Dear Editors of the Journal of Oral Medecine and Oral Surgery,

Clinical photography is integral to modern medical practice [1]. Photographs are considered part of the medical record and are increasingly reused to train artificial intelligence models [2,3]. Yet, clinical photography remains insufficiently standardized, with persistent challenges related to quality control, data security, and the lack of harmonized consent procedures [4,5]. Within hospital systems, these issues are amplified by institutional complexity. Assistance publique – Hôpitaux de Paris (AP-HP), Europe’s largest university hospital network, provides a unique setting in which to study these challenges. We therefore conducted an internal survey to propose institutional strategies for improvement.

Between February and April 2025, we conducted an email-based survey assessing: (1) the presence of a photographer (position and contact); (2) availability of a photographic space; (3) availability of advanced equipment (e.g., 3D photography); (4) use of dedicated storage and data management tools (search engines, linkage with electronic health records); and (5) patient consent practices. The following specialties were contacted: internal medicine (clinical immunology, infectious diseases, neurology, physical medicine and rehabilitation, rheumatology, dermatology, hepato-gastro-enterology, cardiology, geriatrics, endocrinology, clinical genetics), general surgery (adult general surgery, paediatric general surgery, orthopaedics, vascular surgery, cardio-thoracic surgery, obstetrics and gynaecology), head and neck specialties (oral and maxillofacial surgery, ophthalmology, neurosurgery, ENT & head and neck surgery, plastic surgery, dentistry), paediatrics, and forensic medicine.

Of the 220 services contacted in 39 hospitals, 115 responded (52.3%): 42/103 internal medicine, 24/56 general surgery, 24/39 head and neck specialties, 9/12 paediatrics, 4/7 dentistry, and 2/3 forensic medicine. Only 10/115 departments employed a photographer (permanent or part-time), whether as a medical photographer, redeployed nurse, freelance, university or communication staff member, or student intern. Four departments had discontinued previous photographer positions because of lack of sustainability. Eleven departments had some photographic space, ranging from dedicated rooms to consultation areas or external studios.

Thirty-two departments provided details on equipment: 10 reported using personal mobile phones, 6 had departmental cameras, and 11 used specialized devices (slit lamps, dermatoscopes, intraoperative cameras, 3D systems). Seventy-five departments lacked dedicated storage. Among the 40 with solutions, systems were fragmented: electronic patient file integration (Orbis) (12/40), AP-HP network-attached servers (NAS) (9/40, with bespoke interfaces in 2 cases), specialized software such as CaloPix (4/40), Kitview (3/40), Forum (2/40), Ajaris (1/40), or Surgeon (1/40). Six used external hard drives, one a protected Google gallery, and one a learned society repository.

Consent practices were inconsistent: 59 departments never sought consent, 13 only for publication (retrospectively), 6 documented oral consent, 2 considered non-identifiable photography exempt, and 2 used a generic image rights form. Twenty-one respondents expressed interest in institutional support, although one feared administrative over-complexity, while six expressed no interest in change.

This survey highlights the heterogeneity of photographic practices within AP-HP. Photographer positions are precarious, equipment is often non-professional, storage systems lack standardization, and consent procedures are inconsistently applied, exposing institutions to legal risks. We propose that AP-HP implement a comprehensive institutional policy including human and technical resources, interoperable tools integrated into electronic patient files, secure indexed storage with clinical metadata, standardized consents aligned with regulations, and staff training in ethical and secure image management. This case-study within a large trust of academic hospitals intersects the issues raised by clinical photography in most teaching hospitals and our results and recommendations can be transposed to other institutions.

In brief, clinical photography within AP-HP is currently fragmented and insufficiently regulated. This first large-scale survey underlines the urgent need for harmonization. Institutional support is essential to ensure high-quality clinical documentation, protect patients’ rights, and unlock the potential of clinical photographs for teaching, research, and AI development.

Funding

No funding.

Conflicts of interest

No conflict of interest.

Data availability statement

All the relevant data is included in the article.

References

© The authors, 2026