Table 6.
Final Condensed Data Set for NGT Results
| Category and Related Criteria | CV1 | CV2 | CV1 − CV2 = | Final Endorsement by Rank (≥4) | Final Rank* | Consensus Stability† | Endorsement of Criteria after Re-rank | |
|---|---|---|---|---|---|---|---|---|
| PURPOSE | ||||||||
| Define intended photograph audience | ||||||||
| Office patients | 0.20 | 0.26 | −0.06 | 0.75 | 4 | N | Y | |
| Patients’ families | 0.00 | 0.26 | −0.26 | 0.125 | N | N | ||
| The general public | 0.61 | 0.56 | 0.04 | 0 | ||||
| Patients considering surgery | 0.11 | 0.10 | 0.01 | 1 | 5 | Y | Y | |
| General public excluding minors | 0.52 | 0.53 | −0.02 | 0.125 | ||||
| What are appropriate platforms to use? [types, eg, online (web, social media), office photograph] | ||||||||
| Websites | 0.16 | 0.17 | −0.01 | 0.875 | 5 | N | Y | |
| In-office devices | 0.26 | 0.47 | −0.22 | 0.5 | N | N | ||
| Private links sent to patients | 0.38 | 0.35 | 0.03 | 0 | Y | N | ||
| Brochures/print | 0.35 | 0.33 | 0.02 | 0 | Y | N | ||
| Social media | 0.67 | 0.61 | 0.05 | 0.125 | ||||
| Online (social media/web) everything | 0.31 | 0.48 | −0.16 | 0.5 | N | N | ||
| Where should patients view the photographs? (eg, with physician, in office; if with clinician, then, brainstorm how to regulate) | ||||||||
| Anywhere | 0.00 | 0.24 | −0.24 | 0.875 | 5 | N | Y | |
| Office | 0.17 | 0.31 | −0.14 | 0.5 | N | N | ||
| Home | 0.35 | 0.14 | 0.20 | 0.25 | N | N | ||
| Anywhere on a secure site | 0.37 | 0.43 | −0.06 | 0.375 | N | N | ||
| IMAGE TYPE | ||||||||
| What type of images should be used? (eg, hand drawing, modified photographs versus thirrd party images, morphed images) | ||||||||
| Hand drawings | 0.33 | 0.00 | 0.33 | 0 | N | N | ||
| Photographic | 0.31 | 0.27 | 0.04 | 0.75 | 5 | Y | Y | |
| Formal illustrations | 0.54 | 0.38 | 0.16 | 0 | Y | N | ||
| Videos | 0.45 | 0.23 | 0.22 | 0.375 | N | N | ||
| Any | 0.35 | 0.35 | 0.00 | 0.375 | Y | N | ||
| Simulations (3D/morphed) | 0.35 | 0.46 | −0.12 | 0 | N | N | ||
| Peer-to-peer support (live) | 0.61 | 0.71 | −0.10 | 0 | ||||
| Unedited photographs | 0.19 | 0.47 | -0.28 | 0.5 | N | N | ||
| What should be included in the chronologic timing of photographs? [timing and number of follow-ups (eg, how far out postoperative, how many postoperatives)] | ||||||||
| 2 weeks | 0.39 | 0.00 | 0.39 | 0 | N | N | ||
| 6 weeks | 0.37 | 0.42 | −0.05 | 0.125 | N | N | ||
| 6 months | 0.19 | 0.28 | −0.09 | 0.5 | N | N | ||
| 1 year | 0.18 | 0.27 | −0.10 | 0.75 | 5 | N | Y | |
| 3 months | Undefined | 0.32 | Undefined | 0.375 | ||||
| Intraoperative | Undefined | 0.47 | Undefined | 0.125 | ||||
| Immediate postoperative | 0.50 | 0.84 | −0.34 | 0.125 | ||||
| ANATOMY | ||||||||
| Define standard clinical photograph [brainstorm which published standards to use (eg, Toronto/Kingston)]‡ | ||||||||
| Consistent lighting (pre and postoperative) | 0.43 | 0.20 | 0.23 | 1 | 4 (shared) | N | Y | |
