Detection and management of pornography-seeking in an online clinical dermatology atlas

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Detection and management of pornography-seeking in an online clinical dermatology atlas. Lehmann CU, Cohen BA, Kim GR. J Am Acad Dermatol. 2006 Apr; 54(4): 633-7


Medical image archives require monitoring, filtering to prevent misuse

The development of the Internet has made it possible for clinicians, researchers, patients, and other interested parties to access archived images of medical conditions more quickly and easily than ever before. At the same time, the Internet facilitates access to medical images for non-medical purposes including use as pornography. Digital librarians need to prevent image misuse because pornography-seeking and dissemination undermine collections through misrepresentation and create traffic that reduces the prevalence of legitimate information.

DermAtlas is a publicly available online dermatologic library with 7,800+ images released by the Johns Hopkins University School of Medicine. In this report, DermAtlas curators describe efforts to 1) analyze site visits for pornographic use of archived digital images after noticing increased search and retrieval of images containing genital sites and excessive server load and 2) establish a system to reduce image misuse. They recorded the Internet Protocol (IP) address, timestamp, and referring URL of all queries to DermAtlas between October 19, 2004 and March 5, 2005 and evaluated a convenience sample of 10,000 free-text queries (e.g., "herpes simplex virus infection) made during February 2005. During the study period there were 3,664,191 queries; analysis yielded these findings:

  • 10.9% contained one of 108 defined anatomic sites, and of these, 37% were for one of 14 genital sites (the top ten anatomic sites by frequency included the penis, vulva (labia), genital, vagina, face, scrotum, leg, groin, anus, and tongue);
  • 62.0% contained one of 1,139 diagnoses, and of these, 12.5% were for diagnoses that included a genital location such as anogenital warts;
  • 2.8% specified an anatomic site and an age range, and of these, 33.4% a genital site, 56.7% specified children, and 43.3% specified adults. Of those specifying genital sites, 72.3% also specified children.
  • Of the free-text queries, when corrected for spelling there were 3,919 unique queries; 12.1% of the 10,000 retrieved images with a genital anatomic region.
  • Of the 43 Web sites with the most referrals to DermAtlas, 21% were pornography/fetish sites. Investigation of a 40% surge in site traffic indicated that linkage from an identified pornography/fetish Web site was responsible.

After analyzing the query patterns, the curators developed rules to filter out inappropriate queries. Ideally, filters would permit access for every legitimate clinical or educational user while screening out every inappropriate request, but in practice it's difficult to create filters that do so. The curators tested filters based on IP addresses, but this approach blocked legitimate requests, including those from proxy servers of Great Britain's National Health Service and U.S. military services. The site now records IP addresses from which more than a specific number of queries for genital sites or images are received and returns thumbnail images to the user. Users from these IP addresses who want access to full-size images must request passwords from the curators. This process results in 1.5 password requests per day and denial of access for an average of 10.7 IP addresses per day; thus, 86% of users denied access do not request a password. In addition, the system redirects queries from inappropriate referring Web sites to a page stating that DermAtlas doesn't want traffic from these pages and records the user's IP address.

Comment

Webmasters tend to focus on content development and site maintenance, but need to manage site use as well. Limiting access to a site containing images sought for pornographic use promotes the availability of the archive for legitimate clinical and educational use and facilitates respectful treatment of patients who have given permission for images of their body to be archived.