eMedicine Specialties > Dermatology > Technology & Dermatology

Digital Photography

Author: Ashish C Bhatia, MD, FAAD, Assistant Professor of Clinical Dermatology, Department of Dermatology, Northwestern University, Feinberg School of Medicine; Director of Clinical Research, Department of Dermatology and Dermatologic Surgery, River North Dermatology and Dermatologic Surgery, DuPage Medical Group
Coauthor(s): Robert T Brodell, MD, Clinical Associate Professor, Department of Dermatology, Case Western Reserve University; Professor, Head, Section of Dermatology, Department of Internal Medicine, Northeastern Ohio University College of Medicine; Mikhenan M Horvath, BS, MS, Northeastern Ohio Universities College of Medicine
Contributor Information and Disclosures

Updated: Aug 1, 2008

Fundamentals of Digital Photography

For more than a century, physicians have relied on photography to capture and document the wide-ranging manifestations of skin diseases. Over the last decade, interest in the use of digital photography, which allows images to be encoded into computer memory instead of on film, has exploded. Dramatic reductions in cost and improvement in the quality of digital cameras have fueled this interest. With the widespread use of computers and their connection to the Internet, digital photography has become a powerful tool for physicians with an interest in skin disease. Digital photography enhances the physician's ability to communicate with peers, patients, and the public. To understand this technology effectively, one must understand the fundamentals of digital imaging, especially the concepts of resolution and image compression.

Components

A digital camera consists of a conventional camera body and lens with a photosensitive sensor made of complementary metal oxide semiconductor (CMOS) technology or a charge-coupled device (CCD) positioned within the camera in place of film. The sensor is a device composed of a grid of individual elements (pixels) that react to light, similar to the way the film grains do in a traditional camera. Instead of turning chemical emulsions into millions of silver grains, as in traditional film-based photography, the chip transforms reflected light into voltage. The camera's computer converts the voltages (analog) into zeroes and ones (digital).

The sensor is not capable of distinguishing colors; therefore, red, green, and blue filter strips are placed in front of the sensor to enable the chip to digitize the color components of an image to produce a digital color representation, which is stored within the camera's memory. The sensor is the critical portion of the digital camera. The capacity of a sensor to reproduce an image is a function of its resolution, which can be defined as the density of the light-sensitive elements, or pixels, that it contains.

Resolution

The resolution of the sensor determines its ability to record the level of detail of the images. The number of pixels must be high enough to produce a digital representation of the subject; the goal is to produce an image in which the human eye cannot detect the dots without looking closely. For the dermatologist, the criterion standard of image quality is the KODACHROME slide, which contains silver grains at a density of approximately 2500 lines per inch, or 4096 X 2736 pixels per frame (see Media File 1). Although some sensors have this level of pixel density (11.2 million pixels), the high cost of producing the chips and the memory requirements for storage of the images once limited widespread use.

With the recent demand for low-cost and higher-resolution cameras, manufacturers produced megapixel sensors that capture images at resolutions greater than 1000 X 1000 pixels. These megapixel sensors are suitable for use in the clinical setting; the literature has shown that the minimum resolution needed to recognize the relevant details of patient images is only 768 X 512 pixels, but 3 megapixels is typically the minimum resolution that is generally recommended.

Resolution and memory requirements

The greater the resolution of an image, the greater the memory requirement for storage of that image. A sensor with a resolution comparable to that of film produces an image requiring an impractical 33.6 megabytes (MB) of storage space, equivalent to 24 conventional 3.5-inch diskettes. A megapixel sensor produces an image requiring 3 MB of storage space, which, although more reasonable, still exceeds the memory capacity of 2 conventional diskettes. To avoid this issue, camera manufacturers have implemented compression of the images to eliminate redundant information, thereby further decreasing the amount of memory needed for storage.

