- Email: [email protected]
Digital imaging for orthopaedic surgeons
ARTICLE IN PRESS Current Orthopaedics (2005) 19, 209–214
www.elsevier.com/locate/cuor
ORTHOPAEDIC INFORMATION
Digital imaging for orthopaedic surgeons Lennard Funk Hope Hospital, Eccles Old Road, Salford M6 8HD, UK
KEYWORDS Digital photography; Pixels; Storage media; Image processing
Summary The age of digital photography and video is well upon us now. Most surgeons use digital cameras, DVDs and digital camcorders in their personal lives. Most surgeons have also tried to apply digital photography in their clinical practice for recording interesting cases, teaching purposes and as part of clinical records. However, this technology is still fairly new and advancing at rapid pace. The particular requirements for Orthopaedics, such as photographing radiographs and operative images, are not usually addressed by the automatic settings of digital cameras. This paper is aimed at those surgeons with digital cameras and imaging equipment, who want to maximise and improve their technique in digital photography in the setting of Orthopaedic and Trauma surgery. I am no expert in photography (digital or otherwise). Nor do I put forth this content as fully verified and error-free, although I try very hard to make it so. My goal here is simple—to share what I have learned through experience and cross-checked reading in a rapidly growing and developing field, still rather poorly documented by the vendors and mainstream publications. & 2005 Elsevier Ltd. All rights reserved.
Introduction This paper deals with the following common difficulties: 1. Why do I need digital photographs? 2. Which camera should I buy? 3. How do I best photograph Operations and Clinical subjects? 4. How do I best photograph X-rays? 5. How do I e-mail, print and publish Images? 6. How should I Store & Manage images?
E-mail address: [email protected].
Before proceeding there are a few terms requiring clarification 1. Exposure: Relates to the brightness of an image. It represents the length of time the camera film or CCD (charge coupled device, which recovers the image in digital camera) is ‘exposed’ to light. The darker the environment you are photographing, the longer you need to expose the film to the ambient light to get a good image. 2. Exposure Compensation: The amount you increase or decrease the exposure is specified in ‘‘stops.’’ One ‘‘stop’’ increase represents a
0268-0890/$ - see front matter & 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.cuor.2005.05.003
ARTICLE IN PRESS 210
L. Funk
doubling of the amount of light reaching the film. You specify +1 to open the aperture or slow down the shutter speed and –1 to achieve the converse. It is easy to use exposure compensation because you can preview your changes on the LCD camera’s monitor. I would recommend an EC (exposure compensation) of 2 for Xrays, where an extremely dark background occupies a very large part of the image and you want to retain detail in the brighter parts of the scene. You can alter this according to your camera and requirements. 3. ISO Equivalent: ISO is the sensitivity of traditional films to light. A high ISO film (or ISO equivalent in digital cameras) is more suitable for low light conditions, but the image becomes more ‘grainy’. Therefore one should have the option of different ISO Equivalents in a digital camera. 4. Spot metering: Metering is the determination of the amount of light entering the camera, which is used to determine focus and exposure settings. This can be an average reading of the entire image or a reading of a small section of the image, within the central portion-so-called ‘‘spot metering’’.
How do I best photograph operations/ clinical subjects?
Why do I need digital photographs?
Orthopaedics is a very visual specialty and every aspect of our work requires some form of imaging. This includes clinical care, education, research and medicolegal work. The inclusion of a visual record is of great benefit to all concerned in a patient’s care—a picture is worth a 1000 words.
These are a few tips gleaned from medical photographers and bitter experience.
Which camera should I buy? The best you can afford is the simple answer, though there are some specific features you require when using a Digital Camera for Orthopaedic purposes. These include
At least 3 Megapixels image capacity—the current minimum requirement for publication (see below). Macro facility of about 8 cm—for clinical photographs and X-rays. Attachment for Tripod—improves the sharpness when photographing radiographs Manual override—for manual focus, manual exposure control is particularly useful for radiographs and operative photographs.
Preview image facility—on an LCD screen allows you to immediately assess the quality of the photographed subject and then readjust the settings appropriately for subsequent shots. Flash control—flash intensity often has to be reduced for operative photographs. An external hand-held flash or option for a ring flash is ideal for operative photographs, allowing light to wash the subject without unwanted shadows.
