Medical Imaging: A Picture is Worth a Thousand Words

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Trial lawyers have used photographs and other images as tools of persuasion for generations. Images help jurors understand, absorb, and retain information. The pictures created by modern medical imaging devices can reveal otherwise hidden information about injuries suffered by victims of accidents and medical malpractice.

Medical imaging is a powerful tool in the presentation of personal injury and medical malpractice cases. Images reach us on a deeper level than words, drawing out thoughts and emotions. The images can be used prior to trial to prove to opposing lawyers, insurers, and defendants that the injured person’s claim is just and that she should win. At trial, images can persuade judges and jurors both intellectually and emotionally. Images literally enable jurors to see the harm suffered by a plaintiff.

In order to use medical images on behalf of injured clients, a trial lawyer must develop an understanding of the techniques used, what the images depict, and how to present them in a persuasive manner. Before relying on any particular image, an attorney should discuss the particular image with either the client’s treating physician or a retained expert. These images often include subtle findings that an attorney cannot recognize without assistance.

Plain x-ray, computed tomography (“CT”) scanning, and magnetic resonance imaging (“MRI”) are the imaging modalities most commonly ordered by a physician. X-rays can show fractured bones, spinal degeneration, and even foreign objects left in a patient’s body during surgery.

CT scans are performed by sending a beam of x-rays through the body to a detector on the other side. The x-ray source and detector rotate around the patient’s body, capturing multiple snapshot images. These individual images are then reconstructed to show internal structures in larger two dimensional slices or even in three dimensions. CT scans show bony abnormalities at higher resolution than plain x-ray and can reveal other abnormalities, including internal bleeding, brain swelling, tumors, and injuries to internal organs. Here, CT scanning depicts a tumor on the side of a patient’s femur (Fig. 1).

MRI images are obtained by using a magnetic field to stimulate the nuclei of hydrogen molecules in the body and detecting the signals produced with a receiver. The most common applications of MRI include neuroimaging (brain and spine), cardiovascular, joint disease, and the diagnosis and staging of cancerous tumors. Here, an MRI image shows a vertebral fracture impacting a patient’s spinal cord (Fig. 2).

Positron emission tomography (“PET”) is a nuclear imaging technique in which a receiver is used to detect gamma rays emitted by a radionuclide tracer introduced into the body. PET scanning is most commonly used to examine cancer patients for the spread of disease to other parts of the body. PET can also demonstrate the presence of a traumatic brain injury that cannot be seen on CT or MRI. Images from PET scans, in correlation with neuropsychological testing, can show a jury the existence and effects of post-concussive syndrome, an injury that is usually invisible to jurors.

Single photon emission computed tomography scans (“SPECT”) study circulation and perfusion. They are most commonly used to study the function of a patient’s heart but can also depict damage to areas of the brain. SPECT studies can be used to show damaged areas of organs because once the damage occurs there is reduced blood flow to the affected area. In a case involving a failure to diagnose and treat a heart attack, or a traumatic brain injury, SPECT scans will show, in vivid color, the permanent injury. Normal brains are represented as a lively mix of red, blue, yellow, and green. Blues and greens predominate in traumatic brain injury victims’ scans. Portions of the heart that have been damaged in a heart attack can display distinctive dark areas on SPECT scans, showing that some of the heart muscle can no longer function.

The days of displaying medical images with a light box are over. Almost all of the medical images described above are captured, saved, and shared electronically. Any attorney attempting to use these images in litigation must be prepared to produce high quality printed versions to use as exhibits at deposition and in briefs and to display and manipulate the images electronically in front of the jury. Where medical imaging is central to a case, an attorney may choose to use dedicated software with capabilities far beyond those of the viewers provided on CDs supplied by hospitals or imaging centers. In cases involving catastrophic injury, an attorney might contract with a service that can create custom images and videos from the data obtained by advanced imaging techniques.

Medical imaging enables us to show what our clients have suffered in a tangible way. Words alone rarely convey to listeners the magnitude of information that a picture can, and the images will linger in the minds of jurors who will come to a better, and more compassionate understanding of what our clients have endured.