Medical Photography

[sunsnow]

Hello everyone, I'm new to this forum and look forward to the wealth of advice that you offer!

Here's the situation. I work in a wound care research division where we will be using the camera(s) to document wound progression over time. The pictures will be used both for in house documentation and for submission to medical journals for publication.

We will be taking pictures both in and out of the OR - meaning that when we are OUT of the OR we can be all right up in the wound, but while IN the OR we have to be about 1-3ft away from the wound.

Some of the wounds are shallow, and some of them can be a few cm deep. Various textures, contours, and degrees wetness are involved.

Right now, there is no post manipulation of the photos, but the ones that get submitted for publication might be worked on by the journals before printing.

Oh, yes... And the people that DO the photography are AMATEURS. You can assume minimal to no photographic experience. I have found a guide or two for them to use to at least try to give them a little step up, but be that as it may... Amateurs.

Our current rig is a Nikon d800, with a AF-S Nikkor 24-120mm 1:4 G ED lense. We have no flash currently, just the pop-up one on the body. It works well, but I'm sure would be much better with a proper flash.

My boss has tasked me with finding the best camera for the job with money being no object, and this is the rig that my research came up with:

-Canon D5s

-Canon EF 24-70mm f/2.8L II USM satndard zoom lense

-Canon EF 100mm f/2.8L IS USM Macro lense

-Canon Speedlite 430EX III-RT Flash - with diffuser

-Canon MR-14EX II Macro Ring Lite

-and various accessories like a monopod, extra battery, memory cards, and extra batteries for the flashes...

PLEASE - tell me what you think! My specific questions are as follows...

1. Which ring flash and or regular flash would you recommend for the Nikon?

2. Would it be better/worse to go with generic flash equipment for the Canon ($500 vs. $90 ring flash)?

3. Any other thoughts about these rigs for medical photography...

THANKS IN ADVANCE!!!

 

[PenPix]

To be the Devil's advocate, I suggest a Sony A7ii instead.

Since it's all amateurs, I think they will find the A7ii a lot easier to use since they will be composing the pictures on the rear LCD screen, which flips out so you can view it at various angles. It also has fewer buttons and dials to worry about The Sony lens is a 90mm macro and there are a few options for a ring flash.

BUT... what is wrong with the Nikon? The lack of a 105mm macro lens and ring flash is the biggest weakness to your system and adding those should be sufficient and cheaper than starting fresh.

 

[Tim Reidy Productions]

-Canon EF 100mm f/2.8L IS USM Macro lense

start with something like the lens above what ever system you get.

good luck there is a macro section of the forum for help

 

[Richard B99]

Hello everyone, I'm new to this forum and look forward to the wealth of advice that you offer!

Here's the situation. I work in a wound care research division where we will be using the camera(s) to document wound progression over time. The pictures will be used both for in house documentation and for submission to medical journals for publication.

We will be taking pictures both in and out of the OR - meaning that when we are OUT of the OR we can be all right up in the wound, but while IN the OR we have to be about 1-3ft away from the wound.

Some of the wounds are shallow, and some of them can be a few cm deep. Various textures, contours, and degrees wetness are involved.

Right now, there is no post manipulation of the photos, but the ones that get submitted for publication might be worked on by the journals before printing.

Oh, yes... And the people that DO the photography are AMATEURS. You can assume minimal to no photographic experience. I have found a guide or two for them to use to at least try to give them a little step up, but be that as it may... Amateurs.

Our current rig is a Nikon d800, with a AF-S Nikkor 24-120mm 1:4 G ED lense. We have no flash currently, just the pop-up one on the body. It works well, but I'm sure would be much better with a proper flash.

My boss has tasked me with finding the best camera for the job with money being no object, and this is the rig that my research came up with:

-Canon D5s

-Canon EF 24-70mm f/2.8L II USM satndard zoom lense

-Canon EF 100mm f/2.8L IS USM Macro lense

-Canon Speedlite 430EX III-RT Flash - with diffuser

-Canon MR-14EX II Macro Ring Lite

-and various accessories like a monopod, extra battery, memory cards, and extra batteries for the flashes...

