Annie Gough Explains 2D Illustrations and 3D Animations: Differences & How to Decide What to Use in Your Case
That’s the scene Annie Gough helps create. In today’s episode, Annie’s expertise as a certified medical illustrator takes center stage. Imagine stepping into a courtroom where the complexities of medical malpractice and product liability unfold like a storybook, where jurors are captivated not by words alone, but by the artistry of visual persuasion.
Together, we unravel the fabric of legal storytelling through the lens of detailed 2D illustrations and lifelike 3D animations, which turn abstract concepts into tangible realities for those who decide the fates of others.
Visuals can make or break a case. Listen in as we discuss the process of crafting images that resonate with a jury’s sense of belief. We also delve into the territory of human anatomy, where a seemingly small detail on a medical illustration, such as the precision of a spine model or the exactness of a surgical animation, can pivot a juror’s understanding of the truth.
In this episode, you will hear:
- Impact of image in courtroom proceedings
- Importance of 3D models in court
- Medical illustration case preparation process
Follow and Review:
We’d love for you to follow us if you haven’t yet. Click that purple ‘+’ in the top right corner of your Apple Podcasts app. We’d love it even more if you could drop a review or 5-star rating over on Apple Podcasts. Simply select “Ratings and Reviews” and “Write a Review” then a quick line with your favorite part of the episode. It only takes a second and it helps spread the word about the podcast.
Supporting Resources:
You can watch the interview video & see all of Annie’s examples here: https://youtu.be/7hbj4wLHDR4
Want to work with Annie?
Email her directly: anniegcmi@gmail.com
Website: www.injuryillustrated.com
Want to work with Elizabeth? Need a virtual focus group?
Set up a free consultation call: https://calendly.com/elizabethlarrick/30min
Website: www.larricklawfirm.com
Episode Credits:
If you like this podcast and are thinking of creating your own, consider talking to my producer, Emerald City Productions. They helped me grow and produce the podcast you are listening to right now. Find out more at https://emeraldcitypro.com Let them know I sent you.
Episode Transcript:
Elizabeth Larrick: Hello and welcome back to the podcast Trial Lawyer Prep with me your host, Elizabeth Lyric. And welcome to the podcast, our lovely guest, Annie Goff. Hello, Annie. Hi, Elizabeth. Thank you for having me on again. Again, because you are [00:01:00] amazing. Yay. Oh, thank you. Of course. Well, so here’s the deal.
Annie and I have had lots of conversations since the last time she came on, and one of the things that I always get asked when getting ready for trial or case preparation or looking at cases, or even doing focus groups is about animations and about illustrations and really how to visually present your case.
And. I know I always had lots of questions when I was gearing up for trial, what’s the best. And I always had a lot of assumptions because of my experience that it was really expensive to do animation. So I thought, you know, who better to come talk to all of us about this than my good friend, Annie. So Annie, you got to come back on the podcast and help us out because we want to know what is the difference between illustration and animation.
So she’s going to be here to talk to us all things. And that’s because you have experience in both. So tell us a little about kind of your background. Cause again, before we [00:02:00] came, we had you come in certified medical illustrator. We totally know you do that fantastic stuff, by the way, since Annie and I worked together, I’ve gotten to see her work.
We’ve even focus grouped it and I got to tell you very good stuff. So we’ll do how to contact Annie. All of her information will be in the show notes, but tell us about your experience with animation. Thank you.
Annie Gough: Yes. So I’ve been a medical illustrator since 2001. And since then I have been involved in tons of animations, especially because I started work at Frank Branson’s office in Dallas, where I think he was one of the first lawyers that started actually videotaping his own actors and reconstructing his own.
traumatic scenes. So he would request animations a lot. There’s a difference between 2D, which is two dimensional, not 2D, which I do have experience [00:03:00] doing, and there’s 3D animation, which requires a different skill set. In 3D animation software, and I have worked with a ton of 3D animators, not only like crash reconstructionists, but medical illustrators that also do 3D work.
So yes, I have worked extensively and incorporated a lot of animations into many of my cases.
Elizabeth Larrick: Awesome. I should also point out, and I got really excited because I’m glad that Andy is here, that we are going to put this particular episode on YouTube. So we’re recording the video because Andy is going to be showing us a lot of actual visuals, differences.
