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In 1874, Indian polymath physician Bhau Daji (1822–1874) passed away suddenly – and the details of his secretive ‘cure’ for leprosy died with him. Drawing on a collection of clinical photographs and illustrations at the Royal College of Physicians (RCP) Museum, this paper will unravel Daji’s place in the College’s empire-wide enquiry into leprosy in the mid-nineteenth century. We will argue, drawing on Elizabeth Edward’s (2014) work, that these images represent ‘photographic uncertainties’ – both conforming to and undermining traditional conventions of colonial photography, while at the same time highlighting Daji’s place as an ambiguous figure in colonial medical hierarchies. We treat the images as ‘visual arguments’ (Fox and Lawrence, 1998) testifying to the effectiveness of Daji’s secret remedy and the contagious nature of the disease. Despite the supposed objectivity of the photographic form, Daji’s treatment was never seriously investigated by the Leprosy Committee of the Royal College of Physicians. Transported from Bombay to London, we will consider the differential value placed on Daji’s medical expertise as captured by the patient images. In the spirit of the current movement to ‘decolonise collections’, we reflect on how this case study demonstrates the need for specialist medical museums to interrogate their own colonial pasts.

Medical photography collections often remind us of the inescapable reality of human suffering and pain, and at the same time they oblige us to deal with questions of ownership and privacy. Medical photography collections are thus considered ‘sensitive’ collections within the museum context. This essay investigates privacy issues involved in the curating of historical photographic collections in museum spaces. When medical photography entered into non-medical domains privacy issues emerged. It is these privacy issues that cast a shadow of sensitivity on the medical material. But the relationship between clinical photograph collections and museums is not as straightforward as it may seem. Personal pictures involve power and privacy, and both aspects play a role in the public display of historical medical photographs, often in unexpected ways.

The essay explores the process of curating Misbehaving Bodies: Jo Spence and Oreet Ashery, an exhibition held at Wellcome Collection from May 2019 until January 2020. The exhibition brought together two artists of different generations who explored the representation of illness and care narratives from the perspectives of patient and lived experience. The project was co-curated by Bárbara Rodríguez Muñoz and George Vasey. The Wellcome Collection challenges how people think and feel about health and this essay explores how the exhibition built upon those ambitions. The text addresses how the content of the exhibition was supported by the various exhibition elements: narrative, process, architecture and design, interpretation and live programming. ‘How we die is how we live, only more so’ (Ashery, 2016)

In order for enterprise imaging to be successful across a multitude of specialties, systems, and sites, standards are essential to categorize and classify imaging data. The HIMSS-SIIM Enterprise Imaging Community believes that the Digital Imaging Communications in Medicine (DICOM) Anatomic Region Sequence, or its equivalent in other data standards, is a vital data element for this role, when populated with standard coded values. We believe that labeling images with standard Anatomic Region Sequence codes will enhance the user’s ability to consume data, facilitate interoperability, and allow greater control of privacy. Image consumption—when a user views a patient’s images, he or she often wants to see relevant comparison images of the same lesion or anatomic region for the same patient automatically presented. Relevant comparison images may have been acquired from a variety of modalities and specialties. The Anatomic Region Sequence data element provides a basis to allow for efficient comparison in both instances. Interoperability—as patients move between health care systems, it is important to minimize friction for data transfer. Health care providers and facilities need to be able to consume and review the increasingly large and complex volume of data efficiently. The use of Anatomic Region Sequence, or its equivalent, populated with standard values enables seamless interoperability of imaging data regardless of whether images are used within a site or across different sites and systems. Privacy—as more visible light photographs are integrated into electronic systems, it becomes apparent that some images may need to be sequestered. Although additional work is needed to protect sensitive images, standard coded values in Anatomic Region Sequence support the identification of potentially sensitive images, enable facilities to create access control policies, and can be used as an interim surrogate for more sophisticated rule-based or attribute-based access control mechanisms. To satisfy such use cases, the HIMSS-SIIM Enterprise Imaging Community encourages the use of a pre-existing body part ontology. Through this white paper, we will identify potential challenges in employing this standard and provide potential solutions for these challenges.

This chapter provides tools for using photographic sources in the history of psychiatry. It demonstrates that photographs are very versatile sources that can be integrated into the history of psychiatry in different ways to explore the history of psychiatric categories and medical theories, patients’ experiences and more. The first section examines several case studies, from the renowned images made by Hugh Welch Diamond and Jean-Martin Charcot to lesser known materials. It discusses questions such as the supposed objectivity of photographs, the emergence of photographic protocols and the lack thereof, the circulation of photographs and practices among different institutions, the agency of patients, the relationship between photographs, text and other visual media and the impact of colonialism and criminology studies. The second section presents the main historiographical trends, from the influence of Foucauldian studies on power and the medical gaze to recent work on material practices. Lastly, the final section provides tips for searching medical photographs in archives and discusses the ethics of researching and publishing sensitive sources.

