Digital vs 35-mm photography. To convert or not to convert?

OBJECTIVES To compare the quality of images generated from a conventional 35-mm camera with those generated from various digital cameras; and to note the costs of the cameras and ease of use. DESIGN A prospective, randomised, independent analysis of specific facial images taken with a 35-mm camera and 3 digital cameras by 3 facial plastic surgeons who were blinded to camera type. SETTING An academic medical center. SUBJECTS Thirteen volunteer subjects ranging from age 27 to 58 years. MAIN OUTCOME MEASURES The overall quality, focus, distortion, trueness of color, resolution, contrast, and presence of shadows were evaluated for each image. Attributes were scored on an ordinal scale of 1 to 5. A 1-way analysis of variance was used to test whether the average scores across cameras were significantly different. Results using analysis of variance did not differ from the results using a nonparametric Kruskal-Wallis test. When significant differences were found, the Duncan multiple range test was used to group significantly different scores. RESULTS The null hypothesis that there is no difference between photographs taken with the various cameras was rejected (P < .001) for each of the image attributes. The images produced by the 35-mm camera (Nikon 6006) had the best overall quality, followed by the Olympus D600L, Kodak DCS 315, and Olympus D320L digital cameras. Differences in individual attributes between several of the cameras in each category were statistically significant (P < .05). CONCLUSIONS The 35-mm camera produced the best overall image quality and ranked first for each of the individual attributes analyzed in this study. The Olympus D600L digital camera placed second in overall quality, but there was no statistically significant difference in focus, distortion, and resolution compared with the images generated by the 35-mm camera. The Olympus D600L digital camera also ranked second in color, contrast, and shadow. The Kodak DCS 315 and D320L digital cameras finished well behind the 35-mm camera in most categories. Although the 35-mm photographs were superior to the digital images, the surgeon should also consider other factors before selecting a system for photodocumentation of surgical results.