So there’s actually a PowerPoint that goes along with this podcast. So I’m really encouraging everybody to go watch it. The link will be in the show notes as well as I’ll probably put the link also on LinkedIn. So just so you know, she just gave us a quick visual and I forgot to tell you guys we’re doing this [00:04:00] also the video will be on YouTube.
So, okay. So you’ve done lots of animations as far as like casework goes. So lots of experience with that. So let’s just get right to it because as a lawyer, my lawyer brain One, the experience that I’ve had in working with Mr. Keenan, other people is really, really expensive and the front end, it’s a very big expense.
And then if they don’t do it the way that you were thinking about, because maybe you’re not really clear, then it’s really expensive to make edits. So kind of walk us through, you know, you talked about. 2d 3d animation kind of walk us through if you can the differences. And I know you’ve got a visual aid as well.
So whenever you want to queue up that PowerPoint,
Annie Gough: please do so. I did. I brought some examples, but like in short, a 3d animation. Is going to be 3D models like airplanes crashing in the sky. This can be very expensive or it can be done simply. It depends a little bit on whether it’s just a demonstrative aid to tell a [00:05:00] story, or if it’s demonstrative evidence and every single thing matches the record perfectly.
And then in 2D animation, you might be able to illustrate like a baby in a uterus in a birth trauma case, and you show the uterine wall. contracted and then you do the same drawing with the uterus while not contracted and you can just make it look like the uterus is contracting in a birth trauma case.
So, and that can be cheap or it can be expensive and it really depends on how you’re going to use it in your case. So, I will show some samples. And for those of you that are just listening, if I say 2D a lot, I mean two dimensional and two dimensional is essentially like drawing on a piece of paper or I use a tablet.
If it’s two dimensional, I’m literally just drawing on my tablet, just like I would draw on a piece of paper. And then, yeah, I’m going to [00:06:00] show some examples of this. I think it will help me.
Elizabeth Larrick: I’m new to like everybody else listening here. So three dimensional is obviously looks like there’s shadow.
Annie Gough: Yeah.
It’s like the difference between Shrek and Tom and Jerry.
Elizabeth Larrick: Okay. I love that. Okay. Shrek versus Tom and Jerry. Okay. Okay.
Annie Gough: I am going to share my screen and. Walk through a couple of these. This is just my information. If anyone wants to take a screen grab of this, my website is here. And I did want to mention that I do have medical animators on my team right now.
I’m working with Sarah Constantine all the time. She is a medical illustrator. We all go to medical illustration school and take the first two years of medical school. Our background is mostly medicine, and then she works primarily in animation, where I work primarily in illustration.
Elizabeth Larrick: So, [00:07:00] not to totally sidebar, but so, when I hear animation, I think, like, you’re gonna hit play, and it’s gonna go, and then You are correct.
Okay, and so, then, illustration is just like you’re saying, like, you draw a leg. It doesn’t move.
Annie Gough: No. Okay. It doesn’t, unless You put it in a viewing software as simple as PowerPoint. So for example, gotcha, through a leg, the medial side of a right leg, this is normal. So another thing that I love attorneys to understand is if you start with normal, You have an opportunity to teach the anatomy to the jury and set up the crash that is going to happen.
So you can talk about, do you want to use the word femur or do you not want to use the terminology? Do you want to say calf? Do you want to say gastrocnemius? Like what is the word you want to use? So anyway, this is just a drawing of a normal leg. And then this slide is a drawing of an [00:08:00] injured leg. And this drawing matches the x rays.
So in any case where there’s radiology, MRI, CT, x ray, fluoroscopy, ERCP, you name it, if there is black and white proof in the medical record that’s visual, I will always do your drawing to match that so you can enter it as evidence. So these would be the x rays, This would be the two dimensional illustration of the injuries, and this would be normal.
So if you’re an attorney and you want to talk about this crash, whether it’s an opening, closing or with the expert or with a witness, just depending on how fast you go through the slides, it looks like it’s animated. So it looks like this leg getting crushed. So that is an example of a two dimensional illustration that looks animated and that [00:09:00] animation the attorney can control on their own.
