Producing information for patients has become an increasing part of the medical illustrator's workload. This article looks at the benefits of providing patients with information, against the background of political history, legal requirements and the element of design. It concludes with recommendations for improving the quality of patient information.
Part 1 of this paper explored the origins of process activity mapping, one of the major tools currently being used to modernize patient pathways in the National Health Service in Great Britain. Within medical photography the current notion of modernization is inextricably linked to the development of digital technology. Whilst the core principle of capturing light on a sensitive medium remains as clear and relevant as ever, the mechanisms by which the image is processed and presented to the client have changed profoundly. Part 2 shows how the principles of lean thinking and process activity mapping can be utilized to harness the advantages of digital technology to provide a modern and appropriate medical photography service in a large disparate teaching hospital.
Rules and regulations founded on ethical principles permeate healthcare practice. NHS Trusts formulate policy to govern their activities in which duties and responsibilities are defined to protect patients from harm and protect themselves from potential litigation. Clinical photographers are not immune from the demands of ethical practice and need to have clearly defined duties and responsibilities. This paper maps the dynamics of ethical practice and how this may be expressed in codes of practice related to the principles of professional clinical photography.
Two examples of specialized work undertaken by medical illustrators were featured in this issue. Reconstruction of the heads of three ancient Egyptian mummies by RAH Neave, Assistant Director of Medical Illustration at the Medical School, Manchester, described in great detail, and illustrated with copious photographs, how the faces and heads of the Egyptians were built up in clay from the skulls. This was part of a Manchester Museum Mummy Project to attempt to produce busts which represented as closely as possible the appearance of the persons when alive; these would form the models for drawings and paintings for display alongside the mummies. To check the accuracy of the technique, photographs were taken of the heads of cadavers in the Department of Anatomy in the Medical School; when the students had completed their dissections the heads were made available for reconstruction of the soft tissues by staff who had not seen the originals. With the exception of the detail of the noses, the reconstructions matched the photographs fairly well. Transillumination of the infant skull by Martin Johns, Deputy Director of Medical Illustration at Great Ormond Street Hospital for Sick Children, London, discussed the many attempts made to design a suitable apparatus to examine an infant head by transillumination. This too was copiously illustrated, many of the photographs being in colour. The equipment ranged from a wooden box to a sophisticated apparatus built for the hospital by the Ford Motor Company, and several photographs illustrate the results obtained by the light source. The possible uses of the apparatus include, in smaller hospitals, a means of identifying those cases which should be referred to a larger centre for a CAT scan or ventriculography.
In 1991, the creation of the Media Unit at the St. Augustine Campus, University of West Indies, first established medical illustration as an organized profession within the public healthcare provision of Trinidad and Tobago. Since then the Unit has overcome many difficulties, some of them unusual for medical illustrators in the developed world, not least in obtaining equipment unavailable in the country, in finding suitable working facilities, and in developing practices for veterinary work. Today the Media Unit services a wide range of the University's schools, clinics and media services, and has been instrumental in educating a new generation of healthcare professionals.
The ‘pinworm’ (Enterobius Vermicularis) is an intestinal parasite of the nematoda order, oxyurata. The common name ‘pinworm’ derives from the appearance of its tail, which is long, thin and pointed. Unlike most other nematodes, Enterobius organisms are more common in temperate countries than in the tropics. Enterobius Vermicularis infests more than 400 million people worldwide and is found predominately in temperate or colder climates. 1,2 Although serious clinical disease is extremely rare, pinworm infection carries with it much unwarranted social stigma. 3 Enterobiasis is a familial or institutional infection that has no preference for socio-economic status. This female worm was presented alive in water on a microscopic slide. The worm was visible to the naked eye and was laying eggs; female worms typically measure 8–13mm whereas male counterparts measure approximately 2–5mm. Gravid females emerge from the anus of the host at night, lay about 20,000 eggs on the perianal skin, and then die. The eggs, which embryonate within four hours of exposure to air, cause anal pruritus that leads to scratching and to the deposition of eggs under the fingernails of the already parasitized host. 3 The lifespan of
Telemedicine is a valuable, but as yet underused, resource for the delivery of health-care to patients. This paper describes the development of a new store-and-forward telemedicine service at the Queen Victoria Hospital, which is a tertiary referral centre for plastic surgery in the United Kingdom. The practical requirements of such a system, and the technical and legal difficulties experienced during the initial stages, are also discussed.
