Abstract:
A system for plastic surgery comprises entering patient information ( 130 ) into a database; computing a template ( 160 ) for the patient based on the information; and inserting a synthetic model into the template.

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
       [0001]    Reference is made to commonly-assigned copending U.S. patent application Ser. No. 11/555,313, filed Nov. 1, 2006, entitled AUTOMATED CUSTOM REPORT GENERATION SYSTEM FOR MEDICAL INFORMATION, by Squilla et al., the disclosure of which is incorporated herein. 
     
    
     FIELD OF THE INVENTION 
       [0002]    The field of this invention is the area of medical systems, specifically plastic surgeons, dermatologists, and other physicians performing cosmetic procedures or other specialties that use photographic images as an integral part of their practices. 
       BACKGROUND OF THE INVENTION 
       [0003]    As a matter of routine, plastic surgeons, dermatologists, and other physicians performing cosmetic procedures, take photographs of their patients for patient photographic documentation. This documentation includes: before and after photos, to show results, to share with colleagues, and to prepare for the surgeries they are going to undertake. Plastic surgery residents often photograph most of their patients for educational purposes. 
         [0004]    A guide on what photos should be considered and how to take them is published jointly by the American Society of Plastic Surgeons and The Plastic Surgery Educational Foundation and is entitled “Photographic Standards in Plastic Surgery.” It is a series of 12 “templates” for different parts of the body and not only suggests what photos to take, but how they should be taken in terms of distance and framing. This guide has a single model (female) and a suggested number of photos to be taken and the poses for each photo. As one can imagine, at times, a different pose or other photos can be desired. 
         [0005]    Even using digital photography, the method of matching the digital photos to the template is tedious and time consuming. Often, application packages for digital editing (like PhotoShop from Adobe) are used to try and match the photos taken to the suggested photos in the guide. In addition, the standard problems of digital photography present themselves as well. These include downloading of the images, getting consistent color (especially from different cameras or different conditions and photos taken at different times (for the before and after photos or subsequent surgeries, for example). Additionally, measurements on the photograph may need to be taken. Storing the images (often in multiple locations and with specific image formats like DICOM) need to be supported as well as collaboration with other clinicians of sharing of information is left to the user as a task that is handled outside of the image manipulations. 
         [0006]    Clinicians collect information about the patient as a matter of routine. This information is rarely attached to the images and not often utilized for actions utilizing the images. The workflow that is utilized by the clinicians, both the surgeon and their staff, can be greatly improved by optimizing the process of taking, manipulating, storing and sharing the images in a single application. In this application, clinician is defined as anyone on staff utilizing the present invention. Some templates shown do not have facial images in them as part of the template. By providing a simple means to add this to their process, one can easily see how errors can be reduced. 
         [0007]    Prior art in this area includes both analog (non-digital) examples and those that have utilized aspects of digital photography. An example of the color discrepancies that can occur is shown in the Niamtu Imaging Systems website (see below) or in cosmetic surgery texts such as “Surgical Rejuvenation of the Face” by Thomas J Baker, MD and Howard L Gordon, MD (C. V. Cosby Co., 1986) and “Cosmetic Dermatolologic Surgery” Leonard M. Dzubow, MD (Lippencott/Raven, 1998). Software from digital cameras, like Kodak&#39;s EasyShare software, allows for images to be downloaded from the cameras relatively simply and store them logically, for example, by date. Kodak&#39;s EasyShare Gallery allows images to be uploaded and shared with others, although downloading of full resolution images by others is not allowed. 
         [0008]    Templates are used in many software applications, including Professional Photographers and PictueIt from Microsoft. These applications allow for the sizing of images to suit the individual. Automated sizing of multiple photos on a page and optimizing the size of the individual pictures on that page is shown by commonly-assigned copending U.S. patent application Ser. No. 09/559,478, filed Apr. 27, 2000, entitled Method of Organizing Digital Images on a Page, by Richard A. Simon. Algorithms that find faces within a photograph and recognize objects within photographs are well known in the art, especially in consumer and professional photography applications and, more recently, in the Homeland Security area. Synthetic models of humans are shown using software packages such as Poser from e-frontier (www.e-frontier.com). 
