By Barry Press, MD
Radiograph and MRI/CT photography is best done using a lightbox with the room lights off (this prevents reflections, which are very difficult to remove.) Turn the flash off and stabilize your hands to minimize motion artifact. Use the macro mode; most cameras focus best in the middle zoom range. Set the zoom to the middle of its range and then move closer or farther from the lightbox so that the image is centered and nearly fills the viewfinder. Take multiple images. When editing these, change the format to grayscale; this removes any color cast and decreases the file size. Take care to remove any patient identifying information from images that will be shown to others.
When you know you will be shooting intraoperative photos, have the OR pull several extra pairs of overgloves. Put these over your gloves, grab the camera, and shoot.
For photographs of the operative field, it is generally best to use the camera’s flash and turn off the OR lights or direct them away from the field. If you don’t like the looks of the photo, try it with the OR lights on the field and/or with the ambient light only.
Take a few moments to clean the skin edges of blood, and frame the area of interest with clean OR towels. If necessary, have an assistant hold a towel as a background. Removing distractions in this manner will significantly improve photo quality.
As in the office, attempt to keep the extremity flat and close to the background. Make sure your focusing is accurate. Locking the focus on a high contrast spot in the area of interest and then framing the desired photo can minimize focusing difficulties. Many cameras will “lock” focus by pushing the shutter release halfway down and holding it there until taking the picture.
Hand off the camera, remove the overgloves, redirect the OR lights and continue the case.
For intraoperative digital microphotography/microvideography with a standard consumer digital camera, please consult Yanni DS, Beshara M, Ebersole K et al. Surgical Neurology 72(2009) 153-156.