Medical Photo Documentation

Photo documentation is the process by which patients can easily track a variety of problems over time. This can provide valuable medical information for patients as well as a valuable tool for medical professionals in their assessments. This value however is only true when photo documentation is done correctly. There are many patients who fail in their attempts to properly document a problem which despite their effort provides little, if any information to their provider. The most common reasons that patients may wish to photo document a problem are dermatologic reasons such as skin rashes, skin wounds, skin lesions, or other skin-related problems.

In order for photo documentation to be of any value it must be a high-quality image that clearly demonstrates: 1) Visual of the problem, 2) Scale of the problem, and 3) Change in the problem over time. Take for instance this photo here:

Example: Can you tell what the photo to the left is?

This photo is a common example of a photo sent by patients to evaluate a skin lesion/rash. Unfortunately, it is impossible to tell what it is other than simply: a blurry red dot. No medical or diagnostic assessments can be made from a photo like this.

1) Obtaining a high-quality visual

Obtaining a high-quality visual of a skin problem requires two major factors. In medical photography, the things that will make the biggest differences are simply: Lighting and Focus. There are of course other factors that we could debate with a professional photographer, but for a patient simply trying to get a good photo to show their doctor, good lighting, and focus are all that is truly required.

Camera:

We do not need professional quality cameras for medical documentation. Most patients can do just fine with the ones that are readily available on smartphones or other mobile devices. For the purposes of medical documentation if you have a cell phone that was built any time in the last 5 years you probably have a camera in your pocket that is more than capable of doing the job. There may of course be special settings to get the optimum photo which would depend on the type of camera and operating system you have. But most should be able to get a quality photo without knowing any specialty settings

Lighting

Lighting on the other hand can make all the difference in regards to medical photos. Take the examples below. Notice the difference in sharpness of the photo in low lighting, decent lighting, and good lighting

Notice the differences between all 3 images. All 3 photos were taken the same distance away, from the same person only a minute apart. Yet lighting makes all the difference. Not just the skin lesion itself which is noticeably blurrier in the first photo, but the surrounding skin also has changes in color, texture, and other variations that can be seen in good lighting which are not visible in poor lighting conditions

Focus

Most cell phone cameras have what’s known as focus. Despite often having an auto-focus, a majority of cameras still need you to pay attention to how far away you are placing the camera from your target. If you pay attention you may see your screen zoom in and out automatically as it attempts to focus on the area of concern. Some cameras may require you to tap on the screen to target focus. Take the following photos. All were taken in the same lighting condition but at different distances away from the lesion. Can you see the difference in sharpness in regard to the lesion?

It is easy to see how changing the distance and properly focusing on the lesion can change the sharpness of the photo and how easy it is to tell what it is.

2) Measuring the size of the lesion

The next factor to consider is the scale/size of the lesion. If you look at any of the photos above you’ll be able to see that even with proper lighting and focus, there is no real way of knowing how large the lesion is. In order to do this you need a way of measuring the lesion. The most common way of doing this is to simply use a ruler in the photo. Medical measurements are always in Metric. So be sure to use the metric side of a ruler and try to align the ruler so that one side of the lesion correlates with a whole number.

*Note: Some phones may have built-in rulers to mark up the photo with. These are not typically precise or consistent enough to be of medical use. An actual physical ruler is recommended

3) Tracking changes over time

The final factor to recognize is that lesions can and do change over time. In order to track for progression or healing there must be a way of determining when a photo took place. All of the above photos lack any information on when they were taken. They could be days apart, weeks apart, or taken at the same time and there’s no real way of knowing. Some phones can place a time stamp on the pictures themselves, while others cannot. One of the simplest methods is to simply set a text markup on an image to manually add the date to a photo.

*Note: Most phones contain metadata that logs timestamps in the local system. This information is normally not visible when being submitted or shown to others. The date needs to be visible on the photo itself

Bringing it all together

Remember, medical photo documentation is the art of creating high-quality photos, that bring real value to a patient’s situation. In order to provide a quality photo it must have the right lighting, focus, size, and date. If you can provide all of those details, your healthcare provider will be more likely to help you.

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