Move the operating lights lights off the subject, so as to use flash only. Clear away blood and any metal glare—glare is accentuated in most digital images. Change bloody swabs for clean ones—this will reduce glare and improve exposure control. Compose the shot carefully to ensure that what you want to demonstrate is shown. You may never get the opportunity again. Shoot a perspective shot, showing the entire limb or surgical area. Often when looking at a close-up of a surgical site later the orientation can be lost without a perspective view. Shoot from different angles. Hold camera with two hands. Shove the surgeon out of the way! Optimising exposure for clinical and operative images J Slow ‘film speed’—low ISO Equivalent (ISO 100)—this improves the sharpness and brightness of an often shadowy image. J Use a flash—Handheld preferable. J Alter flash strength—the automatic settings are often too bright. Look for a camera that will allow you to do this. J Spot meter on mid-tone area or meter off the palm of your hand. If in doubt expose for the highlights, to avoid white-outs, and plan to bring up the shadows in post-processing as needed. Focus J Manual focus is preferable. This is especially useful when photographing in a deep wound, such as in shoulder surgery. J Focus and compose: If you do not have manual focus then focus on the part of the image you want sharp, hold the shutter
ARTICLE IN PRESS Digital imaging for orthopaedic surgeons button half-way down, then move the camera to compose a good image, and then push the shutter button all the way down. Most cameras allow this technique.
211 One should appreciate the advantages of common file formats, which can be utilised to aid these processes. Below is a table summarising the qualities we need to be aware of. Common File Formats
Tips for photos using the Operating light and no flash
Uncompressed
Compressed
BMP
JPEG
Native format
Lowest ISO equivalent film. White balance adjusted. Macro 8 cm. Spot metering. Inbuilt flash. J Flash intensity ¼ 3 6
TIFF
Scanned Photographs images Publication True colour images Print & Print & Web & e-mail publication publication
GIF Line diagrams 256 colour images Animations; transparency
How do I best photograph X-rays? Exposure
Avoid reflections—do not use a flash. Photograph in a dark room with no windows reflected on film. Spot meter off a mid-range grey tone. Reduce exposure compensation 2 stops (2)—see below. Alter white balance. Do not alter brightness and contrast. Do not use Black and White (B&W) mode— record in colour and convert to B&W in postprocessing. You will get more conversion options, better results and a colour version of your photo.
Focus
Place camera on tripod. Macro mode. Autofocus. 55 mm macro lens. Shutter speed ¼ 1/2 s( ¼ aperture f 5.6).
How do I best e-mail, print and publish images?
E-mailing photos Small file sizes are the key here, as speed of transfer is more important than print quality (usually). Of course, the purposes of the image and the connection speeds influence the file size requirements, but generally aim for a file size of less than 200 Kb. I recommend converting images to JPEG format at 50% compression. Send one image per e-mail message. Many photo editing packages will convert file formats. Simply save a copy of the file in a different format. However, remember to keep the original uncompressed file also.
Photos for publication Publishers will generally specify the image format and print resolution required. The most common format is TIFF. Remember when converting from a JPEG to a TIFF, there will be no increase in resolution. The most commonly requested print resolution is 300dpi (dpi ¼ dots per inch). Print resolution is not equal to screen resolution. Below is the formula you may require to determine the required print or screen resolution.
Each of these processes demands specific image requirements for optimal useage and results. File size is a priority for sending by email, whilst image quality is more important for printing and publishing images. Publishers also demand specific image resolutions for their publications and this may differ between publishers. This is quite confusing for surgeons.
Print resolution (dpi) ¼ (pixels of length)/ (inches of length).
For example, if we have an image of 1000 pixels across and want to print an image size of 10 in across (length) then the printed resolution required is 100 dpi. We can provide this information to the image software package prior to printing the image.
ARTICLE IN PRESS 212
How should I store and manage images? As you begin to develop a strategy for culling, editing, storing and organising the mountain of images you face, keep in mind that the goal is to end up with an effective retrieval system, not just a storage system. Never, ever edit your original images. Always work on copies. Archive the originals for safe keeping, usually on an external hard drive. Repeatedly saving JPEG images in JPEG format results in a slow but sure accumulation of JPEG artifacts. If you modify an image and think you may edit it again later, save a copy in a lossless format like PNG, TIFF or your editor’s proprietary format. Most digital photographs deserve at least a trial pass through your photo editor’s ‘‘autobalance’’, ‘‘instant fix’’ or ‘‘general enhancement’’ feature. If you are new to post-processing, you can begin to get a feel for what works and what does not by noting what adjustments were made to achieve the good, the bad and the ugly results. Even a suboptimal auto-balance result can be a good starting point for your manual adjustments. This is the stage to convert your X-ray photogrephs to grayscale images, but remember to keep the unaltered original as well.
