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Fig. 29.2 Level of the
necrosis in various skin
burns is shown. D
dermis, (a) supercial
dermal burn, (b) deep
dermal burn, (c)
subdermal burn
(Reproduced from
Mirko Derganc ed.
Present clinical aspects
of burns– a symposium.
1968, Slovenia, p.139)
A. Stritar and M. Mikša
a
b
c
In describing the depth of the burn, instead of
the three-level American classication (1953),
the anatomical classication is more useful.
Burns are divided into epidermal, dermal, and
subdermal (Derganc 1972) (Fig.29.2) [9].
For important practical reasons, depending on
the prognosis and therapy, a distinction must be
made between supercial and deep dermal burns
in dermal burns. Epidermal and supercial dermal burns with good capillary rell and with a
perceived sense of pain are not a surgical problem. Deep dermal burns and subdermal burns,
however, dictate surgical treatment, such as surgical removal of dead tissue, usually within the
rst ve days after the burn trauma. The localization of burns is also important, thus distinguishing functional areas such as face, neck, feet,
shins, genitals, perineum, and mucous membranes and non-functional areas such as torso,
shoulder, and buttocks. When planning an operation, functional areas have priority.
Regarding the soft tissue status, the surgeon
must pay attention to circular burns, where consequent edema, especially in children, compresses the extremity area. This is most often
seen in the wrists, elbows, and ankles. Blood ow
should be monitored distally from conception or
even surgery should be performed.
At the time of admission, we must be especially careful if a deep burn of “eschara” compresses the underlying soft tissues and
neurovascular structures and thus threateningly
increases tissue pressure. In this case, it is
imperative to perform an escharotomy to the
muscles along typical incision lines. The incision must be complete, with precise hemostasis.
Surgically, an incision of the upper extremity,
lower extremities, and thoracic incisions is
made to establish the respiratory mobility of the
thoracic wall. Bronchoscopy is also indicated
for respiratory burns that worsen the prognosis
of treatment.
29.5 Surgical Treatment ofBurns
The best way to organize the treatment of burns
in a larger region is a burn center. Treatment of
large burns requires highly qualied personnel
and equipment, which is often difcult to provide. Treatment is multidisciplinary, long-lasting,
expensive, and with a high disability. Intensive
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treatment of large burns before, during, and after
surgery in shock requires a multidisciplinary
team, which includes in addition to the surgeon
also anesthesiologists, pediatricians, dieticians,
intensivists, nephrologists, psychiatrists, and
psychologists [10].
The surgery requires an experienced team of
surgeons, a complete instrumental team, which
can be doubled, and an anesthetic team. Regarding
treatment in shock, the doctrines in the larger
centers differ, with the burn being treated in some
places by surgeons, and in other places by anesthesiologists or specialist intensivists.
Primary excision in the rst 24 hours is
indicated:
1. In subdermal burns, if patients are in good
condition.
2. In electrical burns, in which deep structures
are affected.
3. In combined injuries, in which necrosis is
excised at the site where the incision is
required, and the wound after the completed
procedure is covered with.
4. Autografts for extensive burns on the extremi-
ties due to the constrictive effect of ESCHAR.
5. In critical burns.
6. In burns that do not respond to anti-shock
therapy.
When organizing the operation, operative
teams must be provided, the anesthetist must be
informed about the operation and the general
condition of the patient. Blood must be ordered
and skin must be provided. Substitutes to cover
operated sites should be available. The plan of
surgery should be clear, due to the location of the
patient, excised sites, retrieval sites, additional
dressings during surgery, tracheostomy replacement, catheters, and organization of additional
nursing teams. The participation of the entire
team during the operation must be active and
coordinated, due to the movement of electrodes
and catheters, turning the patient, due to increased
blood loss, control of the arterial canal, and due
to the risk of hypothermia.
The excision method is consistent with the
requirement that only irreversibly damaged tis-
311
Fig. 29.3 Primary tangential excision of burn wound
sue should be removed to the clinically vital surface on which the grafts are fully grown.
Hemostasis must also be meticulous. If both conditions are not met, the grafts do not grow primarily and less valuable granulation tissue grows.
Excision must be denitive and systematic in the
transition from one region to another (Fig.29.3).
