with their recommended visible light filter. The advantage of using the infrared transmitting filter was greater with the pigskin coated with melanin and the naturally pigmented goat ears than in the non-pigmented pigskin, however, the results remain to be validated using real bruises in naturally pigmented human skin.
