Demonstrative Evidence in Radiology

Expert witnesses are confronted with a difficult task of clarifying complex medical information to a jury of laypersons.
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Radiology is a critical component of most medical care. As a consequence of this, legal cases in
which individuals are claiming injuries will frequently have imaging studies as a central aspect of
the record. Demonstrative evidence can be used as an important instrument in helping to lay the
proper foundation for creating a compelling and memorable argument in the presentation of a
legal case.
Demonstrative Evidence:
Demonstrative evidence is evidence in the form of a representation of an object that helps to
illustrate a concept or assist an expert witness’ testimony. This is as opposed to real evidence,
testimony, or other forms of evidence used at trial.
In order for demonstrative evidence to be admissible, certain factors must be adhered to. Federal
rule of evidence number 702 which states that if “scientific, technical, or other specialized
knowledge will help the trier of fact, a witness qualified as an expert may testify thereto in the
form of an opinion or otherwise if the testimony is based upon sufficient facts or data, or if the
testimony is the product of reliable principles and methods, or if the witness has applied the
principles and methods reliably to the facts of the case.” Rule number 401 requires that the
evidence be relevant in order for it to be admitted in court.
The scientific basis of testimony is founded upon principles resulting from the case of Daubert v
Merrell Dow Pharmaceuticals, which held that scientifically valid arguments may be used in
court, but only if those arguments have been tested, reviewed or are generally accepted.
Experts:
Expert witnesses are confronted with a difficult task of clarifying complex medical information to
a jury of laypersons, while juries are confronted with the difficult task of understanding and
retaining information with which they have no common experience.
Expert witnesses may make effective use of demonstrative evidence in presenting their positions
to the jury or trier of fact. Various types of demonstrative evidence can be used and include
documents, photographs, imaging studies, charts or graphs, videos, animations or models.
An important purpose of an expert witness in the courtroom is to teach the jury and to interpret
the facts. In legal cases involving medical issues, displays of imaging data facilitate the task of
teaching by presenting visual representations of the relevant findings. Radiology, in particular,
lends itself to courtroom presentations by virtue of its photographic qualities.
Methods of Learning:
Individuals learn through a variety of sensory inputs. It has been shown that some people learn
better through auditory, others through visual, or others through kinesthetic means. It has also
been shown that the more sensory modalities that are used to process information, the more
retention there is in learning given material.
Radiology, as a branch of Medicine, is itself especially arcane, even to non-radiological
physicians. It is abstract, unfamiliar, and outside the realm of common experience of most
individuals. Additionally however, it is graphic, pictorial, and therefore concrete. Because of
these features it lends itself extremely well to presentation as a demonstrative evidence exhibit.
Aphorisms such as “seeing is believing”, “a picture is worth 1000 words”, and “every picture tells
a story”, attest to the grounding that people have in accepting and validating pictorial information.
How does Demonstrative Evidence Assist?
Demonstrative evidence aids the jury in several ways:
1. Visual aids empower the jury by allowing them to draw their own conclusions.
2. Converting words to images makes them come alive.
3. Demonstrative evidence improves comprehension.
4. Demonstrative evidence increases juror engagement.
5. Graphic presentations help in informational retention.
6. Demonstrative evidence may leave the courtroom and accompany the jury to the deliberation
room, where it can serve as a reference in decision making.
Demonstrative evidence also assists the attorney and/or their experts by:
1. Allowing the expert to conclusively and comprehensively state his or her position without
distraction or interruption from opposing counsel
2. Educating the opposing counsel, which in turn, facilitates realization of weaknesses in their
case
3. As a result of the above, it may stimulate more rapid and favorable settlement
Demonstrative Evidence Exhibits:
Presentations designed to educate the jury are best developed by the radiologist. A radiologist is
able to make educated selection of the images that are more than just simply documentation or
display. Findings can be distilled in a relevant and cogent visual format, and can be presented
with the necessary medical background. Findings can be highlighted, clarified, and placed in an
intelligible context of normal versus abnormal, pathologic versus non-pathologic, and significant
versus incidental, so that people with no familiarity with such information can grasp the material.
Ultimately the goal is to simplify and make understandable highly complicated and complex
technical information, at the same time ensuring that the representations accurately reflect the
truth in the case.
Pertinent images must be isolated and presented in a manner that can be grasped by lay jurors
with no understanding of the technology, or frame of reference to the spectrum of normal and
abnormal. This can be facilitated by judicious selection of the relevant images, focusing in on the
areas of interest, and color coding and annotating the images (Fig. 1-3).
Displays can be rendered in either hard-copy, “storyboard” format, or can be provided as digital
data that can be enlarged into large poster sized blow-ups, or inserted into powerpoint
presentations. In some instances, it is possible to create three-dimensional images of certain
studies, and it is also possible to create video displays that rotate and move the images in a
manner that is visually informative and appealing.
Such distillations of complicated imaging information into memorable graphic interpretation that
have relevance to a jury of laypersons, and that remain scientifically true to the evidence, has
been instrumental in obtaining successful outcomes in the vast majority of cases in which such
material has been provided to counsel.
The radiologist, because of his/her specialized training, knowledge, and experience, is qualified to
be both an expert witness, and is also uniquely positioned to help provide the demonstrative
evidence, which is a central part of many medico-legal cases.
I am a radiologist with nearly 30 years of clinical and teaching experience in the field, and have
had experience as an expert witness, photographer, and have successfully provided such exhibits
to the legal profession.

Please visit my website: www.medivence.com to learn more.
Marc Glickstein, MD, FACR


Figure 1(above): An individual in a Motor vehicle accident claiming a disc herniation and an
annular tear as a result of the accident. The pre-accident images show an annular bulge
with an annular tear that was unchanged on several sets of images obtained after the
accident itself. Despite the claim, there was no anatomic difference in the pre- and postaccident
images.

 


Fig 2 (above): Illustrative exhibit of a newborn infant with intracranial findings incurred as a result

of a perinatal anoxic episode.

 

Fig 3(above): Sagittal (side view) of head CAT scan in a patient with severe head trauma who
had depressed skull fracture and sagittal sinus thrombosis.

 

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