Much has been published relating to the treatment and surgical outcome of cleft lip and palate disorders. Clinical audit is one of the most important tools for assessing the quality of care provided, with medical photography an invaluable component of this process. The Clinical Standards Advisory Group Report 1998 recommended that cleft lip and palate patients should be audited when 0 (under 1 year of age), and then at the ages of 5, 10, 15 and 20 years. For both audit and research purposes, medical photographs need to be accurate and of a consistently high standard. This paper describes the development of a standardized photographic protocol for cleft patients of audit age, to the benefit of both the multidisciplinary team and the patients.
Within clinical photography, colour reproduction has always been a contentious issue. With the development of new technologies, the variables affecting colour reproduction have changed and photographers have altered practices, moving away from the realm of film to digital photographic imaging systems. In order to standardize the output of digital clinical images, the author researched, and successfully implemented, the GretagMacbeth EYE‐ONE Pro colour management system. This system, which is maintained on a monthly basis, has ensured a colour‐consistent, reliable and efficient workflow throughout the digital clinical set‐up.
This paper considers several aspects of using linear scales in photographs. It describes a method used to measure the variations in scale size and subject size when the two are not on the same plane in a photograph. It discusses the results achieved from experiments using a measuring device and different lenses and lens settings. The results demonstrate the marked differences in measured size that occur as the scale and subject distances vary. The paper provides evidence that placement of scales within the field of view in photographs is critical for useful information to be extrapolated from the scale.
Videoconferencing has enhanced the learning experiences of children who, as a result of medical difficulties, have attended James Brindley School. The School is based in thirteen hospitals and specialist units across Birmingham, and provides educational opportunities for children from 3 to 19 years of age. At one of these sites, the Diana, Princess of Wales, Children's Hospital, the use of videoconferencing has been extremely effective in practice, and experiences suggest that it should be adopted as a fundamental tool by those who wish to develop and enhance the educational process in similar environments.
(2004). Eats, Shoots & Leaves. Lynne Truss. 2003; Profile Books Ltd., London. 209 pp. Hardback £9.99.Between You and I. James Cochrane. 2003; Icon Books Ltd., Cambridge. 126 pp. Hardback. £9.99.Bryson's Dictionary of Troublesome Words. Bill Bryson. 2002; Broadway Books, New York. 242 pp. Hardback. $19.95 (paperback due in October 2004). Journal of Audiovisual Media in Medicine: Vol. 27, No. 2, pp. 74-74.
Denver, the capital of Colorado State, was the venue for the 29 annual conference of the Health and Science Communications Association (HeSCA). Known as the milehigh city – it being a mile above sea level – Denver lies in the middle of high plains at the eastern base of the Rocky Mountains. As one of the most isolated major cities in the United States, there was very much a ‘western’ feel to the city, which is now a modern high-rise metropolis and home to the Valley of Coors Baseball Field, the Colorado History Museum, and the United States Mint. Denver proudly boasts the largest international airport in the USA; the first impression of Denver for the majority of delegates to the conference, who had travelled from all over America, Canada and the UK. The three-day conference was packed with an excellent programme and delegates began their days early, with most sessions beginning at 8.00am. The first day of the conference was devoted to telemedicine and e-learning. Vic Spitzer opened the morning session with a brief update on the Visible Human Project, and then introduced Colin Monks and Richard McIntosh, who described how comprehension and understanding of the human body has developed through threedimensional imaging; the theme was continued by Paul Baker who brought the Visible Human Project to life through animation. He described how programmers designed software capable of tracing anatomical structures, which in turn were converted into 3-D wire-frame models. He showed examples of how the 3-D models could then be used in animations, multimedia projects, or ‘screen-grabbed’ for use in print. Vic Spitzer concluded the session by demonstrating advances in human modelling and simulation for riskfree procedure training, involving three-dimensional stereoscopy. The next session concentrated on e-learning and telehealth, and included presentations by Sally Jonhstone, Mark Brodsky, Karen Adsit, Erwin Boschmann and Frank Brady. The speakers confirmed that the USA is leading the field in this area of education; it was evident that many of the American universities have well-developed e-learning programmes in place. Although some of the programmes were