Patient privacy, photographs, and publication

Opinions of professors, dental students, and patients for publishing the patient images in the articles

INTRODUCTION

The journals must have an instruction for writers to observe the essential ethical principles like privacy-preserving, secrecy, and keeping the patients' identities hidden. Even though patient secrecy is an important ideology in medicine's ethics, most journals have a little guide on this topic for the authors. According to the absence of such studies in dentistry and limited studies in medicine, our goal in this article is to review the opinions of professors, Kerman dentistry students, and patients for publishing the patient images in the articles.

METHOD

This research is an analytical, sectional, and descriptive study. The studied society includes the professors of the dentistry faculty (54 people), the 4th to 6th years dentistry students (122 people), and 129 patients who referred to the offices, the faculty, and other clinics in Kerman city base on simple random sampling method. A query including the personal questions, and questions related to the participants' opinions about publishing the images was given to contributors. Abundance, average tables, chi-square (χ 2) test, T-test, and SPSS 21 software were used for data description.

RESULTS

The contributors' attitudes were different in three groups of participants: more than half of the patients (58.91%), 39.5% of students, and 31.38% of professors believed that no permission is needed. While, 64.34% of the patients, 89.34% of students, and 83.3% of professors believed that written permission is needed for publishing.

CONCLUSION

From the participants' viewpoints, more strict forms are needed by increasing identity recognizability. The professors are more eager than the patients to receive patients' permission for any kind of image. By reducing the level of identification, doctors and students are more eager than patients to receive approvals.

Unobtrusive biometric data de-identification of fundus images using latent space disentanglement

With the incremental popularity of ophthalmic imaging techniques, anonymization of the clinical image datasets is becoming a critical issue, especially the fundus images, which would have unique patient-specific biometric content. Towards achieving a framework to anonymize ophthalmic images, we propose an image-specific de-identification method on the vascular structure of retinal fundus images while preserving important clinical features such as hard exudates. Our method calculates the contribution of latent code in latent space to the vascular structure by computing the gradient map of the generated image with respect to latent space and then by computing the overlap between the vascular mask and the gradient map. The proposed method is designed to specifically target and effectively manipulate the latent code with the highest contribution score in vascular structures. Extensive experimental results show that our proposed method is competitive with other state-of-the-art approaches in terms of identity similarity and lesion similarity, respectively. Additionally, our approach allows for a better balance between identity similarity and lesion similarity, thus ensuring optimal performance in a trade-off manner.

Visible Light Imaging: Clinical Aspects with an Emphasis on Medical Photography-a HIMSS-SIIM Enterprise Imaging Community Whitepaper

Photodocumentation is a subset of visible light imaging and is an important growing segment of enterprise imaging. Medical videography is another subset of visible light imaging that shares many of the challenges of photodocumentation. Medical photographs are used to document clinical conditions, support diagnosis, guide, and document procedures and to enable collaboration among colleagues. They also play a significant role in patient engagement and are a mechanism for patients to share information with their provider without the need for a clinical office visit. The content of medical photographs raises issues for acquisition, management, storage, and access. Medical photographs may contain protected health information, and these images benefit from the standardized, secure processes inherent in any enterprise imaging program. The ability to securely acquire images on mobile, and sometimes personally owned devices, is a necessity. In addition to containing protected health information, photograph content can be sensitive or gruesome or the images may be used for forensic purposes. These types of images require additional protections. Access to these images should be role-based and auditable. To properly identify photographs and to convey information about their acquisition parameters new metadata requirements and mechanisms for its association with the imaging files are evolving. Institutional policies need to be developed to define the organization's requirements for medical photography, including consent processes. Existing policies such as those defining the designated record set and legal health record should address the management of medical photography.

Informed Consent In Facial Photograph Publishing: A Cross-sectional Pilot Study To Determine The Effectiveness Of Deidentification Methods

This study determined the effectiveness of three deidentification methods: use of a) a black box to obscure facial landmarks, b) a letterbox view to display restricted facial landmarks and c) a half letterbox view. Facial images of well-known celebrities were used to create a series of decreasingly deidentified images and displayed to participants in a structured interview session. 55.5% were recognised when all facial features were covered using a black box, leaving only the hair and neck exposed. The letterbox view proved more effective, reaching over 50% recognition only once the periorbital region, eyebrows, and forehead were visible. The half letterbox was the most effective, requiring the nose to be revealed before recognition reached over 50%, and should be the option of choice where appropriate. These findings provide valuable information for informed consent discussions, and we recommend consent to publish forms should stipulate the deidentification method that will be used.

Deidentification of facial photographs: a survey of editorial policies and practices

We analysed all journals from two Journal Citation Reports (JCR) categories: 'Dentistry, Oral Surgery and Medicine' and 'Otorhinolaryngology' published in 2018 for their policies on publishing facial photographs and actual practices of publishing these photographs in articles. We extracted the following data for each journal: JCR category, impact factor, volume, issue, instructions for authors regarding ethical issues, instructions for photograph deidentification, journals' references to standard research and publishing policies, presence and type of published clinical images, separate informed consent for the publication of patient photograph and methods of deidentification. The sample included 103 journals, which published 568 articles with 1404 clinical images. Around a half of the journals (52%) had a policy on clinical images, however, the only predictor of having a journal policy on clinical images was reference in the policy to International Committee of Medical Journal Editors Recommendations (OR=3.00, 95% CI 1.26 to 7.14, p=0.013). Identifiable patient photographs were found in 13% (79/568) of the articles, constituting 9% (128/1404) of the total sample of images. Only 16% (13/79) of articles publishing recognisable patient facial images included a statement about consent for publication of the image. From the total sample of articles, 34% (27/79) contained deidentified but recognisable patient photographs and only 22% (6/27) of them had a statement about patient consent for photograph publication. The patients' consent was more likely stated in the article in cases of recognisable facial images (OR=2.81, 95% CI 1.41 to 5.63, p=0.004). Journals publishing clinical research involving the face and neck region need to establish and enforce policies on publishing clinical images.

