Understanding UV Photography for the Medical Office

 

Since the invention of the Wood’s lamp in 1903, UV imaging has been used in dermatology to help identify and better visualize epidermal dermatologic conditions. Current technology, offered in systems such as the Profect® PhotoPro and Profect® Facial Studio, works by emitting a flash of UV light (at approximately 365nm) and taking a picture simultaneously. The ultraviolet light is absorbed into the skin and reflected back to the camera lens. UV light has been shown to penetrate the stratum corneum and epidermis, thus it reflects dermatological conditions in these layers. Likewise, epidermal melanin absorbs the UV light and therefore reflects the absence of color, black. Comparing before and after UV images is one way medical offices can visualize treatment results.

 

Use of a medical photography system with ultraviolet technology, like the Profect® PhotoPro or Facial Studio, helps the medical practitioner identify dermatological conditions such as:

 

Color Observed in a UV Image Clinical Application
Coral-red Porphyrin
Orange-pink Porphyria cutanea tarda
Yellow-green Pseudomonas infection
Blue-green Scalp Ringworm (Tinea Capitis)
Bluish white Normal skin
Bright white/violet Dehydration
Dark Brown/Black Hyperpigmentation / Melasma / Sun Damage
White Loss of pigment (i.e. Vitiligo)

 

 

Journal References:

  • Gilchrest, B., Fitzpatrick T., Anderson R., and Parrish J., 1977, "Localization of melanin pigmentation in the skin with Wood's lamp," British Journal of Dermatology, 96:245–248.
  • Lunnon, R. 1959, "Direct ultraviolet photography of the skin," Medical & Biological Illustration, 9 (3):150–154.
  • Mustakallio, K. & Korhonen, P., 1966, "Monochromatic ultraviolet photography in dermatology," Journal of Investigative Dermatology, 47:351–356.
  • Phillips, R., 1976, "Photography as an aid to Dermatology," Medical & Biological Illustration, 26:161–166.

    (Articles may be ordered through Infotrieve.)


Understanding Cross-Polarized Photography
for the Medical Office

 

Cross-polarized photography, offered with the Profect® PhotoPro, is a photographic technique that is used to document hemoglobin and melanin conditions not visible with the naked eye. Cross-polarized images are captured when a filter over the light source and a filter over the camera lens are set at 90º to each other. These filters eliminate “glare” from the skin’s surface (light reflected back to the camera without absorption into the skin), and capture “back-scattered” light (light that has been absorbed in the skin, scattered and reflected back to the camera). Absorption of light by hemoglobin in subsurface blood vessels causes the light’s wavelength to lengthen, therefore the visible light reflected back to the camera shows better contrast of those blood vessels. In a similar way, visibility of melanin is also enhanced. This enhanced visibility can be particularly useful for medical personnel to better assess a patient’s pigmentation or vascular condition and to identify improvement between one photo session and the next.

 

Journal References:

  • Anderson, R.R., 1991, “Polarized light examination and photography of the skin,” Archives of Dermatology, 27(7):1000-5.
  • McFall, K., 1996, “Photography of dermatological conditions using polarized light,” Journal of Audiovisual Media in Medicine, 19(1):5-9.
  • Jacques, S., Ramelia-Roman, J., and Lee, K. , 2002, “Imaging skin pathology with polarized light,” Journal of Biomedical Optics, 7(3):329–340.

    (Articles may be ordered through Infotrieve.)

 

HIPAA Guidelines for Clinical Photography

 

When using any photography system, it is important for medical providers of any size to institute policies and procedures consistent with HIPAA guidelines concerning a patient’s Protected Health Information. For photography specifically, the following two guidelines are in place:

 

Photographic Consent
Privacy rules allow a physician to obtain any image(s) for treatment purposes without having to seek HIPAA authorization from a patient. However, physicians who wish to photograph and/or create audio or video recordings of patients for purposes other than treatment must first obtain those patients’ written authorization.

 

The Use of De-identified Patient Images for
Non-Treatment Purposes

There are no restrictions on the use or disclosure of de-identified health information including photographs that are not facially recognizable.1 A photograph or electronic reproduction is de-identified as long as it does not show the full face or comparable image of the patient and if any of the 19 elements of Protected Health Information are not present with the photograph.2

 

19 elements of Protected Health Information

  1. Names
  2. Address
  3. Telephone number
  4. Fax number
  5. Email address
  6. Social security number
  7. Medical record number
  8. Health plan number
  9. Date of Birth/death
  10. Account Numbers
  11. Certificate or License numbers
  12. Vehicle Identification/serial or license #
  13. Device Identification/serial #
  14. Universal resource locators (URLs)
  15. Internet protocol addresses (IPs)
  16. Biometric identifiers
  17. Identifiable photographs
  18. Any unique identifying number, characteristic, or code
  19. Age >89

1 Although HIPAA does not specifically address “blacking out or pixelating the eyes” on full-face views to de-identify a patient, it is better to err on the side of caution and obtain photographic consent from a patient. Recognition of a patient not only applies to the eyes but to other distinguishing features of the face.

 

2 There have been “wrongful appropriation of name and likeness” and “unreasonable publicity to private life” lawsuits for the marketing use of de-identified photographs used without obtaining photographic consent. It is better to err on the side of caution and obtain photographic consent from a patient.


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For additional clinical support, please email Profect at info@profectmedical.com.