Image compression

Image compression is achieved through 2 approaches. The first approach is to retain all of the image information and is termed lossless. Examples of lossless compression formats are graphics interchange format (GIF), portable network graphics (PNG), and tagged image file format (TIF). They typically reduce image size by 5-25%. Recent advances in compression techniques have resulted in the new lossless format JPEG2000 (JPF), which can compress an image 1.5:1 losslessly. A 33.6-MB image could be losslessly compressed using JPF to 22 MB. Cameras today are not capable of natively creating JPF images. To take advantage of JPF's compression efficiency, one must capture RAW (ie, as in not yet "cooked") uncompressed images with the camera and then transfer the images to a computer, where software such as Adobe PhotoShop can be used to compress the RAW image to JPF.

The second approach is to discard various amounts of redundant color data, which is termed lossy. The most commonly used form of lossy compression is the precursor to JPF, joint photographic experts group (JPEG) compression, which reduces the image size from 3 MB to 600 kilobytes (KB). See the Table below. JPEG is typically used to natively compress information in currently available digital cameras. Other image compression technologies are emerging (eg, fractal-based technologies) that produce 200:1 image compression ratios with no perceptible loss of detail. Note that JPF also has a lossy variant that allows for significant image compression.

Maintaining image quality

The need to maximize resolution to maintain image quality while achieving the smallest file size possible is an ongoing dilemma. An excessive degree of compression compromises the quality of the image captured by the CCD; therefore, keeping the compression ratio as low as possible is important. Most digital camera users select high-quality images with a compression ratio of 3:1. This will change as camera manufacturers adapt JPF natively in cameras.

Open table in new window

Approach to Digital Camera Selection

The cost of higher-resolution sensors has dropped significantly. Initially, the market focused on digital cameras with a resolution of 3 megapixels. Now, 5- to 10-megapixel cameras are widely marketed and more affordable, although keep in mind that the storage requirements for the images produced by these cameras are significantly higher. Individual users should take personal resolution requirements into account when selecting a digital camera.

Digital camera types

Digital cameras, similar to conventional cameras, are available in point-and-shoot and digital single lens reflex (DSLR) models.

• Point-and-shoot cameras: These cameras are small, inexpensive, and easy to use because they contain fixed lenses and a built-in flash. To frame a picture, they typically have a liquid crystal display (LCD)–based viewfinder. If they do have an optical viewfinder, they tend to inaccurately frame the image. The advantage and disadvantage of point-and-shoot models is that they are designed to be simple. Thus, they have limited user control over the camera. Some cameras have the focus and exposure set automatically.
• DSLR cameras: In contrast to point-and-shoot cameras, DSLR cameras have optical viewfinders, removable lenses, external flashes, and the ability to focus and to adjust exposure manually when needed. It is a direct replacement of the conventional film–based single lens reflex (SLR) models used by physicians for decades. For these reasons, DSLR cameras tend to be more complicated and expensive than point-and-shoot models. The cost has decreased as demand has increased, although a complete DSLR system is still more costly than a point-and-shoot camera. The early-generation DSLR units tended to be more expensive, larger, and bulkier than conventional film-based cameras. This is no longer the case, with today's DSLR cameras becoming cheaper, lighter, and more compact with each successive generation.

Digital camera selection

Selection of a digital camera depends on individual requirements and cost considerations. If cost is the determining factor, the choice is likely to be a point-and-shoot model. If cost is not a factor, and image quality is paramount, a DSLR camera is preferable. After either a point-and-shoot or DSLR model has been selected, the following individual camera features should be considered:

• Sensor size (megapixels)
• Sensor type (CCD/CMOS)
• Optical zoom wide
• Optical zoom telephoto
• Image stabilization
• Manual focus
• White balance override
• Built-in flash
• External flash
• Manual exposure control
• Automatic exposure control
• Capture movie clips
• Time-lapse image capture
• Storage types - Compact flash, SmartMedia, xD, Memory Stick, SD/MMC
• Supports uncompressed TIF/RAW capture
• Viewfinder - Optical/electronic
• LCD monitor size
• Battery - Size AA or proprietary
• Weight/size, including batteries

In 1995, only one choice of digital camera was available. In 1996, 4 choices of cameras were available from 3 different manufactures. By 2005, dozens of cameras choices from 25 different manufactures were available. The industry is continually developing. With this exponential growth in cameras, up-to-date information cannot be made available in this forum; relying on Internet-based resources that track the daily changes in the field of digital photography is critical.