As a rule, only deep burns are excised in the operative eld. However, supercial burns are excised
only exceptionally if there are deep burns in the
middle. On the eighth day, all such supercial
dermal burns become deeper, due to damage to
the wall and the path in the larger veins and irreversible damage to the collateral circulation. The
end result of necrectomy is a clean wound with a
vital base, and the biological potential of the
excised surface is reduced by 20% (Janžekovič
1977). Such a wound further necrotizes due to
dehydration and deepens, so we cover it with
grafts. Covering follows immediately after surgery or at the latest after 24hours. As a rule, autografts are harvested before excision of the carcass
[3, 9].
The only denitive biological cover is its own
skin graft (autotransplant), which primarily
grows into the defect and to a greater or lesser
extent replaces the destroyed skin (Fig.29.4). In
insufcient quantities of autografts, we use temporary grafts such as cadaver skin (homograft
and allograft) and xenografts or heterografts such
as semisynthetic dermis and amniotic
membranes.
The strategic plan for a large burn (60% of the
body surface) would be as follows: In the rst
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Fig. 29.4 Use of autologous skin graft is the gold standard for surgical management of burns
surgery, a necrectomy of the largest possible area
is performed (the limit is blood loss or coagulation and the general condition of the patient).
Then performed the excised areas with autografts, with functional and esthetically important
areas having priority. If there are not enough
autografts, we use homotransplants from the skin
bank. Before infection and spontaneous lysis of
homotransplants occur, which usually occurs
after a week to ten days, they are replaced with
homotransplants from another donor. Then, gradual replacement of homotransplants with autografts takes place, which can be taken several
times from the same donor areas at intervals of
7–10days, until the patient is completely covered
with his skin.
It should be noted that mesh graft growth is
significantly better than a complete graft, due
to hematoma drainage. The mesh graft can
also be more or less stretched. With the mentioned technique of creating mesh, stretched
skin grafts, we can excise most of the burned
area in one to two operations and thus economically cover the wound with autografts.
This prevents the wound from drying out and
bacteria from invading.
Even when using laboratory-grown skin, the
procedure is similar. After three weeks, when the
skin is grown and the wound is covered with it,
we do not remove the homographs completely,
but serve as a neodermis, or a connective base for
the grown keratinocytes. Cultured keratinocytes
A. Stritar and M. Mikša
deposited directly on the vital fatty subcutaneous
tissue lyse in a higher percentage.
In recent years, novel technological solutions
emerged as alternatives to standard grafting techniques. The RECELL® Autologous Cell
Harvesting Device (RECELL® System, AVITA
Medical, Valencia, CA, US) was developed to
minimize the amount of healthy skin to achieve
denitive closure of burn injuries. It is developed
for point-of-care preparation and application of a
suspension of non-cultured, disaggregated, autologous skin cells, using 1cm2 of the patient’s skin
to treat up to 80cm2 of excised burn. It can also
be used in addition to normal skin grafting in
order to maximize results and graft intake [10].
Another technique used to optimize and maximize donor skin to cover large burns is the Meek
micrograft technique. Although mentioned in the
early 1953, before the invented mesh technique, a
young doctor Cicero Parker Meek published
using a partial-thickness skin expansion device,
called a micrograft. It cut skin to small islets that
were later transferred to the wound bed. During
this time, the Meek micrograft was forgotten,
until the 1990s when it was renewed and
improved by doctors in the Netherlands.
Nowadays, micrografting can be used when there
is poor bed vascularity, such as in patients with
diabetes, with a greater success rate due to low
metabolic demands [11, 12].
Skin substitutes have important roles in the
treatment of dermal and full-thickness wounds,
including burns. At present, there is no ideal substitute in the market that provides an effective
and scar-free wound healing. Further research
should be carried out not only to compare different skin substitutes but also to evaluate new biological and synthetic materials that can be utilized
in wound healing [13].
There have been many interventions using different types of stem cells and stem cell-derived
products to promote better healing and minimize
recipient defects. Even with promising results in
experimental studies, there is still a lack of
enough published clinical trials to make an inference about the safety and efcacy of stem cells in
burn wound care [14].
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29.6 Postoperative Care
This is an important part of rehabilitation and is
divided into sub-acute, acute, and chronic phases.
In the acute phase, treatment of burns is combined, using dressings, antibiotics, antiphlogistics, and analgesics in supercial burns, and early
excision of necrotic skin cover in deep burns
(Fig.29.5) [15–17].