PLEASE - tell me what you think! My specific questions are as follows...

1. Which ring flash and or regular flash would you recommend for the Nikon?

2. Would it be better/worse to go with generic flash equipment for the Canon ($500 vs. $90 ring flash)?

3. Any other thoughts about these rigs for medical photography...

THANKS IN ADVANCE!!!

Hi

Just wondering why you don't stick with the D800. It's more than good enough for your purposes and switching to the Canon, while it is excellent, doesn't get you much further for this sort of thing

Easy route is to:

- Add Nikon 105mm f/2.8 Micro VR. For the work you outline, you dont need a zoom, just move closer / further away! Fantastically good lens for this sort of thing.

- Add Nikon R1 macro flash. The R1 uses the D800 to control the flashes using the pop up flash on the body. (There is a R1C1 set, that adds a controller that plugs into the hot shoe but this isn't needed with the D800.). This macro flash system is very good and doesn't have any trailing wires - possibly handy in an OT. Its also very easy to use because Nikon's CLS flash system is pretty foolproof.

Nikon don't do a ringflash system anymore. The R1 gives better more flexible light modelling. Ringflash gives such a flat balanced light that its pretty 'boring'. However, for medical applications, that can be useful and a ring flash has less 'sticky-out-bits' than the R1 which you may welcome in the OR at 1'. So if that's better for your needs then look at the Metz Mecablitz Ringflash 15 MS-1. Another completely wireless TTL system. Metz have long been the pro choice for 3rd party flashes and are very well engineered and reliable. For this use, much better than the cheap $90 options.

Not sure I'd bother with a monopod for your purposes. Flash will almost certainly 'solve' any of your current problems over blurring because it freezes action and throws on so much more light that you get much greater depth of field (e.g f/22). A. Monopod will just be awkward to manoeuvre over a patient; I suspect you want to take the camera to the wound not the other way round!

If you go this way (macro lens plus ringflash) you are probably going to spend only $1000 odd which may be welcome and may win you some 'brownie points' even if money is no object. (Indeed, this would probably be ideal Nikon setup anyway - although, from new you would get the D810 but no real point in that.)

 

[a_c_skinner]

I've taken and seen taken a lot of photos in operating theatres.

The suggestion of the Nikon D800, 105VR and the Nikon R1 kit is good. I'd not use a zoom lens, it will add more complication, especially if you are trying to estimate the actual size of the wound. You will gain nothing by changing systems.

Our professional medical photographers used D800 and the 105VR and a normal Nikon flash.

105mm on full frame will get you far enough away from most surgery unless:

1. The wound is very small or

2. The operation is orthopaedics (or neurosurgical) where there is a lot of worry about infection. If it is done in a laminar flow theatre strictly speaking they won't like you within the laminar flow area (marked on the theatre floor usually), and then you can be in great difficulties as your viewpoint is limited and a long way away.

You might be better with a small step ladder too, though most UK theatres have standing stools which will be available unless the first assistant is very short.

Our single use skin markers used to have a sterile cm scale packed with them, and you may find having one of these in the shot is helpful.

Oh and BTW the photographers will be professionals, since they will be doing it as part of their work. Amateur/professional is about if it brings in money, not how good or knowledgeable you are or indeed what gear you use. I accept they may be unskilled.

--
Andrew Skinner

 

[sunsnow]

Thanks for the input! From what I'm gathering from everyone is that the Nikon is great but would benefit from the 105 macro lens and the R1 flash system. I'll run that up the flagpole so to speak.

We definitely will keep using the Nikon but due to needing to take pictures in clinic at the same time we're in the market for a new camera anyway. I do think we'll go with the Canon, and that way we can kind of do a head to head comparison. BUT, it sounds like I can leave off the monopod, and that I should go with a ring flash instead of the speedlight (and pivoting frame). Finally it seems like we would only need the macro lens and not the other 24-70 lens.

Sounds right?

Thanks SO much for your advice!

