The Case of Ken Lowery: Visual Knowledge Building and Translation of Volumetric Radiographic Imagery for Dynamic 3D Medical Legal Visualization

INTRODUCTION: Advancements in medical imaging technology allow for the use of 3D volumetric radiographs in personal injury trials. Volumetric radiographs provide more comprehensive information than 2D imaging (i.e. CT scans/MRIs) but are more complicated for a judge and jury (non-medical audiences) to understand. The purpose of this medical legal visualization research project was to create and evaluate a plaintiff expert witness presentation that incorporates volumetric radiographs, combined with 3D anatomical models and animated sequences to improve understanding of complex medical information (e.g. to clarify the full extent of the traumatic brain injuries) and to obtain feedback on design strategies. METHODS: The name of the individual in this case has been anonymized; his real name has been changed to a fictitious name, i.e. Ken Lowery. MEDIA DESIGN: 3D models were created using patient specific DICOM data sets, Horos, Pixologic ZBrush, and animated in Autodesk Maya. RESEARCH DESIGN: The medical legal animation was evaluated by mock jurors (n=20), personal injury lawyers (n=10) and medical experts (n=2). A design research study was conducted. Mock jurors completed the 25-question pre/post-test; all participants completed the 90-question online feedback survey. RESULTS: Mock juror pre/post-test results demonstrated 44% increase in knowledge, from 33% on pre-test to 77% on post-test. Pre-test scores ranged from 8% to 64% and post-test scores ranged from 52% to 92%. Effectiveness of design strategies was verified including: (1) transparency to contextualize neuroanatomical spatial relationships; (2) saturation to focus viewer attention on area of importance; (3) colour-coding to clarify corresponding elements in radiographs and medical models and (4) movement constraints to tell a concise case story. Overall, survey feedback demonstrated that all mock jurors, lawyers and medical experts agreed/strongly agreed that medical legal animation has an important role to play in juror understanding. Discussion & Conclusion: Results clearly demonstrated that mock jurors had little neuroanatomical/neuroradiology knowledge; however after watching the medical legal animation, knowledge improved significantly (44%). This study provides strong evidence of the importance of 3D medical legal visualizations; visual explanations are essential for juror knowledge building and translation, to enable understanding of complex medical concepts and inform decision-making.