This gentleman is a similar example. So this is our client. He rollover crash with a roof crush. So this is his normal and this is his crash. And these are just two slides. And I’m just moving in between these two slides and you can see C5 crushed in half. And of course it matches his CT. So this would be the CT, the injury, the normal.
Elizabeth Larrick: While you’re doing that, let me court reporter this for people who are listening. She’s literally clicking through the slides, but I think like for the first one with the leg, it was the normal leg then a broken, and then she literally had the x ray and that’s what we’re looking at right now as well. So it’s like, there’s three slides and that last slide actually has the x ray.
In the slide, I don’t mean to be totally nerding out, but like, how are you putting that x ray, [00:10:00] are you putting that down and then drawing on top of it?
Annie Gough: Yeah, so I’m opening up all the radiology films, all the radiology scans are saved as, they’re called DICOM files. Which is really weird. But if you work in a lot of catastrophic trauma, you know what a DICOM file is.
And that’s the way all the radiology scans come from the hospital. And so I put that into a radiology viewing software and I go through and I choose the best images of all the fractures. I take them, they’re now files, and then I put them on a white screen in Photoshop and I stack them all up so that they’re anatomically in position.
And then I literally draw over the top to match them exactly. Gotcha. And you can see that.
Elizabeth Larrick: For people who are not, like, if you’ve not gone to see the YouTube yet, if you’re just listening to this for this episode, like, that’s what you can actually see is, you can see basically the outline of the leg or the outline of the neck, and, but you can [00:11:00] still see the black and white imaging, uh, that basically
Annie Gough: lines up.
Yeah. And then if I just delete the x rays away, then that’s like the standard just injury illustration. And from that, Where those broken bones are jagged and displaced from one another, I can take my drawing and I can make it into what was the normal leg before that. So you basically put all the pieces back together to show normal.
But as an attorney, you would start with the normal and then show this. So it’s the same with the head. You would start with normal and then fracture him. And CT.
Elizabeth Larrick: Gotcha. Versus Trying to animate, if we ever say, Oh, well, I want an animation. That is the neck breaking,
Annie Gough: breaking. Well, so you can animate this in that way.
So because this is a two dimensional illustration and there are two drawings. You could [00:12:00] put both of these in an animation software and have one fade from one to the other. Or you could even, like, have the frame flip upside down and you could talk about the car rolling over and then break his neck when the roof crushes.
And then you would put that into a movie file that would play in QuickTime. So you could do that. And then as the attorney, all of those visuals would be in one file, and when you wanted to play it, you would just hit play, and it would play through. One of the things that you want to think about when you have an animation is, is this file going to get thrown out?
Is opposing counsel going to fight it? Is the judge going to say, no, it’s too inflammatory? And then if you lose your animation, do you still have any other visuals? So you don’t want to put all your eggs in one basket. So you’re still probably going to want these individual illustrations somewhere in your exhibit list, just in case [00:13:00] you lose your animation.
And this is one thing that happens. So if you want an animation for your trial, create it way in advance. Get used to working with it. Use it with your experts and show it to opposing counsel and get them used to it early so that they’re not going to throw it out. Because if you spend a lot of money making an animation and you walk into trial and the other side is like, whoa, wait, what’s this?
We haven’t seen this. And then they argue it. You’re toast. You have no visuals and really quick. So this actually happened with a series of slides, just these 2D illustrated slides. This man, our client had a lot of preexisting back problems. He had previous back surgeries and then he had our injury and then he had many, many back surgeries.
And so to do all the drawings of what went on in his back, we had 65 slides. Wow. Yes. [00:14:00] And they took him to court and the other side argued, No, we can’t use them. And they fought tooth and nail over every slide. But they ended up keeping 14 slides. And those 14 slides were enough for the jury to see what was going on.
And so If they had put all of that into an animation, they would have had no visual at all because it would have been thrown out. So that’s something to think about when you’re preparing these. And this is another just really quick example before I show an actual animation. So this is a 2D. illustration of our client, but this is a three dimensional model of a product that is going to explode.
So it’s still a 2d illustration. We did have a medical animator, make the model of this product so that we could show it exploding. But if you look at this, and I click to the next slide, do you really need to spend the money to [00:15:00] animate the canister exploding when all you really need are the two pieces?
