Burkley Loc: Park City

I have never shot in a studio. I am setting up a new office and will want to take serial photos of patients’ facial contours to compare before and after results of surgical interventions. I do some cosmetics but mainly reconstruction surgeries fixing traumatic injuries or other’s less desirable outcomes. The pictures are taken by medical assistants so simplicity and reproducibility are keys. With the advent of LED studio lights, I wanted to mount LED studio lights that can be turned on with a switch, paint a wall with background paint and place foot positions on the floor so that the patient can easily turn to the appropriate angles. Currently, we use a portable ring light with a fabric background in an exam room.

My questions: what lights would you use and at what angle from the center would you place them? Would you place any lighting on the ceiling? Or, would you just continue with a ring light on a moveable stand?

Leitz Loc: Solms

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JohnSwanda Loc: San Francisco

Normally I think the lighting from a ring light is too flat, and I feel like more directional light is more flattering. But for your purposes in recording for medical use, the ring light might be better. It might be even better to light specifically for the condition you are trying to show, but that won't work if you want the same setup for everyone.

PHRubin Loc: Nashville TN USA

And I also would think a ring light would be too flat, but even for this purpose. You want to highlight features, not flatten them. I would experiment with using a small external flash you can bounce for the simplest solution.

E.L.. Shapiro Loc: Ottawa, Ontario Canada

I have done medical photograhy for plastic surgeons and doctors that specialize in oral & maxillofacial surgery.

There are various approaches to lighting, your choice depends on exactly what you want to document and illustrate. Unlike in portraiture where the photographer needs to flatter the subject with the application of light and shadow in order to aesthetically "sculpt" the shape of the face, an accurate clinical photograph shows that face "as is" before, during progressive treatments and after. Therefore comparatively flat lighting is not a bad concept, however, not entirely flat so as to completely lack dimensionality and texture.

COAXIAL LIGHTING is one method that has merit so the ring light may suffice in many cases. A camera/lens-mounted ring ligh/electronic flash is convenient to use in an office/clinic setting. The camera can be hand-held or tripod-mounted and once you have the exposure standardized it is fast, efficient and not especially prolonged or uncomfortable for the patient. The setup does not require very much space.

If recording texture is important as in documenting scaring, burned tissue, injuries or deformities of the skin and subsequent repair, OFF CAMERA LIGHTING is advisable. The main ligt source can be placed whereby the edge of the light beam skims the surface of the face thereby emphasizing the texture, coloration or discoloration and the results of the final repair. For this kind of illustration, I have used a couple of monolights (studio-type individual flash units with continuous modelling lamps) equipped with 24" white umbrellas or softboxes. Unlike a typical portrait setup, each light is placed at about 25 and 35 degrees to the camera/subject axis and feathered, that is, turned in toward the camera/subject axis whereby the edges of each beam illuminate the face- this will reveal the texture. This setup will require more space and a couple of light stands to support the monolights.

I was called in because the clinic I did the work for had a high volume of work to be done and many (power-point) slides had to be produced for teaching purposes and patient documentation. Eventually, I created a setup that could be remotely handled by medical, nursing, and technical staff.

The ring light is oftentimes considered the goto light in medical photography because it is very appropriate for intra-oral work, surgical fields, etc where you are shooting into a cavity or surgical operation where shadows would obscure important details. In documenting facial surgery you may want just enough shadow or modelling to provide dimension without altering the authentic shape of the facial structure.

In my experience, as alluded to above, the doctors were using the image for teaching and technical discussion and perhaps required more detail and accuracy. For general recording, perhaps the simple ring ligt will do the job. There are many new models with LEDs as opposed to flash but I still recommend flas as you needed work about came or subject movement and exposure calculation is easily determine and standardized. There are many modes where the ring light can be removed for the lens and transferred to the hot shoe atop the camera, lie a standard speedlight- that may provide a bit more modelling and still provide relatively flat lighting. There are other models that feature 3 or 4 individual flash tubes rather than one encircling tube. One or more of the individual tubes can be shut down to provide slightly more directional but still coaxial lighting.