Physical therapy is essential for a burn patient,
starting from the day of injury and lasting for the
entire duration of treatment. The aim of physical
rehabilitation is to improve the functional independence of the burn patient by restoring the
functional ability of the hand or minimizing the
loss thereof. Scar management after sustaining a
burn injury is a lengthy process. Among the main
physical therapy, assessment procedures are measurements of joint mobility, massage, ultrasound
therapy, laser therapy, therapeutic exercises for
the extremities, and patient education Moore
etal. [16].
It is of most importance to start anticontracture positioning and splinting from day
one and continue for many months thereafter.
Positioning is important to inuence tissue
length by limiting or inhibiting loss of range of
motion secondary to the development of scar tissue. Elevation of all limbs affected is necessary in
order to quickly reduce edema; hands should be
splinted or positioned and feet kept at 90 degrees,
and care and attention must also be given to the
heel area, which can quickly develop pressure.
Legs should be positioned in a neutral position
ensuring that the patient is not externally rotating
at the hips [18].
The hand exercise program begins immediately. The active mobilization is rst physiological, followed by passive mobilization. The
exercise therapy is carried out according to a protocol, taking into account the patient’s condition
and the burn injury timeline (Moore etal.).
Simultaneously, occupational therapy is
included throughout the rehabilitation process in
order to prevent deformities and improve the
functional status. Occupational therapy includes
applying splints, both static and dynamic, monitoring scar maturation, hydrotherapy, use of ointments and creams, applying compression
garments and simultaneous education. Passive,
static splints have multiple functions, such as
immobilization of the affected body part, and
maintaining an optimal and functional position.
Splints prevent development of contractures. The
function of dynamic splints, however, is to regain
and restore the affected hand function. Finally,
scar management is a function of physiotherapy
and occupational therapy, with the goals of reducing hypersensitivity of scars, softening scarred
tissues, preventing scars from raising above the
Fig. 29.5 Postoperative
care includes vital
functions monitoring,
uid replacement,
medication, and frequent
dressing change
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A. Stritar and M. Mikša
skin level, preventing and reducing contractures,
and, nally, psychosocial education with regard
to coming to terms with scarred skin (Moore
etal.; Callahan etal. 1988; Cowan etal. 2013).
29.7 Conclusion
It is typical for the treatment of burns that the
treatment is long-lasting and expensive and that
the disability is still very high. The operational
technique itself has advanced, as has the instrumentation. Of course, there are new possibilities
in bioengineering, where not only
laboratory- grown keratinocytes or semisynthetic
dermis but fully cultured skin with dermis, epidermis, and derivatives will represent the optimal
solution for your own skin graft. Burn surgery is
seemingly very simple, but it requires a tremendous amount of experience, skills, immediate
solutions, anticipation, and timing. Even further
reconstructive procedures, after the acute phase,
require the complex knowledge of a plastic surgeon, who thus operationally establishes the
entire algorithm of surgical burn therapy.
Good teamwork, careful preparation for surgery, professional anesthesia during surgery, and
postoperative intensive care are postulates for a
good result and survival of a large burn.
Finally, we must not forget the humane and
kind attitude toward the burnt patient, who can
also be a child and isolated in the room with his
anxiety, fear, and pain. The moral support of the
surgeon, anesthesiologist, and all employees is
irreplaceable for the patient if we want to achieve
success in treatment.
References
1. Sneve H.The treatment of burns and skin grafting. J
Am Med Assoc. 1906;47(1):1–8.
2. Switzer WE, Sixth National Burn Seminar. Wound
management. Use of homografts. J Trauma.
1967;7(1):79–86.
3. Janzekovic Z.The burn wound from the surgical point
of view. J Trauma. 1975;15(1):42–62.
4. Brcić A.Primary tangential excision for hand burns.
Hand Clin. 1990;6(2):211–9.
5. Baxter CR. Management of burn wounds. Dermatol
Clin. 1993;11(4):709–14.
6. Moore RA, Waheed A, Burns B.Rule of nines. In:
StatPearls. Treasure Island, FL: StatPearls Publishing;
2021.
7. Lund CC, Browder NC. The estimation of areas of
burns. Surg Gynecol Obstet. 1944;79:352–8.
