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A simple system of photography for the trainee plastic surgeon
Brirish Journal C$ Plastic Surgery ( 1982) 35, IDo-1 0 I (Y 1982 The Trustees of British Association of Plastic Surgeons
0007-1226/82/0291-0100
A simple system of photography surgeon Ii. P.
$02.00
for the trainee plastic
HENDERSON
Plastic and Jaw Department, Fulwood Hospital,’ Sheffield
Most plastic surgical trainees find it worthwhile taking their own photographs, either for teaching purposes or to record their clinical and research work. In choosing the best camera for this one is faced with a bewilderingly large selection of possible cameras, lenses, flash guns, and other accessories. The purpose of this paper is to make some suggestions and show that it is possible to carry out most clinical photography very simply, reliably and rapidly with a camera and apparatus that is relatively cheap to buy. The most important thing in trying to simplify this type of photography is to reduce the possible number of variables. In terms of lighting it is undoubtedly best to use flash for everything. In terms of aperture setting it is best to reduce the possible number of distances of the camera from the subject to as few as possible so that one has to remember very few variables. Fortunately most clinical photographs that the plastic surgeon will be interested in taking fit into two main sizes, that can be best illustrated by example. In the first category the object is about the size of a finger, a nose or an ear. In the second category the object is something larger, like a view of the whole face, the front of the chest, or the whole hand and wrist. By the addition of a simple add-on lens to the front of the ordinary 50 or 55mm lens that most single lens reflex cameras now have, it is possible to achieve the range of magnification needed for these two sizes of object. These add-on lenses are cheap and are simply screwed onto the front of the main lens. It is usually possible to close the camera case with them left in-situ, making the camera immediately ready for use, I believe this to be an extremely important point for the trainee who may not have the time or opportunity to devote more than a few seconds to taking each photograph. A plus 2 dioptre lens is ideal for most work. When the main lens is turned to the infinity position the image size is 100
appropriate for the larger of the two sizes of picture. When the main lens is turned to the close-up position the image size is suitable for the smaller objects like a finger or mouth, or eyelid. For these two sizes of object only two aperture settings are needed which thus simplifies everything to the level of the “box-brownie”. The actual aperture. setting will depend upon the strength of the flash gun and the speed of the film. Each person will have his own preference in this combination. By simple trial and error and using up one film it is possible to work out the correct aperture setting for a given size picture and type of film. If one wishes for even higher magnification one can use a plus 4 dioptre lens instead of or in addition to the 2 dioptre lens. This will allow one to photograph something the size of a finger nail. The aperture setting will need to be one stop higher for this. If one wishes to record an operation done under tourniquet it is advisable to use an aperture setting one higher (in number) than would normally be used for that amount of magnification. My own choice of camera is the Pentax K 1000. The standard lens with which it is fitted is an Asahi 55mm. The add-on lenses are made by Hoya. The flash gun is a Starblitz 220M. The flash gun can be angled towards the subject as desired by a small connecting piece. This whole combination can be purchased for less than &lo0 at current prices. I use Kodachrome 25 film and this means that the aperture setting for the high magnification pictures is f16 (f22 under tourniquet) and fl 1 for the lower magnification. Using this simplified system it is usually possible to instruct someone else to take a satisfactory photograph with a minimum of fuss, when it is inconvenient to take it oneself, for example when scrubbed up. I have used this system for three years and have had very few failures on account of incorrect exposure. This has reduced the amount of film needed and has
A SIMPLE SYSTEM OF PHOTOGRAPHY
FOR THE TRAINEE
led to very few disappointments. The only field which requires special skill is intraoral photography. The position of the flash gun is crucial and I believe the ring-flash is indicated for this if direct into the mouth views are to be attempted. A ring flash is not required if an indirect photograph is obtained using a mirror. Specially polished chrome plated angled spatulas held inside the mouth comfortably on the tongue, give an excellent view of the palate right up to the incisor teeth. This is the method that I
PL.ASTIC SURGEON
101
have adopted when the result must be perfect first time. With experience photographs of larger fields can be taken but require more thought and calculation about the aperture setting and therefore the system is no longer fool-proof. The Author Hugh P. Henderson, FRCS, Senior Registrar, Plastic and Jaw Department, Fulwood Hospital. Sheffield S10 3TD.
