Advertisement

Journal of Digital Imaging

, Volume 27, Issue 4, pp 419–442 | Cite as

Do Physicians Make Their Articles Readable for Their Blind or Low-Vision Patients? An Analysis of Current Image Processing Practices in Biomedical Journals from the Point of View of Accessibility

  • Bruno Splendiani
  • Mireia Ribera
  • Roberto Garcia
  • Miquel Termens
Article

Abstract

Visual content in biomedical academic papers is a growing source of critical information, but it is not always fully readable for people with visual impairments. We aimed to assess current image processing practices, accessibility policies, and submission policies in a sample of 12 highly cited biomedical journals. We manually checked the application of text-based alternative image descriptions for every image in 12 articles (one for each journal). We determined whether the journals claimed to follow an accessibility policy and we reviewed their submission policy and their guidelines related to the visual content. We identified important features concerning the processing of images and the characteristics of the visual and the retrieval options of visual content offered by the publishers. The evaluation shows that the actual practices of textual image description in highly cited biomedical journals do not follow general guidelines on accessibility. The images within the articles analyzed lack alternative descriptions or have uninformative descriptions, even in the case of journals claiming to follow an accessibility policy. Consequently, the visual information of scientific articles is not accessible to people with severe visual disabilities. Instructions on image submission are heterogeneous and a declaration of accessibility guidelines was only found in two thirds of the sample of journals, with one third not explicitly following any accessibility policy, although they are required to by law.

Keywords

Medical images Publishing Biomedical journals Accessibility policies Image description Alternative text Visual impairment Disabilities Publications 