Open fractures incur significant morbidity and mortality, and as such have standardised guidelines for their management. Photography of open fractures is an essential component of documentation in the treatment of open fractures as per the British Orthopaedic Association Standards of Trauma and National Institute for Health and Care Excellence guidelines. Smartphones have made photography easily accessible to the clinician, but serious concerns exist regarding data security and the consent process around the use of sensitive clinical images. This project sought to overcome this issue by developing a Caldicott-compliant hospital imaging protocol that allows clinicians to use their smartphone to upload open fracture images into the patient's permanent record. Implementation of the protocol was audited and resulted in the increase of safe and secure open fracture photographic storage to inpatient medical records. This protocol would be transferrable to other hospital trusts and could be adopted across major trauma networks.

This article focuses on the untapped, complicated, fragile, and fluid visual archives of the elite White surgeon Rudolph Matas, a large proportion of which was produced during the late 19th and early 20th century, a time when he was a resident at New Orleans’ Charity Hospital in Louisiana and a professor of general and clinical surgery at Tulane University’s Medical Department. The article’s main aim is to understand the role of visual materials in the production, uses, circulation, and impact of a form of knowledge that Matas termed “racial pathology.” A small but representative sample of visual materials from the Matas collection are placed in context and examined in order to make known this untold chapter from the life story of “one of the great pioneers” in American surgery. The article reveals that many of the photographs were most significant in having been produced and assembled in parallel with the making, publication, dissemination, reception, and use of Matas’ racialized medical research, in particular his influential 1896 pamphlet, The Surgical Peculiarities of the American Negro.

Medical photographs are commonly employed to enhance education, research, and patient care throughout the neurosurgical discipline. Current mobile phone camera technology enables surgeons to quickly capture, document, and share a patient scenario with colleagues. Research demonstrates that patients generally view clinical photography favorably, and the practice has become an integral part of healthcare. Neurosurgeons in satellite locations often rely on residents to send photographs of diagnostic imaging studies, neurological examination findings, and postoperative wounds. Images are also frequently obtained for research purposes, teaching and learning operative techniques, lectures and presentations, comparing preoperative and postoperative outcomes, and patient education. However, image quality and technique are highly variable. Capturing and sharing photographs must be accompanied by an awareness of the legal ramifications of the Health Insurance Portability and Accountability Act (HIPAA). HIPAA compliance is straightforward when one is empowered with the knowledge of what constitutes a patient identifier in a photograph. Little has been published to describe means of improving the accuracy and educational value of medical photographs in neurosurgery. Therefore, in this paper, the authors present a brief discussion regarding four easily implemented photography skills every surgeon who uses his or her mobile phone for patient care should know: 1) provide context, 2) use appropriate lighting, 3) use appropriate dimensionality, and 4) manage distracting elements. Details of the HIPAA-related components of mobile phone photographs and patient-protected health information are also included.

Objective To understand the ways in which providers use a mobile photography application integrated with the electronic health record (EHR) to facilitate clinical care, and the process outcomes that result from the application's use. Methods An e-mail survey was sent on November 13, 2017, to 1,463 health care providers at Mayo Clinic who had used an internally developed, EHR-integrated medical photography application. Results The survey was completed by 712 (49%) providers. Providers reported using the application on approximately 1 in 7 days spent in clinical practice. Median provider satisfaction with the use of the application (0–100 scale; higher numbers indicate favorable response) was 94 (interquartile range [IQR]: 74–100). Although the use for store-and-forward telemedicine was reported (22% often or frequently used the application to send photographs to a specialist for advice), the most common use was for clinical documentation (65% often or frequently used the application to supplement text-based notes with photographs, and 71% often or frequently used the application to take photographs for reference by a colleague who may see the patient in the future). Of the health care providers, 36% indicated that the application's use often or frequently expedited treatment. Discussion Health care providers reported using a mobile point-of-care medical photography application regularly in clinical practice and were generally satisfied with the application. Conclusion Point-of-care medical photography using a secure mobile, EHR-integrated application has potential to become a new standard of care for clinical documentation and may facilitate continuity across the continuum of care with multiple providers who see a patient.