If you are also want to create a body of images to show prospective patients, you can always utilize the 2- umbrella system with one off-camera main light and one behind the camera fill light and swing into "portrait" mode. I have done this for the doctors- they say it helps encourage and raise their morale. I have experienced this at a veterans hospital where soldiers and vets were recovering from some serious war injuries.

I do most of this kind of work with a 100mm macro lens on a full-fram body. This provides sharp images and a working distance that negates any optical distortion so the facial features are rendered in good perspective. The working distance is comfortable for the patient and is just right for the even distribution of light from the ring light flash.

I hope this helps.

Thomas902 Loc: Washington DC

Doctor Buckley I recommend listening to Mr. Shapiro's wisdom here... He is coming from a place of much experience and I second nearly all of what he shared with your needs here...

Especially with a choice of camera lens... a 100mm macro....
"...100mm macro lens. This provides sharp images and a working distance that negates any optical distortion so the facial features are rendered in good perspective. The working distance is comfortable for the patient and is just right for the even distribution of light."

In fact I have and use one of the most popular Nikkors with Oral Surgeons of the 1990's the epic vintage AF 105mm f/2.8D micro Nikkor. (Provided you are using a Full Frame camera).

As for lighting? Again I agree with Mr. Shapiro "...I still recommend flash as you needed worry about camera or subject movement and exposure calculation is easily determine and standardized..."

Also I might add, while LED's may be easier for one visualize the results with they can be very annoying to the patient/subject at the illumination level required for high shutter speeds necessary for requisite acuity appropriate for medical documentation. Experience is a brutal teacher here. .

As for background? Many studio shooters prefer portable panels that can be easily wheeled into place as requirements predicate... As for light placement? I have a long Manfrotto wall mounting boom arm to safely hold a beauty dish high above the sitter/model etc. Please keep in mind that the many serious studio "accidents" occur when a heavily laden light stand tips over and falls on a model, subject or other team member. Heavy lighting equipment is a hazard to be cognizant of... And a very real and present danger in photographic studios. They typically require very heavy counter weights and running power cables on the floor is never a good idea... Thus the reason I have my BD wall mounted with cabling attached... Zero power cables on the floor...

You will also likely want to shoot a Color Calibration Target with every lighting configuration change... This is germane to achieving accurate color balance in the final images.

Hope this helps Doctor Burkley...
btw, I totally concur with your post on the creation of "David"
"... Michelangelo was amazing in his ability to create perfection from marble by manipulating perspective..."

All the best on our noble journey...

E.L.. Shapiro Loc: Ottawa, Ontario Canada

PS-

I have set up these facilities for 5 hospitals and clinics in my geographic location. If you tell me the size of the room you intend tooling up for photography- with, depth and ceiling height, I'll gladly sketch out a rough diagram of light positions, subject position and distances between the subject and the background. I can also suggest background colours or shades and types of paint or variable background materials.

If the images are going to be printed or lithographically reproduced, good colour accuracy, gradation of tones and acutance is important and is all dependent on good lighting control as to volume, quality of the light (soft or hard) and control over contrast. If more than one light is used, a good light ratio needs to be established. The installation I design at the vet's hospital includes a turntable on the floor as some of the patients are disabled. They can take a seat on a comfortable with back support and the turntable can be rotated for full face and profile shots. In some installations, ligh can be mounted on brackets or ceiling-mounted rails to conserve floor space.

medphotog Loc: Witness protection land

I'm going on the assumption that you are familiar with the Frankfort Horizontal for photographing the head. I'm sure you'll want to have some sort of standardization to your images. We/I used the Nikon 105 and photographed the AP's/Lat's/OBL's at 1:10 and added 1:4 for Rhinos/Blephs, worms/birds eye etc. (Of course you'll end up with a head that is out of this spectrum but it should give you good consistent results.

tcthome Loc: NJ

E.L.. Shapiro Loc: Ottawa, Ontario Canada

Excellent notation! Some years ago when I started doing this work, the doctors gave me some homework. Here is a link for anyone who is interested.

https://dtjournal.org/uploads/pdf_files/525/Cruz_and_Gasperini._Issue_3-4__2017.pdf

Burkley Loc: Park City

Thank you all. Very helpful. It will take me a bit to digest it all. I was not familiar with Frankfort Horizontal, or the advantages of flash over fixed light.

