Distraction Management

Whenever time and a patient’s condition allow, distractions should be eliminated from a clinical photograph. These include clothing, jewelry (unless jewelry caused the condition), hair, medical equipment, cosmetics (unless cosmetics caused the condition) blood, IV tubing, oxygen tubing, and patient identification bracelets.

 

Contact dermatitis from nickel allergy from the button on the patient’s jeans. Sometimes the jewelry helps provide the cause of the exam findings.
Rings on the index and small fingers contribute to the ischemic index finger and swollen small finger. In this case the pathology was caused by the jewelry.
This metal wedding band was touching a wrench that arced between the positive and negative terminals of a car battery causing a circumferential burn to the ring finger. The ring was positioned to demonstrate its contribution to the pathology.

Removing clutter from the background that competes with the pathologic detail will make a more visually appealing image. Every effort to clean up or cover the background should be made. Having a consistent background draws the viewer’s attention to the pathology.

Removing clutter be as simple as moving the subject to a less cluttered area. Pulling the sleeve up out of the camera’s view would have made this a less cluttered image.

A blank, un-textured, neutral colored wall or door makes an excellent background for the head, neck, or torso.

This drug-induced skin eruption (trimethoprim-sulfamethoxazole) was taking with patient standing in front of the exam room door. The eye is also drawn to white areas of the photograph, but the uniformity of the back ground makes it less distracting.

Surgical towels, bedsheets, or surgical gowns create a uniform background for smaller subjects. Reflective surfaces such as tile, granite, glass, mirrors, wood should be avoided as they cause unwanted, distracting reflections.

 

The best background colors for clinical photographs are blue, black, white or gray. These colors seem to recede into the background and are less noticeable. Red or yellow tends to stand out from the image and are eye are drawn to these colors and away from the pathology.

Effect of background color on the viewer’s perception of the subject.

The viewers perception of color is affected by the background. For example, erythema of the skin seems less apparent if a red back ground is used. Blue surgical towels are effective in draping a small subject.

Blue surgical towel gives a relatively consistent background to accentuate the early frostbite. Care to straighten the towels on the medial side of the foot may improve the image.
The black background gives the appearance there is not background at all. This technique requires one to carry a black sheet to create this effect.

The ubiquitous white sheet is an effective background in most clinical situations, but can create exposure problems in patients with extremely dark- or extremely light-colored skin.


White sheet held behind the subject’s head and positioning the flash so no shadow is seen give this excellent result of a partially avulsed pinna.
A blue surgical gown is used as a background for this patient with meningococcemia.
A light-skinned subject with a white background will require adding light with exposure compensation to because of the tendency of the camera to want to render the toward neutral gray.