Number 7 July 1982

VI Radiography and Photography Repût12102 Pageii

Original article:

A Practical Approach to Clinical Photography (III)

LTC Albert C. Goerig. B.S., D.D.S., M.S.
Staff Photographer, American Association of Endodontists
Commander and Chief of Endodontics
Address: 124th Med. Det. (DS), {U.S. Army Dental Clinic, Munchweiler, West-
Germany), A.P.O., N.Y. 09189
Matthias J. Hourigan, B.S., D.D.S., F.A.C.D.
Associate Professor and Department Head of Oral and Maxillofacial Surgery
Address: Southern Illinois University Dental School, Alton, Illinois 62002

In parts I and II, we looked at clinical
photography equipment and the require-
ments for both the camera body and
macro lens system.
In part III, we will review the require-
ments for lighting, exposure control, film
and filters, and sources of clinical photo-
graphy equipment.
3. Lighting Requirements. The light
source should be attached to the lens.
This will help compensate for the inverse
square law of illumination. The closer
you move toward a 1:1 image ratio the
further away the lens is from the film
and, consequently, more light will be
needed to travel down the lens or bel-
lows to properly expose the film. With
the flash attached to the lens, the
intensity of the light will be greater as the
lens moves closer to the subject, thus
compensating for the loss of light by the
extension of the lens. Because of this the
lens aperature (f/stop) setting will remain
constant in all intraoral views. Macro
lens do not generally extend as far out as
the bellows and the f/stop may have to be
changed when focusing down from a full
mouth view to 1:1 ratio. If using a point
source electronic flash it should be
attached to the lens, so it rotates 180
degrees around the lens. This is to ensure
adequate access of light to the area to be
photographed, especially when using
mirrors. The center of the point source
flash should be ahgned with the center of
the lens.
The light source should have a color
temperature of 5400-5600 degrees Kel-
vin. This is the same temperature of
dayhght and is coordinated for proper
exposure and color tone of daylight film.
Because we use daylight film in clinical
photography this reduces the necessity of
using color correction filters and gives
good color balance.
The light source (electronic flash) should
have a guide number of 28-45 at ASA 25
to produce enough light enabling the
chnician to use a high f/stop (f/22). The
guide number is an indication of the
strength of the flash. It can be easily
determined by setting the arrow in the
dial on the back of your flash to ASA 25
and then looking at the 10-foot mark on
the dial. The corresponding f/stop at 10
feet is multiplied by 10, indicating the
strength or guide number of the flash.
For example, if the f/stop reads 4.0 the
guide number is 40 at ASA 25 (Fig. 7). If
it reads just above 2.8 the guide number
is 30. There are three basic hght sources

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available for clinical cameras. These are
the point source light (electronic flash)
(Fig. lb, c and e), the ring light
(Fig. Id), and the Lester Dine combina-
tion ring light and point source (Fig. 1 a).
There are certain advantages and disad-
vantages to each but all adequately
illuminate the subject. The quality of the
slide with either flash is pretty equal and
few operators can tell the difference in
the slides taken with a ring or slide iight.
One way to tell the difference is that ring
lights leave a white circle when reflected
off moisture in the mouth.
The point source light is mounted in a
bracket and attached to the lens.
Because light from the point source
comes from the side, proponents of this
light feel it produces deflnite shadows,
color contrast and texture to the object,
and gives depth to the picture. They also
point out that the point source and
bracket cost about '/• to '/: less than the
ring and point source. They also criti-
qued the bulkiness of the power source
needed for the ring light and combina-
tion ring-point source light (Fig, la).
Those who use the ring light flnd it is best
for deep cavities, craters, and photo-
graphing back in the mouth. Those that
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VI
Fig, 7 The strength or guide number of the
flash can be determined by setting the arrow
on ASA 25 (A) and looking at the 10-foot
mark (B). Multiply the f/stop by 10 and you
will get the guide number of the flash. In this
case it is 40
use the combination ring light/point
source flash feel they have the best of
both worlds, however, 90-95 percent of
the time they use only the point source.
The power source used with the ring light
does have the advantage of increasing or
decreasing the intensity of the flash for
immediate variations in exposure, In
many instances these reostats short out
and do not function, A light source
should be selected that operates on and
can be plugged into AC current. If the
cord which plugs into the socket is too
short, then a normal household exten-
sion cord is added to allow unhindered
mobility. It is recommended to power
the flash with AC current rather than
relying on batteries which are expensive
and cannot be relied upon for consistent
and continuous power for the flash. The
PC flash cord is synchronized for and
plugged into the "X" outlet of your
camera. A six inch PC flash cord exten-
sion may be needed with some flashes.
The shutter speed of most cameras must
be set at '/w of a second or less when a
flash is being used. If set liigher, i.e., /n'^
or 1/25», only half of the photograph will
be recorded. Because the speed of the
flash is usually Vvm of a second, there is
"Quintessence Inter •1982