A new, store-and-forward, fully digitised Teledermatology (TD) pathway was designed and implemented in an urban setting for non-two-week wait routine patients. In total 8,352 new patients had a TD consultation over 37 months. Of these, 4,748 (56.8%) were referred back to their GP, 1,634 (19.6%) were referred directly for a surgical procedure and 1,970 (23.6%) for a face-to-face review with a Dermatologist (F2F). The average waiting time for a TD appointment was 3 vs. 30 weeks for a routine F2F appointment. Between 2019 and 2018, TD referrals rose by 38%, routine dermatology referrals reduced by 16% and cancer referrals increased by 6%. Using medical photographers proved to be effective with only two cases (0.02%) of images being of insufficient quality to form a clinical opinion. Hitherto, savings for the local Commissioning Groups were estimated at £671,218. Last financial year savings (2019-2020) were £284,671. The average cost savings per TD patient appointment was £80.36. Savings in the Trust's overhead costs were £53,587. TD consultants reviewed almost twice the number of patients vs. F2F for the same amount of consultant programmed activities. 95% of surveyed patients would be likely or extremely likely to recommend this service to friends and family.

Lateral crural cephalic malposition (LCCM) is a well-known deformity of the nasal tip which contributes to functional disturbances of the external nasal valve. Accurate diagnosis of this deformity helps surgeons plan for better outcomes. A total of 176 candidate patients for primary rhinoplasty underwent standard 2D medical photography of the face. Senior authors analyzed photography results and differentiated the patients with LCCM. In addition, we measured the angle between the dorsal septum and lateral end of the long axis of the alar cartilage in the operation room. Ninety-five patients were diagnosed with LCCM on photography. As much as 31.3% (55) of all the patients had LCCM in intraoperative measurements. The sensitivity and specificity of 2D photography for diagnosing LCCM were 0.7924 and 0.5391, respectively. The main surgical techniques for correction of LCCM were alar repositioning (34.3% in total, 56% in LCCM patients) and lateral crural strut graft (43.8% in total, 69% in LCCM patients). LCCM is overdiagnosed via 2D photography, and this method lacks sensitivity. The overall frequency of LCCM seems to be lower than the previously reported frequency. For optimal results in rhinoplasty, surgeons must focus on the best contouring and function rather than solely correcting angles and rotations.

BackgroundModern day otolaryngology has expanded beyond the ear, nose and throat to include head and neck surgery and aesthetic facial procedures. Photographic documentation is important within this expanded horizon. The spectrum of clinical photography includes photomicrographs, endoscopic photographs, peri-operative photography and medical social photography.MethodThis article aimed to review the standard guidelines essential to obtain, store and disseminate photographs and looked at setting up a small clinic with minimal gadgets to suit clinical photography requirements. Elaboration of basic photography techniques in otolaryngology was reviewed, with examples of photographs taken in a clinic by a clinician. Advances and innovation in clinical photography, in the form of smartphone photography, artificial intelligence, device editing and newer hardware and software in otorhinolaryngology was reviewed.ConclusionHaving a professional photographer to aid a clinician is a luxury. Simple knowledge and regular practice of basic photography guidelines by a clinician is imperative.

BackgroundPaediatricians are responsible for carrying out child protection medical examinations, which will sometimes include the use of photography to document injuries. Ideally, a trained medical photographer would take all photographs when needed. This service is not always available and the paediatrician may have to take time critical photographs.ObjectivesOur aim was to audit the child protection photographs taken in one year at our hospital and compare them to the national guidelines from the Institute of Medical Illustrators.MethodsAll children (0–18years) who had a child protection medical in 2019 were identified. Those that had photographs taken during their medical were highlighted and the photographs were compared against the standards set out by the Institute of Medical Illustrators.Results49 child protection medicals with photography were completed in 2019. Clothing was removed appropriately in 86% of cases. However, an appropriate background was used in only 18% of photographs. The three photograph principle (a location photograph, a close-up photograph, and a close- up photograph with a linear scale) was used in 0% of cases. Location photographs or close-ups with no linear scale were taken in only 14% of cases. Photographs with a linear scale were taken in 67% of cases, in which a triangle ruler was used in 83% of these.ConclusionsOverall, child protection medical photography in our centre is of inadequate quality. Ideally, support from medical or police photography should be available at all times for child protection medicals and other medical photography. This is not currently the case in all centres. With the COVID-19 pandemic, there has been an increase in domestic child abuse cases, possibly leading to more of us, as paediatricians, needing to complete child protection medicals. We recommend that training is offered to all paediatricians who may be taking medical photographs, and could be considered an important part of trainee induction. Any photographs taken can be used as evidence in court and, therefore, their quality is of paramount importance.

