Basic Definitions

Demonstrative evidence

Demonstrative evidence refers to visual aids – diagrams, charts, models, displays, maps, illustrations, animations, photographs, or other visualizations or objects that represent a concept and provide support to prove or disprove key information in a case. These visual aids assist in presenting a legal argument or position, often clarifying and buttressing the testimony of a witness.

By visually reinforcing testimony, demonstrative evidence can optimize the communication of complex information, enhancing judge and juror comprehension during trials, or other litigation participants during mediation and other legal actions.

The admissibility standard for demonstrative evidence entails a determination that it is a relevant, fair and accurate representation of an expert’s testimony, and will assist the court without distorting the facts – i.e., that it is more probative than prejudicial.

Other terms for demonstrative evidence include demonstrative aids, demonstratives, litigation visuals, legal visuals and trial exhibits.

Medical legal demonstrative evidence refers to visual aids that take the form of medical illustrations, animations, interactive media, 3D models and other visuals that communicate medical concepts in a personal injury or medical malpractice case. Customized medical legal demonstrative evidence is case-specific, portraying injury, anatomical, surgical or complication issues, and based directly on the radiological evidence, when applicable. Depictions adhere to the content of medical records, as well as the opinions of case experts, and provide support to prove or disprove key information in a case. These visuals assist in presenting a legal argument or position, often clarifying and buttressing the testimony of a medical witness.

Another term for medical legal demonstrative evidence is medical legal art.

Medical illustrations are visual representations of biomedical subject matters. They are used for educational purposes within the patient education, healthcare, litigation, medical and scientific research, marketing and educational fields. Visualizations created by medical illustrators can be found in patient-education materials, websites, medical textbooks, scientific journals, pharmaceutical communications and many other healthcare-related materials.

Medical illustrations can include:

Anatomical illustrations

Detailed portrayals of the human body’s internal structures, including tissues (e.g., bones and muscles), organs and systems.

Surgical illustrations

Typically step-by-step depictions that show the key stages of a medical procedure, but also post-operative views.

Pathological illustrations

Depictions of diseased or injured structures, organs, limbs, or tissues, demonstrating the presentation of medical conditions, illnesses, or trauma.

Diagrams or schemas

Schematic portrayals of the relationships associated with processes – such as physiological actions, disease pathways, or chemical interactions (e.g., drugs).

Patient education materials

Visual depictions oriented for non-medically trained lay people to understand healthcare related concepts such as medical conditions, operative procedures, implanted devices, or treatments.

Scientific and research illustrations

Figures created for use in scientific or research publications to communicate data, experiments and findings, in a clear manner, typically to augment the written component of the article.

Medical legal illustrations are a subset of medical illustrations. These visuals are specifically related to litigation, portraying the medical concepts of a personal injury or medical malpractice case. Customized medical legal illustrations (otherwise known as exhibits, boards, or panels) are case-specific, demonstrating the unique injury, anatomical, or surgical issues related to a file. Typically, the case radiological imaging is analyzed and directly translated into illustration format, to ensure proportions and pathology details conform directly to case x-rays, CT scans, MR images or other radiological evidence. Portrayals of surgical steps, soft-tissue trauma and other injury details, adhere to medical record descriptions, as well as the opinions of case experts.

A medical legal illustration exhibit is a static presentation that includes medical diagrams (often with different angles and magnified views), as well as titles and labels. Exhibits are sometimes presented in printed format – enlarged for the courtroom participants to see from a distance and mounted on a stiff backing to facilitate their display and handling. Alternatively, they are presented digitally using monitors or other electronic means.

Medical legal illustrations bring clarity to a broad range of case concepts, including:

mechanism of injury
trauma findings
anatomical issues
surgeries and other treatments
long-term complications

Medical legal illustrations are used during case development (including at discovery and pre-trial), as well as during mediation, arbitration, or trial, and serve as support for proving or disproving key information in a case. They assist in presenting a legal argument or position, often clarifying the testimony of a witness when testifying.

See also Demonstrative Evidence.

Medical animations are motion-based videos that integrate animated graphics with anatomical and other motion simulations to explain biomedical issues. They often present complex scientific information in a simplified, engaging, and digestible way. Typically used for educational purposes, these visual communication tools are rendered using 2D and/or 3D computer graphics to provide dynamic and understandable communications.