Digital camera selection resources

Because multiple variables factor into the selection of a digital camera and because manufacturers produce new camera models several times per year, one must take advantage of Internet-based resources that can assist in the selection of a camera. Digital camera information sites on the Internet typically include reviews of new cameras, examples of images taken using the cameras, and side-by-side comparisons of similar cameras. Some of the digital camera resources available on the Internet are listed below. After narrowing the available options to a few, testing the digital cameras at a local camera store is useful because individual users have different preferences regarding the suitability of various digital cameras.

Internet resources

• The Imaging Resource
• Digital Photography Review
• Steve's Digicams
• Digital Camera HQ

Hardware Requirements and Software Applications

This section provides a general introduction to the hardware requirements of digital imaging systems. Because this technology is constantly changing, new products are available to the public daily. Many Internet resources may be helpful in selecting the components of a digital system (see Internet resources above).

Computer

The computer required to support a digital photographic system may be a personal computer (PC) or a Macintosh. At a minimum, a Pentium III or Power PC G3/G4 processor is needed, along with 128/256 MB of random access memory (RAM), a 40- to 500-gigabyte (GB) hard drive, a 24-bit color display monitor (preferably 17 in or larger), and removable storage media.

Storage media

The total storage requirements of the user should be determined before selecting storage media because overestimating the memory requirements is better than underestimating them. Assuming a single image size of 1000 KB per image at 20 images per day, a total of 20 MB of storage capacity per day is required. This translates into 100 MB per week, 400 MB per month, and 4800 MB per year, or 1 digital videodisc (DVD). The capacity and cost of each storage device and the number of disks per year required for storage must be taken into consideration when selecting removable storage media. Keep in mind that one should backup the images regularly.

An effective strategy is to store all images on the PC's internal hard disk and keep a mirror image on an external hard disk to protect against internal drive failure. Additionally, images should be archived to removable optical storage so they can be moved offsite. This is to protect against theft or loss of the system. Some people keep 2 optical copies, one onsite and one offsite. This means an allocation of 2-3 times as much storage may be needed for each image.

Beyond the internal storage in the PC, maintaining removable storage is also important. This storage is critical for backup and for exchanging images with patients and referring physicians. The types of removable storage fall into 2 classes, optical and magnetic. Optical is compact disc (CD), DVD, Magneto Optical, phase change, and Blu-Ray. The latter 3 technologies are more likely to be found in large hospitals or group practices, where long-term archival systems are in place.

The most common removable media are optical disks, either low-capacity CD-R/RW or higher-capacity DVD±R/RW. CDs are ideal for exchanging images with patients or referring physicians. DVDs are ideal for offsite backups of images. The abbreviation ±R media is write once, and ±RW media indicates rewritable. ±RW is best used for incremental backups, and ±R is ideal for archives because these discs cannot be changed. Archival storage is for offsite storage to protect against catastrophic loss such as hard disk failure or theft of the computer.

A more convenient form of image storage is Web-based image cataloging software, which is designed for the field of medicine. These are similar to online programs used for sharing pictures with family, but they have more features and security designed for medical application. This provides reliable, simple, and instant backup of all images while avoiding the complications of backing up information daily or requiring that it be stored in 2 locations. Additionally, this service provides easy, yet protected, access for physicians at any time or place with Internet access. Versions aimed towards the public population are described under Using Digital Images in an Analog World.