 

[photosen]

You could keep the current camera, get a 105mm Nikkor Micro lens, and a Yongnuo yn-14 macro ring flash, which happens to have ettl so all your users have to do is point and shoot, wait for the flash to refresh, and shoot again. I have an older Tamron 90mm macro lens which I bought used and that Yongnuo flash, it works well. I would also buy a big padded bag that holds the camera with the lens and flash on so it doesn't get knocked around in emergency situations. Use eneloop batteries.

 

[PenPix]

Sounds about right. Although I doubt you will gain anything switching to Canon... I see it more of a lateral move than an improvement of any sorts.

Only get the 24-70 if you want some nice group pictures at the Christmas party.

 

[a_c_skinner]

Buying into a second system in one enterprise for no obvious reason is foolish. Actually it is crazy. You'll get support on here because this is a gear forum and people will encourage you to do what they want for themselves which is a lot of gear to play with irrespective of the utility.

The only logic I can see is to enable people to play with both systems, which probably isn't what your boss had in mind and I'd ask some pretty difficult questions if one of my staff did something so self indulgent.

If you need a second setup look at the lower end Nikons with the DX macros which are excellent. The 85mm will give a working distance that infection control will tolerate as will the 60mm FX which would give you some backup on a big system.

I'd stick with the Nikon macro flash setup in both locations personally, but either way I'd buy the same system in both places.

All the medical photography depts I've dealt with have been Nikon, but that is historical, they never saw any reason to switch and I've NEVER seen any department that had a mish mash of gear.

Finally it sounds to me as if the OP has modest experience of close up photography and perhaps limited technical knowledge and this is undoubtedly true of some of the other operators. My strong advice is to get someone who really knows his/her stuff, probably a professional medical illustrator, to give about a day's tuition in a group to everyone. Close ups are difficult and no matter what the gear you won't pick it up yourself quickly. In UK there is a society of medical illustrators and something similar could find you the right person. This is probably more important than any gear you could buy.

--
Andrew Skinner

 

[Richard B99]

Buying into a second system in one enterprise for no obvious reason is foolish. Actually it is crazy. You'll get support on here because this is a gear forum and people will encourage you to do what they want for themselves which is a lot of gear to play with irrespective of the utility.

The only logic I can see is to enable people to play with both systems, which probably isn't what your boss had in mind and I'd ask some pretty difficult questions if one of my staff did something so self indulgent.

Completely agree, having two sets of gear that have different user interfaces is just going to make it all the harder for your users to get familiar with using it. The task is to make it as easy as possible not more taxing.

Finally it sounds to me as if the OP has modest experience of close up photography and perhaps limited technical knowledge and this is undoubtedly true of some of the other operators. My strong advice is to get someone who really knows his/her stuff, probably a professional medical illustrator, to give about a day's tuition in a group to everyone. Close ups are difficult and no matter what the gear you won't pick it up yourself quickly. In UK there is a society of medical illustrators and something similar could find you the right person. This is probably more important than any gear you could buy.

That is really excellent advice. Spend some of the money on training/coaching is much smarter use of resources. (Just as true for any other branch of photography too...)

 

[sunsnow]

These are some good points.... I can see the wisdom in fostering familiarity with one system. It seems that the extra megapixels are not worth making the switch?

Unfortunately with the way that the medical research fellowships work is that we're only here for a year, maybe two. So spending money on training on people that are essentially long-term temporary wouldn't fly.

 

[a_c_skinner]

Thanks, as I implied above I was a senior theatre (OR) based physician anaesthetist for my whole career so I understand that. What I had in mind was a bloke visiting for about 3 hours to show everyone the ropes, not detailed training.

If what you have in mind is detailing wound healing (or not healing!) and perhaps publication in a learned journal 6Mpix would be more than enough, so no, don't worry about the quality of the sensor. Incidentally I'd not assume a journal will publish significantly manipulated images, I've never tried to get photographic images published since the age of silver based imaging.

 

[sunsnow]

Thank all of you for your taking the time to comment and guide our purchase! I think that the outcome will be to purchase another Nikon D800 with the macro lens and flash. I appreciate all of your guidance and thoughts!

 

[Cherylynne1]

It sounds like everyone else has covered the basics of switching vs not switching systems and lenses, so I won't worry about that.