References

  1. 1.
    Fox S: Online health search 2006. Washington DC: Pew Internet & American Life Project, 2006. Available at: http://www.pewinternet.org/~/media//Files/Reports/2006/PIP_Online_Health_2006.pdf.pdf. Accessed 20 May 2013
  2. 2.
    Hughes B, Joshi I, Wareham J: Health 2.0 and Medicine 2.0: Tensions and Controversies in the Field. Journal of Medical Internet Research, 10(3), 2008. doi: 10.2196/jmir.1056
  3. 3.
    Smith R: The trouble with medical journals. JRSM 99(3):115–119, 2006CrossRefGoogle Scholar
  4. 4.
    Lo B, Parham L: The impact of Web 2.0 on the doctor-patient relationship. J Law Med Ethics 38(1):17–26, 2010PubMedCrossRefGoogle Scholar
  5. 5.
    Iezzoni LI, O’Day BL: More Than Ramps: A Guide to Improving Health Care Quality and Access for People with Disabilities. Oxford University Press, New York, 2005Google Scholar
  6. 6.
    Fox S: E-patient with a Disability or Chronic Disease. Washington DC: Pew Internet & American Life Project, 2007. Available at: http://www.pewinternet.org/~/media//Files/Reports/2007/EPatients_Chronic_Conditions_2007.pdf.pdf. Accessed 20 May 2013
  7. 7.
    Liang H, Xue Y, Chase SK: Online health information seeking by people with physical disabilities due to neurological conditions. Int J Med Inform 80(11):745–753, 2011PubMedCrossRefGoogle Scholar
  8. 8.
    Fox S: The engaged e-patient population. Washington DC: Pew Internet & American Life Project, 2008. Available at: http://www.pewinternet.org/Reports/2008/The-Engaged-Epatient-Population.aspx. Accessed 20 May 2013
  9. 9.
    Purcell GP: The quality of health information on the internet. BMJ 324(7337):557–558, 2002PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Marschollek M, Mix S, Wolf KH, Effertz B, Haux R, Steinhagen-Thiessen E: ICT-based health information services for elderly people: past experiences, current trends, and future strategies. Med Inform Internet Med 32(4):251–261, 2007PubMedCrossRefGoogle Scholar
  11. 11.
    Beverley CA, Bath PA, Barber R: Health and social care information for visually-impaired people. ASLIB Proc 63(2/3):256–274, 2011CrossRefGoogle Scholar
  12. 12.
    Gardner J, Bulatov V, Kelly R: Making journals accessible to the visually impaired: the future is near. Learn Publ 22(4):314–319, 2009PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Blind Citizens Australia (BCA): Access to Health Services for people who are blind, 2012. Available at: http://www.bca.org.au/attachments/Blind_Citizens_Australia_Access_to_health_services.doc. Accessed 20 May 2013
  14. 14.
    Royal National Institute of Blind People (RNIB): Supporting blind or partially sighted patients, 2011. Available at: http://www.rnib.org.uk/professionals/services/equalityact/health/Pages/health_professionals.aspx. Accessed 20 May 2013
  15. 15.
    Association of Directors of Social Services: Progress in Sight – National Standards of Social Care for Visually Impaired Adults, London: Disabilities Committee of the Association of Directors of Social Services, 2002Google Scholar
  16. 16.
    Clark L: Liverpool Central Primary Care Trust – Accessible Health Information: Project Report, 2002. Available at: http://disability-studies.leeds.ac.uk/files/library/Clark-Laurence-liverpool-NHS.pdf. Accessed 20 may 2013
  17. 17.
    Parmanto B, Zeng X: Metric for web accessibility evaluation. J Am Soc Inf Sci Technol 56(13):1394–1404, 2005CrossRefGoogle Scholar
  18. 18.
    Lüchtenberg M, Kuhli-Hattenbach C, Sinangin Y, Ohrloff C, Schalnus R: Accessibility of health information on the internet to the visually impaired user. Ophthalmologica 222(3):187–193, 2008PubMedCrossRefGoogle Scholar
  19. 19.
    Anderson K, Sack J, Krauss L, O’Keefe L: Publishing online-only peer-reviewed biomedical literature: three years of citation, author perception, and usage experience. The Journal of Electronic Publishing, 6(3), 2001. doi: 10.3998/3336451.0006.303
  20. 20.
    Hersh W, Müller H, Kalpathy-Cramer J: The ImageCLEFmed medical image retrieval task test collection. J Digit Imaging 22(6):648–655, 2009PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    You D, Antani S, Demner-Fushman D, Mahmudur Rahman MD, Govindaraju V, Thoma GR: Automatic identification of ROI in figure images toward improving hybrid (text and image) biomedical document retrieval. SPIE Proceedings, 7874, Document Recognition and Retrieval XVIII(78740 K), 2011Google Scholar
