Photography in Medicine

Updated 3/2017-- all links removed as many are no longer active and it was easier than checking each one.

Fellow blogger Sterile Eye recently did a post on the historical use of mirrors in photos of wounded soldiers.  At the time I was reading an article in the journal Advances in Skin & Wound Care (full reference below) on wound photography.

Photography, not only in wound care, but in many areas of medicine/surgery (before and after photos, changes in hemangiomas, etc) is important.  As the article points out, if more than one person is to be responsible for taking these photos it is equally important that practice standards be implemented and adhered to.

The authors created a wound photography performance checklist to ensure consistency.   In addition to the patient’s name, wound evaluator’s name, and date, here are a few (not all) of the critical items on the checklist:

• Confirm patient has written consent for wound photographs on approved hospital consent form.  [This could apply to any medical photograph and any location, ie office.]
• Explain procedure to the patient and/or caregiver.
• Place camera case on hard, clean surface, avoiding floor or patient care items.
• Record patient information on customized photo label to include patient initials, medical record number, date, wound number, and location.  [Body part or hemangioma or nevus could substitute for wound.]
• Place the patient in a comfortable position to expose the wound for picture.  [Use consistency of position as suggested in pdf from ASPRS for photography in plastic surgery.]
• Apply customized photo label to the border of the wound for photograph.  [Could do this for nevi or skin lesion photos, but not for breast/abdomen photos.]
• Wash hand and remove camera from carrying case while maintaining appropriate infection control practices.  Avoid using gloves when handling camera.

The American Society of Plastic and Reconstructive Surgeons (ASPRS), along with the Plastic Surgery Educational Foundation(PSEF) and Canfield Imaging Systems have put together a really nice brochure (pdf file) as a reference.  Once again, consistency is key to having photos that can be used to assess change from growth,  healing, or surgery, etc.

The brochure show standard position when taking photos of the face, the ear, the breasts, the abdomen, the hip/thigh, the leg/foot, the hand, the forearm, and the finger.

Consistency in key.  Changes can be more reliably measured when consistency in position, distance (camera to patient), lighting, makeup (same or none when photographing the face) is maintained.

The ASPRS brochure offers these additional tips which are nice.  Sometimes photos will be taken in different locations (an ER documenting the initial injury, the office for followup) so lighting and background may be different.  Optimally:

• Use an appropriate backdrop.  Photograph patients against a solid-colored background. Light to medium blue is a good choice because it contrasts well with skin tones.  Medium gray
  may also work well.  Use a fabric drape or other non-reflective material.
• Remove distractions.  Jewelry and clothing create an unnecessary distraction in patient photos.  They should be removed from the area of interest prior to photography.For
  body photos, it is advisable to use special modesty garments (available from medical supply dealers) instead of the patient’s underwear.
• Use controlled lighting.  Patients should be photographed using a flash system or studio strobes (available room lighting is not appropriate).  Balanced cross-lighting (i.e., two strobes positioned symmetrically on either side of the camera) brings out surface texture without creating shadows that are overly harsh.
• Reduce cast shadows.  The use of balanced lighting with diffusers can soften the shadows cast by the patient.To completely eliminate cast shadows, one or two additional lights may be aimed directly at the backdrop.
• Record settings.  As much as possible, the same camera settings should be used for every patient. For settings that must be adjusted from patient to patient (such as exposure compensation), all values should be recorded, stored with the photos and referenced during post-op photography.

 

 

REFERENCES

Collaboration in Wound Photography Competency Development: A Unique Approach; Bradshaw, Leah Marie; Gergar, Margaret E.; Holko, Ginger A.; Advances in Skin & Wound Care. 24(2):85-92, February 2011; doi: 10.1097/01.ASW.0000393762.24398.e3

Photographic Standards in Plastic Surgery; ASPRS, PSEF, 2006 (pdf file)