         [0009]    The workflow that a clinician follows can vary from one person to another, whether it is their standard practice, what their comforts and preferences are, or simply performing different functions within the same office. For this reason, the handling of the workflows in an application package of this nature needs to be flexible enough to handle them. 
         [0010]    Canfield (www.canfieldsci.com) is a provider of camera systems and software to the plastic surgeons, dermatologists and other physicians performing cosmetic procedures. Their products range from cameras to camera systems to software specifically designed to take and analyze images for these specialties. They do not, however, assess and optimize the workflow of these clinicians nor are they particularly easy to use. They are relatively complicated cameras and do not address issues such as automated download and storage within the clinician&#39;s system, adding the images to a customized template, or any of the template features offered in the present invention. There is a direct analogy to consumer digital cameras, there is software to support the camera, but the bulk of what happens after the download is left to the user to handle. Canfield solutions are expensive and require specialized equipment in an effort to make images reproducible. The present invention requires no specialized equipment. 
         [0011]    Color targets (for color consistency and color management) are well known in the art. Examples of companies that provide color targets for this purpose are MacBeth and Eastman Kodak Company. Photogrammetry (the ability to make measurements from photographs is also a well known science. The American Society of Photogrammetry and Remote Sensing, Manual of Photogrammetry, 5th edition, 2004 (Chris McGlone—Editor, Published by ASPRS) shows how this is done. 
         [0012]    In U.S. Patent Application Publication No. 2002/0092534 A1 (Shamoun) a networked system for previewing potential effects of cosmetic surgery procedures. The present invention does not predict effect, but concentrates on the workflow aspects of the steps prior to the surgery without any prediction of outcome. While the present invention shows past results of other patients, no effect of the current patient is provided. 
         [0013]    Similarly, U.S. Patent Application Publication Nos. 2002/0009214 A1 (Arima), 2002/0064302 A1 (Massengill), and 2005/0203495 A1 (Malak) refer to procedural methods of assisting with the surgery rather than improving the workflow of the steps before the surgery or showing pre-surgical information within the OR, without any predictive outcome methods as shown in these applications. 
         [0014]    There are several offerings in the area of cosmetic and plastic reconstructive surgery that mention photographic images and systems within their offerings. These can be found on the Internet and examples include:
       http://www.beautysurg.com/see/digital.html   http://www.plasticsurgeryimaging.com/   http://www.angelslab.com/   http://www.profectmedical.com/   http://www.niamtuimaging.com/   http://www.medicalmodeling.com/flashsite/splash.html       
 
         [0021]    Each of these sites either provides a service to make a “before and after” photograph or attempts to predict the results of a surgery on an individual. There is nothing about the improvement of the workflow within a clinician&#39;s office nor mentions about improvements in the way the images are taken, edited, stored and/or shared for collaborative purposes. One such site, Profect Medical Systems, offers a photographic system, much like the Canfield offering, but does not assist in the management, manipulation or other aspects mentioned in the present invention. Niamtu Imaging Systems does offer image editing, but only for “before and after” images to attempt to make them look the same in terms of size and lighting. They only attempt to match the original image of the patient to one taken later and make no attempt to match this automatically, only to use standard image editing tools to do this (resize, adjust contrast, brightness, etc.). 
         [0022]    The present invention creates a synthetic model to assist in taking the proper photos for many different purposes, not just “before and after” photos; these include: photos taken for use in surgery, teaching purposes, documentation, multiple procedures, training aids, and assistance is allowing non-clinical personnel to perform the photographic taking and editing in accordance to pre-determined needs. 
