Clinical photography in cancer care

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Published: 8 May 2019
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John Hillson - Duke Cancer Institute, Durham, USA

John Hillson speaks to ecancer at ONS 2019 about the benefits of clinical photography.

He says that since technology for clinical photography are becoming more readily available, however there are some security and privacy measures that need to be carefully considered.

John notes that it is important that clinical photography should not be seen as an alternative to examinations, but as a supporting resource.

It all started when we had a patient come in on Monday morning and said he thought that there was a new tumour site outside of where we were treating him and his physician was not available that day. So I took a camera, took a piece of tape measure and took a photograph of that. 48 hours later the doctor was available, it was the patient’s usual treatment check day, and we were able to go and show that in fact this one lesion had grown half a centimetre larger in a couple of days. One of the opportunities we have with the new medical records is we can go and upload digital photography, we’re not reliant on Polaroids anymore. Photography is already used a lot in QA for delivering radiation therapy but not much from the radiation side.

I’ve been able to go and collect photographs and send it back to the surgeon to show possible new disease or surgical site infections. We’ve been able to go and remotely get in with the wound care service and get their recommendations even when they’re not immediately available. And we’ve been able to go and follow these patients over time. In some cases even when the original physician has gone and left our facility we’ve been able to go and show exactly what the wound was like before treatment, all the way throughout treatment and these patients are coming back months later, years later. We’ve been able to catch recurrent disease and really it’s just a more effective method of documentation.

Are there other benefits to using clinical photography?

Those have been the principal ones that we can go and make this part of the patient’s permanent record and it’s very easy now to go and write a note, essentially email a note, to any of the stakeholders in the patient’s care. So the patient is not having to go and walk considerable distance to the next clinic, they’re not having to undergo multiple dressing changes a day.

It’s important to say that a picture does not go and replace the basic note. You can’t go and see how much pain the patient was having or what it smelt like or what was draining but to go and actually describe some of what we see in treatment and the detail that is warranted, it’s very difficult to do that in sentence form.

What are the challenges to providing clinical photography to patients?

The largest barriers to clinical photography, at the very least in terms of cost, we’re now finding that digital cameras are getting cheaper and cheaper. Some of the electronic medical systems are going and using provider cellphones to go and upload directly into the chart. Cost hasn’t been so much the barrier but there are very real security concerns and would we potentially be doing something untoward with these images. For all that, I’ve been seeing a lot of papers coming out of Britain where they’re using this a lot more in home care and lot more in wound management. While it has not been used a great deal in radiation oncology I was finding a lot of other protocols in forensics, dermatology, wound care, other areas.

What is your take home message for oncology nurses?

I believe it’s a very good tool and it has been very helpful for us. Certainly in the infusion room if you have somebody that gets an extravasation you can have a very solid visual as to what that looked like at the time, something that the nurse on the next shift or a few days later can go and see exactly what you saw. It’s something we could be making more use of than we are. Most of the documentation on clinical photography right now, most of the literature centres on hip and on avoiding security concerns and it’s very important but I’m hoping that we have more discussion on when we should be taking photographs instead of just simply not doing it.