Medical Photography

[ldhrads]

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Any advice would be appreciated, and please, if mods need to move this, do so. As some of you may have surmised I am in the medical field, I treat cancer with radiation for a living. I often document skin lesions etc. with a crappy canon P/S that we've had in the department for taking face photos of our patients.

 

I'd like to start taking better photos of skin cancers before and after for a variety of reasons, I'd also like to better photograph the before and afters of my breast cancer patients for cosmesis review. I don't want to break the bank, but I would like to do better than what I've been doing.

 

Any suggestions would be greatly appreciated as to gear and perhaps simple/reproducible/effective lighting setups

 

Thanks

 

[jaapv]

If you want to keep it simple, buy a dedicated medical camera system. If not, you need a DSLR with a longish macro-capable lens and ring flash. I use the Digilux3 with the standard zoom, 2x converter and Olympus ring flash. I’m on holiday now. I’ll post a few examples when back at work.

[TomB_tx]

A very capable system could be based on the Pentax K-5 dSLR, perhaps with their 50mm f2.8 autofocus macro lens. The K-5 body is on sale now for $999; the macro lens about $600. The K-5 is APS sensor size, so the 50 macro covers about like a 70 would on 35mm.

I use a K-5 along with my Leica M9, and have been impressed with the K-5 image quality. For macro I use the old film-type manual focus 100 mm macro, which can be found used for under $200, and is an excellent lens. Pentax, like Leica, can still use every lens they have ever made (from 1952) on their dSLR cameras.

[marknorton]

I agree, a dSLR is the way to go. Jaap uses that rebadged Pansonic clunker but I would use a small Nikon dSLR and their 60mm AF-D lens - the new AF-S is even better. A bigger issue is illuminating your subject without frightening them and the Nikon ring-flash equivalent is a bit of an ungainly beast.

 

In the old days, there used to be a lens called the Medical-Nikkor which was a 120mm lens with built-in ring flash. Long gone and now a collector's curiosity, so I would be more inclined to use a third party ring flash. Exposure accuracy is an issue because of the proximity of the subject, so some sort of auto-mode is important. The Nikon CLS flash system gives you that, their earlier ring-flash was too much trial and error.

 

Other SLR vendors will have their own solutions...

[jaapv]

Panasonic -they rebadged Olympus and Leica rebadged Panasonic- but in the end it is plenty good enough for the purpose. And the Olympus ring flash is a gem and fully compatible. 60 mm is far too short for the purpose. 135 to 200 equivalent is best.

[thighslapper]

My partner in her dermatology clinic uses a cheap sony cybershot DSC W55 with a sony lens adapter allowing it to be used with a Dermlite II Pro Dermatoscope. Results are as good as complex set ups costing thousands.

 

That limits you to lesions up to about 2cm though...... and is more for diagnostic purposes....

 

For more general medical use a camera with a ring flash or similar is really required..... which really pushes you into DLSR land and dedicated macro/medical lenses.......

Adequate and consistent illumination is the main problem in most medical settings..... what you actually take the photos with is not that critical....

 

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[SJP]

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The father of one of my best friends (still) as a internationally renowned cancer surgeon used a technical grade Polaroid. Anything digital out there I expect is better if you know what you are doing. For archival stuff I expect only a raw format is acceptable.

[jaapv]

Panasonic -they rebadged Olympus and Leica rebadged Panasonic- but in the end it is plenty good enough for the purpose. And the Olympus ring flash is a gem and fully compatible. 60 mm is far too short for the purpose. 135 to 200 equivalent is best.

 

forgot the reason: for documentary purposes you want a natural looking perspective. hence the focal length. the IQ is fairly irrelevant. Storage is computer grade Jpeg, display at most beamer and powerpoint...Color rendering as good as you can get it.

[Guest srheker]

 

Any suggestions would be greatly appreciated as to gear and perhaps simple/reproducible/effective lighting setups

 

 

I'd recommend a Canon/Nikon APS-C DSLR, a Canon/Nikon macro lens and a TTL macro flash like this one:

 

Canon MR-14EX TTL Macro Ring Lite Flash 2356A002 B&H Photo Video

 

 

This leads to a simple fixed combination that can be operated with fixed settings.

[pico]

In my earlier career I digitally processed thousands of medical photos and x-rays and most doctors who commissioned them regretted that there were no magnifying nor fiduciary markings for scale and orientation.

 

I would make some myself, knowing the dimensions involved, but that's not truly the same. Such is unacceptable now.

 

Consider looking into dedicated cameras that make images that can be accepted by critical journals. You would be one of the few. You would not believe how many professional researchers doctor their images not because they want to deceive people but because they can.

.

[Guest]

A very capable system could be based on the Pentax K-5 dSLR, perhaps with their 50mm f2.8 autofocus macro lens. The K-5 body is on sale now for $999; the macro lens about $600. The K-5 is APS sensor size, so the 50 macro covers about like a 70 would on 35mm.

I use a K-5 along with my Leica M9, and have been impressed with the K-5 image quality. For macro I use the old film-type manual focus 100 mm macro, which can be found used for under $200, and is an excellent lens. Pentax, like Leica, can still use every lens they have ever made (from 1952) on their dSLR cameras.

 

If I remember it right, the Pentax has an useful feature: you can give a four digit number to every picture before taking it, as an alternative to consecutive picture numbers given by the camera. So you can have the patient's number on each picture. Works with up to 9999 patients. Setting the individual number takes 10-15 seconds (if it works as easily as on my trusted Canon).

