How Camera-to-Subject Distance and Height Affect Breast Measurement and Follow-Up Assessment in Plastic Surgery.

BACKGROUND: Due to several factors that affect photograph quality, bias is inevitably present in two-dimensional (2D) breast photography. The principal variables affecting image performance at a fixed focus length are the distance between the camera and the subjects and the photography angles. OBJECTIVE: This study aimed to investigate the effects of camera-to-subject distances and camera height on breast measurement parameters to understand the trend of breast deformation and provide guidance for the accurate evaluation of planar follow-up. METHODS: We enlisted 16 volunteers with various breast cup sizes (A-D). Frontal and lateral photos were obtained with a steady focus of 50 mm at distances between 1.10 m and 2.20 m and at heights between 30 cm above the nipple and 30 cm below the nipple at intervals of 10 cm. Two researchers independently evaluated each volunteer's breast aesthetic parameters, including 11 linear parameters, 3 area parameters, and 3 ratio parameters, using Vernier calipers and Photoshop. RESULTS: The correlation coefficient of the two investigators ranged from 0.922 to 0.999. The results measured by Photoshop were 29.67 ± 5.23% greater than those of the Vernier caliper (p < 0.01). In contrast to ratio parameters, which showed no significant changes in each distance group (p = 1.00), linear parameters and area parameters significantly increased as object distance decreased (p < 0.05). The lower pole of the breast grew wider and flatter and occupied a larger proportion of the breast as height declined. CONCLUSION: Camera-to-subject distances of 1.5-1.7 m are recommended for stabilized and uniform breast photography. Varying shooting height affects breast distortion. Quantifying the relationship between photographic conditions and breast morphology enables plastic surgeons to conduct more comprehensive and accurate assessments. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Bullet point list: 1. The breast morphology will get more distortion with a smaller camera-to-subject distance. 2. Camera-to-subject distances of 1.5~1.7m are recommended for stabilized and uniform breast photography. 3. Height rather than distance affects the breast proportion.

The use and ethical assessment of medical photos taken by physicians.

With the increased use of technology, the use of medical photography has also increased, especially for secondary purposes. Secondary use only results in a benefit for clinicians and is considered a one-way process. This, in turn, raises several potential ethical issues, despite the numerous benefits of medical photography. The descriptive cross-sectional study was conducted with 82 physicians who took medical photos, in Ankara, Turkey. The mean age of the participants was 44.7 years. Of the participants, 95.1% reported using their personal mobile phones for photographing and 84.1% reported taking medical photos for "use in clinical trainings (clinical seminars, student and patient trainings, etc.)". Among physicians who took photos for research purposes, 29.3% reported obtaining only verbal consent. In addition, 53.7% of physicians reported storing medical photos on their personal computers. It seems that there is no consensus among physicians regarding taking, storing, and using medical photos, and these results cause ethical problems.

Family-acquired photographs for the evaluation of pediatric head shape via telemedicine: an analysis of photograph quality.

OBJECTIVE: Telemedicine can be an effective tool for the evaluation of the pediatric patient with a cranial deformity, but it increases the reliance of neurosurgical providers on data provided by patients and families. Family-acquired photographs, in particular, can be used to augment the evaluation of pediatric head shape abnormalities via telemedicine, but photographs of sufficient quality are necessary. Here, the authors systematically reviewed the quality and utility of family-acquired photographs for patients referred to their pediatric neurosurgery clinic for telemedicine-based head shape evaluations. METHODS: All telemedicine encounters that were completed for head shape abnormalities at the authors' institution between May 2020 and December 2021 were retrospectively reviewed. Instructions were sent to families prior to each visit with examples of ideal photographs. Three orthogonal views of the patient's head-frontal, lateral, and vertex-were requested. Data were collected regarding demographics, diagnosis, follow-up, and photograph quality. Quality variables included orthogonality of each requested view, appropriate distance, appropriate lighting, presence of distracting elements, and whether hair obscured the head shape. RESULTS: Overall, 565 patients had 892 visits during the study period. A total of 1846 photograph requests were made, and 3335 photographs were received for 829 visits. Of 2676 requested orthogonal views, 1875 (70%) were received. Of these, 1826 (97%) had adequate lighting, 1801 (96%) had appropriate distance, and 1826 (97%) had no distracting features. Hair did not obscure the head shape on the vertex view in 557 visits with orthogonal vertex views (82%). In-person follow-up was requested for further medical evaluation in 40 visits (5%). CONCLUSIONS: The family-acquired photographs in this series demonstrated high rates of adequate lighting and distance, without distracting features. Lack of orthogonality and obscuration of the head shape by hair, however, were more common issues. Family education prior to the visit may improve the quality of family-acquired photographs but requires an investment of time by medical staff. Efforts to further improve photographic quality will facilitate efforts to perform craniometric evaluations through telemedicine visits.

Publishing Identifiable Patient Photographs in Scientific Journals: Scoping Review of Policies and Practices.

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.

Visible Light Imaging: Clinical Aspects with an Emphasis on Medical Photography-a HIMSS-SIIM Enterprise Imaging Community Whitepaper.