VI
tittle chance of blurring the photograph
through minor movement of the eamera.
4. Exposure Control. When the operator
has assembled his camera system, a test
roll of film should be made to determine
the correct exposure for that particular
camera system. Exposures will vary from
system to system. Most systems bought
from clinical camera outlets will have the
exposure setting already determined. A
test roll is made by shooting at frequently
used image rations such as 1:1, full
mouth (1:2), and full face. At these
positions the exposures are bracketed at
a 1 to 2 f/stop variation using /; f/stop
intervals. Most clinical camera exposures
for intraorat pictures range between f/16
and f/22 and for futt face f/5.6 to f/ll. Put
a 20-exposure rott of film in your camera,
shoot at a 1:1 image ratio atf/11-16, f/16,
f/16-22, f/22 and f/22-32. The same is
done at 1:2 image ratio (full mouth).
Then full face shots are taken at f/5.6-8,
Ü8, f/S-11 and f/ll. On full face expo-
sure , measure the distance from the
patient to the camera and use the sug-
gested exposure reading found on the
back of the flash as a starting point.
Intraoral mirror exposures are also
taken. Some palatal mirror exposures
may have to be open '/; f/stop to allow
for the extra distance that the light
travels. All exposures are recorded in
order and compared with the developed
slides. Project the slide and setect the
best exposure. This is recorded and from
then on the best exposure at each setting
witt be known. We cannot over
emphasize the importance of taking a
test roll when von first use your camera.
Exposure is dependent upon flve vari-
ables: f/stop; the strength (hght output)
of the flash (guide number); speed of
film used (ASA); type and position of
flash bracket; and surrounding walls and
lighting conditions. To lighten or darken
your slides any one of the above can be
changed to improve exposure. If the
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Report 2102 Page 13
exposure of the test rotl is too dark at il
22, the f/stop may be opened V-. to a
position between f/16-22 (f/19). Con-
versely, if it is too light at f/16, then the
aperature may be closed down V2 or one
f/stop to f/19 or f/22. If the exposure is
too dark at f/16 and you do not want to
tower the f/stop to f/ll and lose depth of
fletd, it will be necessary to adjust one of
the other variables to enable you to
obtain proper exposure at f/16 or above.
You can use a film with a higher speed or
ASA, i.e., use ASA 64 rather than ASA
25, or use a light source with greater
output, i.e., use a guide number of 4Ü
instead of 32. Conversely, if the camera
system produces slides that are over
exposed at the camera's highest f/stop,
i.e., f/22, you can either move the flash
V2 to one inch closer to the camera body
or obtain a new flash with a smaller guide
number or place a neutral density fllter
over the flash.
A neutral density fllter is used to reduce
the light output of the flash without
appreciably affecting the color of the
subject. Kodak manufactures a No. 96
Wratten Neutral Density Filter which
comes in various thicknesses or densities
and can be used over the lens or flash.
Placement of the filter over the flash is
recommended.^ For every 0.10 increase
in filter density there is a corresponding
Vi reduction in f/stop, therefore, if you
need to decrease the f/stop by one, place
a 0.30 density filter in front of the flash.
Once you have determined what density
you need, the cover of the flash can be
removed and the desired filter is placed
on top of the flash tube just behind the
face of the flash cover. Do not touch the
electric leads of the capacitor because a
severe electric shock could occur. The
filter can be attached to the outside of
the flash but is subject to dust and
scratches. It is recommended that you
wait at least 10 seconds between expo-
sures to allow the flash capacitor to reach
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a full charge and obtain maximum
uniformity of exposure.
Most exposures made from a full mouth
to a 1:1 image ratio will be the same,
however, color and texture variations in
skin tone may cause a slight change.
Several exposures should be made to
determine correct f/stop and then a chart
can be developed to cover specific cir-
cumstances. If f/19 {f/16 to f/22) is deter-
mined to be the standard exposure, a
patient with very fair or blond skin would
be best photographed at f/22, while a
patient with dark skin tones may require
f/16 exposure. This recommendation also
follows for inanimate subjects. When
photographing a dental chart the f/stop is
closed on full stop (i.e., f/16 to f/22) to
compensate for the light color of the
chart. On full face exposures place the
patient close to a backdrop so the light of
the flash will fill in the background and
reflect back to the patient and give
proper exposure and clearer detail,
5. Film and Filters. Kodachrome II film
had always been the film of choice for
chnical photography because of its
extremely fine grain, good tonal range,
good color separation and particularly
because of its good tissue color reproduc-
tion. But since removal from the market
in 1975. the search has been on to find
the right fllm and filter combination to
obtain the same results. The type of film
and filter used will depend largely on the
colors which look natural to each prac-
titioner. The most popular films used in
intraoral photography today are Koda-
chrome 25 and 64, Ektachrome 64 und
Ektachrome 64 professional. All render
high quality slides and the basic decision
to use one over the other falls to personal
preference. Kodachrome film has more
of a red tint, while Ektachrome lies in
the blue-green range. Clifford Freehe,
one of the foremost experts in clinical
photography, recommends Kodachrome
64 film. We prefer Kodachrome 64 or
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VI
Ektachrome Professional. Ektachrome
professional film gives great quahty
slides but must be refrigerated until
ready to use and then used within a
reasonable period of time. Ektachrome
films do have the advantage of being
developed by most local photo labs in
one day, while Kodachrome film is usu-
ally sent to Kodak labs and may take
from three to seven days to return.
Processing of Kodachrome fllm is best
done by a Kodak processing laboratory
because it consistently maintains the
color balance during processing. Color
correction filters can be used with color
films for making subtle changes in the
slide color rendition or color balance
caused by the type of film and color
temperature of light source used. If your
slides tend to be slightly blue, then a
yellow correction filter might be used or
conversely, a yellow result would indi-
cate a need for a bluish filter. Kodak*
Data Books # AB-1 and # E77 explain the
selection and use of filters with color
films. Filters can be placed either over
the lens or over the flash itself with
equally good results. Some clinicians
believe the addition of a glass filter over
the lens may add to further distortion of
the picture. This may be true, but you
will have to decide.
6. Sources of Clinical Photography
Equipment. Purchasing a chnical system
can be very confusing, especially if you
are not that familar with close-up photo-
graphy. The best, easiest, and most reli-
able approach to purchasing your clinical
camera is to write for a price hst from the
major clinical photography stores.^•''•''''^
• Kodak, Consumer Market Division, Rochester New
York 14640
a, Washington Scientific Camera Company PO Box
88681, Tnkwila. WA 98188
h, Lester A, Dine, Inc. PO Drawer F. 100 Miiber
Bivd., Farmingdale. NY 11735
c, Trojan Intra-Oral Camera Systems, 3540 S Fieneroa
St,,Los Angeles, CA 90007 ' ^
d, Adolph Gasser, Inc, 5733 Geary Blurl. San Fran-
cisco, CA 94121
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W l Number 7 July 1982
» • Report 2102 Page 15