Storage unit manufacturers

• CD/DVD -Hewlett-Packard, Iomega, Sony
• MO -BreeceHill, Plasmon
• UDO -Plasmon
• Blu-Ray -Sony, BreeceHill
• Rev -Iomega
• External Hard Disks -Iomega, Maxtor, Western Digital, LaCie

Printer

A color printer is required to print the acquired digital images (see Color printer information below). Printers are commonly available in 4 types, as follows:

• Inkjet printers produce near photographic-quality images at moderate speed and are relatively inexpensive.
• Dye sublimation printers produce images of photographic quality but at slow speeds and high cost.
• Color laser printers produce images of near photographic quality for a high initial cost, but the cost per print is low, and the printing speed is relatively rapid.
• Photo printers attach to the camera and produce an immediate print much like a Polaroid image. These units may attach directly to the camera or use a removable storage device that does not require a computer. Photo printers generate prints within 1-2 minutes for instantaneous documentation, at a cost less than that of a Polaroid print. However, the print size capability is often limited to 4 x 6 inches.

Available color printers are as follows:

• Inkjet printer - Near photo quality, low cost, moderate speed
  • Canon - Pixma
  • Hewlett-Packard - PhotoSmart
  • Epson - Stylus Photo Series
  • Lexmark - P Series
• Laser printer - Near photo quality, moderate speed, image stability, and higher initial cost
  • Hewlett-Packard - Color LaserJet
  • Lexmark - C Series
  • Okidata - C Series
  • Samsung - CLP Series
  • Xerox/Tektronix - Phaser
• Dye sublimation printer - Photo quality, high cost, slow speed, image stability
  • Canon - SELPHY
  • Kodak - Professional Thermal Printers
  • Olympus - P10, P11 or P400
  • Sony - Digital Photo Printer DPP-FP30, FP5

Another feature to consider when purchasing a photo printer is wireless capability. By connecting to your home network, multiple computers may easily print to one station.

Software

Several types of software are used for image transfer, editing, storage, and retrieval. The first type of software transfers images from the camera to the PC. This software is typically packaged with the camera and is used to transfer images over serial, small computer systems interface (SCSI), universal serial bus (USB), or FireWire cable. With the recent advent of PC-based removable memory card readers, this software may never be used because the card reader provides direct transfer of images from the memory card to the PC.

The second type of software consists of image enhancement or manipulation software, which converts images into other file formats for use in documents and slides or adds text, lines, or graphics. The most commonly used program of this type is Adobe PhotoShop CS. This is a professional image-editing tool that must be purchased separately from the camera. Often, Adobe Elements, a useful consumer software package, may be bundled with the camera.

Image database software is the most important software component of all because it stores patient images and other relevant information (eg, demographics, physical findings, treatment plans, operative data) in an organized fashion for future retrieval.

A wide variety of software choices are available, ranging from basic consumer image databases to medical- and dermatology-specific databases to customized applications tailored specifically to individual types of practices. Available database options are as follows:

• Basic databases
  • Iview - Iview Multimedia
  • Extensis - Portfolio
  • Mediadex Pro - Formerly Cumulus rebranded for single user
  • Google - Picasa, Free
  • Others
• Medical-specific databases
  • CasImage
  • iBase
  • Image Store for Healthcare
• Dermatology-specific databases
  • Canfield - Mirror DPS Advanced Image Management and PhotoFile Image Management
  • Canfield - Vectra - Volumetric 3D surface imaging
• Custom databases
  • FileMaker - FileMaker Pro 5 (If more than 5 simultaneous users are accessing, consider the Server version.)
  • Microsoft - Access

Applications of Digital Photography in Dermatology

Dermatologists have long relied on photography in the practice of their specialty; therefore, it is not surprising that they have been among the first to explore the applications of digital photography in clinical practice. Digital imaging systems are also currently used to teach medical students and physicians-in-training about skin disease and to enhance clinical record keeping. Digital systems are being developed to assist in diagnosing patients with melanoma and to monitor patients over time. Digital imaging is used in conjunction with telecommunications technology to extend the reach of dermatology to medically underserved areas through teledermatology.

