HUMAN NECK
Client: Dave Mazierski.
Media: Adobe Photoshop, Adobe Illustrator.
Audience: Undergraduate students.
Objective: Make a digital tonal illustration of the anatomy of the anterior neck and inferior lateral cervical region. A specimen from the J. C. B. Grant's Museum was used as the primary reference for this illustration.
Last updated in January, 2018.
Medical legal case:
Congenital Transposition of the Great Arteries
CLIENT
Dr. Leila Lax
MEDIA
Adobe Photoshop, Adobe Illustrator, iPad Procreate.
FORMAT
Four-panel (30"x 40" each) courtroom exhibit.
TARGET AUDIENCE
Lay audience; courtroom judge.
OBJECTIVE
Make a clear and comprehensive graphic representation of the key events involved in a medical malpractice case. Following guidelines for admissibility of demonstrative evidence, scaffold knowledge necessary to understand the relevant anatomy and pathology. Since our client was representing the defendants (Orry and Gill), our goal was to provide visuals that would allow them to make the case that arterial switch surgery was necessary for the plaintiff (Dobby) and completed successfully, and that the complication was unlikely to have been caused by actions of the defendants.
Collaborative project with Felix Son, Maurita Hung, and Shawn Liu ("Vein Studios").
Completed in December, 2018.
1. Communication objectives
After reviewing the legal documents provided, our team came up with the key questions that our visuals would need to answer in order for the judge to fully understand the medical information involved in this case. We presented our proposed visualization solution to the client. We decided that each of our four panels would focus on one key event in the case, with a summary at the beginning.
3. Layout & composition
For our first (low-fidelity) drafts, we made sketches and composited the scans in Adobe Illustrator. Our first iteration of the layout had a horizontal timeline running continuously across the four panels.
4. Rendering
While taking into account ongoing internal and client feedback, individual assets were gradually digitized and iterative changes were made to refine layout and anatomical accuracy.
5. Final iterations of layout & rendering
Layout design was also improved to resolve communication concerns that arose during feedback sessions.
References (Annotated)
Agur, A. M. R. & Dalley, A. F. (2017). Grant’s Atlas of Anatomy 14th ed. Philadelphia: Lippincott Williams &
Wilkins.
- Figure 1.3 (pg. 4-5) were used as a reference for illustrating the vertebrae
- Figure 1.20 (pg. 26) was used as a reference for the pelvis
- Figures 6.5 (pg. 472) and 6.18 (pg. 488) were used as a reference for innervation of the legs
Aljishi, M. & Abernethy, D. (2015). Spinal cord infarction. New Zealand Medical Student Journal, 20, 18-21.
Amato, A. & Stolf, N. (2015). Anatomy of spinal blood supply. Jornal Vascular Brasileiro. doi10.1590/1677-5449.0004.
- Figure 2 was used as a reference for illustrating the anatomy of spinal arterial supply including the Adamkiewicz artery
Cochard, L. R. (2002). Netter’s Atlas of Human Embryology 1st ed. Teterboro: Icon Learning Systems.
- Figure 3.12 (pg.63) was used as a reference for illustrating the spinal cord and vertebral column in the newborn
- Figure 4.22 (pg. 105) was used as a reference for understanding postnatal circulation
- Figure 8.26 (pg. 211) was used as a reference for illustrating the nerve innervation of the lower extremities
Deeg, K. H., Lode, H. M., & Gassner, I. (2007). Spinal sonography in newborns and infants--Part I: method, normal anatomy and indications. Ultraschall Med, 28(5), 507-517. doi:10.1055/s-2007-963052
Hoehmann, C. L., Hitscherich, K., & Cuoco, J. A. (2016). The Artery of Adamkiewicz: Vascular anatomy, clinical signicance and surgical considerations. International Journal of Cardiovascular Research, 5(6). doi:10.4172/2324-8602.1000284
Lemke, R. P., Idiong, N., al-Saedi, S., Giddins, N. G., Ward, C., Hamilton, A., . . . Odim, J. N. (1996). Spinal cord infarct after arterial switch associated with an umbilical artery catheter. Ann Thorac Surg, 62(5), 1532-1534. doi:10.1016/0003-4975(96)00778-3
- Figures 1 (pg. 1533; Chest roentgenogram showing tips of umbilical arterial and venous catheters) and 2 (pg. 1533; MRI
image showing hemorrhagic infarction) were incorporated into panels 2 and 4, respectively.
Moore, K. L., Agur, A. M., & Dalley, A. F. (2015). Essential Clinical Anatomy. Philadelphia: Wolters Kluwer Health.
- This textbook was used to reference general circulatory and bone (vertebra, spine) anatomy.
- Figure 1.28 (pg.82) and gure 1.37 (pg. 91) was used for illustrating the vessels of the heart
- Figure 1.44 (pg.100) was used as a reference for illustrating the descending aorta in the lateral view
- Figures 5.14 (pg. 334) and 5.23 (pg. 343) were used as a reference for illustrating innervation of the lower limbs.
Muller, K. I., Devik, K., Vorren, T., & Johnsen, S. H. (2013). A man in his 60s with chest pain and pareses. Tidsskr Nor Laegeforen, 133(12-13), 1320-1324. doi:10.4045/tidsskr.12.0979
- Figure 4 (pg. 1323) was used as reference for course of arteries supplying the spinal cord in relation to the spine and aorta
in a lateral view.
Ponrartana, S., Aggabao, P. C., Dharmavaram, N. L., Fisher, C. L., Friedlich, P., Devaskar, S. U., & Gilsanz, V. (2015). Sexual Dimorphism in Newborn Vertebrae and Its Potential Implications. J Pediatr, 167(2), 416-421. doi:10.1016/j.jpeds.2015.04.078
- Figure 1 (pg. 418) was used as reference for positioning of newborn spine for lateral illustration in panel 4.
Sadler, T. W. (2010). Langman’s Medical Embryology 11th ed. Baltimore: Lippincott Williams & Wilkins.
- Figure 12.31 (pg. 184) was used as a reference for understanding the pathology of Transposition of the Great vessels.
SickKids Sta. (2016). Arterial switch procedure Risks of an arterial switch procedure. Retrieved from https://www.aboutkidshealth.ca/Article?contentid=1656&language=English
Vargas, M. I., Gariani, J., Sztajzel, R., Barnaure-Nachbar, I., Delattre, B. M., Lovblad, K. O., & Dietemann, J. L. (2015). Spinal cord ischemia: practical imaging tips, pearls, and pitfalls. AJNR Am J Neuroradiol, 36(5), 825-830. doi:10.3174/ajnr.A4118
The Vertebral Column and Spinal Cord. (1997). Retrieved from http://www.emory.edu/ANATOMY/Anatomy-Manual/back.html
- Figure 1 was used to cross-reference newborn spine curvatures.
Wang, C., & Ehnmark, B. (2010). Intraspinal extension, tethered cord in 2-week-old. Retrieved from http://clinical.netforum.healthcare.philips.com/us_en/Ex-
plore/Case-Studies/MRI/Intraspinal-extension-tethered-cord-in-2-week-old
- First MRI image was used to cross-reference positioning of newborn spine.
Yoo, S.-J., MacDonald, C., & Babyn, P. (2010). Chest Radiographic Interpretation in Pediatric Cardiac Patients. New York: Thieme Medical Publishers, Inc.
- Figure 8.1 (pg. 77; lateral chest radiographs) was used as a reference to check the size of the heart in comparison to
the thoracic cage