And then all of these pieces of the canister are exactly the pieces of the canister that we found at the scene after her injury.
Elizabeth Larrick: Gotcha. So, Behind the scenes here, Annie sent me these and I thought somebody threw this at her like My lawyer, Ray, was like, someone threw this at her. So I’m glad that you explained it exploded, but that would be obviously a very, you know, the crux of the whole case would be the explosion of the product.
Annie Gough: So this is a cream whipper that you use when you put cream in your coffee and it’s under a nitrogen pressure canister. And back in the day, they used to make these with a plastic. Ring and the plastic would explode. Now they’re all made in metal, but at the time that this canister exploded, all of the plastic canisters had been taken off the market in all markets, except for the United States.
And so through this case, we were [00:16:00] able to get the plastic ones also removed in the U S.
Elizabeth Larrick: Wow. That’s amazing. I also have to say this really quickly because you said this before, but like in our other podcast episode, and it didn’t really click with me until I saw some of your work with one of these cases that we were focus grouping and you make the person like the actual, like, like their leg or the face or whatever, like you make it in their likeness.
And I was just like, wow, And they didn’t really hit me until I actually saw them. And I was like, Oh, this makes it so much more, like you said, like much more connection with the person. It makes it much more realistic to the focus group and the jury we’re talking about, but I just want to say like, if I ever hire you, can you please make me with like six pack abs and like, you know, muscles, like, My question is, can we make requests about bodies?
Annie Gough: I actually had a client request some augmentation to her anatomy. Yeah. Oh my gosh. For her illustrations. Yeah. [00:17:00] Like, okay. The attorney was like, we better just do it. I was like, all right, here we go.
Elizabeth Larrick: I mean, that would be like the dream being like, I’m not so sure, but it really does makes it so much more realistic, even though it is an animation.
I mean, an illustration. But it’s custom to the actual person.
Annie Gough: Yes. That can be really good if they’re there in trial, but also if they’re not present in trial, so that it’s still like a real person, and you have any photographs from the family, or if the person’s passed away, it’s really nice to have that likeness in everything.
Elizabeth Larrick: Right. And also, I mean, from a preparation standpoint, I think that because jurors have so much time to sit and critique, They critique what you’re wearing, they critique what pen you’re using, they critique, like, did you get binders or did you not, like, and there’s always this constant comparison and so if you’ve got an illustration with, like, a guy with a six pack and, like, big shoulders and then you’ve got an average [00:18:00] size.
Person. They’re going to be like, wait a second, like, yeah, just win and pull something off the internet. So also it does like those tiny little details or things that really, whether they consciously or subconsciously do it, like it definitely makes a difference.
Annie Gough: It does. It’s an excellent point about using stock illustration that is just of a generic male or generic female.
If it doesn’t look anything like your client, it looks like you just stole it off the internet. It really does. Like the Ken Barbie doll versus who your person really is.
Elizabeth Larrick: Yeah, the average person, I mean, does not look like that. No offense. A majority
Annie Gough: sees through that. Yeah, for sure. So I am going to share my screen again.
What I’m going to bring up here is I’m going to bring up a 3d animation where everything in the animation is modeled. So it happens in a 3d software. The man is a 3d object. The car is a 3D [00:19:00] object. Like, I feel like this is what the typical attorney thinks when they think, oh, I want to animate this. So this is a 3D animation of a very unusual incident that is definitely easier to describe as a motion animation than with words.
So let me come back up to my screen. I’m going to get out of PowerPoint and I want to show you this scene. So this is a typical 3D animation. So the car pulls up to the railroad crossing. I can narrate this since some of you are just listening. So the So the railroad crossing is bars down, but then it goes up and there’s no train and the railroad bar crossing ends up coming down on his car.
So he has to get out of his car to push the bar up and off. And because this is a malfunctioning railroad crossing, it does come down on him and hits him in the [00:20:00] head. And he suffers a neck injury. Well, it lacerates the top of his head, but he does experience neck injury from this, and this is a great example of.
a typical 3D animation with people and a scenario and a vehicle and things happening. This was a very successful animation because it’s a weird story of how he got injured. And it’s just kind of like, really? Does that really happen? But if you see it like a movie, the jury’s like, Oh, I can imagine that happening.