Education

Digital images have been shown to be as effective as 35-mm photographic transparencies in teaching medical students the morphology of skin lesions, and they are becoming more popular. Currently, software programs are available that allow text, lines, or graphics to be added to images; photographic artifacts to be removed; or color, brightness, or contrast to be altered, thereby further enhancing the communicative power of digital images. A variety of interactive programs have emerged in recent years that use software programs to teach medical students and physicians about diseases of the skin.

Many dermatology textbooks are available on CD-ROM and contain exclusively digital images. An image database is also available on the World Wide Web that may be used for continuing medical education for physicians or for student education.

Clinical applications

Digital imaging systems are currently used commonly in clinical practice to archive patient records, generate consultation notes, provide documentation of procedures, follow clinical improvement in a variety of dermatoses, and generate letters with photodocumentation for referring physicians.

Systems have been developed that allow prospective cosmetic surgical patients to view digitized preoperative photographs on a computer monitor and to modify the views in conjunction with surgeons to project possible surgical outcomes.

Mohs surgeons are beginning to use digital imaging to more precisely and accurately map complex Mohs surgical specimens.¹ Image databases enable the practitioner to store and rapidly retrieve images for later use, so that conditions such as hair loss, psoriasis, and atypical moles may be monitored objectively over time. Then, the images may be analyzed quantitatively to assess the progress of innumerable clinical parameters (eg, the healing of ulcers after treatment with various therapeutic modalities, improvement in wrinkles after medical or surgical intervention).

A specific application of digital cameras in clinical practice involves the use of the LCD preview feature (available on selected camera models) as a substitute for Polaroid prints. The LCD preview screen appears similar to a small color television screen and is located on the back of the camera. The LCD screen initially ranged in size from 1.8-2.5 inches and some now are as wide as 5 inches. This feature may be used on some cameras as a viewfinder when capturing new images, allowing the photographer to assess lighting, focus, and quality of the image before capture. This feature is also useful in allowing the photographer to see the captured image, to review previously captured images, and to delete poor-quality images immediately and reshoot. In a dermatologic surgical practice, one of the most powerful attributes of the LCD screen is that it allows patients to see themselves immediately after surgery without using a mirror and often gives them the courage to look in the mirror afterwards.

Melanoma

Digital imaging systems are currently being developed to assist in diagnosing malignant melanoma. A computerized analysis of the thickness, size, color, and texture of pigmented lesions can be performed after digitization of the photographic images. By assembling a database of the characteristics of malignant and nonmalignant lesions, sophisticated computer systems are being formulated to identify melanomas rapidly and reproducibly simply by scanning in an image of the lesion and evaluating its physical characteristics. This technology ultimately will be useful in following high-risk patients over time, in preventing unnecessary biopsies, and in identifying early malignant melanomas in patients with multiple clinically atypical lesions.

Teledermatology

The application of digital images to teledermatology has gained in popularity in recent years. The use of digital imaging systems in medically underserved areas may be helpful in providing care to patients who otherwise may not have easy access to a dermatologist. Digital photography for store-and-forward teledermatology has been found to produce high-quality images and diagnostic concordance rates that compare favorably with in-person clinical diagnoses. See Teledermatology and Store-and-Forward Teledermatology for more information.

Teleconsultation using clinical and dermatoscopic images of skin tumors via email has been found to provide a degree of diagnostic accuracy similar to that of face-to-face diagnosis. Overall patient satisfaction with real-time teledermatology was found in one study to be high, although diagnostic accuracy and the ability to generate an optimal clinical management plan using digital images are variable.^2,3

The diagnostic accuracy of primary care physicians in recognizing common dermatologic problems has been found to vary according to the level of experience and is at best 52-60%, while dermatologists demonstrate accuracy of diagnosis at least 90% of the time. When image quality is consistent, digital images can substitute for the dermatologic physical examination in as many as 83% of patients; therefore, remote access to dermatologists via a digital imaging system likely will be helpful in improving patient outcomes and reducing costs in the current managed health care environment.