Principles 1. Stable Storage Media—I prefer an external hard disc drive, but removable storage media, such as CD-R, DVD-R, Zip drives, etc. are perfectly adequate. 2. Inexpensive—the cheapest £/Mb is advisable. 3. Rational folder structure—rational file-naming system. 4. Fast access. 5. Versatile.
Folder structures Arrange the folders on your computer in a way that is logical and allows you to easily find an image. Put a lot of thought into this. An example of the hierarchical system I use is given below C:/My Documents /Orthopaedics /Shoulder /Arthroplasty /History /History_Images. So if I wanted an image of a historical shoulder prosthesis, I know exactly where to look. You
L. Funk should develop a system that is logical to you and suits your personal way of working. Thumbnail image management software does help significantly in this process, but you still need a good folder structure. Some common, good image management software programmes include ThumbsPlus—www.cerious.com (my personal favourite); ACDSee—www.acdsystems.com -(easy & quick); Axialis—www.axialis.com (good for video & multimedia). For those familiar with Microsoft Access or Excel, these can also be used as an image management databases, by utilising the hyperlink field property. An example of this can be seen at: http://www.northernjourney.com/photo/articles/ Two useful image management software solutions, specifically written for Orthopaedic Surgery are PhotoIntern—www.desktopmedical.com Endocom, by Contec Medical—www.contecmedical.com
File naming tips Dates ¼ ‘0020816’, not ‘16082002’ Alphanumeric ¼ use ‘001’, not 1’ Long file names—suggestions: sd00475_murrayj_humerus_prox_3part_malunion_ 001a 11/cl.l_sd00475_20020317_plantan_malunion_ 001a Picture information extractor (PIE) shareware— www.picmeta.com—this utility deftly manages camera-to-PC image transfers with on-the-fly file renaming to insure a unique file name for every image. For instance, the PIE filename 0001011541-I4.jpg refers to an image taken at 3:41:14 PM on 1/1/2000. You can easily customize the filename mask PIE uses to rename downloaded images to suit your own filing scheme. For more information see: www.shortcourses.com
Consent for patient images As it becomes easier and more commonplace for clinicians to take photographs of their patients, issues of confidentiality and consent have become more important. Liability issues need to be considered. Not only is it good practice to obtain consent for images from a patient, but it is required by most NHS Trusts and laid out in the GMC Guideline document ‘Making and Using Visual
ARTICLE IN PRESS Digital imaging for orthopaedic surgeons and Audio Recordings of Patients’ published in 1997. Most NHS Trusts have a Consent From for Photography and Video, However, this may not include consent for education, research and publication. You may need to add these to the consent forms if you plan to use the images for these purposes. The American Health Information Management Association recommendations for photographing or video of patients are as follows:
Clinicians should have written policies addressing (1) circumstances under which patient photography is permitted, (2) patient consent, (3) ownership, storage, and retention of the images, and (4) patient authorisation for the release and/or use of images outside the organisation. Generally, the patient or his or her legal representative should give written consent before photography is done by anyone other than a friend or family member of the patient. Photographs, videotapes, and other images should be clearly identified with the patient’s name, identification number, and date, and stored securely to protect their confidentiality. If used to document patient care, they should be kept for the same time period law requires medical records to be kept.
Useful websites
213
It is worthwhile bearing this in mind when developing a library of patient images and establishing a procedure of consent.
Useful websites
Diploma in Medical Informatics—http://www. diploma.rcsed.ac.uk/ A Short Course in Digital Photography—http:// www.shortcourses.com/book01/contents.htm Digital Photography Tutorials—Basics—http:// www.huntfor.com/photography/tutorials/ digitbasics.htm Digital Photography for What It’s Worth (dpFWIW)—http://www.cliffshade.com/dpfwiw/ Digital PhotoCorner—Digital Terms—http:// www.dpcorner.com/al_about/terms.shtml Camera Basics—http://www.azuswebworks.com/ photography/ph_cam.html Digital Camera Resource Page—http://www. dcresource.com/ Digital Cameras & Imaging—http://www. photoworld.com/digital/digital.htm Gross Specimen Photography—http://www. neosoft.com/uthman/gross_photo.html Macro Photography—http://www.photo.net/ photo/macro
KODAK Flash Photography—Introduction— http://www.kodak.com/global/en/consumer/ pictureTaking/fIash/flashPhoMain.shtml CNET Help.com How-Tos and Tips—http:// www.help.com/cat/5/39/ht/index.html Advice for first-time digital camera users—http:// www.cliffshade.com/dpfwiw/advice.htm Exposure—http://www.88.com/exposure/ Written authorisation from the patient or his or her legal representative should be obtained before photographs, videotapes, or other images are released to outside requestors.