Background Publishing identifiable patient data in scientific journals may jeopardize patient privacy and confidentiality if best ethical practices are not followed. Current journal practices show considerable diversity in the publication of identifiable patient photographs, and different stakeholders may have different opinions of and practices in publishing patient photographs. Objective This scoping review aimed to identify existing evidence and map knowledge gaps in medical research on the policies and practices of publishing identifiable photographs in scientific articles. Methods We performed a comprehensive search of the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, CINAHL with Full Text, Database of Abstracts of Reviews of Effects, Ovid MEDLINE, and Scopus. The Open Science Framework, PROSPERO, BASE, Google Scholar, OpenGrey, ClinicalTrials.gov, the Campbell Collaboration Library, and Science.gov were also searched. Results After screening the initial 15,949 titles and abstracts, 98 (0.61%) publications were assessed for eligibility at the full-text level, and 30 (0.19%) publications were included in this review. The studies were published between 1994 and 2020; most had a cross-sectional design and were published in journals covering different medical disciplines. We identified 3 main topics. The first included ethical aspects of the use of facial photographs in publications. In different clinical settings, the consent process was not conducted properly, and health professionals did not recognize the importance of obtaining written patient consent for taking and using patient medical photographs. They often considered verbal consent sufficient or even used the photographs without consent. The second topic included studies that investigated the practices and use of medical photography in publishing. Both patients and doctors asked for confidential storage and maintenance of medical photographs. Patients preferred to be photographed by their physicians using an institutional camera and preferred nonidentifiable medical photographs not only for publication but also in general. Conventional methods of deidentification of facial photographs concealing the eye area were recognized as unsuccessful in protecting patient privacy. The third topic emerged from studies investigating medical photography in journal articles. These studies showed great diversity in publishing practices regarding consent for publication of medical photographs. Journal policies regarding the consent process and consent forms were insufficient, and existing ethical professional guidelines were not fully implemented in actual practices. Patients’ photographs from open-access medical journals were found on public web-based platforms. Conclusions This scoping review showed a diversity of practices in publishing identifiable patient photographs and an unsatisfactory level of knowledge of this issue among different stakeholders despite existing standards. Emerging issues include the availability of patients’ photographs from open-access journals or preprints in the digital environment. There is a need to improve standards and processes to obtain proper consent to fully protect the privacy of patients in published articles.

Introduction Medical photography is a noninvasive technique used for diagnostic, monitoring, and educational purposes. It is important to understand the patient's attitude to all or part of their body being photographed. The objective of this study was to analyze the attitudes of patients towards medical photography at a district hospital in Tarragona, Spain. Methodology This exploratory study used a questionnaire to evaluate attitudes to medical photography among outpatients at Pius Hospital de Valls. The questionnaire explored the patients’ beliefs about the usefulness of medical photography, the circumstances in which they would agree to be photographed and by whom, as well as their prior experience of medical photography. They were also asked whether they would authorize the use of photography and, if not, to explain their motives. Results The questionnaire was completed by 134 patients. The results showed that patients had a clearly positive attitude to being photographed for medical purposes (94.8%), treatment follow-up (88.1%), and consultation of their case with other physicians (86.6%). Acceptance was 88.8% if the lesion was malignant and 85.1% if it was extensive. For facial lesions, only 78.4% were willing to be photographed and in the case of genitals the percentage fell to 70.2%. Most patients (95.5%) would agree to being photographed by their doctor. The rate of acceptance was 66.4% in the case of a nurse, 64.9% for another doctor, and 21.6% for a professional photographer. Conclusions Our study revealed that patients have a positive attitude to being photographed for medical purposes, particularly when they have a malignant lesion, when the photograph is taken by their specialist, and when they cannot be identified.