         [0023]    Medical Modeling is a site that allows models to be created for use in medical applications. This site can be used as a source of the models used in the present invention in the same way Poser from e-frontier can be used. It does not, however, offer the workflow or the automation of that workflow seen in the present invention, nor does it provide for customized templates showing the photos that are to be taken for the purposes stated above. 
       SUMMARY OF THE INVENTION 
       [0024]    Briefly, according to one aspect of the present invention a system for plastic surgery comprises entering patient information into a database; computing a template for the patient based on the information; and inserting a synthetic model into the template. 
         [0025]    The present invention allows for a camera agnostic methodology for clinicians to easily bring in photographs into an application specifically designed to optimize their workflow, minimize the manipulation of images, allow for data to be added to the images, advanced storage and retrieval capabilities, and allow for automated collaboration and usage in other applications. 
         [0026]    It is a software application with optional storage hardware and utilizes customizable menus and preferences on data, searching and modifying templates for images. Instead of using a human model, a synthetic model is used. The model used is determined by the data for the particular patient. This data entry is part of the application. 
         [0027]    The templates used are completely modifiable so that other or additional cell images can be added to, or substituted for, in a template. The software allows for alignment lines to be added to the cells. This allows for different poses to align themselves with each other along a common point. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0028]      FIG. 1   a  is a flowchart of typical workflow for plastic surgery clinicians. 
           [0029]      FIG. 1   b  shows modification of the default workflow. 
           [0030]      FIG. 2   a  is an example of a color/measurement target. 
           [0031]      FIG. 2   b  illustrates how measurements can be taken with the target in the photo. 
           [0032]      FIG. 3  shows a sample template and cells within a template. 
           [0033]      FIG. 4  shows a sample sign on screen. 
           [0034]      FIG. 5  shows a workflow and patient information screen. 
           [0035]      FIG. 6  shows a sample synthetic models within a template. 
           [0036]      FIG. 7  shows a “before and after” database. 
           [0037]      FIGS. 8   a  and  8   b  show template modification screens. 
           [0038]      FIG. 9  shows template/photo implementation screen. 
           [0039]      FIG. 10  shows sample export screens. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0040]    The present invention has specifics in cosmetic and plastic surgery but can be used in other specialties where photographs are an integral part of the data collection process. This includes dermatology, dentistry, and others. It combines aspects of separate systems, allows for customization of the workflow within an office (even to different clinicians within an office), allows for manual tasks to be done automatically and combines image and patient data with multiple storage options and sharing capabilities. For the purpose of the present invention, workflow is defined as “A process description of how tasks are done, by whom, in what order and how quickly. Workflow can be used in the context of electronic systems or people, i.e. an electronic workflow system can help automate a physician&#39;s personal workflow.” The source of this definition is “Healthcare Informatics Online” and the URL is: 
         [0000]    http://www.theebusinesssite.com/IT%20Terms/Health%20Terms.htm#sectW 
         [0041]    In order to understand the present invention, one needs to understand the workflow in a typical cosmetic surgeon&#39;s (and others previously mentioned) office. In this scenario, the clinician can be the doctor, nurse, or a trained assistant. In fact, it may be a different person at specific steps. 
         [0042]      FIG. 1   a  is a flowchart that shows a typical example of pre-surgical workflow for a plastic surgeon. The first step is a meeting between the patient and the clinician(s)  110  to discuss the patient problem and talk about the procedural alternatives that are to be considered. Once it is decided (by both the patient and clinician) that there is something to be done for the patient  120 , information about the patient that is pertinent to the case is collected  130 . Samples of previous procedures, often called “before and after” photos are shown to the patient  140  so they can get an idea of the results that may be seen in their case. Once a decision of performing the procedure has been reached by the patient  145 , the clinician then reviews the photographic standard templates to determine which photos are to be taken  150 . Certain situation may occur when the clinician wishes to use a special template or photos that are different  160  than the ones suggested by the template. Photos are then taken  170  of the patient as suggested in the standard template. The software from the camera is typically used to download the images to the computer  180  or a standard interface such as TWAIN is used to bring them into a specific application. The photos are then edited  185  in a application program like PhotoShop (see www.adobe.com) or PaintShop Pro (see www.jasc.com). Typically, zooming, cropping, color adjustments and alignment from picture to picture within a template is done manually with this software. Additionally, the images are then combined into a single image and finally, the images are stored  190  for further use later on. 
