Photography With William D Edwards

Color photographs, prepared with a 35-millimeter single-lens-reflex (SLR) camera or a digital camera, have become an integral part of autopsy records and the main tool of presenting findings at clinical conferences, in the classroom, and in court. These advantages have led to the decline of the pathology museum. Because most autopsy pathologists are sufficiently familiar with photographic equipment and the indications for its use, only a brief overview shall be provided here.

INDICATIONS Four main reasons exist to request autopsy photography:

• Documentation of autopsy findings to supplement the protocol;

• Documentation of autopsy findings for use in clinico-pathologic conferences, classroom teaching, and related activities;

• For the development of teaching files and scientific registries to supplement collections of actual (museum) specimens or, if necessary, to substitute for such specimens;

• For medicolegal purposes, such as crime scene investigation, identification of bodies (e.g., face, tattoos, or scars), and documentation of findings (e.g., photography of sequential in situ dissection).

TECHNICAL ASPECTS Generally, one camera unit should be available to prepare, while the autopsy is in progress, in situ photographs with appropriate lighting. Another unit should be available for specimen photography. This type of equipment is readily available commercially.

SPECIMEN PREPARATION Before pictures are taken, specimens should be prepared as if they were intended for display in the museum. This may involve restoration of color with 80% ethanol, additional trimming and dissection, support of lesions with pins or other devices, drying of light-reflecting surfaces and use of a black matte background with rulers. For the use of labels in photographs for medicolegal purposes, see Chapter 2. Comparison with a corresponding normal sample can be most instructive (for example, a normal left ventricle side by side with the left ventricle of a heart with chronic hypertension; see Fig. 3-3B in Chapter 3 and Fig. 15-2).

High-quality in situ pictures are much more difficult to prepare than specimen photographs. Light reflections should be reduced as much as possible, and a probe or other instrument not fingers) may be used to point to the lesion in question. Most important, a clear description of the findings should be provided on the label for the photograph or digital image.

PHOTOGRAPHIC FILES An enormous number of photographs tend to accumulate, not only in institutional files but also in the personal files of pathologists, particularly when they teach and publish. The principles of filing photographs are essentially the same as those for filing other autopsy documents. This is discussed in Chapter 16. Before photographs are filed, the following steps are necessary.

• Slides or digital images (and prints) should be scrutinized to determine whether they are worth keeping. Restraint in this regard may help to reduce an otherwise unmanageable volume of photographs.

• Each picture should be properly identified (e.g., name and identifying number of patient or autopsy, and diagnosis or description of whatever the photograph is supposed to show).

• A retrieval system must be in place that allows users to access the file successfully. Information in such a data carrier (usually a card file or a computer file) should readily locate the actual slide by the patient's name or number and by the subject of the photograph. For example, the identifying data of a photograph showing hepatic metastases from a malignant melanoma might appear in the files under the key words (or SNOMED codes) "liver," "metastases," and "malignant melanoma." Of course, the list of key words can be extended, for example, if a file for pigmented lesions is kept.

• A note should be entered into the autopsy records, stating that photographs are on file, what they show, and how they can be located.

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