And they’ve seen it happen. So now they understand the story. The attorney was able to reinforce this story with lots of witnesses that live in this area that also struggle with the same railroad crossing. And really, I’m going to go through these slides really quick, but kind of like I was talking about, there was a set of illustrations that was 65 slides.
This is a lot of slides, but you go through them really quickly. So this is the man that got hit in the head. With the railroad [00:21:00] crossing and he can see here on the lateral. He’s got a neck injury. He’s got a laceration to his head. It matches his MRI and on the left hand side of the screen, you’ll see that there’s a surgical incision.
We’re going to do his surgery where the green drape is. I’m just going to go through these really quick. So these are just 2D illustrations, but it kind of looks like animation because we’re going to go through each step of the surgery. So the discs are removed, the end plates are prepped, the replacement cages go in, and the plate goes on.
And you can see if you go through these really quick. It’s kind of like animation. So if you’re the attorney telling the story, let’s say an opening or closing or whatever, you can go through this quickly. But if you’re have your expert on the stand, you might want to go slower and you might want to stop here and be like, okay, so what is a vertebral.
disc replacement. And what does this look like? And why do you do this? And you can let [00:22:00] the medical expert talk more in depth about what’s going on. And of course it matches the x ray.
Elizabeth Larrick: Right. And I can also see, cause you talked about like getting the slides in early and I could see if you were trying to do an animation of the surgery, which I’ve seen many of, you know, this is a cervical
Annie Gough: ACD
Elizabeth Larrick: replacement with hardware cage.
I could see where if you were trying to get your medical expert or your treating physician or surgeon to say, okay, I want you to go like Go through this animation and say, like, there would be probably lots of red flags that they wouldn’t feel comfortable with. Plus you’d have to stop and go versus if you do it like this, they can see each slide.
It gives enough room for them to be like, okay, that’s a spacer. And this is what it’s made of. And, you know, bid, it’s not like super specific. So if they need to have a little wiggle room in describing it, like it wouldn’t be difficult for them to do. And like you said, [00:23:00] boom, it’s done. It’s in, they’re relying on it or they’ve walked you through.
So there’s not really going to be any objection with them. Or if they want to make changes to it, you can do that very quickly before deposition to get these things in there. Exactly.
Annie Gough: Exactly. Your point. Exactly. Okay. I’m going to start a different case. I want to talk about, this is still an injury case, still a 2D illustration, but I’m going to go more into 3D models.
So this client, she did not pass away, but I have a black box on her face because she didn’t give permission to show her likeness. But again, you always want to do a custom illustration so you can see your client. And this is her skull next to it, and I’m just going to click to the next slide and you will see her catastrophic skull fractures.
And if you go back and forth, you can watch, especially if you watch her upper teeth on the right, you can see how her hard [00:24:00] palate is crushed. And you can just go back and forth. And the more you look at it, the more you can watch the septum of the nose break. She has a brain bleed, her jaw breaks, but yeah, very extensive skull fractures.
And this is her CT. Now, the CT is really junky. It’s hard to see. So this is something also to remember. Whatever data you have, if you have a really bad CT, if you have a junky CT, you’re going to get a junky model out of it. If you have a really good CT, you’re going to get a really good model out of it.
That’s why you want to have an experienced medical animator always, because You want them to be able to work with even a junky CT and create a beautiful model that is anatomically correct. So this isn’t the 3d model.
Elizabeth Larrick: Let me just slap you real fast because I want to ask because again, my lawyer brain says Are most animators, not [00:25:00] medical illustrators.
So
Annie Gough: well,
Elizabeth Larrick: here’s why I’m asking. Cause the way you described it and was basically, if you have a crummy or an unclear, or you called it a junkie CT, which if you’re listening to this, I mean, it looks like it was from a scary movie. What she just showed us, like it could jump out of the screen and scare you.
But. Obviously this is someone’s actual medical CT, but it’s just not very well done. But what you’re saying is if you have somebody that has a medical background, they’re going to know and be able to kind of piece that back together to create a better model or an illustration versus if you just. Hire an animator who’s just graphic design and they just throw it in there.
