and discuss them with your patient prior to photographing them. The person responsible for
photographing should always inform the subject what areas are being recorded in the camera’s field of view. To provide anonymity, the head should never be recorded in the same field of view as the breasts or body. Although a chaperone is not typically
used when photographing, patients should be offered the opportunity for a chaperone if they would like one. If the patient is under 18 years of age, a parent or legal guardian must be present during the photography session.
Patient consent If you want to use your patient’s photographs for non-treatment purposes — education,
publication,
marketing, Internet — discuss this with him/her and request that they sign a consent for non-treatment purposes, which lists the possible uses of the images. This should be a separate consent form and should be made as a request only. Always review your consent form with an attorney prior to use. If the patient is under 18 years of age, a parent or legal guardian should be requested to sign the photographic consent
form for
non-treatment purposes and use. Make a point to discuss the release for
the Internet. owing to the nature of the web, any image can be downloaded and repurposed so make sure your patient understands this possibility. To deter others from taking your work, embed a watermark with your name/practice name on top of the image. In the past, masking the eyes was used
to de-identify a subject. Today the stance that the International committee for Medical Journal Editors takes is8
: ‘Identifying details should be omitted if
they are not essential, but patient data should never be altered or falsified in an attempt to attain anonymity. Complete anonymity is difficult to achieve, and informed consent should be obtained if there is any doubt. For example, masking of the eye region in photographs of patients is inadequate protection of anonymity.’
Attention to detail After the proper consents have been obtained, the patient can be photographed. Attention to detail is
an important aspect of m edi c al photography. you want your photographs to be generic and neutral to best depict the anatomy. This can be achieved by having the subject remove any jewellery (including navel rings) from the camera’s field of view, as this can often distract the viewer from seeing
what
is intended. Personal undergarments can be
another distraction and disposable undergarments should be supplied for patients to wear to achieve consistency throughout a series of photographs taken at different time intervals, and to keep the images and patients looking generic. Make-up should be removed before
photographing as it can camouflage the skin’s condition and texture. After your subject has washed his/her face, wait until the skin has returned to its normal moisture level before photographing. This will ensure that it is in its most natural state. requesting the patient to come in without make-up prior to their consultation is the best way to ensure accurate documentation. hair should be pulled back with hair-coloured headbands,
or
hair-coloured bobby pins. Long hair should be pushed off the shoulders. People have been trained to smile
when being photographed but this should be avoided for patient photography as it can distort facial features. Unless a particular series calls for animation, careful attention should be paid to not animating the face. having someone completely relax his/her face is not typically a natural feeling. request your patient to relax their brow, eyes, and jaw rather than to just relax their face. This approach can be more successful as often patients do not realise that these areas are animated until they are specifically pointed out. If a series calls for repose and animated
views, ensure that the repose views are photographed prior to the animated ones, as it is often difficult for the subject to completely relax the facial muscles after animation.
The goal of clinical cosmetic
photography is to provide accurate photographic representations from clinical results. This documentation relies on standardising photographic variables. These variables can be categorised in five components: ■ Standardised views ■ Positioning and alignment ■ Lighting ■ Focal length and camera-to-subject distance ■ Simplifying the background.
Standardised views Different staff members often perform photography in a clinical practice, so it is helpful to use a standardised series. A standardised series is a predetermined set of photographs per procedure that ensures that the patient will have the same views photographed each time they come in. The series is built for each specific treatment and the patient is generally photographed either 180° or 360° in 45° increments, depending on the procedure and treatment. It is recommended to have the series readily available for whoever is performing the photography (refer to the full article at
www.informahealthcare.com for a series example).
Positioning and alignment correct anatomical positioning and alignment are important. Identifying reference points and using positioning devices can be helpful in achieving this. For example, placing a target on the
prime-journal.com | July 2011 ❚ 73
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