8. Chong HP, Quinn L, Jeeves A, et al. A comparison
study of methods for estimation of a burn surface
area: Lund and Browder, e-burn and Mersey Burns.
Burns. 2020;46(2):483–9. https://doi.org/10.1016/j.
burns.2019.08.014.
9. Derganc M. Classifying burns. Br J Plast Surg.
1970;23(3):209–10. https://doi.org/10.1016/
s0007- 1226(70)80043- 1.
10. Holmes JH 4th, Molnar JA, Shupp JW, et al.
Demonstration of the safety and effectiveness
of the RECELL® system combined with splitthickness meshed autografts for the reduction
of donor skin to treat mixed-depth burn injuries.
Burns. 2019;45(4):772–82. https://doi.org/10.1016/j.
burns.2018.11.002.
11. Rijpma D, Claes K, Hoeksema H, et al. The meek
micrograft technique for burns; review on its outcomes: searching for the superior skin grafting technique. Burns. 2022;48(6):1287–300. https://doi.
org/10.1016/j.burns.2022.05.011.
12. Ottomann C, Hartmann B, Branski L, Krohn C.A tribute to Cicero Parker meek. Burns. 2015;41(8):1660–
3. https://doi.org/10.1016/j.Burns.2015.06.013.
13. Halim AS, Khoo TL, Mohd Yussof SJ. Biologic
and synthetic skin substitutes: an overview. Indian
J Plast Surg. 2010;43(Suppl):S23–8. https://doi.
org/10.4103/0970- 0358.70712.
14. Abdul Kareem N, Aijaz A, Jeschke MG.Stem cell therapy for burns: story so far. Biologics. 2021;15:379–
97. https://doi.org/10.2147/BTT.S259124. Published
2021 Aug 31.
15. Young AW, Dewey WS, King BT.Rehabilitation of
burn injuries: an update. Phys Med Rehabil Clin N
Am. 2019;30(1):111–32. https://doi.org/10.1016/j.
pmr.2018.08.004.
16. Cowan AC, Stegink-Jansen CW. Rehabilitation
of hand burn injuries: current updates. Injury.
2013;44(3):391–6. https://doi.org/10.1016/j.
injury.2013.01.015.
17. Dodd H, Fletchall S, Starnes C, Jacobson K.Current
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org/10.1016/j.cps.2017.05.013.
18. Richard R, Baryza MJ, Carr JA, Dewey WS,
Dougherty ME, Forbes-Duchart L, etal. Burn rehabilitation and research: proceedings of a consensus
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Part V
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Measurement and Documentation
Imaging andMeasurement
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JacopoSecco
30
30.1 Introduction
As in all medicine research elds, the importance
of a newly developed solution is measured
through the gravity of the problem. Regarding
chronic wounds, it is a fact that kin ulcers are a
chronic pathological condition affecting around
1–2% of the world’s population [1]. In Europe
alone, over four million patients are affected by
this syndrome, costing =C4 billion in national
health treatment every year. Primarily found in
people > 65 years of age (> 60%), skin ulcers are
commonly associated with preexisting chronic
diseases such as diabetes, vascular problems,
heart disease, and obesity [2]. Early detection
and assessment of the wound are vital; after four
weeks, there is a 30% chance of the lesion never
healing, a 50% chance of loss of limb and a 50%
chance of mortality in the following 5 years [3].
Chronic pain, reduced mobility, and psychological and emotional stress are just a few of the
difculties commonly experienced by patients
with this skin condition. Furthermore, treatment
of skin ulcers may prove lengthy, taking several
months or even years for the wound to heal [4]. In
many patients, complications arise that require
urgent surgical intervention leading to long periods of hospitalization [5].
J. Secco (*)
Department of Electronics and Telecommunications,
Politecnico di Torino, Torino, Italy
e-mail: jacopo.secco@polito.it
From the presented data, it is clear that there is
the need in common clinical practice regarding
chronic wounds of tools that can assist the caregivers in delivering the required amount of assistance to their patients. A recent study has shown
that through the use of medical devices and standardized procedures that helped the physicians
and the nurses simply to communicate more efciently, the results of the delivered cures have
substantially increased the healing rate from 75%
to 90% of the overall cases. The same study has
also demonstrated that the same approach has led
to a decrease in the cost of cure by 35% due to
more precise prescriptions and an increased control of the cure plans [6]. These results are surely
encouraging and are the outcome of the last 20
years of research in the eld [7].