  22. 22.
    Sedghi S, Sanderson M, Clough P: A study on the relevance criteria for medical images. Pattern Recogn Lett 29(15):2046–2057, 2008CrossRefGoogle Scholar
  23. 23.
    Sedghi S, Sanderson M, Clough P: Medical image resources used by health care professionals. ASLIB Proc 63(6):570–585, 2011CrossRefGoogle Scholar
  24. 24.
    Kahn CE, Kalpathy-Cramer J, Lam CA, Eldredge CE: Accurate determination of imaging modality using an ensemble of text- and image-based classifiers. J Digit Imaging 25(1):37–42, 2012PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Müller H, Michoux N, Bandon D, Geissbuhler A: A review of content-based image retrieval systems in medical applications—clinical benefits and future directions. Int J Med Inform 73(1):1–23, 2004PubMedCrossRefGoogle Scholar
  26. 26.
    World Wide Web Consortium (W3C): Web Content Accessibility Guidelines (WCAG) 2.0, 2008. Available at: http://www.w3.org/TR/WCAG/. Accessed 20 May 2013
  27. 27.
    ISO/IEC 40500:2012: Information technology – W3C Web Content Accessibility Guidelines (WCAG) 2.0, 2012Google Scholar
  28. 28.
    World Wide Web Consortium (W3C): Understanding WCAG 2.0, 2012. Available at: http://www.w3.org/TR/UNDERSTANDING-WCAG20/Overview.html. Accessed 20 May 2013
  29. 29.
    Siegel R, Naishadham D, Jemal A: Cancer statistics, 2012. CA Cancer J Clin 62(1):10–29, 2012PubMedCrossRefGoogle Scholar
  30. 30.
    Ortiz Hojas, A: Instrucciones y criterios para la producción de libros DAISY. Organización Nacional de Ciegos Españoles, 2008Google Scholar
  31. 31.
    RNIB: Creating accessible eBooks, Royal National Institute of Blind People, 2013. https://www.rnib.org.uk/professionals/publishing/publishertechnical/ebooksaccessible/Pages/accessible_ebook_creation.aspx. Accessed 20 November 2013
  32. 32.
    Alt text, Royal National Institute of Blind People, 2009. http://www.rnib.org.uk/professionals/webaccessibility/designbuild/wacimages/pages/alt_text.aspx. Accessed 20 November 2013
  33. 33.
    Srinivasarao V, Pingali P, Varma V: Effective term weighting in ALT text prediction for web image retrieval. Web technologies and applications. LNCS 6612:237–244, 2011Google Scholar
  34. 34.
    Perera C: The evolution of E-Health – mobile technology and mHealth. J Mob Technol Med 1(1):1–2, 2012CrossRefGoogle Scholar
  35. 35.
    World Wide Web Consortium (W3C): Shared Web Experiences: Barriers Common to Mobile Device Users and People with Disabilities. Available at: http://www.w3.org/WAI/mobile/experiences. Accessed 20 May 2013
  36. 36.
    [36] Sutton, J: A Guide to Making Documents Accessible to People Who Are Blind or Visually Impaired. Washington DC: American Council for the Blind, 2002. http://govoter.org/user_storage/govoter/ResourceClearinghouse/PDF/A%20Guide%20to%20Making%20Documents%20Accessible%20to%20People%20Who%20are%20Blind%20or%20Visually%20Impaired.pdf. Accessed 20 November 2013
  37. 37.
    US Section 508 of the Rehabilitation Act: Section 508. Available at: http://www.access-board.gov/508.htm. Accessed 20 May 2013
  38. 38.
    EDItEUR: Accessible Publishing – Best Practice Guidelines for Publishers. 2012. http://www.editeur.org/files/Collaborations/Accessibility/WIPO_v3.html. Accessed 20 November 2013
  39. 39.
    Epub 3 Support Grid. http://www.bisg.org/what-we-do-12-152-epub-30-support-grid.php. Accessed 20 November 2013
  40. 40.
    Draffan EA: Hardware for reading. 2013. http://youtu.be/d1LWa6gzPfg. Accessed 20 November 2013
  41. 41.
    Codogno P, Mehrpour M, Proikas-Cezanne T: Canonical and non-canonical autophagy: variations on a common theme of self-eating? Nat Rev Mol Cell Biol 13(1):7–12, 2012Google Scholar
  42. 42.
    Voces R, Codina L: La accesibilidad potencial y real del formato pdf: análisis de diarios digitales españoles. El profesional de la información 17(2):205–212, 2008CrossRefGoogle Scholar
  43. 43.
    Dillon A: Designing Usable Electronic Text, 2nd edition. CRC Press, Boca Raton, 2004CrossRefGoogle Scholar
  44. 44.
