Medical imaging has made enormous strides in the 21st century as technology enables doctors to see the human body like never before. Computers and the internet enable patients in remote rural areas to get examined by specialists hundreds of miles away, all thanks to digital imaging.
Automation has also enabled medical technicians, nurses and doctors to do much of the work themselves. Computer programs like PowerPoint and the macro settings on point & shoot cameras saves both time and money; and with rising medical expenses, the photo departments, not covered by insurance, have forced many medical photographers do more than ever before.
First Health of the Carolinas began replacing film based radiological technology with an online digital capture and storage system in 2005 and according to Mike McCarty, director of Imaging, their annual film budget was cut from $800,000 a year to just $50,000.
Adam Cooper, RBP, FBCA and North Shore-LIJ Studios filled a need and survived where other medical photo departments disappeared as hospitals with tightening health care benefits strive to cut overhead.
North Shore-LIJ Studios saves the hospital money as a full service studio doing both video and still photography, micro and macro close-up photography, before and after surgical imaging, along with taking executive portraits, providing all the photos for several annual reports, covering black-tie events, creating posters and designing and running video conferences for 15 hospitals in the North Shore-Long Island Jewish Health System (New York), the third largest health system in America.
Cooper majored in Bio Medical Photographic Communications at the Rochester Institute of Technology, where he took many of the same science classes required by medical students.
He says the program was mainly doing close-up scientific images, which is now only a small portion of his work, but his classes in science, video, and business enable him to understand what the doctor wants to see and get the photo and/or video they need to help diagnose an illness and in education. It also helps the institution make money, as they draw doctors from around the world to view videos of operations and learn new techniques.
North Shore-LIJ Studios also takes portraits of over 8,000 physicians to be used in both print and online directories. The hospital needed to get into tele-conferencing and their director, Dennis Skahill admits he just dove in, but is now considered an authority.
"We reinvented ourselves over and over again, I'm not doing close to what I did 10 years ago" says Cooper, who boasts that they like to keep moving forward and try to add a new service every year. With five people in the department, two specialize in video editing, two photographers do both still and video, and one person handles the video-teleconferencing.
Working closely with doctors
Cooper is also working with facial plastic surgeon Dr. Michael Setzen to create a series of photos that help patients see what changes the plastic surgeon will make. Using Adobe Photoshop CS3 enables Cooper to insert some guidelines to help the surgeon know how much to correct, for example to make both eyelids match. With the computer, both the patient and the doctor can see what needs to be done before the operation.
Plastic surgery doesn't change that much and often before and after photos resort to simply showing the patient with and without makeup.
To help show what will be done, Cooper starts by taking a well lit photo of the patient, as he/she looks before the operation, then goes into Photoshop and uses the liquefy tool to show how the possible results may look after surgery. Now he has two images, but to make it easier to compare, he makes a third image with the "after" photo superimposed over the darkened "before" photo, to better see the changes.
Dermatologists find photos to be helpful tools in seeing if there have been any changes to the skin's surface. Using photos they can spot any [cancerous] changes sooner and save money, which is why Total Body Photography is sometimes covered by insurance.
Digital Derm contracts out with photographers to take front and back photographs of the hand, each arm, leg, top of head, bottom of feet, and the entire body so doctors can blow-up the photos to check for changes in the future.
Both the doctor and patient get a copy so [the patient] can compare at home and be able to spot [things] quicker and save their life.
Kevin Grabowski, director of Corporate Development at Digtal Derm says their program is user friendly for both doctor and patients suffering from Melanoma, which affects 3-5% of Americans.
It is a baseline, something accurate with quality and that's scientific, he says, "anybody can look great, but we want them to look real and that's a challenge."
When the medical photo department at the University of North Carolina got the axe in 2003, Ricky Roberson started Total Skin Photography. Some patients have driven over 300 miles to get their body photographed. He feels everybody's body is different and sometimes takes up to 75 photos of each patient, and finds it easier to simply include a slideshow with browser from Photodex. Robertson says doctors find it valuable to see actual pictures in color to be able to study the color around the mole(s). He hand delivers every CD to the doctor to insure privacy.
For Sandra Anderson, her 20 years experience helps her spot problems, working for Vanderbilt University's Ophthalmic Imaging Center. Going blind is one of the side effects of diabetics and hard to detect. Anderson links to mobile units traveling in rural areas of Tennessee doing diabetic retinophey screenings, with the images transmitted back to Memphis. Her work allows Anderson to make sure serious cases get moved ahead and are seen quickly by ophthalmologists. She trains the technicians on using the digital camera and needs to use both her medical and photographic experience to spot signs of infection or malfunctions in taking the photos.