The audience for medical animations ranges from lay people with no medical training to seasoned researchers. Providing patient education through to advanced medical training, they can portray information about healthcare, biomechanical injury factors, physiology, drug actions, organ function, surgeries, disease and injury progression, mobility concepts, medical procedures, biological processes, anatomical relationships and other complex topics.

Medical animations may be presented to the viewer as a discrete, standalone presentation, or in combination with other sensory digital input devices, such as VR goggles, haptic gloves, interactive workstations, etc.

Medical legal animations portray medical issues specifically related to a personal injury and malpractice case, in a sequential format that maximizes understanding by lay people – particularly the jury – as well as the mediator, judge and other litigation participants. These visuals communicate motion and time-based concepts via either 3D or 2D graphics (or a combination), to create movies that highlight critical case details.

Motion-sequencing optimizes understanding, providing an educational tool that fosters full appreciation of key injury matters. Some case issues that medical legal animations portray include:

  • mechanism of injury
  • biomechanical factors
  • surgical procedures
  • gait and other mobility issues
  • long-term complications
  • degeneration concepts
  • cause-and-effect dynamics

3D printing, also known as additive manufacturing, uses technology to construct intricate and customized three-dimensional objects from a computer-aided design (CAD) or other digital file formats. Each pass by the 3D printer is essentially a cross-sectional, thin slice of the object, that is laid down layer by layer. A variety of materials are used in printing, such as plastics, metals, resins, composites, ceramics and biomaterials.

Medical legal 3D printed models can portray reconstructions of CT or MR imaging to demonstrate skeletal or soft tissue anatomy, post-surgical views that incorporate implanted hardware, or other pathology and trauma concepts. They can be hand-painted or have illustrations printed onto them to add details for high impact and enhanced understanding. Kinesthetic learning is optimized by tactile perception (which combines with visual perception) when the model is passed around to litigation participants.

These models combine radiological data with 3D printing technology to portray:

  • injury pathology
  • cartilage and other joint features
  • skeletal and soft tissue anatomy
  • post-operative views including hardware
  • cancer progression or other pathology tracking

Medical legal 3D printed models retain exacting fidelity to the radiological dataset, with artifacts (e.g., flaring from metal) removed. They are printed in resilient plastic/resin polymers, with colorized details (e.g., fracture clefts, cartilage surfaces, etc.) added. They often include internal reinforcements to hold the bones together and add strength.

Interactive digital media are digital communications users can engage with actively, with the output or information presented contingent on the input of the user. Interactive digital media can integrate various elements, including text, images, video, animation and audio, to create an interactive experience.

Benefits of interactive digital media include:

  • enhanced engagement
  • more memorable experiences
  • active participation in the content
  • improved learning of complex information with better retention
  • streamlining of communication
  • increased accessibility

Medical legal interactive digital media incorporate an interface that allows the presentation of information dynamically. Media can integrate transitions, motion effects, contrasting views, portrayals that build, and images that morph or transform. Some interactive media include:

Digital visual timelines

Visual timelines for medical legal litigation portray temporal factors linked to case concepts. They incorporate images such as illustrations, diagnostic images, notations from the hospital records or test results, animations and other graphic elements and symbols. They assist in understanding the chronological sequencing of events and the passage of time between events. They can be an effective tool for analyzing the arc of a litigant’s medical course, and the tracking of treatments or health factors over time.

Interactive overview medical illustrations

An interactive overview medical illustration typically contains one main image that provides orientation (or another form of menu) for the viewer to navigate through the presentation. When specific anatomical regions are selected, a detailed view fills the screen. This type of exhibit is ideal for cases that require depictions of injuries and/or surgeries to numerous parts of the body.

Transitional image sliders

These digital presentations allow for transitioning (or ‘morphing’) from one image to another. This allows for depiction of things such as comparisons between ‘before’ and ‘after’ views, and radiological images with accompanying explanatory illustrations and labels.

Step-by-step surgical series

Step-by-step series communicate the critical stages of an event as though in time-lapse format. The lawyer or expert can display each image for as long as required to explain it. This visual format is ideal for showing surgeries where details of complex procedures need to be emphasized.