0007-1226/82/0291-0100
A simple system of photography surgeon Ii. P.
$02.00
for the trainee plastic
HENDERSON
Plastic and Jaw Department, Fulwood Hospital,’ Sheffield
Most plastic surgical trainees find it worthwhile taking their own photographs, either for teaching purposes or to record their clinical and research work. In choosing the best camera for this one is faced with a bewilderingly large selection of possible cameras, lenses, flash guns, and other accessories. The purpose of this paper is to make some suggestions and show that it is possible to carry out most clinical photography very simply, reliably and rapidly with a camera and apparatus that is relatively cheap to buy. The most important thing in trying to simplify this type of photography is to reduce the possible number of variables. In terms of lighting it is undoubtedly best to use flash for everything. In terms of aperture setting it is best to reduce the possible number of distances of the camera from the subject to as few as possible so that one has to remember very few variables. Fortunately most clinical photographs that the plastic surgeon will be interested in taking fit into two main sizes, that can be best illustrated by example. In the first category the object is about the size of a finger, a nose or an ear. In the second category the object is something larger, like a view of the whole face, the front of the chest, or the whole hand and wrist. By the addition of a simple add-on lens to the front of the ordinary 50 or 55mm lens that most single lens reflex cameras now have, it is possible to achieve the range of magnification needed for these two sizes of object. These add-on lenses are cheap and are simply screwed onto the front of the main lens. It is usually possible to close the camera case with them left in-situ, making the camera immediately ready for use, I believe this to be an extremely important point for the trainee who may not have the time or opportunity to devote more than a few seconds to taking each photograph. A plus 2 dioptre lens is ideal for most work. When the main lens is turned to the infinity position the image size is 100
appropriate for the larger of the two sizes of picture. When the main lens is turned to the close-up position the image size is suitable for the smaller objects like a finger or mouth, or eyelid. For these two sizes of object only two aperture settings are needed which thus simplifies everything to the level of the “box-brownie”. The actual aperture. setting will depend upon the strength of the flash gun and the speed of the film. Each person will have his own preference in this combination. By simple trial and error and using up one film it is possible to work out the correct aperture setting for a given size picture and type of film. If one wishes for even higher magnification one can use a plus 4 dioptre lens instead of or in addition to the 2 dioptre lens. This will allow one to photograph something the size of a finger nail. The aperture setting will need to be one stop higher for this. If one wishes to record an operation done under tourniquet it is advisable to use an aperture setting one higher (in number) than would normally be used for that amount of magnification. My own choice of camera is the Pentax K 1000. The standard lens with which it is fitted is an Asahi 55mm. The add-on lenses are made by Hoya. The flash gun is a Starblitz 220M. The flash gun can be angled towards the subject as desired by a small connecting piece. This whole combination can be purchased for less than &lo0 at current prices. I use Kodachrome 25 film and this means that the aperture setting for the high magnification pictures is f16 (f22 under tourniquet) and fl 1 for the lower magnification. Using this simplified system it is usually possible to instruct someone else to take a satisfactory photograph with a minimum of fuss, when it is inconvenient to take it oneself, for example when scrubbed up. I have used this system for three years and have had very few failures on account of incorrect exposure. This has reduced the amount of film needed and has
A SIMPLE SYSTEM OF PHOTOGRAPHY
FOR THE TRAINEE
led to very few disappointments. The only field which requires special skill is intraoral photography. The position of the flash gun is crucial and I believe the ring-flash is indicated for this if direct into the mouth views are to be attempted. A ring flash is not required if an indirect photograph is obtained using a mirror. Specially polished chrome plated angled spatulas held inside the mouth comfortably on the tongue, give an excellent view of the palate right up to the incisor teeth. This is the method that I
PL.ASTIC SURGEON
101
have adopted when the result must be perfect first time. With experience photographs of larger fields can be taken but require more thought and calculation about the aperture setting and therefore the system is no longer fool-proof. The Author Hugh P. Henderson, FRCS, Senior Registrar, Plastic and Jaw Department, Fulwood Hospital. Sheffield S10 3TD.