ImageJ: A Free, Easy, and Reliable Method to Measure Leg Ulcers Using Digital Pictures

Wound measurement to document the healing course of chronic leg ulcers has an important role in the management of these patients. Digital cameras in smartphones are readily available and easy to use, and taking pictures of wounds is becoming a routine in specialized departments. Analyzing digital pictures with appropriate software provides clinicians a quick, clean, and easy-to-use tool for measuring wound area. A set of 25 digital pictures of plain foot and leg ulcers was the basis of this study. Photographs were taken placing a ruler next to the wound in parallel with the healthy skin with the iPhone 6S (Apple Inc, Cupertino, CA), which has a camera of 12 megapixels using the flash. The digital photographs were visualized with ImageJ 1.45s freeware (National Institutes of Health, Rockville, MD; http://imagej.net/ImageJ ). Wound area measurement was carried out by 4 raters: head of the department, wound care nurse, physician, and medical student. We assessed intra- and interrater reliability using the interclass correlation coefficient. To determine intraobserver reliability, 2 of the raters repeated the measurement of the set 1 week after the first reading. The interrater model displayed an interclass correlation coefficient of 0.99 with 95% confidence interval of 0.999 to 1.000, showing excellent reliability. The intrarater model of both examiners showed excellent reliability. In conclusion, analyzing digital images of leg ulcers with ImageJ estimates wound area with excellent reliability. This method provides a free, rapid, and accurate way to measure wounds and could routinely be used to document wound healing in daily clinical practice.