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DOCUMENTATION THROUGH PHOTOGRAPHY

As an objective recording practice, photography has become widely popular and now plays a vital role in aesthetics and dermatology. This section shows a basic layout on how this simple way of documentation can be absorbed into various practices and how quality of the same can be optimised.

General requirements for an imaging system in the Medical field

Analogue photography has long become a thing of the past with digital photography growing in leaps and bounds. Earlier ‘before and after’ pictures lack the relevant information for them to be suitable for a full extensive documentation. Medical photography needs to meet the following conditions:

  • Be user friendly making it possible for you to delegate the photography work
  • Standardization of shots
  • To be used in patient data archives
  • To be used in evaluating patients
  • Be practical in terms of cost
  • Be suitable for publicity material
  • Be used in report writing

Requirements for Standardized images

There are various factors that can distract the viewer from the information in the image, and the following should be kept in mind while capturing photographs of treatment procedures.

Space:

  • To get the best for your image, dedicate an area for photography, preferable one
    without sunlight so you can control the lighting in the room. Use a simple background
    colour like blue which is standard in the industry

Neutral Backgrounds:

  • When setting up your subject for a shot, you have to make sure that the area is free of distractions that may detract from the image. There should be no objects lying around and no people should be in the frame. One point to keep in mind is to avoid placing the subject in the centre of the room for image capturing. This makes it very hard for background control and therefore will be hard to reproduce in the future. Choose one fixed spot with a neutral background as bright and colourful backgrounds will distract the viewer from the image. A neutral coloured wall, door or even a room divider would be good locations for the photography session.

Standard settings for your camera and other photography aided programs:

  • Manual camera settings can be complex for achieving quality images and there are a few programs that have been created for addressing this issue. One good example of software that helps control camera settings so you get the shot you want is the Medi-scope solution for FotoFinder®. Your camera and computer are connected via a lead cable and can be controlled by the program. You can then use the ‘Cam-Control’ menu to choose your desired image profile and the software generates the necessary actions. The program will automatically select the same settings configured in your earlier shot for the subsequent photos. If required, you can manually change the settings to suit your requirements.

Pose:

  • It is quite useless to have the best equipment, studios, environment and software if the pose is not correct. The patient’s pose matters as only in the correct pose can you see how the treatment has succeeded. This is also where the software comes in. It suggests positioning templates for all types of treatment, like angles, corresponding pose and guides the user through the entire image capturing process. Immediately after an image is captured, the software shows the user the next position making it easy for the therapist to concentrate on their work and allowing the software and the image capturing process to be handled by another person.

Image detailing:

One thing to keep in mind is that if a patient has posed a certain way for the first shot, the same pose must be used in the subsequent shots to make the photo documentation a comprehensive process. The software will guide the user as certain parameters can be replicated so that the pose can be recreated down to the last millimetre. Certain positioning aids mounted on tripods and placed strategically in the area will help calculate exact angles to help you ensure that the pose and angle of the patient is identical to the previous image. Such image precision ensures that the patient has continued trust in the therapist’s capability in their treatment and also reinforces the reliability and success of the treatment.

a)Facial Images:
To ensure absolute precision in image capturing, a portrait shot can be captured using a tripod equipped with a chin rest. The patient can rest their chin on it to help the user to replicate exact angles to reproduce the capturing of the treatment effectively. As the tripod can be swivelled and turned by 180°, this allows the patient to be photographed from 9 different angles in a frontal shot or a side profile depending upon the requirements of the user. Bounce the flash off two reflectors to achieve optimum brightness so that you remove any shadows or unnecessary glares that will detract from the captured image. The chin rest may be removed later for chin and neck shots.

b)Complete frame shots of the patient:
Another height adjustable tripod can be used for capturing body contouring treatments that require a photograph to be taken of the patient from head to toe. In order to effectively capture the full body shot, the camera moves slowly downwards 5 cms at a time to process the data. A laser beam acts like an indicator for the camera and calculates the distance between the patient and the camera to ensure that it is standardized and identical to the previous shots.

c) Filters for skin conditions:

Certain skin allergies and conditions can be better captured using filters that remove unwanted reflections, showing the condition in its true form and colour. A cross polarization filter may be used in skin conditions like acne, couperose, varicose veins and spider-burst veins.

  • To effectively capture wrinkles and other lines, parallel polarisation filters may be used with intense side lighting to highlight even the smallest of wrinkles.

1) Lighting:

  • Light can differ from image to image and can either enhance or detract from the subject. At times, it can be difficult to reproduce colour in images due to mixed light situations which includes the use of lamps, room lighting and daylight. As every light source has a different colour temperature, this has an effect on colour reproduction in photography. There can be various colour variations in the usage of artificial lighting and this makes it hard for subsequent shots to be reproduced as per the original shot.
  • Such shots cause poorer lighting and produce poor quality images that are hard to colour correct in post image capturing. You can avoid this hassle by using a bright artificial light for your image capturing that can be controlled by you. This helps the user achieve the required lighting irrespective of time, daylight and other factors.
  • Usage of lighting with a flash involves two types and is very useful in reproducing the correct colour requirement provided that certain instructions are followed:
    • Direct: The adjustable reflector is aimed directly onto the subject.

    • Indirect: The reflector is aimed at a white surface that will bounce the light off, lighting the subject indirectly. You could aim the reflector at any white surface like the wall or ceiling of the room.

Records, Study and Publication
1) Records
All images should be labelled correctly and filed in a systematic order so that retrieval for future reference is easy. They should be stored in a patient’s file and all relevant data must be given. There should be separate filing for before, during and post treatment shots and should be organized either according to the type of treatment or procedure taken, or by date.

2) Study:
If an image has to be reviewed at a later date, there is software that allows the user to see the before and after shots on the screen in high resolution and quality. Good software helps in searching for patients’ data at a later stage for comparison.

3) Publication:
Most images are touched up post production to achieve the best possible effects. It is important not to touch up the first original image as this shows a comparison between the first and last pictures. Software like FotoFinder® uses arrows and text to help in producing treatment plans. The enhanced images are then stored as a new file and indicated by an orange frame. The images can be stored as PDFs and these files don’t use up a lot of space and retain important data which can be used for printing at a later stage. These images can be inserted in PowerPoint presentations for lectures.

A study of the Skin
When an analysis of the images is required, a variety of systems may be used to help in outlining and forming treatment plans and boost patient-doctor relationships.

Important points
This type of image capturing process using the help of software has become common practice in many clinics and, as no formal training is required to operate it, this task can be delegated to assistants, freeing the doctor’s time for more important matters.