Diploma in Medical Informatics—http://www. diploma.rcsed.ac.uk/ A Short Course in Digital Photography—http:// www.shortcourses.com/book01/contents.htm Digital Photography Tutorials—Basics—http:// www.huntfor.com/photography/tutorials/ digitbasics.htm Digital Photography For What Its Worth (dpFWIW)—http://www.cliffshade.com/dpfwiw/ Digital PhotoComer—digital terms—http:// www.dpcorner.com/alLabout/terms.shtml Camera Basics—http://www.azuswebworks. com/photography/ph_cam.html Digital Camera Resource Page—http://www. dcresource.com/ Digital Cameras & Imaging—http://www. photoworld.com/digital/digital.htm Gross Specimen Photography—http://www. neosoft.com/uthman/gross_photo.html Macro Photography—http://www.photo.net/ photo/macro KODAK Flash Photography—Introduction— http://www.kodak.com/global/en/consumer/ pictureTaking/flash/flashPhoMain.shtml CNET Help.com How-Tos and Tips—http:// www.help.com/cat/5/39/ht/index.html Advice for first-time digital camera users— http://www.cliffshade.com/dpfwiw/advice.htm Exposure—http://www.88.com/exposure/
Summary As more surgeons and clinicians routinely photograph their radiographs and patients, a whole new
ARTICLE IN PRESS 214 world of imaging and image management skills need to be learnt. Publications are demanding digital images and presentations are now almost universally digital. I have briefly covered most of the basics you may require when embarking on
L. Funk digital imaging. No doubt, many will have their own preferred equipment, software and techniques. Digital imaging adds a useful dimension to a surgical practice, but one must be aware of consent and liability issues.
www.elsevier.com/locate/cuor
ORTHOPAEDIC INFORMATION
Digital imaging for orthopaedic surgeons Lennard Funk Hope Hospital, Eccles Old Road, Salford M6 8HD, UK
KEYWORDS Digital photography; Pixels; Storage media; Image processing
Summary The age of digital photography and video is well upon us now. Most surgeons use digital cameras, DVDs and digital camcorders in their personal lives. Most surgeons have also tried to apply digital photography in their clinical practice for recording interesting cases, teaching purposes and as part of clinical records. However, this technology is still fairly new and advancing at rapid pace. The particular requirements for Orthopaedics, such as photographing radiographs and operative images, are not usually addressed by the automatic settings of digital cameras. This paper is aimed at those surgeons with digital cameras and imaging equipment, who want to maximise and improve their technique in digital photography in the setting of Orthopaedic and Trauma surgery. I am no expert in photography (digital or otherwise). Nor do I put forth this content as fully verified and error-free, although I try very hard to make it so. My goal here is simple—to share what I have learned through experience and cross-checked reading in a rapidly growing and developing field, still rather poorly documented by the vendors and mainstream publications. & 2005 Elsevier Ltd. All rights reserved.
Introduction This paper deals with the following common difficulties: 1. Why do I need digital photographs? 2. Which camera should I buy? 3. How do I best photograph Operations and Clinical subjects? 4. How do I best photograph X-rays? 5. How do I e-mail, print and publish Images? 6. How should I Store & Manage images?
E-mail address: [email protected].
