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Call NOW! 800.899.2153 Home About Company Process Client Testimonials Meet the Team Contact Is Your Medical Illustrator Qualified? Products / Services Illustrations Animations 3D Precision Diagnostics Interactive Presentations Trial Presentation Services CLE Presentations Models Request a Case Consultation Attorney Resources Educational Blog Case Outcomes Upload Reports / Imaging Studies Find an Attorney FAQ Medical Legal Illustration and Animation - Cross Sections Posted by Tara Rose on Mon, Jun 18, 2012 Tweet By: Robert Shepherd MS, Certified Medical Illustrator, Vice President and Director of Eastern Region Operations, MediVisuals Incorporated Long before science had advanced to allow imaging of the body in sectional views by computed tomography (CT) and magnetic resonance imaging (MRI), medical illustrators were illustrating the body in sectional views because these views are the best way to appreciate some anatomical relationships. Medical illustrators, physicians, and others who have studied anatomy are familiar with sectional views of the body and appreciate the value of these views in explaining the relationship of anatomical structures. However, accomplished and well respected jury consultants and non-medical illustrator legal graphics experts have expressed concerns that sectional views may be difficult for some jury members to understand. These individuals' opinions are valuable to those of us in the legal graphics business, and I agree with their opinions that, when other views can communicate a particular relationship message equally as well or better, sectional views should be avoided. I also believe most of these experts will agree that there are times and places in which sectional views of anatomy are the best way to appreciate some anatomical relationships. Granted, there have been times when we have been working on specific cases and experts have insisted that sectional views be absolutely and unconditionally avoided. Unfortunately, in these situations the experts were unable to suggest a more effective view to communicate the relevant anatomical relationships (at least in a way that was practical in terms of time and expense). That being the case, sometimes the sectional views were used despite the input of the experts, and at other times, the relationships of the structures had to be explained without the benefits of graphics. A way to perhaps explain how sectional views help decision makers appreciate relevant anatomical and pathological relationships is to compare them to aerial views or photographs of the scene of a collision. Space is defined in three planes. Only two of these planes can effectively be demonstrated in a two-dimensional rendering. For example, aerial views have long been used to help explain the positions of vehicles and structures that simply can't be appreciate from "street views". When viewing the scene of a collision from a "street view", one can appreciate vertical and horizontal distances, but not depth; distances close to and far from the viewer's perspective are very difficult to appreciate (see the below figures). By comparison, when viewing an operative site through a "surgeon's view", vertical and horizontal distances can be appreciated, but the depth of the incision and the relationships of the various structures within and around the incision are very difficult or impossible to appreciate. The "aerial view" of the collision scene allows the viewer to appreciate distances in two geographical planes as well (distances right and left, and toward and away from the "street view," but the ability to appreciate up and down is lost). Also, the locations of relevant structures or vehicles that may have been obstructed by nearby structures (such as buildings trees, signs, or other vehicles) can now be appreciated. Similarly, a sectional view of anatomy can help decision makers appreciate depth relationships of structures. Or, a sectional view of a step in a surgical illustration can allow the viewer to appreciate the depth of the surgery as well as the additional structures that may have been injured (or at risk of injury) during the invasive procedure. These specific depth relationships could not be appreciated from the "surgeon's view" of the same surgery shown in the above illustration. Exhibits developed to help explain the invasive nature of a surgery and the disruption of the soft tissues during operative procedures are critical. For that reason, sectional views are critical in aiding a testifying physician to explain these issues. For example, the exhibit panel that demonstrates an anterior cervical discectomy and fusion (ACDF) that does not include a cross-section through the neck fails to emphasize the depth of the incision and disruption of tissues (essentially all the way to the center of the neck). This depth simply cannot be appreciated in a "surgeon's view". In order to appreciate cross-sections, orientation views that show the level and direction of the section are helpful (see below), or when time, budget, and presentation format (digital as opposed to a physical panel) allow, a short animation showing the sectional view actually coming out of the orientation view such as MediVisuals' " Scan Selector TM " can be used. 0 Comments Click here to read/write comments Topics: intervertebral disc , coup-contracoup , medical-illustrator , trial exhibit , disc herniation , degenerated disc , disc bulge , trauma , hematoma , traumatic-brain-injury , medical exhibits , medical-legal-illustration , disc injury , brain , TBI , medical expert , intracranial , surgery , MediVisuals , medical exhibit , personal injury , spinal injury Disc-Osteophyte Complex Explained Posted by Delia Dykes on Wed, May 2, 2012 Tweet By: Robert Shepherd MS, Certified Medical Illustrator, Vice President and Director of Eastern Region Operations, MediVisuals Incorporated Individuals who develop new or suddenly worsening symptoms consistent with nerve root or spinal cord impingement following a traumatic event are sometimes diagnosed with disc-osteophyte complexes”. The term disc-osteophyte complex” generally refers to abnormal extension of intervertebral disc material that accompanies immediately adjacent osteophyte formation at the vertebral body margin (see the below figure). It is important to note (as shown in the illustrations) that the disc almost always extends further than the osteophytes into the neural foramen or spinal canal to irritate or impinge upon nerve roots or the spinal cord. Occasionally, individuals who are evaluated shortly after a traumatic event are found to have disc-osteophyte complexes. Because a minimum of several weeks is required for osteophytes to form as a result of a traumatic event, defendant insurance companies may argue that the presence of osteophytes so soon after the traumatic event in question may prove that the plaintiff’s injuries preexisted the traumatic event. Since it is the disc pathology extending beyond the osteophytes that is the actual cause of the nerve root or spinal cord irritation and inflammation, the defense’s arguments are not valid. As shown in the illustrations below, the sequence of events that typically takes place in these cases is that the plaintiff had minimally symptomatic or asymptomatic disc osteophytes prior to the traumatic event in question. During the traumatic event, the disc sustains trauma that results in worsening of the disc pathology while the osteophyte portion of the osteophyte/disc complex remains essentially unchanged. This worsening of the disc pathology in turn results in new or increased irritation or impingement of the neural elements. 1 Comment Click here to read/write comments Topics: intervertebral disc , medical-illustrator , trial exhibit , disc herniation , disc bulge , trauma , medical exhibits , medical-legal-illustration , disc injury , MediVisuals , medical exhibit , personal injury , spinal injury , osteophyte , cervical strain...