8 Intraoperative Photography
This chapter discusses special techniques required to safely obtain useful clinical images in the constrained environment of the operative theater. Sterility concerns are discussed, with attention to techniques for surgeons taking pictures and for medical photographers. Appropriate camera settings and use of supplemental lighting are detailed. Image composition and methods to maximize image quality are described. Techniques specific to endoscopy and intraoperative videography are also discussed.
composition, endoscopy, intraoperative photography, lighting, sterility, technique, videography
Intraoperative photographs can be incredibly useful to communicate the exact status of relevant anatomic structures during surgery, or to demonstrate surgical techniques. Several modifications of photographic technique are required for patient safety and optimal image quality (Fig. 8.1).
Many surgeons take their own intraoperative photographs, either by preference or by necessity. An extra pair of sterile gloves is used to handle the camera, then removed prior to resuming the operation. Live-view focusing and composition is generally easier. Alternatively, a separate photographer is used, which frees up the surgeon to concentrate on the operation, but requires that the photographer be sufficiently familiar with the operation to take helpful photographs. To avoid contamination, the camera and photographer must be at least 12 in away from the sterile field. This is aided by removing the dangling camera strap, and using a telephoto lens, preferably a zoom for flexibility. With some caution, a macro lens can also be employed using techniques from Chapter 4, but extreme close-ups are generally not possible. As with other medical photographs, an intermediate-to-small aperture is required, as is a moderately fast shutter speed.
Lighting for Intraoperative Photography
Supplemental lighting via ring flash produces optimum results. The overhead operating lights should be directed away from the field as the light they produce is harsh, uneven, and poorly color balanced. One exception to this is when working in deep, dark cavities. The overhead lights will require some adjustment but should not be totally removed, as they not only help illuminate the cavity, but also assist with focusing. This may require some trial and error. Additionally, it can be helpful to increase ISO to approximately 800 to 1,000, although this will cause a slight increase in visible noise in the image. Use spot metering mode on the structure of interest.