Phase II

PHASE II – Determine the validity of a set of digital images for each item using the VAGIS by a panel of experienced SA forensic examiners.

Consent for Use of Digital Images

CalEMA 923 requires that all victims requesting a forensic exam for the purposes of obtaining evidence for a SA acknowledge in writing that they understand that digital images may be taken during the exam and saved for purposes of:

  • use as evidence in court
  • as a means of memory recall by the examiner
  • peer review by individual groups
  • research (the signed consent pertains to this research)

A private forensic nurse company that contracts RN’s and NP’s to perform SA exams has agreed to using their database of digital images for the purpose of this study.

Phase II – Part A

The participants will be three very experienced SA forensic examiners who work at the same Forensic Nurse Company (FNC). They will convene in a one-time focus group to compare decisions, discuss, remove, and reassign images to different categories as they see fit. Very experienced is defined as having performed either 1000+ SA forensic examinations, or having performed 100+ cases and peer reviewed 1000+ cases.

Examiners will be asked 3 quality questions:

  1. Are you able to identify tissue landmarks within the vulva?
  2. Is there sufficient lighting within the digital image?
  3. Is the digital image in focus?

Image Selection Process:

  • Only those images where 100% of the examiners agree as ‘excellent’ in all three qualities will stay in the VAGIS digital image set.
  • Images judged ‘acceptable’ will be kept for back-up by the researcher. Images where not all structures are easily identifiable, where lighting is either insufficient or overexposed, and/or those where sharp borders are not present will be discarded.
  • If there is an item on the VAGIS that cannot be represented by a digital image judged as ‘excellent’, then an image judged as ‘acceptable’ will be substituted.
  • If no images available in either category, then the item will be labeled as ‘unable to capture on digital image’ on the VAGIS.

Phase II – Part B

The participants will be 15-20 very experienced (defined above) SA forensic examiners known to the researcher and from snowball sampling.

Method of validating digital image set

  • Research Electronic Data Capture (REDCAP) – a secure web application for building and managing online surveys and databases.
    • A random four-digit number and an online link will be sent for access to the initial survey site.
    • Participants will attest to the inclusion criteria and informed consent will be given via electronic signature.
  • Consensus rounds – 80% agreement will be required for the digital image to be considered ‘acceptable’ as representing the item.
  • Items not reaching 80 % agreement in Round 1 will be reconsidered for another category in Round 2, based on panel feedback using content analysis.
  • If all items reach 80% consensus in Round I then Phase II will be complete. If 80% consensus is not reached, then a Round II will be performed.
  • Any item not reaching 80% agreement in Round II will be discarded.

Image validation study designs used in this research:

Harris, Bates-Jensen, Parslow, Raizman, Singh & Ketchen (2010)

  • Validate a set of digital images that would reflect 11 of the 13 wound characteristics on the Bates-Jensen Wound Assessment Tool (BWAT)
  • Phases I – 75 digitalized images preselected by Harris
  • Phase II – used 15 wound ostomy nurses
  • Consensus was set at 75%
  • At least one digital image representing all 65 wound characteristics was validated

Werschler, Fagien, Thomas, Paradkar-Mitragotri, Rotunda & Beddingfield (2015 )

  • Validate a set of digital images with the Allergan Lip Fullness Scale (LFS)
  • 200 photographs of various skin colorations were taken and evaluated for photographic quality by the PI.
  • A panel of two dermatologists and one oculoplastic surgeon convened to determine how the scale suitability and descriptors were assigned by the initial reviewer. 95 sets were chosen.
  • No predetermined consensus level was set.
  • 12 sets of digital images remained and were validated by the panel