         [0043]    One can easily see how parts of this workflow would need to be modified for different clinicians and different patients. For example, one may choose to show the “before and after” images  140  before data on the patient is collected  130  or one may choose to take the photos  160  before selecting the template  150 . Since there are a limited number of templates, a clinician may become familiar with the pictures that need to be taken and not need to reference the template. The present invention will allow for these changes in workflow by allowing a dynamic menuing structure that can be easily modified. This is shown in  FIG. 1   b.  The general workflow buttons  192  can be positionally exchanged (in the setup part of the program) by “grabbing” and button  198  (for example) and moving this ahead of or behind another button  196  (for example). This will cause the buttons to exchange position (as can be done with sheets in Microsoft Excel) with each other. In this case, the result is a change in the logical next steps in the application program to match a different, but preferred workflow. In addition, the tabbed areas  194 , which represent sub categories of a general workflow step  192 , can be changed. In this case the tabbed area  199 , currently assigned to a particular workflow category (patient information  197 , in this case), can be reassigned to a different one such as templates  196  or import  198 . The tabs in those categories would adjust their size, if needed. Similarly, the tabs can be moved in position within a workflow area by dragging them as the buttons were illustrated to be able to be moved previously. 
         [0044]    In dealing with photographs, especially those taken at different times and different conditions (lighting, backgrounds, different cameras, etc), it can be difficult to control the color of the images. Color differences can have significant meaning in dealing with medical images and a means to allow consistent color is important to the clinicians. In addition, there are times when it would be desirable to make measurements on the photographs (the science is known as Photogrammetry).  FIG. 2   a  shows a target that can be used in a controlled environment to allow for both consistent color and allow accurate linear measurements to be taken. The target consists of two parts, a measurement area  210  containing a known scale and a color target area  220  containing color patches of known color values (such as a MacBeth color target or Pantone colors, both well known within the professional photography world).  FIG. 2   b  illustrates how measurements can be obtained from a photograph taken with the target in the photo. The dimensions in the measurement area  210  are known. This target  240  is placed on a wall  230  or other background area that is fixed. The subject is then placed (via a set of shoeprints  260 , for example) a specified distance  270  from the wall  230 . Since this distance is known and the distance to patient and the distance to the target is known, linear scaling on the resulting photograph is possible. Alternatively, the target  240  can be placed on the same plane to the camera  250  and the subject  260 . The known distances allow the scaling to be done as well. This also means that a movable target can be places on the same plane as a body part (hand, foot, finger, etc.) and the scaling is accomplished. By placing this target in a known distance from the camera and any part of the subject, we can assess the measurement information on the target relative to the subject and camera and determine linear measurements within the resulting photograph. By knowing the camera brand and model, color characteristics can be determined through standard profiles (known in the industry as ICC profiles) for that camera and by comparing the rendered color in the digital image with the standard patches on the target; the image can be corrected for a consistent color rendering. This can be carried through to printers and displays, if the ICC profiles and color management software. Please refer to the website of the International Color Consortium (ICC) (www.color.org) for more information on how this is done. By combining these targets and assigning known distances from the image to the target in specific templates. This can be done without assistance from the user (other than making sure the target is in the proper location and in the image when taken.) 
