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Year : 2020  |  Volume : 28  |  Issue : 1  |  Page : 80-82

An efficient method for image archiving: Tagging images with structered keywords

Department of Plastic and Reconstructive and Aesthetic Surgery, Marmara University, Pendik, Istanbul, Turkey

Date of Submission30-Jan-2019
Date of Acceptance14-Apr-2019
Date of Web Publication31-Dec-2019

Correspondence Address:
Dr. Bulent Sacak
Department of Plastic and Reconstructive and Aesthetic Surgery, Marmara University, Pendik, Istanbul
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/tjps.tjps_13_19

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Photographic documentation is an integral part of plastic surgery practice. While there are reports in the literature that discuss photographic documentation and archive security, it is hard to find studies on image archiving and searching. This report aims to introduce a structured tagging system that can be used with all digital archiving programs and easily adapted to the everyday routine and practices of users. The system facilitates finding the images of a patient that were photographed at different times and allows to quickly and easily view all images related to a certain anatomical region or all of those that were photographed with a certain technique.

Keywords: Archiving, photography, tagging

How to cite this article:
Sacak B. An efficient method for image archiving: Tagging images with structered keywords. Turk J Plast Surg 2020;28:80-2

How to cite this URL:
Sacak B. An efficient method for image archiving: Tagging images with structered keywords. Turk J Plast Surg [serial online] 2020 [cited 2020 Feb 28];28:80-2. Available from: http://www.turkjplastsurg.org/text.asp?2020/28/1/80/274434

Dear Editor,

Photography has become a routine practice for almost all plastic surgeons for the purposes of visually documenting the baseline characteristics of patients when planning surgical or nonsurgical applications, both as reference and for objective outcome assessment, or for presenting on scientific platforms and as evidence in forensic processes when necessary. A study by Kasielska-Trojan et al.[1] showed that 97.7% of plastic surgeons maintain photographic records. Together with this routine, subtopics of photography such as accurate and standardized photographing techniques, image archiving, and ensuring the security of digital archives have emerged as the everyday concerns of the plastic surgeon. As these aspects are not included in the structured specialty training in many educational institutions, surgeons are driven to find their own empirical solutions. There are various reports[2] in the literature on how to take patient photos accurately. While the ability to access the images stored in the archive is as equally important as accurate photographing, it is difficult to find reports that describe standardizable, reliable, and simple systems. Convenient archiving and retrieving images from the archive at the time of need poses a potential problem, particularly in high-volume clinics, and it is not possible to easily and quickly find the images from a certain date and time. This report discusses the tag system used by the author for image archiving and proposes an easy and convenient tagging system.

Since 2014, I use the photo management application Apple Photos (v. 03, Apple, USA) to transfer my personal photography archive to the computer. The application enables to eliminate the folders' and subfolders' structure labeled with diagnosis codes or patient names and allows to keep all images in a single library environment. All digital images are marked with metadata that can be easily identified [Figure 1]. Instead of naming folders, here, keywords are tagged in the metadata cards of images. Keyword tags are entered using an easy-to-remember system based on anatomy, diagnosis, and treatment data, rather than a random sequence. In this system, patient name and surname are followed by anatomical and subanatomical regions, diagnosis (etiology), and subdiagnoses, where applicable, and treatment and special procedures [Figure 2] and [Figure 3]. It is not necessary to perform this process individually for each image, but can be performed on multiple photographs by selecting all relevant images of a patient that were taken within the same time frame. Because keyword tags are stored in the application's memory, users need to type a certain word in full only once and can later select and insert from the pop-up list after typing the first few letters [Figure 4]. Images stored in the archive can be retrieved in seconds by typing one or more tag names in the search box and in different combinations as needed [Figure 5]. In this system, photographs of a patient that were taken at different time frames and photographs showing a certain anatomic region or showing a specific treatment for a specific etiology can be quickly retrieved, and used in patient examinations, or for self-assessment or academic activities.
Figure 1: A metadata card showing the content applicable to all digital images. The metadata can be used to view the date and time of the photograph, as well as its technical information; and new definitions, keywords, and location information can be added

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Figure 2: The system based on anatomy, diagnosis, and treatment as used by the author and samples of clinical data

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Figure 3: View of the metadata card after keyword entry. Because tags are sorted alphabetically, they may not be displayed in the order they are entered

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Figure 4: Tags are stored in the application's memory and displayed without the need to rewrite the keyword in full, facilitating the task with a quick insertion. In this example, when entering the tag “üstekstremite” (upper extremity), all entries starting with “üs” are displayed to allow for a quick and error-free process once these first two initial letters are entered

