Physician Spotlight

Todd E. Schlesinger, MD, FAAD, is director of Dermatology and Laser Center of Charleston and Clinical Research Center of the Carolinas. He is also Clinical Instructor at the University at Buffalo Department of Dermatology, an assistant clinical professor of the Medical University of South Carolina Department of Family Medicine, and clinical preceptor at the Medical University of South Carolina College of Health Professions in Charleston. Dr. Schlesinger often lectures on medical photography and the art of before and after images. He shared some pearls with Practical Dermatology®.

What are the best cameras for medical photography?

Todd E. Schlesinger, MD: The best cameras for medical photography depend on the application. For routine clinic use, a mini single-lens reflex (SLR) would work just fine. Modern cameras have very good lens quality, sensor quality, and resolution. One of the most important things to look for is one or more custom settings. These allow the user to set memorized settings for important parameters like white balance, shutter speed, aperture, and zoom. Our practice uses cameras for routine use that cost between $300 and $500, so one does not have to spend a lot to get a lot. Using tablets or phones for imaging may not produce as high-quality images because of the small lens, wide angle, and lack of ability to customize settings and their use of a strobe flash.

Any advice on how to set up standardized backgrounds?

Dr. Schlesinger: My best advice for standardizing backgrounds is to dedicate a photo room if your space allows and using standard photo backgrounds, usually light blue. Many offices do not have space for this, however, so a backdrop may be used in an exam room or treatment area, depending on the application. Of course, consistent lighting is key, a windowless room allows the best control, but blackout shades also work. Photography lighting equipment is surprisingly available online and can be portable and set aside when not in use. Be sure to use more than one lighting source to reduce shadowing, possibly three or four sources with reflectors/diffusers. Modern LED lighting often has color temperature controls so one can match skin tones.

Any tips on organizing, storing, and sharing the photographs among multiple providers in a single practice?

Dr. Schlesinger: This is a tough one because many online providers are not HIPAA compliant. Using a compliant cloud server is one way, but one may also use an intranet, where the files are maintained on a shared server network accessible from all office locations. Be sure any cloud-based service has the proper business associates agreement in place with your practice, as well as HIPAA compliant safeguards such as audit trails and restrictions on copying and access. The problem becomes attaching metadata, such as orientation, location, diagnosis, procedure, or patient. One may need a file system for that purpose. Several medical camera companies offer such a system, but multi-user concurrent licenses can be expensive.

Can you integrate photos with EMR systems?

Dr. Schlesinger: Some EMRs use an integrated photo platform, but many lack the robust metadata that may be desired for searching/sorting the photos later. The ability to import photos off devices other than tablets/phones is important. New, wireless SD cards can send photos over WiFi straight into the software, so that can be very helpful. In our practice, we keep the photos outside the EMR on a private cloud server. No licensing is needed and the photos are accessible throughout our offices. We have changed EMRs three times, but our photo filing system remains intact. For any EMR system, be sure the photos can easily be exported.