Before proceeding there are a few terms requiring clarification 1. Exposure: Relates to the brightness of an image. It represents the length of time the camera film or CCD (charge coupled device, which recovers the image in digital camera) is ‘exposed’ to light. The darker the environment you are photographing, the longer you need to expose the film to the ambient light to get a good image. 2. Exposure Compensation: The amount you increase or decrease the exposure is specified in ‘‘stops.’’ One ‘‘stop’’ increase represents a
0268-0890/$ - see front matter & 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.cuor.2005.05.003
ARTICLE IN PRESS 210
L. Funk
doubling of the amount of light reaching the film. You specify +1 to open the aperture or slow down the shutter speed and –1 to achieve the converse. It is easy to use exposure compensation because you can preview your changes on the LCD camera’s monitor. I would recommend an EC (exposure compensation) of 2 for Xrays, where an extremely dark background occupies a very large part of the image and you want to retain detail in the brighter parts of the scene. You can alter this according to your camera and requirements. 3. ISO Equivalent: ISO is the sensitivity of traditional films to light. A high ISO film (or ISO equivalent in digital cameras) is more suitable for low light conditions, but the image becomes more ‘grainy’. Therefore one should have the option of different ISO Equivalents in a digital camera. 4. Spot metering: Metering is the determination of the amount of light entering the camera, which is used to determine focus and exposure settings. This can be an average reading of the entire image or a reading of a small section of the image, within the central portion-so-called ‘‘spot metering’’.
How do I best photograph operations/ clinical subjects?
Why do I need digital photographs?
Orthopaedics is a very visual specialty and every aspect of our work requires some form of imaging. This includes clinical care, education, research and medicolegal work. The inclusion of a visual record is of great benefit to all concerned in a patient’s care—a picture is worth a 1000 words.
These are a few tips gleaned from medical photographers and bitter experience.
Which camera should I buy? The best you can afford is the simple answer, though there are some specific features you require when using a Digital Camera for Orthopaedic purposes. These include
At least 3 Megapixels image capacity—the current minimum requirement for publication (see below). Macro facility of about 8 cm—for clinical photographs and X-rays. Attachment for Tripod—improves the sharpness when photographing radiographs Manual override—for manual focus, manual exposure control is particularly useful for radiographs and operative photographs.
Preview image facility—on an LCD screen allows you to immediately assess the quality of the photographed subject and then readjust the settings appropriately for subsequent shots. Flash control—flash intensity often has to be reduced for operative photographs. An external hand-held flash or option for a ring flash is ideal for operative photographs, allowing light to wash the subject without unwanted shadows.
Move the operating lights lights off the subject, so as to use flash only. Clear away blood and any metal glare—glare is accentuated in most digital images. Change bloody swabs for clean ones—this will reduce glare and improve exposure control. Compose the shot carefully to ensure that what you want to demonstrate is shown. You may never get the opportunity again. Shoot a perspective shot, showing the entire limb or surgical area. Often when looking at a close-up of a surgical site later the orientation can be lost without a perspective view. Shoot from different angles. Hold camera with two hands. Shove the surgeon out of the way! Optimising exposure for clinical and operative images J Slow ‘film speed’—low ISO Equivalent (ISO 100)—this improves the sharpness and brightness of an often shadowy image. J Use a flash—Handheld preferable. J Alter flash strength—the automatic settings are often too bright. Look for a camera that will allow you to do this. J Spot meter on mid-tone area or meter off the palm of your hand. If in doubt expose for the highlights, to avoid white-outs, and plan to bring up the shadows in post-processing as needed. Focus J Manual focus is preferable. This is especially useful when photographing in a deep wound, such as in shoulder surgery. J Focus and compose: If you do not have manual focus then focus on the part of the image you want sharp, hold the shutter
ARTICLE IN PRESS Digital imaging for orthopaedic surgeons button half-way down, then move the camera to compose a good image, and then push the shutter button all the way down. Most cameras allow this technique.
211 One should appreciate the advantages of common file formats, which can be utilised to aid these processes. Below is a table summarising the qualities we need to be aware of. Common File Formats
Tips for photos using the Operating light and no flash
Uncompressed
Compressed
BMP
JPEG
Native format
Lowest ISO equivalent film. White balance adjusted. Macro 8 cm. Spot metering. Inbuilt flash. J Flash intensity ¼ 3 6
TIFF
Scanned Photographs images Publication True colour images Print & Print & Web & e-mail publication publication
GIF Line diagrams 256 colour images Animations; transparency
How do I best photograph X-rays? Exposure
Avoid reflections—do not use a flash. Photograph in a dark room with no windows reflected on film. Spot meter off a mid-range grey tone. Reduce exposure compensation 2 stops (2)—see below. Alter white balance. Do not alter brightness and contrast. Do not use Black and White (B&W) mode— record in colour and convert to B&W in postprocessing. You will get more conversion options, better results and a colour version of your photo.