         [0045]    There is a need to define some terms for the present invention. A template is defined as a set of pictures designed to suggest the pictures to be taken for procedure on a particular part of the body.  FIG. 3  is an example of a set of sample images suggested by the American Society of Plastic Surgeons and The Plastic Surgery Educational Foundation in their publication entitled: “Photographic Standards in Plastic Surgery.” This particular example is for the “Full Face” (there are 12 standard templates in the publication). The entire set of images  340  (there are three images) make up this particular template. The publication has as many as six images depending on the part of the body imaged. In fact, a clinician may decide to use more images, less images or different images in a particular procedure. If he chooses to save these for later use, this is a custom template for that clinician. The individual photos within a template  310 ,  320 ,  330  are known as “cells” for the template in the present invention. Alignment lines  340  are used to make sure that the cells are lined up properly with each other. 
         [0046]      FIG. 4  represents an example of an integrated application specific for plastic surgery preparation. The way in which the workflow was shown in  FIG. 1  is translated into the order and logic of the screens in the application. 
         [0047]      FIG. 4  represents an initial screen  400  for the example application. The only input here is the patient name  410  which is used to search the clinician&#39;s database if this is an existing patient  430 . If this is the case, information about the patient (shown in  FIG. 5 ) is automatically filled in. If this is a new patient  420 , the data is filled in by the user. The selection of a new  420  or existing  430  patient leads to the data screen shown in  FIG. 5 . 
         [0048]      FIG. 5  shows the patient data input form  500 , but illustrates much more. The top level buttons  510  also represent the major components of the workflow as shown in  FIG. 1 . The tabs  530  (of  FIG. 5 ) represent the rest of the workflow components. These are customizable in the setup area of the program where the top buttons  510  can be moved to match a different workflow. The tabs are also changeable and can be moved within a button or moved from button to button. Several pre-determined choices are also provided as standard sets in the setup utility. By allowing the menus and the tabbed areas to be changed, the workflow can be customized (functions modified, changed, added or deleted) to a particular clinician&#39;s preferences and allow different functions within the office (clerical, administrative, medical assistant, or trained professionals) to optimize this application to their particular needs. 
         [0049]    All of the data fields shown in  FIG. 5  are also customizable. Different clinicians and specialties have their own set of informational requirements. The data that is recorded here is able to be added to a patient record  520  (via an HL7 or CCR conversion utility, standard in the medical industry) and is also attached (as metadata to each photo) to the patient photos chosen to be used by the clinician. Each photo will have the same data from this page attached. The data (some or all of it) is also used in different parts of this application for other purposes. 
         [0050]    One example is customization of the model that is used for overlaying patient photos.  FIG. 3  shows a female model used for the image template, but, even though recommended by the aforementioned organizations, it can become difficult to match photos of patients of different sex, weights, heights, body types and body mass indexes. This information is all part of the standard information gathered by plastic surgeons in preparation for procedures, as well as the type of procedure and the place on the body where the procedure is to be done. This personal data  530 , the procedure to be considered  540  and the body location as illustrated on the homunculus  550  can be used to create a synthetic model much more closely matching that of the patient. The body location element  550  is also useful for predetermining the templates that are in consideration for the procedure on the patient. 
         [0051]    An example of how a synthetic model is advantaged over a human model is illustrated in the case of a very large male patient about to undergo a series of procedures to sculpt his body via liposuction and body sculpting surgeries. It is very cumbersome to try and match the patient images (different height, weight, sex, body type, etc.) to the slender female in the template, as well as set up the alignment lines. A synthetic model of the approximate weight, height and sex of the patient with the same body type would make this very simple. Software such as Poser from e-frontier allows these synthetic models to be generated. This can be done on the fly with the data provided or a set of models can be pre-rendered. Examples of these poser models are abundant on the Internet.  FIG. 6  shows an example of a synthetic model used in lieu of a human one. A template using a human model  610  can be replaced by a synthetic model  620 . Alignment locations  625  are shown on the synthetic image. The application of the current invention allows the user to identify these points on the patient image. With this information, the patient images can be sized and matched to the template cell automatically. It is envisioned that these alignment locations will be on each of the template cells. 
