II. Precautions

  1. Obtain Informed Consent to take medical images
    1. Take a picture of the Informed Consent and store with the Clinical Images

III. Preparations

  1. Cameras
    1. Smartphones (e.g. author uses the iphone)
      1. Readily available and offers high resolution images
    2. Digital SLR (e.g. author uses the Nikon D90)
      1. DSLR lens (e.g. macro lens) offers best image lighting and quality
      2. Spot focus and overall better functionality in a dedicated camera
      3. Higher resolution images offer more options for cropping the image
      4. Raw format images allow for maximal editing
  2. Software
    1. Photo-editing (e.g. author uses Photoshop)

IV. Technique: Image Quality

  1. Sharp camera focus
    1. Take multiple photographs
    2. Use 2 hand to minimize camera movement
    3. Camera may be difficult to autofocus at close range (macro)
      1. Take image at closest range for which autofocus works
      2. Crop image later
  2. Avoid distortion
    1. Take photograph at perpendicular angle
  3. Optimize lighting
    1. Avoid shadowing the subject
    2. Built in camera flashes typically offer poor lighting
      1. Consider external flash as an alternative (available with DSLR)
    3. Light the subject by a window or with lamps
      1. Skin lesions may be best seen with lighting shined at the object from a 30-40 degree angle from the camera
    4. Consider the high dynamic range (HDR) setting in cameras and imaging software
      1. Composites several images of the same object but with different lighting

V. Technique: Image composition

  1. Avoid patient identifiers in field of view
    1. Avoid unique Tattoos, clothing or jewelry
    2. Avoid patient ID wrist bands
  2. Remove distractions from photograph
    1. Optimize background to be uncluttered (remove wires, tubes and other distracting objects)
    2. Try to provide a smooth, unwrinkled, single color background (especially blue, black or white)
      1. Consider a towel or drape as background
  3. Provide clues to context and scale
    1. Photograph a wide shot and then a close-up
    2. Photograph one side compared with another
    3. Photograph with a ruler in the image or other standard object (e.g. coin)

VI. References

  1. Lin in Herbert (2014) EM:Rap 14(8): 7

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