Interactive fetal monitoring strips

In birth injury cases the fetal heart rate monitoring (or ‘tracing’) documents specific medical findings of both fetus and mother during labor. This includes the fetal baseline heart rate, accelerations and decelerations to the heart rate, and uterine contractions. Interactive fetal monitoring strips are created by digitally assembling a long tracing into a seamless display, thereby showing hours of monitoring in a concise digital format. Electronic interactivity assists in presenting key information, such as highlighting and annotating, and searching by timestamp. Explanatory illustrations may be added to demonstrate issues such as placental abruption or other birth trauma complications.

Virtual 3D fly-around models

Virtual 3D models are constructed to be rotated onscreen and viewed from whatever angle the viewer choses. These interactive exhibits are particularly helpful when the case entails pathology that must be appreciated from more than one perspective, facilitating enhanced understanding.

Radiology, otherwise known as diagnostic imaging, includes x-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI), nuclear medicine functional imaging such as positron emission tomography (PET) scans, as well as ultrasound and other diagnostic technologies. These images assist in the diagnosis and monitoring of medical conditions – such as trauma or cancers, allowing healthcare providers to assess and treat patients.

However, radiological imaging can be difficult for a juror or other non-medically trained viewer to understand – even when being explained by a medical expert. Illustrated overlays – or illustrated radiology exhibits – can visually clarify this information for all litigation participants. Explanatory overlays retain exacting fidelity to the radiological details, and take the form of simple linework diagrams to fully rendered images in color, with titles and labels added for clarity.

Visualizations are the graphical representation of information, concepts or data, in a clear and concise manner. They take the form of diagrams or other images that are accessible and understandable. Conversion of information into visual formats like illustrations, charts, graphs, maps, animations, or other graphics, facilitates understanding, assists in analysis of ideas, and fosters insights.

Data visualizations use graphical elements in the form of charts and graphs as well as maps to understand patterns and trends as well as outliers.

A medical illustrator is a professional artist who has a unique combination of advanced education and experience in medical life sciences and visual communication. In North America, many medical illustrators hold a Master’s Degree from a specialized department within a medical school. Science courses incorporated into their studies typically include human anatomy, embryology, neuroanatomy, pathology and histology.

Medical illustrators are visual problem-solvers, often researching scientific, medical and technical topics and translating that complex information into visual images that communicate anatomy, surgery and other health-related information in an accessible visual format. Their intent is to enhance communication and foster understanding to a varied audience – from highly-educated physicians to lay people, using compelling and accurate visualizations of biomedical concepts.

See also Accredited school of medical illustration and Association of Medical Illustrators (AMI) and Certified Medical Illustrator (CMI).

Some medical illustrators are certified by the Board of Certification of the Association of Medical Illustrators – which requires formal academic training, as well as ongoing professional development, to acquire and maintain certification. The designation of Certified Medical Illustrator (CMI) requires proven competency in the field with a written entrance exam and portfolio review, as well as the ongoing acquisition of continuing education credits. Certification indicates a high degree of competence and professionalism in the field.

The Association of Medical Illustrators is a professional organization of individuals trained and working in the field of medical illustration and associated visual communication specialities. The AMI provides a forum for professional development, exchange of knowledge, ideation in the industry, and networking. With associated sharing of experience, collaboration on projects, and continuing education (including conferences, workshops and lectures), members stay up to date on medical visualization techniques and technology, biomedical science advancements and industry trends.

The Journal of Biocommunications is the professional journal of the AMI and the BioCommunications Association. The publication documents research findings, case studies and other articles on biomedical visual communications, and showcases biocommunication imaging applicable to the health sciences.

The AMI offers membership participation at the professional, associate and student levels, for those working or studying in the field of medical visual communications or affiliated with it.

There are five graduate programs of medical illustration in North America, accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP). These are overseen and reviewed by the Accreditation Review Committee for the Medical Illustrator (ARC-MI). More information on the rigor of this accreditation system is available on the CAAHEP website. The North American programs are offered at the following institutions:

  • Augusta University (formerly Georgia Regents University)
  • Johns Hopkins University School of Medicine
  • Rochester Institute of Technology
  • University of Illinois at Chicago
  • University of Toronto

The Institute of Medical Illustrators (IMI) manages the European accreditation program. The accredited European programs are listed on the IMI education page.