         [0052]    Note that the synthetic model in  620  is in its basest form and features such as hair and clothing can easily be added in software applications like the aforementioned Poser software. In this example, patient information like gender, age, weight and body mass index can be used to find a pre-rendered model that most closely approximates the patient. Additionally, in another embodiment, the same characteristics can be used to generate a model directly from the software that generates the model and completely customized to the particular patient. There are other advantages to using a synthetic model over a human one, including the time and cost to employ a human model and licensing and royalty fees that can incur. In addition, the model is separable from the background and is a distinct object that can be scaled, moved or posed within each cell of the template. If desired, the model can even be made to look like the patient by mapping the patient&#39;s photograph onto the model (well-know in the art of photography and 3D-modeling). Software like Poser allows modification of almost every part of the body. Examples are a male emaciated body  630  and male with a heavy body  640  or a body with a heavy torso and normal lower body  650 . These synthetic models can be exported to 3D packages that would allow further functionality to be implemented. It is also possible with current know technology to be able to automatically map photos onto these models. Technology examples include, but are not limited to, face finding so that we can automatically place a patient image into a template cell of a face and object recognition technology that can identify a body part (torso, hand, foot, finger, etc) and automatically place patient photos into these templates. In addition, Poser provides for the models to be edited so that information for a particular patient can be used to provide a reasonable model for each individual. 
         [0053]      FIG. 7  illustrates how the present invention uses information from the data sheet shown in  FIG. 5  to assist the clinician&#39;s effort in improving the workflow of finding samples of previous work to show a new patient what can be expected. These “before and after” photos  700  are currently kept in a physical photo album or digitally on a computer. There may even be some information about these in a related database. The present invention differs from this due to the integrated nature of this function and the ability to interactively label and find specific images of interest. When the procedure  540  (in  FIG. 5 ) is entered, it triggers the body field  710  to the part of the body of interest and limits the before and after photos to those of potential interest to the patient. In addition, the clinician can use the search field  720  to further limit the choices. Any information collected on the patient information screen  500  can be used as a search criterion in the search field  720 . An example of this is the Google Desktop, which will search your computer using words you enter. The present invention integrates this functionality and limits it to the data collected. 
         [0054]      FIGS. 8   a  and  8   b  illustrates another workflow improvement over current methodologies. In this case, the clinician is allowed to modify a template for a particular procedure and replace and/or remove any of the cells within a template. 
         [0055]    Once a template has been chosen, the present invention allows for a modification option  800 . Within the templates main area  805 , there is a tab or selection for modifying the template chosen  810 . A method is shown on how to add  830  or delete  840  a cell from the template. If a different number of cells (from the original template) are used, the template will automatically resize and realign the cells to optimize placement on the page. This is done using a means shown in commonly-assigned copending U.S. patent application Ser. No. 09/559,478, filed Apr. 27, 2000, entitled Method of Organizing Digital Images on a Page, by Richard A. Simon. Taking this a step further, it can be seen how a photo can be taken of a patient and used in several different templates by simply cropping and zooming the photo appropriately. A photo can be taken of the entire body and be used for the facial templates, mid, and lower body templates by zooming in and cropping the image. With digital cameras routinely having the ability to take 5-20 Mega pixel photos, the resolution is more than enough to make this possible. 
         [0056]    In this example of modifying a template, it is desired to remove the middle cell  820  which is a ¾ profile and replace it with a left profile  860 . This cell is chosen from a library of poses and templates  855  that were pre-rendered for this purpose. If desired, a 3D model can be used and made to move into any position and pose desired. While this may provide more functionality, the time taken to do this could be a productivity problem. In the preferred embodiment, this is an option, but not the standard means of providing new cells for modification. Once the new template has been created, it can be saved in the library  870  for later use, saved in a patient library for use with a particular patient only  875 , or can replace the default template  880  within the standard template area  850 . 
