Clinical photography is an important aspect of medical practice that involves capturing high-quality images of patients, their medical conditions and treatments. These images are used for diagnosis, documentation, education, research and legal purposes.
Taking consistent clinical photographs and filing them appropriately is not only important for the accurate diagnosis and treatment of patients, but also for maintaining professional standards and protecting patient privacy.
Selecting the right tool
Standardisation is an essential aspect of clinical photography, as it helps ensure consistency and accuracy. Mobile phones and tablets have revolutionised the way we take photographs as they give newcomers to aesthetics a chance to showcase their results without a big investment, but they bring certain disadvantages when it comes to clinical standardisation.1
These devices typically have limited control over settings such as aperture, shutter speed and ISO (brightness). This can limit the photographer’s ability to control the depth of field, motion blur and exposure of their portraits, resulting in less control over the final image.2 They cannot match the quality of a dedicated digital camera or 3D patient imaging system.3 Low light performance, dynamic range and colour accuracy may suffer when using a mobile phone or tablet.2
Most mobile phone and tablet cameras have fixed lenses, which can limit the photographer’s ability to use different focal lengths and perspectives, resulting in less control and therefore less consistency and reproducibility.1,4 Further, the wide-angle lenses used in many mobile phones and tablets can introduce distortion, particularly at the edges of the frame, creating unrealistic proportions in the close-up portraits needed for clinical photography (Figure 1).1,4
Mobile phones and tablets can also be uncomfortable to hold for extended periods, particularly when taking portraits, and they can prove distracting if notifications or calls interrupt the flow of a photography session.5
Moreover, digital cameras, mobile phones and tablets often use ‘computational photography’ – the automatic digital manipulation or alteration of images whereby photos will have surfaces smoothed, shadows removed, more light added etc. This relies on software algorithms to enhance or modify images, which can lead to unintended changes in the appearance of the subject. As a result, this can be problematic in clinical photography, where the accuracy and integrity of the image are critical for diagnosis, treatment and legal purposes. Practitioners should exercise caution when using computational photography techniques and should always prioritise accuracy and integrity.6
Using dedicated 3D patient imaging equipment has its advantages, including the ability to capture highly detailed and accurate images of patients’ anatomy, which can be used for diagnosis, treatment planning, measuring and quantifying clinical outcomes and research. 3D imaging equipment can also provide multiple views and angles of the patient – particularly useful in complex cases. I use Canfield’s Vectra H2 which specialises in comprehensive patient imaging solutions; there are multiple other solutions available to help you out in-clinic.
However, there are also some disadvantages to using 3D patient imaging equipment, including the high cost of the equipment and the need for specialised training and expertise to operate it. Additionally, this equipment may not be available in all clinical settings, which can limit its usefulness for some practitioners.7,8
Key aspects of photography to consider
Consistency is crucial in clinical photography, particularly in the following key areas:9
- Use proper lighting
- Use a neutral background
- Position the patient correctly
- Use proper camera settings
- Remove all makeup and jewellery
- Document patient information
- Obtain consent
- Follow confidentiality and privacy safeguards
These central tenets of consistent, accurate and standardised clinical photography will be explored in more depth below.
1. Lighting
Lighting is one of the most critical factors to consider when taking clinical photographs. Good lighting is essential to ensure the area of interest is well-illuminated, allowing for accurate depiction of the patient’s condition. Appropriate lighting helps to avoid shadows and reflections that can obscure the image and make it hard to interpret (Figure 2).
The ideal lighting source for clinical photography is a dedicated photography light source, which provides bright, diffuse light. This type of lighting ensures the area of interest is evenly illuminated, and there are no harsh shadows or hotspots. The colour temperature of the light source should be considered, as it can impact the colours in the image; the recommended colour temperature is around 5500 Kelvin, emulating natural daylight.9
2. Background
The background used in clinical photography should be neutral, with minimal visual distractions. A neutral background, such as a plain white or grey background, is ideal for capturing the area of interest. This type of background helps provide contrast between the area of interest and the surrounding tissue, making it easier to identify and analyse.
3. Positioning
Proper positioning of the patient is another important factor to consider. The patient should be positioned in a way that allows for capturing the area of interest from multiple angles (Figure 3). This includes taking photos from a close-up perspective, as well as from further away to provide context, especially if the photographs are focusing on a specific lesion or defect.
In addition to the position of the patient, camera angle is also essential. The camera should be positioned at a specific height and angle to ensure all images are consistent in terms of perspective and framing (Figure 3). This helps to facilitate accurate comparisons between images over time, making it easier to monitor changes in the patient’s condition.
4. Camera settings
Camera settings are essential to ensure images are in focus and correctly exposed. The autofocus feature on the camera should be used to ensure the area of interest is in focus, and the aperture and shutter speed should be adjusted to achieve the desired depth of field and exposure. To minimise camera shake, it is recommended to use a tripod or other stabilising device. Most importantly, familiarise yourself with whatever equipment you are using.
5. Remove makeup and jewellery
Remove all makeup with a non-irritant cleanser before clinical photographs are taken as redness of the skin might also create an artifact or distortion, and jewellery may provide a distraction or distort the perception of results.
6. Documentation
Documentation is an essential aspect of clinical photography. It is important to document the patient’s information in the photograph – including the date, patient’s name or identifier and the location on the body where the photo was taken – ensuring the images are properly identified and can be used for accurate diagnosis and treatment planning.
7. Consent
Obtaining written consent from the patient before taking clinical photographs is critical. The patient should be informed of the purpose of the photographs, who will have access to them and in what contexts they might be used, such as training presentations or lecture examples. The patient should also be given the option to decline consent if they are not comfortable with the use of photography depicting them.5
8. Privacy
Protecting patient privacy is a critical consideration in clinical photography. The photographs should be stored securely, and access should be limited to authorised personnel only in order to comply with UK GDPR regulation.10 In addition, privacy laws and regulations should be observed, which state that clinical photography should be treated in the same way as any clinical record or piece of confidential patient information.5,11
Mastering in-clinic photography
Taking good clinical photography is an important aspect of healthcare, as it can help practitioners accurately document a patient’s condition and track their progress over time. This is especially true in aesthetics, where visible results are everything.
While mobile phones and tablets offer convenience and accessibility for clinical photography, they also have several disadvantages compared to dedicated digital cameras. As a result, you may prefer to invest in a dedicated digital camera and lighting for more creative control over your images.