developed in-house, due to the developments in technology and the increasing complexity of the courses, many are now being out-sourced. This session considered many aspects of their operation, including global telemedicine and teaching. The first day ended with a Quicktalk session. Arlyn Bonfield described the development of a website aimed to provide an effective online means to teach teachers how to teach using proven strategies, such as brainstorming, case discussion, reflective exercise and role play. Mark Saba then showed, by means of a case study, how his service can design effective media on a tight budget. After an exhausting first day session, there was no time for delegates to rest as the traditional HeSCA auction began. This was followed by dinner at the Denver Museum of Nature and Science, where the planetarium had been booked for a fabulous private show. The second day of the conference concentrated less on technology and more on human interactions, and included a number of management issues. Allan Wallis began with a look at how threat is communicated, and how delegates might adapt their leadership style as issues such as SARS, AIDS, global warming and terrorism, make life more challenging. Mickey Skiba then described the relationship between organizational change and informal learning in the workplace. Next, Bill Peters described how his career had developed through volunteerism. Carol Beckerman gave a thought-provoking presentation about ethics in the workplace, and pricked at the conscience of each delegate about how their behaviour can affect those they work with. Carol Fleming followed with a presentation about the benefits of quality management systems within health communication departments; this was followed by Bob Myers who described how his service had designed and installed new technology-based facilities. The afternoon session was given over to the practical workshops; many took place off-site giving delegates the opportunity to stretch their legs and see a little bit more of Denver. Subjects included website design, health literacy, and advanced PowerPoint tutorials. The final day of the conference began with a presentation by Helen Osborne, who focussed on health literacy and its relevance to media producers. This was followed by John Jackson who described how the effective use of graphics can help achieve clear health communication. Karen Baker then described how her organization works alongside health professionals in order to produce media which allow people to make better health decisions, by developing partnerships with doctors. After lunch, Christine Perfetti gave an insight into the effective design of websites by describing the secret Journal of Audiovisual Media in Medicine, Vol. 27, No. 4, pp. 176–177
This paper introduces the fields of usability and interaction design in order to highlight their benefits and provide further resources for those that wish to find out more. It is hoped that this review will encourage medical illustrators to adopt certain principles and practices in their own project work, in order to strive towards (and ultimately produce) products and environments that provide more positive interactions for their users. Usability and interaction design are fields of study concerned with aims relating to ensuring that any given interactive product or environment is efficient, effective and safe to use, as well as easy to learn and remember. Of primary importance is the experience of the user whose interactions should be positive, as opposed to frustrating or counter-intuitive.
This study investigated risks associated with the photography of materials that are a potential source of infection, the extent to which medical illustrators are aware of these risks, the relevant government regulations and guidance, and whether recommended control measures are adopted. To seek information about current practice, a questionnaire was sent to randomly selected Medical Illustration Units across the United Kingdom. The data indicated that a significant proportion of medical illustrators routinely photograph materials that could be a source of infection, but that a high percentage know little about the specific regulations and guidance which govern the handling of such materials. Apparent deficiencies in safety procedures currently applied in photographing microbiological materials were identified; recommendations that address these problems at little or no cost are proposed.
From the Journal of Audiovisual Media in Medicine 1982: 5(2)A paper on ‘Graphics and animation for medical television’ by Alan Waller, St Bartholomew’s Hospital, London, set out ideas and advice fo...
The 36th IMI Conference was held in the Hilton Dunblane Hydro, a charming hotel set on a hillside overlooking the smallest city in Scotland. The Scientific Programme was held over the three days of the conference and featured a wide range of professional topics. The ‘State of the Profession’ address was given by Keith Duguid who was asked to assess where the profession currently stands and to visualize the future of medical illustration. Journal of Audiovisual Media in Medicine, Vol. 27, No. 1, pp. 29–32