         [0057]    While this functionality works with a human model and taking photos of the model with different pose changes, it is much more cost effective using the synthetic model. Not only will the model not be required for shots that were not taken (cost and time advantages), but specific model modifications are possible with the synthetic version (hair, facial feature modifications, etc). Specific features of a patient can automatically be detected and applied to the model directly that would enhance the ease of photo placement. Examples are facial shape, eye parameters, lip and nose size and shape, and many others. Advancements in face-finding algorithms and object recognition make this a reasonable feature, as long as the workflow is not interrupted or extended. This capability enables any body type, and any pose of any part of the body (as well as the entire body). This flexibility greatly enhances the workflow and customization of the processes involved in this type of application. Since software like Poser allows for animations to occur as well, a model can be animated to determine the pose in any particular patient case. 
         [0058]    The workflow now moves to the Import functionality  910 . Images are selected using standard OS methods (explorer, “open”, or camera and scan directly into the application using TWAIN or similar methods) and brought together with the chosen template onto a placement screen  900 . The current art has the clinician using a different, general purpose application to create the template images (PhotoShop, PaintShop Pro). This is a painstaking process that requires skill in the use of these applications and the applications are not set up to perform the specific functions as the current invention. Observations on clinical workflow have seen as much as 30 minutes to perform this task when it can be done in less than a minute with the current invention. The appropriate photo is chosen from the thumbnails  920  and placed into the appropriate cell in the template where the image is aligned and sized to the model in that cell. This function can be automated where the proper image for the cell is automatically selected (via image analysis looking for a particular pose and features), placed within the proper cell, and sized properly (using face detection and facial feature finding on both the cell model and the patient photo) and placed properly within the cell. All of the technologies mentioned here are well known in the art of professional photography. A comment area for clinician notes  930  is also provided. 
         [0059]    Several features are shown to aid in the placement of these images into the cells by the clinician. An outline view  935  allows only an outline of the synthetic model to be seen (as opposed to the fully rendered model). It has been observed that some clinicians find on outline easier than an overlay on a fully rendered model. Another feature is alignment from photo to photo within a template. This is recommended and shown on the physical brochure showing the templates. The alignment feature  940  allows lines (across the cells within the template) to be added that shows alignment to a common feature or features (nose, ears, hips, etc.). The user can add as many of these alignment lines as desired in the X or Y dimension (horizontal and vertical). The model within the cells can also be moved (X and Y) within the cell, as well as the lines themselves, to allow for different type of alignments. 
         [0060]    Opacity is the degree of visibility of the template and the photo so that they can be overlaid and matched. The opacity feature  950  provides an interactive means to control how opaque the photo or the template is when matched. Fine tuning of the image to the template may be desired, especially around body extremities. The fine tuning feature  960  allow any of the cells to be seen full screen and zoomed to a finer level. 
         [0061]    An additional feature of the current invention is the ID photo embedded into the application. The concept of an ID photo associated with a patient record is not new. This feature simply allows for the integration of that at the same time photos are used for another purpose (placing them into templates). This is another workflow improvement. There is no longer the need to do this as an independent function using another piece of software. The ID photo can be of significant importance in reducing clinical errors. One of the key outputs of the current invention is for use in the operating room (OR) as a key to the surgeon as to what needs to be done. Many of the templates do not have the patient&#39;s face in them. With this, the photo is always available to the surgeon as another patient check. In the current invention, a photo of the patient&#39;s face is dragged into the ID photo icon  970  and this is kept s part of the template and file. 
         [0062]    There are significant workflow gains to be realized when the effort to construct the templates is completed and the clinician proceeds to next steps. There are several ways in which these finalized templates are used and shared.  FIG. 10  shows how the export part of the workflow for saving  1000  and for sharing  1060  options. The save page  1000  shows the different save formats that are made available and that multiple save options are made available concurrently. 