Focus
Place camera on tripod. Macro mode. Autofocus. 55 mm macro lens. Shutter speed ¼ 1/2 s( ¼ aperture f 5.6).
How do I best e-mail, print and publish images?
E-mailing photos Small file sizes are the key here, as speed of transfer is more important than print quality (usually). Of course, the purposes of the image and the connection speeds influence the file size requirements, but generally aim for a file size of less than 200 Kb. I recommend converting images to JPEG format at 50% compression. Send one image per e-mail message. Many photo editing packages will convert file formats. Simply save a copy of the file in a different format. However, remember to keep the original uncompressed file also.
Photos for publication Publishers will generally specify the image format and print resolution required. The most common format is TIFF. Remember when converting from a JPEG to a TIFF, there will be no increase in resolution. The most commonly requested print resolution is 300dpi (dpi ¼ dots per inch). Print resolution is not equal to screen resolution. Below is the formula you may require to determine the required print or screen resolution.
Each of these processes demands specific image requirements for optimal useage and results. File size is a priority for sending by email, whilst image quality is more important for printing and publishing images. Publishers also demand specific image resolutions for their publications and this may differ between publishers. This is quite confusing for surgeons.
Print resolution (dpi) ¼ (pixels of length)/ (inches of length).
For example, if we have an image of 1000 pixels across and want to print an image size of 10 in across (length) then the printed resolution required is 100 dpi. We can provide this information to the image software package prior to printing the image.
ARTICLE IN PRESS 212
How should I store and manage images? As you begin to develop a strategy for culling, editing, storing and organising the mountain of images you face, keep in mind that the goal is to end up with an effective retrieval system, not just a storage system. Never, ever edit your original images. Always work on copies. Archive the originals for safe keeping, usually on an external hard drive. Repeatedly saving JPEG images in JPEG format results in a slow but sure accumulation of JPEG artifacts. If you modify an image and think you may edit it again later, save a copy in a lossless format like PNG, TIFF or your editor’s proprietary format. Most digital photographs deserve at least a trial pass through your photo editor’s ‘‘autobalance’’, ‘‘instant fix’’ or ‘‘general enhancement’’ feature. If you are new to post-processing, you can begin to get a feel for what works and what does not by noting what adjustments were made to achieve the good, the bad and the ugly results. Even a suboptimal auto-balance result can be a good starting point for your manual adjustments. This is the stage to convert your X-ray photogrephs to grayscale images, but remember to keep the unaltered original as well.
Principles 1. Stable Storage Media—I prefer an external hard disc drive, but removable storage media, such as CD-R, DVD-R, Zip drives, etc. are perfectly adequate. 2. Inexpensive—the cheapest £/Mb is advisable. 3. Rational folder structure—rational file-naming system. 4. Fast access. 5. Versatile.
Folder structures Arrange the folders on your computer in a way that is logical and allows you to easily find an image. Put a lot of thought into this. An example of the hierarchical system I use is given below C:/My Documents /Orthopaedics /Shoulder /Arthroplasty /History /History_Images. So if I wanted an image of a historical shoulder prosthesis, I know exactly where to look. You
L. Funk should develop a system that is logical to you and suits your personal way of working. Thumbnail image management software does help significantly in this process, but you still need a good folder structure. Some common, good image management software programmes include ThumbsPlus—www.cerious.com (my personal favourite); ACDSee—www.acdsystems.com -(easy & quick); Axialis—www.axialis.com (good for video & multimedia). For those familiar with Microsoft Access or Excel, these can also be used as an image management databases, by utilising the hyperlink field property. An example of this can be seen at: http://www.northernjourney.com/photo/articles/ Two useful image management software solutions, specifically written for Orthopaedic Surgery are PhotoIntern—www.desktopmedical.com Endocom, by Contec Medical—www.contecmedical.com
File naming tips Dates ¼ ‘0020816’, not ‘16082002’ Alphanumeric ¼ use ‘001’, not 1’ Long file names—suggestions: sd00475_murrayj_humerus_prox_3part_malunion_ 001a 11/cl.l_sd00475_20020317_plantan_malunion_ 001a Picture information extractor (PIE) shareware— www.picmeta.com—this utility deftly manages camera-to-PC image transfers with on-the-fly file renaming to insure a unique file name for every image. For instance, the PIE filename 0001011541-I4.jpg refers to an image taken at 3:41:14 PM on 1/1/2000. You can easily customize the filename mask PIE uses to rename downloaded images to suit your own filing scheme. For more information see: www.shortcourses.com
Consent for patient images As it becomes easier and more commonplace for clinicians to take photographs of their patients, issues of confidentiality and consent have become more important. Liability issues need to be considered. Not only is it good practice to obtain consent for images from a patient, but it is required by most NHS Trusts and laid out in the GMC Guideline document ‘Making and Using Visual
ARTICLE IN PRESS Digital imaging for orthopaedic surgeons and Audio Recordings of Patients’ published in 1997. Most NHS Trusts have a Consent From for Photography and Video, However, this may not include consent for education, research and publication. You may need to add these to the consent forms if you plan to use the images for these purposes. The American Health Information Management Association recommendations for photographing or video of patients are as follows:
Clinicians should have written policies addressing (1) circumstances under which patient photography is permitted, (2) patient consent, (3) ownership, storage, and retention of the images, and (4) patient authorisation for the release and/or use of images outside the organisation. Generally, the patient or his or her legal representative should give written consent before photography is done by anyone other than a friend or family member of the patient. Photographs, videotapes, and other images should be clearly identified with the patient’s name, identification number, and date, and stored securely to protect their confidentiality. If used to document patient care, they should be kept for the same time period law requires medical records to be kept.
