A Feasibility Study of Thermography for Detecting Pressure Injuries Across Diverse Skin Tones

Pressure injury (PI) detection is challenging, especially in dark skin tones, due to the unreliability of visual inspection. Thermography may serve as a viable alternative as temperature differences in the skin can indicate impending tissue damage. Although deep learning models hold considerable promise toward reliably detecting PI, existing work fails to evaluate performance on diverse skin tones and varying data collection protocols. We collected a new dataset of 35 participants focused on darker skin tones where temperature differences are induced through cooling and cupping protocols. The dataset includes different cameras, lighting, patient pose, and camera distance. We compare the performance of three convolutional neural network (CNN) models trained on either the thermal or the optical images on all skin tones. Our results suggest thermography-based CNN is robust to data collection protocols. Moreover, the visual explanation often captures the region of interest without requiring explicit bounding box labels.