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Figure 5: Once two keywords defining an anatomical region and a flap type are entered side by side in the search bar, the number of images tagged with both keywords can be quickly viewed and retrieved

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Although photography archiving has become a routine task for the plastic surgeon, it is not easy to find reports on archiving techniques. Institutions regard image archiving as a concern of only the radiology department, and activities of hospitals to that end consist of providing software and technical staff.[3] Given the recent advancements, as well as the increasing number of patients in plastic surgery, it is very important that the photographs routinely taken in almost every clinic are securely stored and backed-up, nonetheless quickly screened and retrieved.

The study by Kasielska-Trojan et al.[1] showed that clinicians spend more than 15 min on the average to access the images they look up and demonstrated that surgeons need systems that enable them to look up not only by patient names but also by surgical site and clinical diagnosis. The reason why especially high-volume clinics experience longer lookup times is the traditional folder method used in image archiving. The traditional folder method, which is still the most preferred method, has certain limitations. The major limitation of the still widely used traditional method is that the image remains in a single specific folder if it has not been duplicated. Given the large sizes of today's image files, duplicating images is a time-consuming task, and given the unnecessary disk space usage, one that requires large storage areas. When images are not duplicated, the task of accessing all photographs of the multiple interventions a patient has undergone or the photographs of a specific anatomical region/a specific intervention becomes a difficult and time-consuming process. Another unfortunate situation which many of us clinicians have experienced in the past is the impossibility of finding an image in the presence of a misspelling or a typo in folder names.

Metadata can be defined as “the information describing the data.” The history of using metadata cards in library and archive systems is far older than the digital age.[4] In the digital age, “tag” is the common word used for the terms that define a set of headers as digital photographs and files as a part or the whole of the metadata. All photography management softwares currently available on the market, whether free or paid, allow keyword tagging on metadata cards of digital images. Using a tagging system instead of a folder system in photography archiving pays off when it is time to retrieve the images. Once a tagged keyword is entered in the search bar, all the images that have been tagged with that keyword are displayed on the screen in less than a second. Another major benefit of the search function is the ability to look up multiple keywords at once, which allows to narrow down the search and thereby to access all images under a more specific topic in a very short time.

The weakest point of the tagging system is the complexity that will arise if a basic string or a hierarchy is not followed. That the stored keywords are displayed as a list once the first initial letters are typed when tagging images in the system, and the application based on anatomy, diagnosis, and treatment, as suggested in this report, almost entirely protects the archive against spelling and grouping errors. Whereas the mentioned system may seem to be time-consuming given the task of tagging each image with a keyword, it offers outstanding benefits when the total processing time is calculated including the archiving and retrieval times. While the recommended system also includes patient names, it is essentially based on the characteristics of the patient and the related operations, thus enabling quick and easy access to the desired sets of images as an ideal archive should provide. Because the proposed system is archive specific, each archive can be tailored as needed to suit the surgeon's or the clinic's unique working areas. Here, the major point is to use a tagging hierarchy in a specific order.

Another aspect in documentation is ensuring the security of the archive; however, this extensive topic falls outside of the scope of this report.

The tagging system we use and recommend eliminates typo issues and the need to remember the relevant information and, in other words, eliminates the major problems inherent to the folder system that are widely used today. In addition to facilitating the access to the images of a specific patient, all relevant images can be retrieved within seconds when searching for material to be used in scientific subjects, which, after all, is one of the purposes of keeping archives.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Kasielska-Trojan A, Korczak K, Niedźwiedziński M, Antoszewski B. Photographic documentation in plastic surgeon's practice. Pol Przegl Chir 2016;88:125-9.  Back to cited text no. 1
Persichetti P, Simone P, Langella M, Marangi GF, Carusi C. Digital photography in plastic surgery: How to achieve reasonable standardization outside a photographic studio. Aesthetic Plast Surg 2007;31:194-200.  Back to cited text no. 2
Liu L, Liu L, Fu X, Huang Q, Zhang Y, Luo Q,et al. SmartWADO: An extensible WADO middleware for regional medical image sharing. J Digit Imaging 2015;28:547-57.  Back to cited text no. 3
Wikipedia Contributors, “Faceted Classification,” Wikipedia, the Free Encyclopedia, Available from: https://en.wikipedia.org/w/index.php?title=Faceted_classification&oldid=795609418. [Last accessed on 2018 Mar 06].  Back to cited text no. 4


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]


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