 

Years ago I got a Canon 1DIIN mostly for this advantage, but the Pentax costs and weights less, while the Canon survived constant spraying with disinfectant (and wiping off with water on a sponge in the evening) over many years.

[spydrxx]

One of the popular lenses for dental work is the Kiron produced, Lester Dine badged, 105mm f2.8 macro lens, which goes up to 1:1 without and extension rings. I often use it with an old ring flash. It was produced with mountings for various camera bodies. I have the Canon FD version, but I do know it came with a Nikon F mount, which would be usable on any current Nikon DSLR. The Nikon version (used) runs about $400 these days and are worth every cent....razor sharp, flat field, and smoother than warm butter. Of course, the Nikon Micro 105mm f2.8 is also an excellent lens but more expensive.

[AlanG]

In my earlier career I digitally processed thousands of medical photos and x-rays and most doctors who commissioned them regretted that there were no magnifying nor fiduciary markings for scale and orientation.

 

 

Yes, and if you wish to be exacting, consider using a color chart and step tablet. Shoot raw and adjust the images to the proper color and contrast to standardize your system.

[ldhrads]

Thanks all,

I have an early Olympus e-500 that sees little use thsese days. I do have their 50mm F2 macro lens, Olympus makes a dedicated ring flash for that setup, so I think I'll give that a try for a while. Pico has a point, I put a ruler in all my shots now, wish I could build that into the camera somehow,but we'll see how this works.

 

Thanks again for the great discussion.

[Guest]

You don't need an Olympus ring-flash for this, Lawrence.

Any good, moderately priced and strong ring-flash without TTL (or even eTTL functions) will do.

 

Maybe you test and then memorise (or write on the back of the ring-flash) the ASA settings at different magnifications with your (constant?) aperture of choice and that's that.

Thus, later looking at the ASA setting of each picture, you can tell what magnification you used.

This way the messy little metal ruler becomes superfluous.

 

At work I'm confortable with f:32, the diffraction at the smallest aperture being secondary to the additional depth of field for my purposes.

I shoot RAW&small jpegs simultaneously. Never needed the RAWs though.

Because of the 58 filter diameter of the ring flash I use, I have a Canon 100mm Macro and a teleconvertrer 1.4X.

They don't go together so I had to put a small extention ring of 8mm between them.

A 180mm would have been ideal for my work, but the filter diameter of that lens is too big for my ring flash.

 

Agree with Jaap, that at least the double of the normal focal length gives optimal results, possibly also for flat field as in dermatology.

 

Nothing against Olympus at all. Their 2/90 Macro was my "workhorse" for many years. AndI have a nice old Olypus ring-flash at home, that is not so strong, with 2 circular reflectors of different diameters, that give a very soft light from 1:5 into magnification (for toys of my daughter years ago and mostly flowers, that she uses now).

 

Best regards,

Simon

[adan]

My first job out of college was as a hospital photographer. Still the film era, but our standby for pre, post- op and during the surgeries themselves was a motorized Nikon F3, Nikkor 105 macro, and ring flash - and Kodachrome 25.

 

The surgeons always had sterilized metal metric rulers on their tray that they could place within the picture area (and we kept non-sterile scales in the studio for the pre/post-op studies).

[pico]

My first job out of college was as a hospital photographer. Still the film era, but our standby for pre, post- op and during the surgeries themselves was a motorized Nikon F3, Nikkor 105 macro, and ring flash - and Kodachrome 25.

 

I could not get a camera into the sterile field, and required a remote to get a camera far over the field, so that was a no-go. This is one of a series done for Parade Magazine. They ran a disappointing color closeup of the surgeon on the cover. This is one of the unused pics. Yah, I was in Eugene Smith mode or something.

 

Arthur Rothstein was the picture editor at the time so you know it was from the Seventies.

[jaapv]

Just to put into perspective: a ring flash with GN 16 is considered strong. Most cheap ones are adaptations of the GN 8 Star flash, which I cannot recommend.

As for keeping the setup aseptic, I use adhesive foil infection barrier plastic, which comes in 10x10 cm sheets.

You don't need an Olympus ring-flash for this, Lawrence.

Any good, moderately priced and strong ring-flash without TTL (or even eTTL functions) will do.

 

Maybe you test and then memorise (or write on the back of the ring-flash) the ASA settings at different magnifications with your (constant?) aperture of choice and that's that.

Thus, later looking at the ASA setting of each picture, you can tell what magnification you used.

This way the messy little metal ruler becomes superfluous.

 

At work I'm confortable with f:32, the diffraction at the smallest aperture being secondary to the additional depth of field for my purposes.

I shoot RAW&small jpegs simultaneously. Never needed the RAWs though.

Because of the 58 filter diameter of the ring flash I use, I have a Canon 100mm Macro and a teleconvertrer 1.4X.

They don't go together so I had to put a small extention ring of 8mm between them.

A 180mm would have been ideal for my work, but the filter diameter of that lens is too big for my ring flash.

 

Agree with Jaap, that at least the double of the normal focal length gives optimal results, possibly also for flat field as in dermatology.

 

Nothing against Olympus at all. Their 2/90 Macro was my "workhorse" for many years. AndI have a nice old Olypus ring-flash at home, that is not so strong, with 2 circular reflectors of different diameters, that give a very soft light from 1:5 into magnification (for toys of my daughter years ago and mostly flowers, that she uses now).

 

Best regards,

Simon