Nicholas J DeSciose

Continue with the ring light. There are some new or larger ones that are terrific look into these. I think the ones made my savage our wonderful

srg

Wow. The replies above are a phenominal display of knowledge, experience, intelligence and for lack of a better word sheer humanity. All given gratis on this wonderful site. After I win the lottery, I will offer substantial money to you guys for help with my specific photographic questions. You can name your price.

Timmers Loc: San Antonio Texas.

Any decent school of dentistry would have a complete introduction for this work. Keep in mind that your number one issue is with regards to malpractice insurance, the medical aspect is secondary. My father Dr. Joseph Summa DDS, ACS as chief of clinics set up such a required course for the University Dental Schools. What is important is to think that you have an attorney who is presenting to they lay public in a court of law, the jurors and judges a visual record. The patient prior to treatment and the same patient after treatment. X-rays and descriptions, measurements mean nothing to any of us. It is that visual compare and contrast that will give you what you want and need.

With out getting complicated, your back ground should be 18% gray (this is photographic gray), which you can actually buy or have the people at the box store use a scanner to read a swatch from a clinical color target. In addition, it is always a good idea to include a reference color and density target as well as a scale target, again, in both standard meter and common foot scale.

The new LED lights are always a correct choice, but you need one that exhibits color accuracy and range. Again, most large hospitals have a department of medical documentations. At the University of Texas these are called Medical Communication Departments. They can advise you as to what is best for clinical photographers, further, their personal could be brought in as advisors for a fee to give you examples of what to do and set up the room*.

Last, the use of a portrait focal length for head and shoulders imaging is important. In 35mm photography this is 85mm to 105mm. Again a clinical photographer who knows what they are doing would be able to cover this information for the camera that you would be using.

*What is often over looked in clinical environments is the whole environment (floor, ceilings and side areas). The floor and ceilings are often left out of the scenario. A matt neutral white is best with the 18% gray background. Reelections under the eyes, nose and chin will reflect any density or colors in the environment. This is but a small issue but it does go to having a good scientific set up that is beyond reproach. Remember, it is not just the clinical aspects but the reality that first and foremost you are potently selling this to the lay audience.

Last, elevation must be flexible for lights. Patents in wheel chairs or are tall or short need to be accommodated. Most lights are designed to be attached to a stand and I would look for ones that are not just sturdy but are on castors.

By the way, the ring light is fine for modern portraiture/fashion, it has absolutely no place in patent portraiture. Take a look at your existing results, the catch lights in the eyes are mostly circular rings with a ring light. The sun is not a ring, it is a single point as a catch light. A good clinical photographer doing a general portrait should grasp this most basic of issues. While we are at this, the appeal of any human being is based on a single reference, that is the dilation of the pupil. In classical portraiture this is referred to as pupilation (Dr. Leslie Strobel, Dean of Rochester School of Photography). I'm sure that you have herd the term 'bedroom eyes', this is when the pupil is vary open and refers to sexual arousal. Equally a poor choice would be the drugged look where the pupil is dilated vary wide. So in adjusting the light volume in the environment you will need to not over or under do the volume of light. Dr. Strobel determined that a little more open pupil was found to exhibit as more open and desirable for people viewing the exact same portrait where the pupil was just a bit more open! So the selection of the light volume is much more important than many photographers understand.

Last, keep in mind that the sun comes up over the horizon after sunrise. The catch light in the eye MUST be such that the catch light (so the main light) will be just slightly or more reflected in the upper half of the eye ball. A simple guide for your 'photographer' would be to always see to it that the light is a least slightly higher than the lens used to make the portrait. Unless of course you want to represent the person being seen as insane! (The sun came up before it rose above the horizon!).

There is a lot to know about portraiture and proper clinical photography.

cantona Loc: manchester, england

fantastic discussion,love it.