1 . digital photography is a fundamental art in the day to day practice of a 
 dermatologist .
the main issue in most of the clinical photographs is the lack of good , reproducible and consistent digital images .
digital photography is a fundamental art in the day to day practice of a dermatologist .
but the main issue in most of the clinical photographs is the lack of good , reproducible and consistent digital images .
hence we designed an instrument to address all these deficits and provide quality digital images .
the lack of consistency of serial photographs is due to variation in : 
 patient positioning , camera angles , lighting anddistance between patient and camera . 
 
the instrument which we designed in our workshop is made up of stainless steel and has two parts viz . a fixed and a movable part [ figure 1 ] .
the patient comfortably sits on a chair and rests the chin over a cup shaped cushion ( 41 inches from the ground ) which is the fixed part [ figure 2 ] .
the movable part is where the digital camera or ideally a slr camera is mounted over a firm stainless steel plate .
the camera is kept in position by means of screw ( diameter  inch , length  inch ) which fits into the socket provided on the undersurface of it .
photographs are taken in the same place with the patient 's face against same dark background .
the movable part rotates around a central axis so that photographs can be taken at 0 , 45 and 90 [ figure 3 ] with angles marked in the axis .
the distance between the patient 's face and camera ( 1 feet ) is constant at all these angles .
the distance between the camera and face constant in all angles 90 right , 45 right , 0 front , 45 left , 90 left profile images the device which we designed for perfectly aligned photographs was similar to the omnia imaging station which has a camera column to maintain correct distance through all camera positions , dual intelli flash to provide balanced lighting and match pose image overlay for accurate patient positioning .
comparison of features between omnia imaging station and our instrument small inconsistencies with patient positioning can be corrected using image analysis software photoshop adobe cs5 .
each photograph is aligned to the previous photograph by manually selecting points of obvious anatomic landmarks [ figure 4 ] .
this increases the ability of the observers to confidently track the same lesions in the same place in serial photographs [ figure 5 ] .
( a ) before treatment photograph : yellow dots are the anatomic landmarks chosen for alignment to match those in follow - up photograph .
( c ) without digital alignment : photographs of before treatment and follow - up on overlaying shows mismatching of anatomic landmarks .
( d ) with digital alignment : yellow and red dots are superimposed to exactly match both photographs separation of images after alignment the photo - editing software allows perfect alignment of photographs taken serially without altering color or contours of the lesions . by monitoring the same area over time sequentially , interpretation of changes is made easy [ figure 6 ] .
had used serial digital photographs and similar spatial alignment software , the software picture window pro 4.0 ( digital light and color , belmont , ma , usa ) to examine the evolution of facial acne lesions . serial tracking of acne scars before each laser sitting -images are comparable and consistent the applications of digital photography in our field include : 
 tracking serial photographs after cosmetic procedures like peels and lasers , storing patient data , medico - legal proof , discussion in forums andmedical publications . 
 
tracking serial photographs after cosmetic procedures like peels and lasers , storing patient data , discussion in forums and medical publications .
the digital photography forms the basis of store - and - forward system of teledermatology .
the medical images are captured in the referring center and subsequently forwarded to the specialty centre .
a proper digital photograph highlighting the representative lesions is essential for a dermatologist to make a reliable diagnosis .
it can also be used in the field of dentistry to assess the improvement of facial profile after wearing orthodontic braces .
the lack of consistency of serial photographs is due to variation in : 
 patient positioning , camera angles , lighting anddistance between patient and camera . 
 
the instrument which we designed in our workshop is made up of stainless steel and has two parts viz . a fixed and a movable part [ figure 1 ] .
the patient comfortably sits on a chair and rests the chin over a cup shaped cushion ( 41 inches from the ground ) which is the fixed part [ figure 2 ] .
the movable part is where the digital camera or ideally a slr camera is mounted over a firm stainless steel plate .
the camera is kept in position by means of screw ( diameter  inch , length  inch ) which fits into the socket provided on the undersurface of it .
photographs are taken in the same place with the patient 's face against same dark background .
the movable part rotates around a central axis so that photographs can be taken at 0 , 45 and 90 [ figure 3 ] with angles marked in the axis .
the distance between the patient 's face and camera ( 1 feet ) is constant at all these angles .
the distance between the camera and face constant in all angles 90 right , 45 right , 0 front , 45 left , 90 left profile images the device which we designed for perfectly aligned photographs was similar to the omnia imaging station which has a camera column to maintain correct distance through all camera positions , dual intelli flash to provide balanced lighting and match pose image overlay for accurate patient positioning .
small inconsistencies with patient positioning can be corrected using image analysis software photoshop adobe cs5 .
each photograph is aligned to the previous photograph by manually selecting points of obvious anatomic landmarks [ figure 4 ] .
this increases the ability of the observers to confidently track the same lesions in the same place in serial photographs [ figure 5 ] .
( a ) before treatment photograph : yellow dots are the anatomic landmarks chosen for alignment to match those in follow - up photograph .
( c ) without digital alignment : photographs of before treatment and follow - up on overlaying shows mismatching of anatomic landmarks .
( d ) with digital alignment : yellow and red dots are superimposed to exactly match both photographs separation of images after alignment the photo - editing software allows perfect alignment of photographs taken serially without altering color or contours of the lesions . by monitoring the same area over time sequentially , interpretation of changes is made easy [ figure 6 ] .
had used serial digital photographs and similar spatial alignment software , the software picture window pro 4.0 ( digital light and color , belmont , ma , usa ) to examine the evolution of facial acne lesions .
the applications of digital photography in our field include : 
 tracking serial photographs after cosmetic procedures like peels and lasers , storing patient data , medico - legal proof , discussion in forums andmedical publications . 
  tracking serial photographs after cosmetic procedures like peels and lasers , storing patient data , discussion in forums and medical publications .
the digital photography forms the basis of store - and - forward system of teledermatology .
the medical images are captured in the referring center and subsequently forwarded to the specialty centre .
a proper digital photograph highlighting the representative lesions is essential for a dermatologist to make a reliable diagnosis .
it can also be used in the field of dentistry to assess the improvement of facial profile after wearing orthodontic braces .
digital photography is transforming the specialty of dermatology and standardization of photographs is of prime importance in this era of digital technology . the major limiting factor in a developing country like india is the cost of such sophisticated instruments to provide images of high quality .
hence there are always alternatives to get the best out of the resources we have and this device is one kind of it
. digital photography along with image analysis will open avenues onto a more detailed view of the patient and their response to treatment .
a low - cost instrument has been devised to provide consistent digital facial images that is comparable to the higher end alternatives .
 photography has proven to be a valuable tool in the field of dermatology . 
 the major reason for poor photographs is the inability to produce comparable images in the subsequent follow ups . 
 combining digital photography with image processing software analysis brings consistency in tracking serial images . 
 digital photographs were taken with the aid of an instrument which we designed in our workshop to ensure that photographs were taken with identical patient positioning , camera angles and distance . 
 it is of paramount importance in aesthetic dermatology to appreciate even subtle changes after each treatment session which can be achieved by taking consistent digital images . 
Introduction
Background and Materials
Reasons for inconsistent images
Photography device
Alignment software
Uses in dermatology
Future directions
Conclusion