Useful websites
213
It is worthwhile bearing this in mind when developing a library of patient images and establishing a procedure of consent.
Useful websites
Diploma in Medical Informatics—http://www. diploma.rcsed.ac.uk/ A Short Course in Digital Photography—http:// www.shortcourses.com/book01/contents.htm Digital Photography Tutorials—Basics—http:// www.huntfor.com/photography/tutorials/ digitbasics.htm Digital Photography for What It’s Worth (dpFWIW)—http://www.cliffshade.com/dpfwiw/ Digital PhotoCorner—Digital Terms—http:// www.dpcorner.com/al_about/terms.shtml Camera Basics—http://www.azuswebworks.com/ photography/ph_cam.html Digital Camera Resource Page—http://www. dcresource.com/ Digital Cameras & Imaging—http://www. photoworld.com/digital/digital.htm Gross Specimen Photography—http://www. neosoft.com/uthman/gross_photo.html Macro Photography—http://www.photo.net/ photo/macro
KODAK Flash Photography—Introduction— http://www.kodak.com/global/en/consumer/ pictureTaking/fIash/flashPhoMain.shtml CNET Help.com How-Tos and Tips—http:// www.help.com/cat/5/39/ht/index.html Advice for first-time digital camera users—http:// www.cliffshade.com/dpfwiw/advice.htm Exposure—http://www.88.com/exposure/ Written authorisation from the patient or his or her legal representative should be obtained before photographs, videotapes, or other images are released to outside requestors.
Diploma in Medical Informatics—http://www. diploma.rcsed.ac.uk/ A Short Course in Digital Photography—http:// www.shortcourses.com/book01/contents.htm Digital Photography Tutorials—Basics—http:// www.huntfor.com/photography/tutorials/ digitbasics.htm Digital Photography For What Its Worth (dpFWIW)—http://www.cliffshade.com/dpfwiw/ Digital PhotoComer—digital terms—http:// www.dpcorner.com/alLabout/terms.shtml Camera Basics—http://www.azuswebworks. com/photography/ph_cam.html Digital Camera Resource Page—http://www. dcresource.com/ Digital Cameras & Imaging—http://www. photoworld.com/digital/digital.htm Gross Specimen Photography—http://www. neosoft.com/uthman/gross_photo.html Macro Photography—http://www.photo.net/ photo/macro KODAK Flash Photography—Introduction— http://www.kodak.com/global/en/consumer/ pictureTaking/flash/flashPhoMain.shtml CNET Help.com How-Tos and Tips—http:// www.help.com/cat/5/39/ht/index.html Advice for first-time digital camera users— http://www.cliffshade.com/dpfwiw/advice.htm Exposure—http://www.88.com/exposure/
Summary As more surgeons and clinicians routinely photograph their radiographs and patients, a whole new
ARTICLE IN PRESS 214 world of imaging and image management skills need to be learnt. Publications are demanding digital images and presentations are now almost universally digital. I have briefly covered most of the basics you may require when embarking on
L. Funk digital imaging. No doubt, many will have their own preferred equipment, software and techniques. Digital imaging adds a useful dimension to a surgical practice, but one must be aware of consent and liability issues.