There is an almost innate urge in human beings to represent reality in a visual form. From rock art in the Paleolithic to images of galaxies, the quotidian and the extraordinary have been visually represented through the ages. Medical and scientific disciplines are no exception. Accurate representation of the human body structures and anatomy based on cadaver dissections was almost not possible up to the Renaissance due to ethical, social, and religious beliefs and objections. The works of Leonardo da Vinci (1452-1519) and others and, later, Andreas Vesalius (1514-1564), who produced De Humanis Corporis Fabrica, are considered landmarks in the history of medicine. During the following centuries medical and scientific illustration relied upon the expertise of physician-artists and scientist-artists until a new paradigm appeared in the realm of scientific (medical) illustration: the invention of photography in the 19th century. Two of the medical disciplines most rapidly influenced by photography were dermatology and pathology, both macro- and microscopic. Physicians rapidly started to use photographs as a tool for consultation, documentation, and education, and large collections of images were amassed by individuals and institutions for these purposes. Photographic images are produced by visible light impressing a light-sensitive material such as a silver halide plate, and nowadays a silicon chip. But photons are reflected by nontransparent objects, including the human skin. Developments in science and technology allowed the use of other types of radiation to reveal internal structures in the human body and, most interestingly, noninvasively. Thus today much of the medical diagnosis and treatment is guided by the so-called medical imaging with the use of these techniques, that is, medical photography, endoscopy, x-ray radiography, computer-aided tomography, magnetic resonance imaging, ultrasonography, thermography, and nuclear medicine functional imaging techniques as positron emission tomography (PET) and single-photon emission computed tomography (SPECT). Some of these techniques are being applied at the microscopic level to study cell structure and even functional changes in real time. All these advancements in science and technology applied to medicine and other disciplines pose the question as to what extent physicians are trading their capabilities as clinicians. Ethics issues add to the complexity of this new era governed by constant changes in scientific paradigms.

Medical visual documentation is a concept of taking medical still images called as photographs and recording medical movies obtained in clinics, outpatient clinics, and operating theaters that are used in many branches of medicine. Medical photography is the main branch of medical visual documentation. The concept of medical photography requires three basic elements in terms of achieving good-quality and appropriate medical images. Those are basic photography knowledge in medical photography, features of the medical subject (object), and medical sensitivities and ethical-legal issues. Today breast cancer is also an important mortality cause in women. So, breast surgery plays a great role in medicine. For successful surgical practices, education, and treatment of breast surgery, standardized, high-quality medical photographs have become an essential component of success. Medical photography in breast surgery can be discussed in three subgroups according to the purpose of the photographs as clinical photography, intraoperative photography, specimen photography, and photography for radiological images. Because of the great importance of medical photography in medicine, the main steps of taking high-quality photographs in breast cancer management are discussed in this chapter, and the main clues are given.

Medical photographs have been used for decades to document clinical findings. The ease with which medical photographs can be captured and integrated into the electronic health record (EHR) has increased as digital cameras obviated the need for the film development process. Today, cameras integrated into smartphones allow for high-resolution images to be instantly uploaded and integrated into the EHR. With major EHR vendors offering mobile smartphone applications for the conduct of point-of-care medical photography, health care providers and institutions need to be aware of legal questions that arise in the conduct of medical photography. Namely, (1) what are the requirements for consent when taking medical photographs, and how may photographs be used after consent is obtained, (2) are medical photographs admissible as evidence in court, and (3) how should a provider respond to a request by a patient or parent requesting that a photograph be deleted from the medical record? Herein, we review relevant laws and legal cases in the context of accepted standards of medical practice pertaining to point-of-care medical photography. This review is intended to aid health care providers and institutions seeking to develop or revise policies regarding using a mobile application at their clinical practice.

Erbium: Yttrium-aluminum-garnet laser (Er: YAG) treatment has been used in resurfacing the acne scars for a long time; however, we could not find any study reporting the recovery rates after each session of the treatment. In this study, we aimed to report the improvement rates after each session. We retrospectively analyzed the data of 35 patients with acne scars treated with fractional ablative Er: YAG laser. The patients received one to four sessions of treatment with 4-week intervals and improvement rates were recorded after each session. Data are available on request from the authors. The improvement rate of the lesions varied between 1% and 25% in 34 patients at the end of the first session, while in one patient, the improvement rate was detected as 26% to 50%. At the end of the fourth session, the rate of improvement was 26% to 50% in 14 out of 24 patients and 51% to 75% in 10 patients. None of the patients showed a 76% to 100% improvement at the end of the fourth session, whereas 48.6% of the patients were satisfied with the treatment. In patients with a high expectation of an excellent improvement, a higher number of sessions of the laser treatment and/or combination treatments with different treatment methods should be planned. © 2020 Wiley Periodicals LLC.

Professor William Macewen (1848-1924) is one of the most important figures in world’s surgery during 18th and early 19th century. He managed to provide numerous innovative techniques and instruments in various fields of surgery such as general surgery, orthopedic surgery, neurosurgery, and thoracic surgery. His innovations had a great impact after his time and constituted the fundaments for further surgical developments. He also was a pioneer in clinical photography with the creation of a huge archive. During his surgical career, he received many honors.