Digital Tampering

Although digital image manipulation is beneficial when performed for appropriate reasons, the ease of digital manipulation is such that digital falsification may become tempting to some users. Editorial boards of journals and newspapers are beginning to devise strategies to cope with this issue.

The American Society of Dermatologic Surgery (ASDS) has developed a statement of ethics addressing the issue directly and considers the manipulation of photographs used in presentations to patients, the media, in journals, or at scientific meetings for the purpose of deceiving the audience to be a violation of the ethical standards of the society.⁴ Speakers at ASDS meetings are asked to make audiences aware of alterations in images depicted on slides, whether by alerting the audience to alterations verbally or by placing a designated reference icon in the corner of each altered slide.

Implications of digital manipulation in patient education

Implications of digital manipulation for patient education must not be ignored. Although computer-altered images may be used to teach or to explain what to expect after a surgical procedure, no attempt should be made to overexpose, underexpose, or otherwise alter a photograph to deceive viewers.

In Media File 3, an underexposed digital image of a Mohs surgical defect is shown, followed by the corrected properly exposed image. The last image of the 3 has been manipulated to completely eliminate the Mohs surgical defect. The legal issues surrounding the use of computer imaging in plastic surgery practices have been reviewed.⁵ Physicians who use computer imaging carefully and conservatively to educate their patients and to facilitate physician-to-patient communication should not have increased vulnerability to legal claims. The risk of possible claims of implied contract, failure to instruct, and malpractice from use of or failure to use computer imaging is small and may be decreased further if appropriate safeguards are incorporated into the surgical practice.

The Medscape Medical Malpractice and Legal Issues Resource Center may be of interest.

Cost Effectiveness of Digital Imaging

With improvements in camera quality and resolution and decreases in camera costs, digital photography increasingly has become cost effective. Consumer point-and-shoot cameras with megapixel resolution, 3X optical zoom, LCD preview, and built-in flash have significantly decreased in price. DSLR cameras with a view-through lens, +6 megapixels of resolution, 3X optical zoom, LCD preview, and flash have also become more affordable. These prices increase primarily as resolution increases, but also with the addition of other features. Even DSLR cameras, with their features, are becoming lighter and currently weigh as little as 22 oz without lens and batteries, making them easier to carry and use.

Using Digital Images in an Analog World

Although hard copies of electronic patient images can be generated rapidly and easily on a color laser or inkjet printer, occasionally, generating a true photographic print of an image may be necessary, whether for insurance documentation or to meet publication requirements of peer-reviewed journals. While dye sublimation and some high-end inkjet printers can generate photographlike images from electronic files, cost and speed make it impractical for most physicians to own them solely for the purpose of generating this type of print on an occasional basis. Furthermore, these photographlike images do not resemble real photographs sufficiently to be a good substitute for glossy photographic prints.

Online photographic printers

Photographic printers that print digital images on the same paper used for traditional film-based photography are currently available through Internet-based service bureaus. With the assistance of the service bureaus, digital images may be converted into photographic prints, as follows:

1. The electronic image is transferred from the camera to the computer with the standard software supplied with the camera.
2. If an Internet connection is available, the Web browser is pointed toward one of the following service bureaus:
   • Kodak EasyShare Gallery
   • Shutterfly
   • SnapFish
   • Walmart Photo Center (United States only)
3. The digital images to be converted into prints or slides are uploaded to the site, either by following the company's instructions for image transfer or by downloading the company's custom upload software. The images are cropped as necessary depending on print size.
4. The user may select the size and quantity of prints or slides, the shipping method, and the time of delivery. The prints typically arrive within 1-3 days depending on the type of shipping selected.

The service bureaus listed offer a variety of options for printing digital images as photographic prints, ranging from $0.19 for a 4 X 6-inch and going as low as $0.09.