Can We Reach a Consensus on the Appropriate Use of Before and After Photos in Breast Surgery?

Breast surgery is an area of practice where patients value before and after photographs (BAPs). Consensus is needed to develop guidelines to address the deficit in the literature regarding appropriate use of BAPs, as these may ultimately play a significant role in the breast surgery consent process.

Assessment of dentists' behaviour on the use of patients' images

BACKGROUND

Photographs and radiographs are indispensable resources for dental education, research and dissemination of clinical cases in scientific journals. The objective of this study was to evaluate the behaviour of dentists on the use of patients' images.

MATERIAL AND METHODS

Fifty-two dentists were interviewed using a semi-structured script containing open-ended questions on the use of patients' images. The answers were analysed using a qualitative-quantitative method of the discourse of the collective subject, and the distribution of the absolute and relative frequency of the answers was presented according to the central ideas obtained from the discourses.

RESULTS

The following central ideas on the use of patients' images were identified: (a) purpose: didactic and/or academic; (b) informed consent: verbal or absent when the patient cannot be identified; (c) discussion groups on social media contribute to learning; (d) most dentists would not appreciate and sue the author if they had their own photographs/imaging examinations posted on social media; 5. most dentists received some information on ethical regulations during dental school and state that images can be used with patient authorisation, without identification and for didactic/academic purposes.

CONCLUSION

Dentists consider the use of patients' images for didactic and scientific purposes beneficial, request informed consent to share mainly images that reveal the identity and would not appreciate if their personal images were shared without consent.

What Patients, Students and Doctors Think About Permission to Publish Patient Photographs in Academic Journals: A Cross-Sectional Survey in Croatia

Use of patient clinical photographs requires specific attention to confidentiality and privacy. Although there are policies and procedures for publishing clinical images, there is little systematic evidence about what patients and health professionals actually think about consent for publishing clinical images. We investigated the opinions of three stakeholder groups (patients, students and doctors) at 3 academic healthcare institutions and 37 private practices in Croatia (total 791 participants: 292 patients, 281 medical and dental students and 281 doctors of medicine or dental medicine). The questionnaire contained patient photographs with different levels of anonymization. All three respondent groups considered that more stringent forms of permission for were needed identifiable photographs than for those with higher levels of anonymization. When the entire face was presented in a photo only 33% of patients considered that written permission was required, compared with 88% of the students and 89% of the doctors. Opinions about publishing patient photographs differed among the three respondent samples: almost half of the patients thought no permission was necessary compared with one-third of students and doctors. These results show poor awareness of Croatian patients regarding the importance of written informed consent as well as unsatisfactory knowledge of health professionals about policies on the publication of patients' data in general. In conclusion, there is a need for increasing awareness of all stakeholders to achieve better protection of patient privacy rights in research and publication.

Guidelines for the Ethical Publication of Facial Photographs and Review of the Literature

Facial photography presents a unique ethical dilemma, as faces are difficult to deidentify for publication. We performed a review of the literature to examine current guidelines for the publication of facial photographs. We also reviewed societies’ websites, journal requirements, and ethical and legal aspects of confidentiality. Most articles emphasized the importance of consent for photography and publication. Masking is not appropriate, but some journals continue to allow masking. Most legislation allows patients to restrict the uses of photographs. In the end, it is imperative to protect patient privacy by obtaining consent for photograph publication after full disclosure of risks, and specific recommendations are provided regarding a comprehensive consent process.

When Is Posting about Patients on Social Media Unethical "Medutainment"?

Social media is characterized by online spaces for rapid communication, advertising, professional development, and advocacy, and these platforms have revolutionized the way we interact with people and our culture. In plastic surgery, platforms like Facebook, Snapchat, and Instagram are especially attractive for practice promotion and instantaneous connection with potential patients. However, considerable risks and ethical dilemmas lie in wait for the plastic surgeon who attempts to use patient photographs and videos for advertising. It is critical for plastic surgeons who use patient images for this purpose to facilitate fully informed consent, consider both context of use and the patient-physician power differential, and put patients' interests ahead of their own.

Best practices to optimize intraoperative photography

BACKGROUND

Intraoperative photography is used extensively for communication, research, or teaching. The objective of the present work was to define, using a standardized methodology and literature review, the best technical conditions for intraoperative photography.

MATERIALS AND METHODS

Using either a smartphone camera, a bridge camera, or a single-lens reflex (SLR) camera, photographs were taken under various standard conditions by a professional photographer. All images were independently assessed blinded to technical conditions to define the best shooting conditions and methods.

RESULTS

For better photographs, an SLR camera with manual settings should be used. Photographs should be centered and taken vertically and orthogonal to the surgical field with a linear scale to avoid error in perspective. The shooting distance should be about 75 cm using an 80-100-mm focal lens. Flash should be avoided and scialytic low-powered light should be used without focus. The operative field should be clean, wet surfaces should be avoided, and metal instruments should be hidden to avoid reflections. For SLR camera, International Organization for Standardization speed should be as low as possible, autofocus area selection mode should be on single point AF, shutter speed should be above 1/100 second, and aperture should be as narrow as possible, above f/8. For smartphone, use high dynamic range setting if available, use of flash, digital filter, effect apps, and digital zoom is not recommended.

CONCLUSIONS

If a few basic technical rules are known and applied, high-quality photographs can be taken by amateur photographers and fit the standards accepted in clinical practice, academic communication, and publications.