Shadowing can easily be eliminated by simply rotating the camera so the flash angle changes. The photo on the left shows an image taken with the camera upright and the resultant shadow, while the photo on the right shows the same image without a shadow taken with the camera rotated 90 degrees. The image is simply rotated with the imaging software.

San Diego — Advances in digital photography have brought the proverbial mountain to would-be photographers, making it less time-consuming, and, let's face it, less daunting when it comes to documenting procedures and patient outcomes. And with documentation being an important, albeit time-consuming, factor in a physician's work, the advent of the digital camera is a boon to the process. Joseph Niamtu, III, D.M.D., would agree.

"In my 21 years of practice I have made a constant observation of countless doctors I know from all specialties of medicine and dentistry... is that the best doctors take a lot of pictures! [And] they don't just take the pictures, but they make their images work for them," said Dr. Niamtu at the American Academy of Cosmetic Surgery annual meeting.

Stop stalling Dr. Niamtu, who practices Cosmetic Facial Surgery in Richmond Va., says though many doctors have left slide photography behind to embrace the new technology, there are still some who haven't. His message to them: Get with it!

"One common excuse I hear is that 'things are changing so rapidly, I am going to wait until better equipment exists.' The message to these procrastinators is that you cannot outrace technology...Every day you wait you will be losing opportunities to use your valuable images."

The very first step to going digital is buying the equipment, and the initial investment can be steep, Dr. Niamtu says, but he assures that it pays for itself several times over. First, you need to decide on a digital camera. But, if you really want the magic to happen, you'll also need a computer, printer and imaging software.

The quest for a digital camera doesn't need to take on Homeric proportions.

"Most high-end, off-the-shelf, name brand digital cameras will suffice for most clinicians. Most of them have adequate macro function for close-up images and can zoom out enough for full body pictures.

Because simplicity is key to prolific documentation, he also recommends checking out any reputable professional camera company that modifies the camera software and flash to simplify macro flash photography. For close-up photography in the macro mode, a standard flash may not suffice. The flash set up on off-the-shelf cameras is too close to the subject in most macro situations and will not illuminate the area. Lens mounted ring or point flashes will solve this problem, but purchasing a factory modified camera can produce the same results without bulky or add on flashes.

He adds that the camera should be simple enough, with automatic settings, so staff members can pick up, point and shoot during in-surgery photo ops when the surgeon is scrubbed and otherwise unavailable to take photos. Also, look for a camera small enough to throw in a briefcase to take anywhere and use at a moment's notice.

Resolution requirements Ten years ago, digital cameras had a grainy 640x480 resolution; today, the technology has exploded, offering upwards of eight megapixels. The resolution relates to the actual size of the image, Dr. Niamtu explains. So how much resolution is enough to produce great images?

"One misconception is that you constantly need to upgrade to higher megapixel cameras," Dr. Niamtu says.

"Granted, the higher the resolution, the better the picture, but cameras are like stereo equipment in that after a certain point the differences are miniscule.... Personally, I feel that there is no need to take eight megapixel images for routine digital clinical photography. You just don't need that size and these image files are very memory-intense."