Converting color images to black-and-white images

Because black-and-white images are less expensive to publish than color, converting color images to black and white using a service bureau is sometimes desirable. With image correction software such as Adobe PhotoShop, any digital color image can be converted into black and white, from which the service bureau generates black-and-white prints. This option is useful because it eliminates the time-consuming and expensive process of creating the internegatives necessary to convert film-based slides or negatives into black-and-white prints.

Portfolios

Another useful feature of the online service bureaus is the ability to create a portfolio that allows images to be shared with other dermatologic surgeons via the Internet.

Advantages of online services

Using online services, photographic prints may be generated from digital images at low cost and with a turnaround time ranging from 1 day to 1 week. Prints and slides generated by bureaus are consistently of high quality, enabling them to be used for submission to journals or to insurance companies as photodocumentation. The use of online photofinishing bureaus currently appears to be the most cost-effective method of generating high-quality color or black-and-white prints from electronically stored patient images.

Instant prints

Local photo printers are printers that attach to the digital camera or read their removable storage devices and do not need to be attached to a computer to function. These printers generate color prints from digital images within 1-2 minutes at a cost lower than that of a Polaroid print. These printers are useful when an immediate hard copy of a digital image is required, whether to share that image with a patient or another physician or to provide instantaneous chart documentation of a physical finding.

Future Directions in Digital Imaging

Over the last several years, a remarkable improvement has occurred in the performance, ease of use, and cost of digital cameras. Simultaneously, the Internet and the World Wide Web have created a powerful framework for communication between dermatologists, their patients, and other physicians. The newest generation of patients and physicians has been exposed to the technologies from their inception and is already routinely using digital imaging systems.

We are now in a time when skin lesions may be tracked long term and analyzed 3-dimensionally through advanced digital imaging hardware and software packages is not difficult. These improved systems enable dermatologists to quantify changes in nevi over time, to highlight new or suspicious lesions, and to assess the impact of therapeutic regimens or surgical treatments on a variety of dermatologic conditions. The rapid clinical diagnosis of skin disease through teledermatology will continue to be enhanced as the resolution of digital cameras improves. The ability to transmit digital images rapidly and securely over the Internet will help teledermatologists to see an optimal number of patients as efficiently as possible, which, in turn, should improve patient outcomes and reduce costs.

Potential educational benefits of digital imaging are limitless. If dermatologists using digital imaging systems merged their photographic resources to form a database of clinical images accessible over the Internet, a remarkable teaching and reference tool would be created instantaneously, from which medical students, residents, and practicing dermatologists would benefit immeasurably. Adding digitized images of associated histopathologic findings would further enhance the value of such a system.

Digital photography is transforming the specialty of dermatology, and the World Wide Web will serve as the medium by which these images will reach patients and physicians. A communications revolution is emerging, which undoubtedly will influence the practice and teaching of dermatology and dermatologic surgery in the years to come.

Multimedia

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Media file 1: Relative pixel resolution of digital cameras versus film.

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Media file 2: Digital camera preview.

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Media file 3: Image enhancement and manipulation.

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Media file 4: Two examples of producer/consumer or professional lite class cameras that differ greatly in size and shape: (Left) Fuji MX-2700 (pocket size); (Right) Toshiba PDR-M5 (bulkier).

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Media file 5: Front of a typical point-and-shoot producer/consumer digital camera: (A) lens, (B) viewfinder, (C) built-in flash, and (D) shutter button (press halfway to set exposure and to focus, press completely to capture image).

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Media file 6: A SmartMedia card (removable storage media card) being inserted into a digital camera. Touching the gold contact area can cause damage to the card or corruption of the images stored on the card.

Keywords

digital imaging, digital camera, digital photos, digital photo-documentation, digital photodocumentation, teledermatology, teleconsultation, photodocumentation, store-and-forward teledermatology, store and forward teledermatology

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, D é sir é e Ratner, MD, and Craig Thomas, MS, to the development and writing of this article.

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