Ever since the case of Smith v. Grant, sharing medical images in the courtroom has been an accepted tool in the arsenal of litigation attorneys. But understanding exactly how to use medical images, ensuring that you have them when you need them, and optimizing their presentation, can be the difference between winning and losing at trial.
Medical Images as Evidence
Medical images are generally accepted as evidence at trial in a similar manner to other photographic evidence. It is important to ensure that the images are original, not subject to third-party manipulation, can be displayed in full fidelity and are controlled with an appropriately documented chain of custody.
It used to be that bringing a film of an x-ray to trial, with the radiology technician who performed the scan vouching for the authenticity, coupled with expert testimony of what the image indicates, was sufficient. Now, with digital images taking on higher resolutions and additional dimensions of time and space (Cines and 3-D scans), it is more challenging to properly introduce these into court.
Both moving pictures (often referred to as Cines) as well as 3-D scans can’t be displayed on a two-dimensional film or other static display, as we were able to to do in the past with x-rays. Instead, these more complex images require a computer and some method for projection for sharing medical images in the courtroom. Ensuring that these images, which often are quite large in volume and don’t easily fit on a thumb drive or even a CD or DVD, are available at trial and having the equipment able to read and display these, can be a bit challenging for the trial attorney.
But well before these display at trial, it is incumbent on the attorney to understand and be able to prove the provenance of the images he or she wishes to introduce.
Most medical images are digital these days. They are generated by complex scanning devices and then are re-assembled to display with special purpose software. When these images are generated, they are coded with something called a DICOM tag. This tag provides a good deal of information about the institution that performed the scan as well as patient demographics, date and time of the scan, and other information that may include the physician’s name.
Medical images are then electronically transmitted to something called a PACS. This is a special purpose database in which the images are maintained until they are needed for diagnosis or treatment.
Following the work flow (chain of custody) of an image from its inception to its presentation in the courtroom requires the trial attorney be sure of the origination of the study (set of images) and that it has not been altered either purposefully or due to the process (including things like compression that may reduce the fidelity of the image).
Sharing Medical Images in the Courtroom
One of the problems that trial attorneys have with medical images is ensuring they can be shared with expert witnesses and their trial team colleagues, as well as provided to the opposition in a timely and efficient manner.
Often CDs or DVDs have been used as media to transport images. However, these discs are subject to delay or loss in transport and sometimes are hard to view, are defective, or include the wrong information. When this happens, attorneys scurry to figure other ways to compensate for the lack of images when they need them or ask for continuances.
The Cloud Comes to The Rescue
Recently with the advent of cloud-based PACS, attorneys can be confident that the images they need for their trial will be there when and how they require them. The cloud obviates the need for physical transport. Having only a single image that is available for viewing in any location, the cloud also ensures a consistent chain of custody and authenticity of the image, making it much easier to prove that the image has not been manipulated or has lost its authenticity.
Sharing using the cloud cuts down on costs and wasted time. It also preserves evidence that may be need for appeals or case review.
Medical images are increasingly becoming an important part of the trial attorney’s arsenal. Ensuring their availability, authenticity and full fidelity can ensure the images are a compelling part of the trial attorney’s argument. The cloud can make the trial attorney’s life much easier ensuring chain of custody, availability and a clean way to display your medical images at trial.