Operating room photography

PSA Journal, June, 2005 by Barry Slaven

Fledgling authors are told to "write what you know" because that's what is often easiest for people to write about. I believe that the same maxim applies to photography and have for many years been photographing what I know: the operating room (OR).

As a board-certified surgeon in a major Pennsylvania teaching hospital, I have essentially unfettered access to the operating suite where I photograph frequently. My kind of medical photography is more like photojournalism than nature or scenic photography. Grizzly bears, mountains, and flowers are pretty much uncaring when people take their pictures (although occasionally the bears can have a problem with it!). In the operating room, one must be careful of what and whom one photographs.

Probably 80 or 90% of Photographic Society of America (PSA) members do at least some landscape, travel, or nature photography as part of their daily existence or when on vacation. There certainly is no shortage of photography magazine articles, on-line instruction, and videotapes to tell people how to shoot rivers, trees, sunsets, and the like. A few people are able to make a nice living from this work, and many, many more will sell photos from time to time to help defray the cost of their photography.

While the operating room is a venue that's not generally available, it does provide a fascinating place to photograph. My photos encompass three specific areas: anatomic/ pathologic shots of diseased organs in situ; technical shots of surgeons at work, e.g. laparoscopic procedures, breast surgery, and neurosurgery; and the "art" of the OR, character studies of surgeons and other OR personnel at work.

As alluded to above, medical photography is very different from "normal" photography in that one must be ever mindful of patient confidentiality. For this reason, I never take a photograph of a patient's face or any other identifiable body part unless explicitly asked for such a photo by the patient. In fact, I don't identify any patient in my photos by name, medical record number, or any other artifact. In addition to legal and ethical issues, common courtesy is also important. If any OR staff person indicates to me that he/she does not want to appear in a photo, I honor that wish.

From a technical viewpoint, OR photography offers many challenges. One can photograph in either color or black and white, of course, and both media offer advantages depending on the image or emotion one is attempting to convey. For medical illustration, generally color is preferred; while for the art photos, B&W is often most effective. Until about three years ago, I used film cameras exclusively. Both 35mm and medium format were used, but these were not entirely satisfactory for a number of reasons. First, the ISO had to be the same for an entire roll, and second the mix of light sources in an OR is beyond the ability of film to capture in the absence of filters and/or special lighting. On-camera flash is rarely satisfactory because of its harsh nature. Ambient lighting in the operating room can be either fluorescent or a mix of daylight with fluorescent if windows are present. Task lighting is incandescent, but the color temperature of OR lights varies greatly.

Digital photography has brought a world of changes to this particular venue--all of them positive. Shooting with a Canon EOS D10, I now can tailor both the ISO and the color balance to each photo. I generally shoot wide angle and "set" shots with my camera set to fluorescent white balance since the majority of our ORs have no windows. For close-ups, I switch to tungsten. On occasion, I will use flash but rarely. Shooting in RAW format gives me tremendous latitude, and my percentage of "keepers" has increased dramatically because I can fine-tune the color in post-production. I usually shoot using available light, thus rendering my presence less obtrusive and making dramatic candid shots much easier to obtain. I find that after a few minutes, the surgical team generally ignores my flitting about the room, snapping away. Yet should an interesting finding present itself during the case, I am right there to capture it.

Two lenses are particularly useful in my photography. I use a wide-angle zoom for many shots and a moderate telephoto zoom for isolating faces, instruments, and the operating field. Most digital cameras have a sensor smaller than a 35mm film frame, and there is therefore an inherent "magnification factor." With my D10, this is about 1.6 compared to a standard 35mm SLR. To overcome this, since operating rooms can be cramped and confined spaces, my favorite lens is a Sigma 12-24mm zoom. Even corrected for the digital factor, this gives me a 19mm capability on the wide end which I find extremely useful. With this lens and my Canon 28-105mm zoom, I can photograph pretty much anything I envision. On occasion, I will also use a 50mm macro lens.

Shooting for black and white, of course, obviates color temperature concerns. Converting color images to B&W is straightforward using most any image processing software and can give strong images, portraits, chiaroscuros OR scenes, and moody shots of personnel and performance in the operating room.