1/29/2009 - We are presently preparing artwork for surgical texts by Springer-Verlag, McGraw-Hill, and BC Decker
REVEALING THE INVISIBLE INJURY BY JON COULTER, M.A., C.M.I.
How does one convey to a jury the true scope of an internal injury? Some try reproducing figures culled from anatomy books, some have their medical expert draw circles and x's on standardized chart pads. Some rely on radiographs, hoping that jurors can envision his client's condition after viewing a sheet of film. The most effective method, however, is consultation with a board-certified medical illustrator.
A medical illustrator is a rigorously trained specialist in the art of visual communication. Typically, this artist earns an undergraduate degree in biology and/or art, then advances to graduate work in medical illustration. The course work at this stage may vary. In my case, studies at the Johns Hopkins University School of Medicine included gross anatomy, embryology, histology and pathology. The medical artist is taught to communicate directly with the physician using his terminology. He is also trained to be precise and accurate in creating his artwork. If the artist can demonstrate a professional knowledge of anatomy and technical competence in his illustrations, he may apply for certification by the Association of Medical Illustrators. Once awarded, certification must be maintained through continuing education and maintenance of professional standards.
The medical illustrator may develop his legal visuals as artwork, photographs, or videotape. He will use whichever medium is most appropriate to the injury under consideration and to the case budget. This is determined in consultation with his client, the lawyer.
Good litigation artwork is case-specific, tailored to the individual problem. It has an inherent clarity of purpose, which cannot be obtained by merely copying a book figure. It is precise and "friendly" both to the expert who authenticates it and the jury, who must understand it. There are several basic types of litigation graphics.
Anatomical illustrations are important in demonstrating the pre- and post-injury condition of your client. They may be descriptive at either a gross (visible to the naked eye) or microscopic level. They also provide a good foundation for surgical illustrations.
Procedural artwork describes a process. Appropriate subjects include surgery, physiology, and mechanisms of injury. Certified medical artists specialize in reducing three-dimensional temporal sequences to understandable two-dimensional images.
Conceptual illustrations show things, which cannot normally be seen. Examples might be the reduction of oxygen intake in an asthmatic or the internal anatomy of a cyst. Such visuals deal frequently with theories and abstractions. Naturally, this artwork is prepared with the expert's active participation.
Charts, graphs and timelines are the other major types of two-dimensional illustrations. They are made as clear and readable as possible. An experienced artist can even adapt them to the low resolution of a television monitor.
Models are three-dimensional illustrations. They can be juror-interactive when designed to permit handling. Their utility in describing complex anatomy and accident scenes is readily apparent.
Internal anatomy may also be depicted through diagnostic photography. The traditional x-ray is the best at showing bone. It is also useful in demonstrating lumina when radiopaque fluids have been introduced. Otherwise, it is poor at describing soft tissues. Computed Tomography (CT) scans function on a sonar-like principle. Consequently, soft tissues show well, but boney details do not. Nuclear Magnetic Resonance (NMR) imaging is very clear with soft tissues - gray and white matter in the brain are easily distinguished - but completely unsuited for boney anatomy. All these film images can be printed out and mounted for easel or deposition. Although certain structures like ribs show best as reversals, this is generally not done. The advantage of not reversing the image is that the expert works with the type of radiograph he is accustomed to seeing.
External anatomy can be photographed convincingly using professional lighting techniques. For example, a trained medical photographer knows that conventional direct flash lighting will not show depressions or skin lesions very well. Different injuries call for different techniques. The experienced professional expects to adapt his equipment to the case under consideration.
Videotape has numerous uses. The most common one is to record depositions. It has also become the medium of choice for computer animation. There are dynamic events such as accidents, pathogenesis and physiological functions, which may benefit from a more fluid presentation than still images provide. In creating an animation, a sequential set of drawings called a storyboard is developed. Selected frames from the storyboard can be printed out for settlement brochures, If the conciliatory hearing is successfully concluded, the time and expense of actually animating the images is avoided, If not, the project is already well on the road to completion.
Artwork, photography, videographics - these are the tools through which the medical artist imparts your information to a jury. The certified medical illustrator is an experienced communications specialist who converts scientific data into high-impact images. His work provides the vital link between your expert witness and the jury.
Jon Coulter is a board certified medical illustrator. He has been serving medical and legal community since 1976.