From the work of Bekara etal. [7] and from
even a more recent review of the new wearable
technologies for ulcer management and assessment by Wang et al. [8], it is clear that the keywords are essentially two: measure and
communicate. Obviously the rst leads to the
second, but it also sub-intends another essential
requirement: standardization. In this last decade
the world of medicine has seen great technological evolution, not only regarding diagnostic
means, but also regarding methods of transmitting the information remotely and in a precise
fashion. The birth of telemedicine and its conquest of a fundamental role in future diagnostics
and patient care due to the COVID-19 pandemic
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023
M. Maruccia et al. (eds.), Pearls and Pitfalls in Skin Ulcer Management,
https://doi.org/10.1007/978-3-031-45453-0_30
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J. Secco
taught a valuable lesson not only to the caregivers, but also to the whole hospital management
community [9, 10]. In order for this to happen, it
is crucial that the information that is gathered
from a patient must be extremely precise and
complete in order to perform the best possible
assessment.
Leading the discussion back to ulcer cure, one
of the fundamental milestones that technological
assessment has reached is the standardization of
the clinical information regarding the assessment. Quantication in wound care is a gray area
in which many works have been published, but
authors have yet to reach a consensus. A number
of parameters are measured. The work of Mani
etal. remains one of the cornerstones, listing the
various measurement possibilities [11]. The pH
is intended to be an indicator of tissue repair,
considering also its role in the microenvironment
of the wound bed [12]. Transcutaneous oxygen
and ow at the microcirculatory level are important, but only as indicators of possible results in
terms of tissue vitality. The fact that a skin ulcer
has a dened area and volume, although not simply measured, has led many authors to further
investigation. For clinicians, the objective of
measuring is to be able to better dene the evolution of a wound, whether it is being repaired,
blocked, or worsened; Flanagan et al. dene
wound reduction parameters as repair indicators
[13]. Sheehan et al. have demonstrated that, in
the case of diabetic ulcers, early assessment
(within four weeks) is crucial for full recovery
[3]. Gorin etal. have analyzed the reduction of
wound, area, width, and length, and concluded
that a linear parameter is independent of the geometric shape of the wound [14]. Cukjati et al.
reiterate how wound area and its variations indicate evolution and prognostics [15].
Moreover, the percentage change of the wound
area is a clinically recognized prognostic measure, although the problem remains of how to
measure it [16, 17]. Wound area is not the only
prognostic indicator. Solutions have been developed that propose a subdivision of the lesions—
in terms of tissue type and exudate
management—may be considered an appropriate
indicator of clinical results. One of the most com-
monly used is the wound bed preparation (WBP)
score proposed by Falanga as an analysis parameter as it is well-known and used on different
types of wounds [18].
As shown, ulcer assessment can take into
account many different variables, and an accurate
relation among them can surely lead to an always
more complete wound classication in diagnostic
terms. In any case as mentioned by Khoo etal.
and by Haghpanah et al., the capability to perform a correct morphological measurement of
the wound and its variations in its healing process
is one of the key elements for a correct diagnosis.
In these terms, the evolution of wound treatment
techniques has been followed by a parallel evolution of the imaging and measurement devices for
wound treatment [19]. Just in the last ten years,
different solutions have been developed, trialed,
and brought to the market, entering one by one in
the standard procedures for wound treatment,
always increasing their efciency and precision.
The following sections will deliver an overview
of both imaging and measurement techniques
used in wound care nowadays, due to their proven
diagnostic signicance. The devices and the procedures that are here described set the actual
standard of cure and show a glimpse of the future
of this always developing eld. The nal goal is
to give a better understanding of the future of
wound assessment and how technology can help
the caregivers, which are always working in the
front line, to render an always higher standard of
cure meeting the ongoing life and social
requirements.