Medical imaging is an integral part of the delivery of modern scientific medical care. Commonplace in secondary care settings such as hospitals, it has yet to make an impact in UK primary care. This is because the cornerstone of the primary care record has been a descriptive written narrative of the patient’s journey. Today, primary care doctors’ records are a computerised version of these paper medical notes and can readily accept images for storage, yet there appears to be no willingness to embrace a medical record with visual data. Advances in technology may soon be making the task easier to reach this version of record keeping. Recently I have seen the future, and this offers tantalising glimpses of a future record embedded with …

This chapter will cover all the fundamental and basic concepts of photography: camera types, sensor size, shutter speed, lenses, and exposure. The objective of this chapter is to help the reader understand basic concepts of photography necessary for medical photography and the settings on the camera for good-quality clinical images.

In this chapter, the concepts and basic guidelines for preservation and conservation of documentation generated as part of the doctor-patient interaction are presented with special emphasis on medical photography, many of which are still in paper or cellulose acetate format. These support materials rapidly degrade under adverse conditions. We will first mention some of the theoretical concepts used in the archival science area and subsequently the various factors that are implicated in deterioration and possible loss, as well as ways to avoid them. These factors are grouped into environmental, biological, natural or human-made catastrophes, chemical, and other. Some specifications are indicated for supports of information other than paper, and finally the basic guidelines for the maintenance of documents and furniture are provided.

What do patients feel when they are photographed in a medical setting? This chapter intends to give some answers, starting from the attitudes expressed by a sample of dermatological patients, analyzed from a psychosocial point of view, particularly the ideas of meaning, subjectivity, and power in the patient-physician relationship. Also, medical photography is presented as a cultural practice of different connotations for the patient and the physician, including the shooting experience. Most of all, the focus of the intended answers is on the sense of tact, the sense of touch in a literal and metaphoric sense, as a claim to the physician in general and the dermatologist in particular, to be sensitive while relating to a Person embodied in the skin: maybe a person who fears in a skin that hurts and it is going to be photographed.

The aim of photography in digestive endoscopy is to obtain adequate, relevant, and quality endoscopy pictures in order to record diagnosis and therapeutic findings. Photo documentation and video recording are mandatory for the following purposes: to provide a complete case record; as a quality measure of complete examination; to facilitate communication; as a useful teaching resource; and in some case to protect physician in medicolegal issue. Endoscopy is a procedure that allows the inspection of internal hollow organs. Gastrointestinal endoscopy is the examination of GI tract witch is performed for diagnosis and therapeutic purpose. In this chapter we describe the technical evolution of both digestive endoscopy and medical photography during the last 70 years, coming from fiberscopes to high-resolution endoscopes and from argentic photography to digital pictures. Nowadays photography is an integral part of digestive endoscopy in clinical practice.

Photography of nails is an important part of photo-documenting a patient with involvement of these areas. It poses its own difficulties and special posing and light requirements. This chapter will point at these issues and propose some solutions.

Doctors have been taking pictures since photography was invented. Many believed that this machine-regulated image was a powerful tool to achieve objectivity. Cameras found their way first in photographer’s studios, later into specialized areas of hospitals. In psychiatry, it was used to objectivize outer manifestations that could help recognize inner disturbances just as forensic and police workers applied anthropometry to improve identification system and recognition of criminal’s traits. Along the way, it also found its space as a generator of social consciousness on medical issues. Images are used today to spread scientific information through social media at speeds never dreamt before.

As described in Chap. 11, color is crucial in many specialisms within clinical photography, particularly those where the colors form some of the diagnostic criteria. In that chapter, color was introduced as a concept, in the context of the color response of the human visual system, the need for color management to standardize colors within imaging chains, and the difference in the balance of requirements of color accuracy and color consistency in different imaging scenarios.

The main purpose of this work is to demonstrate the importance of the image in the personal brand and how it can help us to strengthen our medical practice and make a difference, within a global marketing strategy, to reach potential customers who will use our services. It will explain the main concepts of personal branding and why it is necessary, as well as the compositional characteristics of a professional headshot and the most common mistakes that should not be made, adapted if necessary to the field of physicians.

The first question asked by anyone that wants to start medical photography is: what equipment should I buy? One finds oneself spoiled for choice. There are many options in the market and it is difficult to propose one brand over another. The following chapter wants to show some of the available equipment and help select the one that will fit best the reader’s needs.