Photodocumentation is a subset of visible light imaging and is an important growing segment of enterprise imaging. Medical videography is another subset of visible light imaging that shares many of the challenges of photodocumentation. Medical photographs are used to document clinical conditions, support diagnosis, guide, and document procedures and to enable collaboration among colleagues. They also play a significant role in patient engagement and are a mechanism for patients to share information with their provider without the need for a clinical office visit. The content of medical photographs raises issues for acquisition, management, storage, and access. Medical photographs may contain protected health information, and these images benefit from the standardized, secure processes inherent in any enterprise imaging program. The ability to securely acquire images on mobile, and sometimes personally owned devices, is a necessity. In addition to containing protected health information, photograph content can be sensitive or gruesome or the images may be used for forensic purposes. These types of images require additional protections. Access to these images should be role-based and auditable. To properly identify photographs and to convey information about their acquisition parameters new metadata requirements and mechanisms for its association with the imaging files are evolving. Institutional policies need to be developed to define the organization's requirements for medical photography, including consent processes. Existing policies such as those defining the designated record set and legal health record should address the management of medical photography.

Clinical outcomes and operational impact of a medical photography based teledermatology service with over 8,000 patients in the UK.

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.

The Importance of Body Part Labeling to Enable Enterprise Imaging: A HIMSS-SIIM Enterprise Imaging Community Collaborative White Paper.

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.

Professor William Macewen (1848-1924): The Scottish Pioneer of Surgery.

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.

Mobile Point-of-Care Medical Photography: Legal Considerations for Health Care Providers.

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.

Instructional design of a clinical photography course for undergraduate dental students.

Clinical and dental photography is an acquired skill. It is learned, developed and practised at post-graduate level by medical photographers across the U.K. But where does the medical photography profession stand in terms of transmitting slowly acquired skills to a wider clinical audience? If some or all skills need to be passed on, how and to whom should they be taught? This paper considers how dental practitioners may benefit from training in specific aspects of clinical photography and suggests a tried and tested model of instructional design for a clinical photography course utilised and implemented for undergraduate dental students studying at the University of Leeds. The authors found a course of this nature demanded skills and theoretical understanding of cognitive architecture beyond the purview of most clinical field experts. A collaborative approach to instructional design between a field expert and clinical educator was implemented, which allowed the design of a dental photography course that worked effectively by linking new to prior knowledge.

Mirrorless cameras for medical photography - time to switch?

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.

Alienation and beauty in medical photography.

Though photography was initially touted to overtake medical illustration as a more objective medium, today photographs are underused in medical texts. The concern with aesthetics and the relationship between the body and the patient combined to shape the future of medical photography, and in some ways medicine itself. Closely examining two cases - Duchenne's 'Mécanisme de la Physionomie Humaine' (1856), and Grant's 'An Atlas of Anatomy' (1962) - I consider the role of alienation and beauty in medical photography and the evocative questions each raised in medical history. This is adapted from a talk given at RCPE.

You are a medical photographer and your brief is wide.

A reflection on past product advertisements which were created for earlier versions of this journal and were specifically targeted at the Medical Photographer.

Orders- Versus Encounters-Based Image Capture: Implications Pre- and Post-Procedure Workflow, Technical and Build Capabilities, Resulting, Analytics and Revenue Capture: HIMSS-SIIM Collaborative White Paper.

The decision to implement an orders-based versus an encounters-based imaging workflow poses various implications to image capture and storage. The impacts include workflows before and after an imaging procedure, electronic health record build, technical infrastructure, analytics, resulting, and revenue. Orders-based workflows tend to favor some imaging specialties while others require an encounters-based approach. The intent of this HIMSS-SIIM white paper is to offer lessons learned from early adopting institutions to physician champions and informatics leadership developing strategic planning and operational rollouts for specialties capturing clinical multimedia.

Maximising image quality in small spaces.

A Medical Illustration Department may need to set up a studio in a space that is not designed for that purpose. This joint paper describes the attempts of two separate trusts, University Hospitals Bristol NHS Foundation Trust (UHB) and Norfolk & Norwich University Hospitals (NNUH), to refurbish unusually small studio spaces of 4m × 2m. Each trust had a substantially different project budget and faced separate obstacles, but both had a shared aim; to maximise the limited studio space and enhance the quality of images produced. The outcome at both Trusts is a significant improvement in image quality.

The art and science of photography in hand surgery.

High-quality medical photography plays an important role in teaching and demonstrating the functional capacity of the hands as well as in medicolegal documentation. Obtaining standardized, high-quality photographs is now an essential component of many surgery practices. The importance of standardized photography in facial and cosmetic surgery has been well documented in previous studies, but no studies have thoroughly addressed the details of photography for hand surgery. In this paper, we provide a set of guidelines and basic camera concepts for different scenarios to help hand surgeons obtain appropriate and informative high-quality photographs. A camera used for medical photography should come equipped with a large sensor size and an optical zoom lens with a focal length ranging anywhere from 14 to 75 mm. In a clinic or office setting, we recommend 6 standardized views of the hand and 4 views for the wrist; additional views should be taken for tendon ruptures, nerve injuries, or other deformities of the hand. For intraoperative pictures, the camera operator should understand the procedure and pertinent anatomy in order to properly obtain high-quality photographs. When digital radiographs are not available and radiographic film must be photographed, it is recommended to reduce the exposure and change the color mode to black and white to obtain the best possible pictures. The goal of medical photography is to present the subject in an accurate and precise fashion.