| 1:1 ratio | 0.24 | 0.44 | −0.20 | 1 | 2 | N | Y | |
| Views: AP, 2 lateral ± 2 oblique | 0.22 | 0.41 | −0.19 | 0.75 | 3 | N | Y | |
| Background | 0.50 | 0.41 | 0.09 | 0.875 | Unranked | Y | Y | |
| Nonaltered (no photoshop/filter) | 0.35 | 0.43 | −0.08 | 0.75 | 5 | N | Y | |
| Same body position (standardized position) | 0.53 | 0.38 | 0.14 | 1 | 4 (shared) | Y | Y | |
| Consistent patient exposure | 0.28 | 0.84 | −0.56 | 0.875 | 1 | Y | ||
| Arms up view | Undefined | Undefined | Undefined | 0.5 | N | |||
| Close-up of scars | Undefined | Undefined | Undefined | 0.625 | N | |||
| What is considered anonymous? (eg removing tattoos and identifiers) | ||||||||
| Fuzzed out/blacked out/covered | 0.27 | 0.34 | −0.07 | 0.25 | N | N | ||
| Erased/photoshopped out | 0.25 | 0.37 | −0.12 | 0.125 | N | N | ||
| No patients with identifiers | 0.08 | 0.08 | 0.00 | 0.75 | 4 | Y | Y | |
| All digital tags (name, location)/file name removed | 0.17 | 0.13 | 0.03 | 0.875 | 5 | Y | Y | |
| Determine number of before and after photographs sets needed for sufficient representation (brainstorm number) | ||||||||
| No limit | 0.07 | 0.00 | 0.07 | 1 | 5 | Y | Y | |
| 3 | 0.14 | 0.16 | −.02 | 0.25 | N | N | ||
| 10 | 0.25 | 0.15 | 0.10 | 0.375 | Y | N | ||
| Labeling photographs–brainstorm what details should images include (eg measurements, proportion, identified defects) | ||||||||
| Age | 0.67 | 0.43 | 0.23 | 0 | N | N | ||
| Time from surgery | 0.12 | 0.21 | −0.09 | 0.75 | 5 | N | Y | |
| All procedures performed (visible in photograph) | 0.40 | 0.28 | 0.13 | 0.625 | Y | N | ||
| Any device, all device information (ie, shape/size/position of implant) | 0.19 | 0.35 | −0.16 | 0.125 | N | N | ||
| Incision | 0.35 | 0.59 | −0.25 | 0.125 | N | |||
| Diagnosis, previous treatment | 0.25 | 0.62 | −0.37 | 0.375 | N | |||
| Define sexualized content | ||||||||
| Alternate poses from common/standard | 0.08 | 0.37 | −0.29 | 0.625 | N | N | ||
| Clothing | 0.20 | 0.34 | −0.13 | 0.375 | N | N | ||
| Backgrounds (beaches, bathrooms) | 0.22 | 0.34 | −0.13 | 0.625 | N | N | ||
| Face showing | 0.49 | 0.54 | −0.05 | 0.125 | N | |||
| Other people | 0.71 | 0.47 | 0.24 | 0.25 | N | N | ||
| Nipple | Undefined | Undefined | Undefined | 0 | N | |||
| RESULTS | ||||||||
| What range of outcomes should be represented? (eg, including reasonable expectations patients should have of before and after photographs, best outcome, middle of the road)? | ||||||||
| Best | 0.22 | 0.28 | −0.06 | 0.25 | N | N | ||
| Average | 0.18 | 0.12 | 0.06 | 1 | 5 | Y | Y | |
| Achievable (reproducible) | 0.12 | 0.20 | −0.08 | 0.75 | 4 | N | Y | |
*Data only included if CV2 has reasonable internal agreement and CV values are real numbers.
†Only included if criteria endorsed.
‡Endorsement based on survey response endorsement section, not rank data.