Smartphones are evolving medicine, with a positive impact to improve diagnosis in different fields, such as dermatology, ophthalmology, or plastic surgery using digital pictures or images. Images obtained using smartphones in association with built-in artificial intelligence will most likely prove the most accessible method for future medical analysis, allowing the differentiation between normal or abnormal medical conditions even from home. These technological advances will serve as enablers for the medical community. Importantly, technology is not considering a replacement for doctors but, rather, another tool to allow to best care for patients. However, negative experiences with smartphone use of pictures and social medias are also described, such as higher body dissatisfaction and significant overvaluation of body shape, resulting in psychological distress, especially in adolescents. This chapter gives an overview about advantages and disadvantages of the use of smartphones in medical photography and provides information about the current use in the clinical setting and legal aspects of using smartphones in medical photography.

Excellent patient photography is essential to accurately manage patients in an aesthetic/dermatologic medicine practice. Photos will be used for proving efficacy of therapy, creating a photographic baseline, marketing the practice, education, and possibly publication. Pre-/post-procedure photos are part of your legacy and proof of your excellence as a clinician.

Photographs have become a vital component of documenting medical encounters; they are used in clinical medicine, research, scientific publications, and teaching. Photographs are so essential to clinical practice that they can be rendered during most medical imaging procedures and saved with the patient’s electronic medical record along with other clinical images. Though serving an important role, obtaining images may be time-consuming and require additional physician skills. The development and use of new imaging devices are somewhat limited by reimbursement issues in the United States (USA). In this chapter, we discuss some important points regarding coding and reimbursement of photography and imaging in medicine in the USA and Europe.

The importance of metadata for medical photography may not be initially apparent. However, metadata are essential to ensure medical images are properly managed and interpreted. Metadata are text-based elements that describe a medical photograph, or clinical information—such as anatomy—associated with a clinical image.

Dr Stanley B. Burns is the head archivist and founder of the Burns Archive, a personal collection spanning over 45 years to date, consisting of antique and vintage medical and military illustration...

Background Various means to facilit ate accurate biopsy site identification have been proposed. Objective To determine the accuracy of biopsy site identification by using photographs taken with a patient's digital device by a dermatologist versus professional medical photography. Methods Photographs of circled biopsy sites were taken with personal digital devices by the principal investigator (PI). Another set of photographs was taken by a professional photographer. Secondary photographs were taken of the biopsy site location pointed to by the staff and PI on the basis of the personal digital device image and professional medical photography, respectively. On the basis of secondary photographs, 2 independent dermatologists determined whether the skin biopsy locations pointed out by the staff were consistent with the ones pointed out by PI. Results Per dermatologist A, the staff correctly identified all 53 biopsy sites. Per dermatologist B, the staff were correct on 51 of 53 observations. Dermatologist C, the final arbiter, concurred with dermatologist A on the 2 cases in which dermatologist B was not certain of the location of the biopsy site. Limitations The mean interval from initial biopsy to reidentification of the site was 36.2 days. Conclusion Utilizing patients' personal digital devices is a cost-effective, Health Insurance Portability and Accountability Act–compliant, and readily available means to identify skin biopsy sites.

Recent privacy breaches by a major social media company have again raised questions from some pathologists regarding the legality and ethics of sharing pathology images on social media. The authors examined ethical principles as well as historic and legal precedents relevant to pathology medical photography. Taking and sharing photographs of pathology specimens is embedded into the culture of the specialty of pathology and has been for more than a century. In general, the pathologist who takes the photograph of a gross or microscopic specimen owns the copyright to that photograph. Patient consent is not legally or ethically required to take or use deidentified photographs of pathology specimens. Current US privacy laws (Health Insurance Portability and Accountability Act [HIPAA] of 1996) permit public sharing of deidentified pathology photographs without specific patient consent, even on social media. There is no case law of action taken against pathologists for sharing deidentified pathology images on social media or elsewhere. If there is any legal risk for pathologists or risk of patient harm in sharing pathology photographs, it is very small. The benefits of professional social media use for pathologists, patients, and society are numerous and well documented in the literature.