30.2 Overview ofImaging
Technology inWound Care
In order to measure something, it is necessary
rst to feel it, or even better, to see it. Historically,
seeing something under the skin has been one of
the major problems to overcome. At rst physicians were obliged to look for different symptoms by touching the patient, searching for
cutaneous eruptions, rashes, or wounds, or even
to auscultate the body by laying the naked year
on the patient’s skin. These methods were the
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319
only available until the eighteenth century for
obvious reasons. The main, and probably the
only, reason was that it was thought to be unnecessarily dangerous to cut open the skin to simply
look inside the body unless no other solution was
possible. As a matter of fact, instant cauterization
techniques such as the electric scalpel did not
exist until the 1920s. For this reason, the rst
studies of the human anatomy and physiology in
Europe were conducted by dissecting dead bodies. Moreover, the rst anatomists also had to
have an outstanding artistic talent since all their
observations had been hand-drawn for future
studies. Two of the most famous artists and anatomists lived between the end of the fteenth century and the rst half of the sixteenth century
were Andreas von Wesel (a.k.a. Andreas Vesalius)
and Leonardo da Vinci, whose some of their studies arrived to us as true pieces of artwork (two
examples of Leonardo’s anatomical work are
shown in Fig.30.1).
In the eighteen-hundreds, two major discoveries gave birth to what today we call medical
imaging. The rst was the invention of photography in 1827 by Nicéphore Niépce in collaboration with Louis Jacques Mandé Daguerre. The
second was the invention of X-ray tube by
Wilhelm Rontgen. The evolution of these techniques has led to the birth of the eld medical
imaging. This eld has become so popular and so
important that it is reported that by 2010 around
5 billion medical imaging studies have been conducted worldwide, and it is estimated that by
2020 these have increased by 10% [20].
Medical imaging started have a greater differentiation between its morphological and functional purposes with the advent of digital images
in the 1990s. At rst, all imaging techniques, not
only in the medicine eld, were analog. This
meant that the resulting image from a camera, an
X-ray machine or whatever imaging device,
imprinted directly the subject of the representation on a portable physical mean. Common cameras used lm rolls made of celluloid, same as the
X-ray machines that initially exploited celluloid
lms with silver ions that had a direct reaction
with the ionizing radiation passing through a
body. Digitalization permitted to convert the
image in a series of bits (i.e., digits, 0s and 1s)
through silicon-based sensors. The obtained data
can be easily stored in semiconductor-based
memories such as the memory of an electronic
Fig. 30.1 Two examples of Leonardo da Vincis’s anatomical work. It is known that the famous Italian artist
used to buy corpses from the dead person’s families in
order to dissect them and draw their observations. Among
the many interests of Leonardo was also medicine at his
arbors
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J. Secco
device and can be directly analyzed using both
simple and complex mathematical models. The
capability of digital images to be both visualized
and analyzed has increased the functionality of
medical imaging. For instance, a defect detected
from an analog X-ray image could not be easily
measured in its size, and comparisons of the same
defect detected from two different X-ray
machines could not be easily performed unless
the same defect presented great variations. On
the other hand, thanks to the computerized
tomography (CT) which is a digital X-ray
machine capable of scanning the whole body
dividing it into slices, it is possible to digitally
reconstruct in 3D the same defect measuring it in
all its dimensions. From a time development perspective, parting from the point that a rst digital
transformation of medical imaging devices
occurred, the spectrum of functionalities that can
be achieved through medical imaging devices has
become exponentially greater (an example is
shown in Fig.30.2).
In wound care, obviously, imaging serves as a
powerful tool not only in representing the wound
per se, but also aiding the physicians and nurses
to have a better understanding of the ulcer evolution. As mentioned in Sect. 30.1, wound care specialists have a need for more efcient instruments
and devices in order to correctly capture the features of the lesion. These features are different
and not always visible to the naked eye. Digital
imaging aids the specialists in different ways,
depending on the clinical parameters that are
needed to be gathered. Not all the imaging techniques are commonly used in this particular eld
of medicine due to several factors such as the etiology of the wound, the presence of required
equipment, and the actual need of distinguishing
different clinical features. In any case, all the
means that are nowadays used permit physicians
and nurses to perform specic and precise measurements and analysis increasing the standard of
care and consequently its healing efcacy. As
mentioned, depending on researched clinical feature, different technologies can be exploited.
These can be subdivided into two main groups
that will be treated in more detail in the following
subsections: optical and nonoptical imaging.
Fig. 30.2 A time functionality development graph with
different examples of imaging techniques. From the
advent of digital imaging, the diagnostic functionalities
that can be obtained from an image have increased exponentially. As shown in the gure, traditional X-ray images
have been the state of the art of diagnostics for many
years: By converting the image into digital form, imaging
devices can perform complex analysis directly on the
obtained data.
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