"You have to know what you are looking for and where to find it," she says, as she scans over images taken by a nurse or lab technician. She is then able to phone them and discuss further the images or retaking shots to get a clearer picture.
Timothy Bennett, president of the Ophthalmic Photographers' Society sees "Eye imaging Experts" as a good career choice using a unique and expensive "fundus camera" that will take several shots a second to show how dye circulates through the blood vessels in the eye.
Anderson explains that it takes 12 seconds after the dye is injected in the arm for it to get to the eye, and her job is to get photos of where blood has "leaked out or pooled in pockets" to help doctors determine disease and how to treat it.
"You have to be able to swing around and get different angles," says Anderson, "you have to know the diseases, how to find them and to image them for the retina or cornea specialist and get stereo images for the glaucoma specialist."
"With the aging baby boomer, the need is increasing to get diagnostic [images] and not just document," says Bennett, who sees that technology is doing the work and has reduced the number of skilled photographers. "But there is still a need for people with strong photographic background, more so in strong academic medical centers," he adds.
Eye imaging experts don't simply record and document the eye, they have to diagnose and identify the problem too. "One of the things the job has warfed into is assisting doctors in checking vision, "where the doctor can rely on you to help analyze things. Knowing optics helps out in that regard," says Bennett.
Ophthalmic Photographic Society strives to promote high standards by offering yearly training and certification. Bennett doesn't like hearing, "I push the button because they told me to and the pictures have looked dark like this for a long time."
For Gary Schnitz, who started out as a medical illustrator and is now at the Hand Institute in Indianapolis, IN, medical photography is a serious craft. Schnitz takes care of all the visual needs at the Institute, from shooting videos in three operating rooms (while located in a recording/editing room one floor above), to doing a series documenting how an amputated hand was reattached.
He knows that doctors and nurses aren't trained in visual communications. "I think if I had a better vantage over on the other side of the elbow it would show a better approach and be more educational," he says. "They're just not thinking outside the box."
In medical photography you have to know what you are looking for, and Schnitz says, "you have to care about the family, really empathize with them. You have to be on it as if you were a medical professional, which most medical photographers think they are."
Today he shoots with a digital Nikon camera with a long lens and a pretty intense ring-flash, "so I don't have to [be] two-inches from an open wound. You want to capture the essence of the image, what the physician wants, but I want to go an extra mile and make it as museum quality as I can."
"I'll come into the emergency room for a quick shot, but you never know that six-months from now they'll want to put it on the annual report cover," he says.
Medical Photography Today
As medical photography moved away from photographers to medical technicians in the 80s, there was no one left to take portraits, cover events, create posters, brochures and multi-media presentations -- and in many cases the doctors simply do it themselves.
But the competition is out there, and hospitals, clinics, physicians, dentists, plastic surgeons, along with businesses selling products to the health industry are looking to get online with "information destination" websites, says DDA Medical outside Philadelphia, PA.
"Whether you are a healthcare professional looking to reach out to patients, a doctor trying to communicate with colleagues, or a marketing director trying to gain product exposure," they see it as a must to have a website with attractive photos and videos.
Doctors who once felt being professional meant having to rely on patient referrals, are now going online, so patients have 24/7 access to their doctor, can get answers to basic questions, find the best directions to his office, and see the faces of those who work in the office.
VC Cubed in Houston, TX, offers its clients an "original stock photography library" along with medical website design, content, hosting and site marketing.
Trying to cut costs, a recent job opening at Cook Children Hospital in Dallas, TX advertised that they wanted a Creative Services Manager who had training in: "news-writing/editing, interactive media, graphic design, video scripting, photography a must," along with "relevant experience in healthcare, insurance, government, consulting, advertising, and public relations." This is a lot for one person to handle--if the hospital wants the creative services departments to succeed in promoting, informing and documenting services--the manager won't be able to do it all. They will have to delegate some work to a professional photographer.
For more information about medical photography there are a number of organizations you can contact including: Ophthalmic Photographers' Society - www.opsweb.org, Mole Mapping - www.digitalderm.com, Biomedical Photographic Communication, Rochester Institute of Technology - www.cias.rit.edu, Bio Communications Association - www.bca.org and Health Sciences Communications Association - www.hesca.org.