Present Status and Prospect of Skin Imaging Equipment in Some Public Hospitals in China
The continuous advancement of imaging science and technology has significantly transformed the field of dermatology, making skin imaging an indispensable subspecialty. This evolution has objectively and comprehensively altered the diagnostic approach in dermatology, establishing skin imaging as a critical skill that all dermatologists must master. Skin imaging equipment plays a pivotal role in both clinical practice and scientific research. It not only aids in the accurate diagnosis of skin diseases but also serves as the hardware foundation for enhancing skin imaging capabilities. Among the most commonly used skin imaging technologies in Chinese dermatological practice are dermoscopy, reflectance confocal microscopy (RCM), and very high frequency (VHF) skin ultrasound imaging diagnostic systems. In recent years, as dermatology has gained increasing attention across hospitals at all levels, investments in medical equipment have surged, leading to the continuous optimization of skin imaging technologies. Despite this progress, there has been a lack of comprehensive literature on the current status of skin imaging equipment in Chinese public hospitals. This study aims to investigate and analyze the present status of skin imaging equipment in the country, providing an objective basis for standardizing and strengthening the development of these technologies and dermatology infrastructure. This effort is expected to lay the groundwork for meeting clinical needs and achieving the optimal allocation of medical resources.
To gather data, a self-filled questionnaire was distributed to dermatology departments in public hospitals across various levels. The questionnaire was disseminated through multiple channels, including the Internet, mail, and paper forms. It was designed to be completed by the person in charge of skin imaging examinations or a designated representative. The questionnaire collected essential information, such as the hospital’s name, the level of the medical institution, the type, model, and duration of use of skin imaging equipment, and the number and qualifications of professionals engaged in skin imaging. The study leader reviewed the collected data, and incomplete information was supplemented via phone calls to ensure accuracy and reliability. After manual correction, the data were classified and summarized using Excel, and a database was established. Statistical analysis was performed using SPSS21.0 software.
As of July 31, 2019, 360 public hospitals from 29 provinces, autonomous regions, and municipalities participated in the survey. These hospitals were categorized based on their grade: 28 non-graded dermatological prevention and treatment stations and dermatological hospitals, 8 primary hospitals, 43 secondary hospitals, and 281 tertiary hospitals, of which 238 were grade A tertiary hospitals.
The survey revealed that 351 hospitals were equipped with dermoscopy, with grade A tertiary hospitals accounting for 66.38% of these facilities. A significant number of hospitals used domestic dermoscopy devices. Tertiary, secondary, and dermatological hospitals were more likely to have desktop dermoscopy devices, while primary hospitals predominantly used portable dermoscopy. In total, there were 826 dermoscopy devices in use, including 294 domestic desktop devices, 199 domestic portable devices, 47 imported desktop devices, and 286 imported portable devices. Desktop dermoscopy was the most common domestic equipment, while portable dermoscopy was the most frequent imported equipment. The average duration of use for dermoscopy equipment was 2.64 ± 2.27 years.
Reflectance confocal microscopy (RCM) was available in 64 hospitals, with an additional 8 hospitals in the process of acquiring the equipment. The Vivascope 1500 was more commonly used than the Vivascope 3000. Grade A tertiary hospitals accounted for 82.81% of hospitals equipped with RCM, while primary and secondary hospitals participating in the survey did not have this technology. There were 73 RCM sets in use, all of which were imported, with 61 being Vivascope 1500 (83.56%) and 12 being Vivascope 3000 (16.44%). The average duration of use for RCM equipment was 4.66 ± 3.16 years.
Very high frequency (VHF) skin ultrasound was available in 47 sets across public hospitals, with 26 being imported and 21 being domestic. The average duration of use for VHF skin ultrasound was 3.00 ± 2.76 years. Forty-three hospitals were equipped with VHF skin ultrasound, and an additional 10 were in the process of purchasing or bidding for the equipment. Grade A tertiary hospitals accounted for 81.39% of hospitals equipped with VHF skin ultrasound, with imported equipment slightly outnumbering domestic equipment.
Geographically, East China had the highest availability of dermoscopy, accounting for 32.20% of the country, followed by North China at 24.33%. East China also led in RCM availability at 30.14%, followed by Central China at 24.66%. North China had the highest availability of VHF skin ultrasound equipment at 31.91%, followed by East China at 25.53%.
Histopathology remains the gold standard for diagnosing skin diseases; however, it is invasive and can cause pain, infection, and scarring. In contrast, skin imaging technologies offer real-time, non-invasive advantages, making them a primary diagnostic tool in dermatology. These technologies enable the objective observation of morphological changes in skin diseases, aiding in the diagnosis and differential diagnosis of various conditions, particularly skin tumors. Skin imaging can also be used in preoperative evaluations to determine tumor boundaries, reduce unnecessary biopsies, and prevent medical errors. Additionally, in teaching hospitals, skin imaging enhances students’ learning interest and deepens their understanding of dermatological conditions. When combined with teledermatology, skin imaging can provide diagnostic assistance and guidance to primary dermatologists.
The survey highlights the uneven distribution of skin imaging equipment in Chinese public hospitals, with a concentration in tertiary hospitals and those located in first and second-tier cities. This disparity is influenced by factors such as urban economic development, hospital department planning, the availability of skilled professionals, and public awareness of dermatological care. Consequently, there is significant market potential for skin imaging equipment in China, as the current quantity and quality of these technologies fall short of meeting medical needs.
Dermoscopy, often referred to as the “stethoscope” of dermatologists, is particularly valuable due to its portability, ease of use, and high performance. In China, portable dermoscopy is predominantly imported, highlighting the need for domestic manufacturers to enhance research, development, and promotion of portable devices. The integration of portable dermoscopy with smartphones and artificial intelligence-aided decision systems can revolutionize medical practices by improving diagnostic accuracy and efficiency. Reflectance confocal microscopy (RCM) equipment in China is entirely imported and relatively expensive. However, domestic research institutions have developed an RCM prototype, which is expected to break the international market monopoly and reduce production costs. VHF skin ultrasound, produced by national enterprises, is increasingly present in Chinese public hospitals.
When purchasing skin imaging equipment, medical institutions should consider the following points: First, equipment should be reasonably configured and integrated to maximize its utility. Each type of skin imaging technology has its advantages and limitations, and dermatology departments should configure equipment based on their specific needs, promoting the integration of different technologies to enhance their complementary benefits. Second, the development of skilled professionals is crucial. Proficiency in using skin imaging equipment and accurately interpreting images require extensive training and experience. Dermatologists should be encouraged to participate in online or offline training courses to enhance their skills. Third, the management of skin image data is essential. Proper storage, management, transmission, and archiving of images are critical, with attention to data privacy and security. Multidimensional and multitemporal skin image data should be fully utilized to advance clinical research.
In conclusion, the total amount of skin imaging equipment in Chinese public hospitals remains insufficient and unevenly distributed, failing to meet the growing medical demands. Skin imaging equipment is a critical component of medical equipment planning, and this study provides an objective basis for its rational allocation and comprehensive utilization. While the survey did not cover all hospitals equipped with skin imaging equipment in China, it offers a preliminary reflection of the current status. Future investigations aim to provide a more comprehensive understanding of skin imaging equipment in the country.
doi.org/10.1097/CM9.0000000000000980
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