    International Committee of Medical Journal Editors (ICMJE): ICMJE: Uniform Requirements for Manuscripts Submitted to Biomedical Journals, 2010. Available at: http://www.icmje.org/urm_main.html. Accessed 20 May 2013
  45. 45.
    Annual Reviews. Examples of before and after graphic treatments. Available at: http://www.annualreviews.org/userimages/ContentEditor/1282928167304/AR_Illus_before-and-after.pdf. Accessed 20 May 2013
  46. 46.
    Jackson GW, Davidson HC, Wiggins RH, Harnsberger HR: Electronic submission of academic works: a survey of current editorial practices of radiologic journals. J Digit Imaging 14(2):107–110, 2001PubMedCentralPubMedCrossRefGoogle Scholar
  47. 47.
    World Wide Web Consortium (W3C): Accessibility Features of SVG, 2000. Available at: http://www.w3.org/TR/SVG-access/. Accessed 20 May 2013
  48. 48.
    Levine D: How to obtain images from picture archiving and communication systems and ready them for publication. Radiology 257(3):603–608, 2010PubMedCrossRefGoogle Scholar
  49. 49.
    Nature Publishing Group: How to submit: Nature Genetics, 2012. Available at: http://www.nature.com/ng/authors/submit/index.html. Accessed 20 May 2013
  50. 50.
    University of Chicago Press: Manuscript Preparation – Artwork. http://www.press.uchicago.edu/infoServices/prep-art.html. Accessed 20 November 2013
  51. 51.
    Steinman RM: Decisions about dendritic cells: past, present, and future. Annu Rev Immunol 30(1):1–22, 2012PubMedGoogle Scholar
  52. 52.
    The New England Journal of Medicine: Images in Clinical Medicine. Available at: http://www.nejm.org/page/author-center/images-in-clinical-medicine. Accessed 20 May 2013
  53. 53.
    The New England Journal of Medicine: Technical Guidelines. Available at: http://www.nejm.org/page/author-center/technical-guidelines. Accessed 20 May 2013
  54. 54.
    Annual Reviews: Instructions for the preparation of the manuscripts – Annual Reviews. Available at: http://www.annualreviews.org/userimages/ContentEditor/1343842722976/AuthorHandbook-BLUE.pdf. Accessed 20 May 2013
  55. 55.
    Science: Preparing Efficient Figures for Initial Submission. Available at: http://www.sciencemag.org/site/feature/contribinfo/prep/prep_subfigs.xhtml. Accessed 20 May 2013
  56. 56.
    Annual Reviews: Annual Reviews Graphics Guide. Available at: http://www.annualreviews.org/userimages/ContentEditor/1285100131653/AR-Graphics-Guide-fullcolor.pdf. Accessed 20 May 2013
  57. 57.
    Kim E, Xiaolei H, Gang T, Long LR, Antani S: A hierarchical SVG image abstraction layer for medical imaging. SPIE Proc 7628:762809–1, 2010CrossRefGoogle Scholar
  58. 58.
    Moreno RA, Furuie SS: A contextual medical image viewer. IEEE Trans Inf Technol Biomed 11(5):583–592, 2007PubMedCrossRefGoogle Scholar
  59. 59.
    Department of Health and Human Services – Centers for Disease Control and Prevention: Public Health Image Library. ID#:13219. Cynthia Goldsmith, 2000. Available at: http://phil.cdc.gov/phil. Accessed 20 May 2013
  60. 60.
    Annual Reviews: Supplemental Materials Policy. Available at http://www.annualreviews.org/page/authors/author-instructions/preparing/supmat. Accessed 20 May 2013
  61. 61.
    Nature Publishing Group: Supplementary information for authors. Nature. Available at: http://www.nature.com/nature/authors/submissions/final/suppinfo.html. Accessed 20 May 2013.
  62. 62.
    Rausch T, Jones DTW, Zapatka M, Stütz AM, Zichner T, Weischenfeldt J, Jäger N, et al: Genome sequencing of pediatric medulloblastoma links catastrophic DNA rearrangements with TP53 mutations. Cell 148(1–2):59–71, 2012PubMedCentralPubMedCrossRefGoogle Scholar
  63. 63.
    Springer: SpringerImages. Available at: http://www.springerimages.com/. Accessed 20 May 2013
  64. 64.
    Google: Google Images. Available at: http://images.google.com/. Accessed 20 May 2013

Copyright information

© Society for Imaging Informatics in Medicine 2014

Authors and Affiliations

  • Bruno Splendiani
    • 1
  • Mireia Ribera
    • 1
  • Roberto Garcia
    • 2
  • Miquel Termens
    • 1
  1. 1.Library and Information Science DepartmentUniversity of BarcelonaBarcelonaSpain
  2. 2.Computer Science and Industrial Engineering DepartmentUniversity of LleidaLleidaSpain

Personalised recommendations