         [0063]    The standard save for use within the application  1010  allows for the clinician to stop the work short of completion and continue at a later time. Saving the work as an image file  1020  allows for the image to be used in other applications that accept standard image files (JPEG, BMP, etc.). The option to save the individual image cells  1030  allows for a single, or selected multiple images, to be saved in a standard image format. A “clipboard” save is a standard Microsoft Windows feature for quick pasting into other applications. This is shown as the clipboard button  1040 . The entire file (images, metadata, and links to the files) can be saved to a CD  1050  for use in an off-site area, such as an OR. commonly-assigned copending U.S. patent application Ser. No. 11/555,313, filed Nov. 1, 2006, entitled Automated Custom Report Generation System for Medical Information, by Squilla et al. shows an example of such an offsite application where this information can be incorporated. By having a CD (or other portable storage, like a jump drive), the clinician is able to bring the data without the dependency on a network or the Internet. This can be especially useful in secure settings or where computer access is limited. The clinician can also provide their computer, if desired. Each, all, or any combination of these “save” options is selectable. When a choice  1010 ,  1020 ,  1030 ,  1040  or  1050  is made, the selection stays highlighted until it is selected again, when that choice is turned off. The same is true for the “share” options  1060 . In this case, the options allow for an e-mail  1070 , collaboration  1080  or other sharing capabilities (video conferencing, net meetings, etc.). Linking in e-mails is a standard function seen in many Windows applications and technologies such as JPEG and Zoomify allow for high-resolution, high-speed communications of images. As in the “save” menu, these can also be selected at the same time. 
         [0064]    The invention has been described in detail with particular reference to certain preferred embodiments thereof, but it will be understood that variations and modifications can be effected within the scope of the invention. 
       Parts List 
       [0000]    
       
           110  initial meeting 
           120  consider procedure 
           130  patient information collected 
           140  examples of procedures 
           145  decision to have procedure 
           150  review of standard templates 
           160  customize template 
           170  photos taken 
           180  downloading of images 
           185  photos edited 
           190  storage of template 
           192  buttons simulating clinician workflow 
           194  tabs simulating steps within workflow components 
           196  templates button 
           197  workflow modification by changing button position 
           198  workflow modification by changing button position 
           199  tab capable of being moved to different workflow step 
           210  measurement target 
           220  color target 
           230  wall 
           240  target 
           250  camera 
           260  indicator for patient placement 
           270  distance from patient to target on wall 
           310  cells within a template 
           320  cells within a template 
           330  cells within a template 
           340  template 
           400  initial screen 
           410  name field 
           420  indicator for new patient 
           430  indicator for existing patient 
           500  patient information screen 
           510  buttons for general workflow 
           520  patient information button 
           530  patient personal information 
           540  procedure field 
           550  body area indicator 
           610  template using human model 
           620  template using synthetic model 
           625  alignment locations 
           630  emaciated synthetic model 
           640  heavy synthetic model 
           650  heavy torso synthetic model 
           700  before and after examples screen 
           710  body part indicator/selector 
           720  search field 
           800  template modification screen 
           805  template workflow button 
           810  modify template tab 
           820  cell to be modified 
           830  add cell option 
           840  delete cell option 
           850  standard template tab 
           855  custom template tab 
           860  modified cell 
           870  save in template library button 
           875  save in patient library button 
           880  replace default button 
           900  screen for placing images into template 
           910  import workflow button 
           920  selected patient images 
           930  comment area 
           935  option to show outline view of template 
           940  button to add lines for cell alignment 
           950  opacity modification 
           960  show cell in full page mode 
           970  means for placement of ID photo 
           1000  export workflow screen 
           1010  option for saving as program file 
           1020  option for saving as image file 
           1030  option for saving part of template 
           1040  option for saving to clipboard 
           1050  option for saving to CD for use elsewhere 
           1060  export share screen 
           1070  export to e-mail 
           1080  collaboration with another clinician