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Accurate Skin Tone Measurement with Smartphone Improves Pulse Oximetry





A smartphone-based imaging technique for measuring skin pigmentation could improve the accuracy of pulse oximetry readings, particularly for people with darker skin tones.

Pulse oximeters are used to measure oxygen saturation levels in the blood. These devices often rely on light absorption through the skin, which varies depending on pigmentation. Pulse oximeters can overestimate oxygen levels in people with darker skin, which can lead to missed diagnoses and delays in treatment. Yet, skin tone is seldom measured directly in clinical settings.

To objectively measure skin tone, researchers at Brown University and Morgan State University developed a method to extract individual typology angle (ITA) values from a patient’s skin using a smartphone camera. ITA values are the metric that is used to classify levels of skin pigmentation.

Using a cell phone camera, the researchers captured the backscattered light from the dorsal and palmar sides of the fingers (a common measurement site for pulse oximetry) of four volunteers. They acquired skin-color data across a diverse set of skin tones, under various camera exposure settings and ambient lighting conditions. They developed an algorithm to extract a standardized skin-tone (i.e., ITA) value from an ITA spatial mapping derived from the RGB images captured by the smartphone.

The smartphone measurements compared favorably to those obtained using an industry-standard tristimulus colorimeter. When taken under controlled lighting conditions, the smartphone-based readings closely matched those from the high-end instrument.

The best results were achieved when both the camera flash and room lights were turned off, and the phone was set to a specific exposure level. The researchers identified an exposure setting of 0.7 as a reliable configuration for achieving ITA alignment with industry-standard colorimeter values.

Under these optimal conditions, the smartphone-based method for measuring skin tone proved consistent across different skin tones and required no extra equipment beyond the phone itself. By validating the technique under various lighting conditions and across different levels of skin pigmentation, the researchers were able to identify settings and configurations that are resilient to skin-tone variations.

To facilitate the use of smartphone cameras for pulse oximetry in nonlaboratory settings, the researchers recommended ways to minimize errors caused by ambient light scattering, which can affect skin-tone readings. They provided simple guidelines for using the technique in hospitals, such as avoiding measurements over tattoos or scars, turning off automatic camera features, and keeping the camera at a consistent distance from the skin.

Although the research was limited to a small group of young adults and tested outside a clinical setting, it could lay the groundwork for similar studies in real-world environments. The findings demonstrate that smartphone-based imaging could provide an affordable, effective way to evaluate skin tone.

The smartphone approach is accessible to the clinical community and others interested in carrying out pulse oximetry across a diversity of skin tones in a manner that standardizes skin-tone assessment. With additional testing and refinement, it could potentially enhance healthcare equity by providing clinicians with a consistent method for quantifying skin tone in a variety of environments.

To develop a reliable, user-friendly tool for real-world applications, future studies could encompass a broader range of skin tones and use lighting conditions commonly encountered in clinical settings.

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