These camera stores specialize in dental correspondence. Each store's philosophy

photography equipment. They have an
excellent inventory selection, are able to
help you with your questions and prob-
lems concerning your individual camera
set-up, and are very responsive to your
on clinical camera set-up varies to some
degree, but each camera system will
deliver quality clinical slides and have
simplified manuals to teach you how to
operate your system. (To be continued)

Another Dietary Hazard

A grisly sense of humor sometimes surfaces in the Journal of ¡he American Medical Association ~
witness the headline "Face Flambé". The article warns of the hazards of flaming food and drink.
The authors are Bruce M. Achauer and his colleagues at the University of California Medical
Center, Irvine,
Achauer and his coworkers reported eight cases of hums sustained in restaurants from flaming
drinks, desserts, and entrées. Half of the victims were waiters or waitresses; the other half were
patrons. Typically, the authors say. such cases trigger lengthy, costly litigation.
In one incident, inexperienced waiters were making cherries jubilee in the kitchen when flames
shot from the bottle of hooch they were using. The bottle fell to the floor, and the flan:ies burned
the legs of a waitress. Earlier that evening, the authors note, a serving cart had burned to the
ground in the same restaurant.
In a second incident, a patron suffered extensive burns while being served cherries iubilee.
Flames entered the neck of the bottle, converting it to a kind of flamethrower when it was
pointed at the patron.
Two of the episodes reported by Achauer and his colleagues occurred in Newport Beach, Calif.
The city's fire department then decreed that restaurants wishing to serve flaming food or drink
had to meet these requirements:
• Obtain a special permit.
• Use no more than 30 ml of fuel.
• Prepareflamingitems only at the table (no transport offlamingitems through the restaurant).
• Have a wet towel at the preparation area.
• Create no flames higher than 20 cm.
• Use a spill-stop pouring device on the bottle of fuel.
These rules set off a minor revolt among the more elegant restaurants, according to Achauer and
his coauthors. Since then, however, restaurants apparently have complied with the rules, and the
flre department has reported no further cases of burns from flaming food or drink.
UAMA April 23. ¡982)

April 11th-15th, 1983

The First International Congress on Dentistry,

Medical Law & Ethics
Tel Aviv, Israel

Details from:
Congress Organizers and Secretariat Peltours Ltd., Congress Department, 28, Achad Ha'am
St., P.O. Box 394, Tel Aviv 61003, Israel, Tel. (03) 65 08 62

"Quintessence Internalional" 7/1982 787