The one thing i would recommend is getting a gray card and adding a section in your guide about setting the white balance before taking the picture. Since it sounds like there is little to no post processing it is important to get as much right in camera as possible. With something like tracking the progression of wounds I imagine that getting the exact shade is very important, and the auto white balance can vary drastically from day to day. Even if you hire someone to do post processing, I doubt that most close-up photos would have a good neutral point for them to work from. Using a gray card to set a custom white balance every time can ensure that your colors are always perfect.

 

[a_c_skinner]

If I understand correctly the OP envisages flash as the illuminant so merely setting the WB once will be enough!

However you remind me of another issue. The latest theatre lights are LED and discontinuous so might cause issues with shutter speeds suitable for hand holding. Happily if the flash plan is correct then that won't matter. Older theatre lights are continuous and not daylight temperature.

 

[sunsnow]

One last question about the lens... In the OR we're seeing a shooting distance of closer to 3-4ft or so. Would this lead to any change in the lens or is the macro lens still recommended?

So now that we've moved beyond the equipment lets talk settings... Right now I have our current D800 rig set for aperture dedicated (A) setting and auto everything else (WB/ISO/Shutter)...

As far as the lighting goes... We've been seeing better photos while using the flash (even though we don't have the macro flash yet). In the OR we try to turn the OR lights away from the field, and just have the overhead room lights on - but it doesn't always happen that way. In the clinic, it's just the overhead lights. Once we get the macro flash set up we'll be using that for sure regardless of what other lighting there is.

Should I change things? Grey card y/n?

 

[a_c_skinner]

IF the macro lens gets the wound big enough then it will be perfectly OK, shooting all at a fixed focal length will make scaling the pictures easier.

Theatre lights vary. Some are halogen, some LED, some very pulsatile too. Turning them away is a good plan. In clinic you can simply take some pictures of a colleague's hand/arm etc to test if local illumination makes any difference.

I'd set the aperture to f8/11 and the shutter to 1/250th, ISO to 200 and WB to flash and see if the camera can take care of the rest with the flash on TTL.

I have no idea why you'd want a grey card. My advice about instruction remains, if you were in the UK I'd come and teach you.

--
Andrew Skinner

 

[sunsnow]

Some of the wounds that we're dealing with are superficial (2-5mm) but some can be rather deep 2-5+cm deep (with varying degrees of 'open-ness'). Would having the f-stop at f8/11 cause problems with the depth of field? Even now, we've got it cranked down to around f20 (maybe 18 or even 22), and I can tell I'm not able to always get the entirety of the wound in focus. Sometimes the floor of the wound is in focus, but the edge is not.

 

[a_c_skinner]

I wonder if you'll have enough light for f22? ISO up to 800 will be OK, beyond that noise will be an issue. Deep wounds might be problematic. Even at f22 you'll be losing resolution to diffraction, I'd certainly not go beyond it. Try it out. Get a colleague to lie on the operating table and make a pretend wound with a skin marker. In fact you could use the try out session to let everyone else get familiar with the kit and technique. Try it out. You cannot easily imitate a depth of wound though there are organisations that make wounds in make up and prosthetics for major trauma training...

Edit: Get a volunteer and skin marker, take some trial pictures and post them here for comment and perhaps advice. Leave the EXIF intact and tell us about the flash settings.

--
Andrew Skinner

 

[sunsnow]

Once we get the macro flashes, would the amount of light be an issue? I thought that the light problem would essentially go away once we're using the macro flashes. I think I'll still try to have them move the OR lights away from the field though. So I've attached some OR shots here. Completely de-identified so it should be OK. I'm not sure if the EXIF info is still intact, but if it didn't transfer with the pictures then just let me know and I'll post it for each picture. Remember, this is with a Nikon D800, and a AF-S Nikkor 24-120mm 1:4 G ED lens, using just the pop-up flash.

Picture 5426 below was taken with the OR lights on field from about 3ft away.

5426

Picture 5190 was likely taken with the OR lights off and from about 1-2ft away.

5190



Picture 5220 was taken with OR lights off as well and again from about 1-2ft.

5220