Background Mobile applications allow health care providers to capture point-of-care medical photographs and transfer them to the electronic health record (EHR). It is unclear how providers use these photographs or how they affect clinical care. Objectives We aimed to understand the content, purpose, and outcomes of point-of-care medical photography performed in the pediatric emergency department (ED) at large academic medical center. Methods A retrospective chart review was conducted of patients Results We identified 619 clinical encounters involving photographs of 605 patients who were eligible for inclusion. Skin was photographed in 499 (81%). The most common finding was rash (N = 177; 29%). Photos were of acceptable quality, with 569 (94%) achieving a score between 4 and 5 out of 5. The primary use of photography was documentation (N = 334; 54%), though teleconsultation was noted in 38 (6%). Nearly one-third (N = 187; 30%) of patients were seen in the ED or outpatient clinic for any reason within 2 weeks, and in 25 (13%), clinical notes explicitly referenced the initial photograph(s). In 53 (9%) cases, patients were photographed at a clinical visit in the subsequent 2 weeks, suggesting that photography was used to track changes over time. Conclusion Documentation of findings using mobile point-of-care photography allows for high-fidelity documentation and facilitates continuity of care.

Teledermatology is a newly growing service delivering dermatologic care, covering the entire field of dermatology, ranging from initial diagnosis to treatment and management. Teledermatology involves the use of medical photography to examine the skin of a patient together with the relevant history to diagnose dermatological conditions. Images are sent electronically to the dermatologist and in most cases receive a response within 48 hours. GP practices have started making diagnostic agreements with GP’s with a special interest in Dermatology. Teledermatology gives the opportunity for the majority of patients to be treated by their own GP/Primary care, following a suitable management plan suggested by the GP with a special interest in Dermatology, but without having to attend hospital. By reducing the number of dermatology referrals to secondary care, Teledermatology can also help address the demand for dermatology care in hospitals. Teledermatology has shown to optimize resourses, provide quick and efficient care as well as reducing the number of referrals to secondary care. It is a service that should be achieved by all primary care physicians. Teledermatology has the potential to permanently change the way that doctors manage their workflow and provide patient care.

This article reviews the use of mirrorless systems in medical photography, based on the author's experience using Sony mirrorless systems. It is not aimed at being an in depth comparative technical review but aims to discuss the technology as a viable alternative to the digital single lens reflex (DSLR) when documenting the most common subjects a medical photographer will face.

To assess patient perceptions regarding medical photography and the use of smart devices, namely mobile phones and tablets for medical photography. A questionnaire-based survey was conducted among 280 consecutive adult patients who presented to the oculoplastics clinic at a tertiary eye care centre. The responses were tabulated and analysed. Of the 280 patients surveyed, 68% felt that medical photography had a positive impact on their understanding of their illnesses and 72% felt that the use of smartphones for medical photography was acceptable. Respondents below the age of 40 years were more likely to approve of the use of mobile phones for photography as compared to those over 40. Most patients (74%) preferred a doctor to be the person photographing them. While a majority approved of doctors and trainee physicians having access to their photographs, they felt non-physician healthcare personnel should not have access to clinical photographs. Also, 72% of the respondents felt that the patient’s consent should be taken before using their photographs. It was noted that patient identification and breach of confidentiality could be some of the potential issues with using smart devices as cameras in the clinic. Clinical photography in general and, specifically, using smart devices for clinical photographs have gained acceptance among patients. The outcomes of this study may be utilized to create policy guidelines for the use of smart devices as photography tools in the clinics. The findings of this survey can also help to create standardized, uniform patient consent forms for clinical photography.

Background Medical photography enhances patient care, medical education and research. Despite medical photography's widespread use, little is known about how dermatologists choose to implement photography in routine clinical practice, and how they approach issues of image storage, image security and patient consent. Objective To characterize dermatologists' medical photography habits and opinions. Methods A 32-item anonymous, multiple-choice SurveyMonkey questionnaire about medical photography practices was emailed to programme directors of the 117 United States (US) dermatology residency programmes between May and August 2015, with a request to forward to faculty and affiliated dermatologists. Only board-certified dermatologists practicing in the United States were eligible. The Institutional Review Board exempted our study from full review. Results Our survey included 153 board-certified dermatologists, primarily representing the north-east (43.1%) and identifying as academic dermatologists (75.5%). Medical photography is prevalent: 61.8% report everyday use and 21.7% photograph every patient. Those reporting rare use (3.3%) were, on average, 20 years older. Dermatologists most commonly use photography to mark biopsy sites (87.5%), track disease (82.9%) and for education/teaching (72.4%). Nearly half (46%) use smartphone cameras. Emailing and texting photographs with patients or colleagues are common (69.1%). Most dermatologists (75.7%) always request patient consent for photographs. Only 23.7% adhere to a photography protocol and 73.9% desire more training opportunities. Conclusion Dermatologists value medical photography. While patterns of image acquisition, storage and consent are noted, a variety of methods and preferences exist. Clearer photography guidelines and increased educational resources are likely to improve image quality, exchangeability and confidentiality.