Annie Gough: Right. Okay. So there are plenty of people that make beautiful models and that create animations, but they’re not medical or scientific or anatomical. So if you’re just working with an animator that [00:26:00] crashes cars, Chances are they’re not going to be completely anatomically correct when they crash a skull, but if you have a medical illustrator that has a background in animation, a medical animator, they’re going to be able to understand not only the radiology scans, but how that data transfers actually anatomically into your client to make it accurate.
So yeah, it’s just a question you can ask before you work with your animator. If it’s purely medical, you can ask them what their medical background is.
Elizabeth Larrick: Right. And then also, because again, if you’re going to have to pass this off to get it admitted, either through an expert, which is generally the way you would do it.
You don’t want to create something that is not going to be admitted or your expert says I can’t even remotely begin to endorse this because it’s not anatomically correct. Exactly.
Annie Gough: Gotcha. So this is the 3D model that’s made and you can just see it here on the screen and what you can do with this model is you [00:27:00] can animate it.
So let me go to the animation. And so this is that same model that you see placed in a 3D software. So you can see how you can pull the pieces apart. You can take the craniotomy off. You can see the internal bleed. You can rotate the skull, take the jaw off, see the hard palate fracture. Let’s look at that one more time.
So it’s the skull, it’s just the model of the fractured skull with the pieces exploding, coming apart, coming back together, moving around, the jawbone is removed so that you can see different angles of the skull. But that would be a 3D animation where you would have this file and you would just hit play.
And then the other thing that you can do with that same 3D model is you can take that file and you can 3D print it. So this is where we’ve taken that exact same model that you’ve become accustomed to. We’ve put it, we have [00:28:00] placed the file correctly into a 3D printer and this is what it comes out like.
So these are all the pieces of plastic of all the individual pieces of skull and when they come out of the machine they’re scaffolding, um, and all that has to be removed and cleaned up. This is the jaw. This is the large piece of the skull and you can tell we did go ahead and cut the craniotomy in the skull so we can take that skull flap off and show her brain bleed underneath and the compression of the brain inside her skull.
This was really cool with the top of the skull flap and the brain. We’re able to squish them together with silicone in the middle and actually make the exact size of the subdural bleed. So the subdural bleed is also removable and it’s just a silicone piece of plastic, a little rubbery piece of plastic.
And then I take all the pieces home and I paint them. And then we put them all together. These are all the pieces that I’m painting. We did paint her [00:29:00] two teeth and I had the attorney. I was like, this is a great idea. Keep these teeth in your pocket. in trial with the jury when you start talking about her and how she was found at the scene and hell, like, I’m pretty sure she went by helicopter to the hospital.
They found her two front teeth in her stomach. Um, my gosh, these x rays of her body. Yeah. So I was like, just put them in your pocket. And then when you talk about her teeth, you can pull out the teeth and hand them to the jury box. And we did try eyes. Because she did have an eye injury, but we decided this was just way too creepy.
We were not going to pass this skull around to the jurors with eyes in it. So the eyes did not make it. Yeah. It
Elizabeth Larrick: looks like from the movie back to Mars or
Annie Gough: whatever. Eyes are so bad without eyelids. And so this was the final 3D model. And you can see how that skull flap comes off and the bleed is [00:30:00] underneath.
And then the bottom jaw is actually just like this one. This is a different case, but the jaw comes off. And so I learned a little trick. You can attach the jaw with magnets. Oh, nice. So you can put the jaw on or you take the jaw off and then you can look inside and see the other fractures. So that’s what we have here.
You can see with the jaw removed, you can see that hard palate fracture. I mean, her upper jaw was just smashed. Here, I’m going to stop sharing for a second. I have one more case to present.
Elizabeth Larrick: Nice. That’s a lot. I mean, for a 3D model with your experience, how often are you doing a 3D model? I mean, are these things that are just really, we’re going to trial, this is an unusual injury, like how often are you doing 3D models?
Annie Gough: I probably only do two or three a year and sometimes we do them for mediation because they’re really fun to set in [00:31:00] the middle of the conference table during mediation and talk about what happened. But you want a 3D model definitely when you want the jury to touch something or when you want to see something in like a lot of angles.
Where if you do the 3D model and you put it in an animation file, you don’t have control over which way you rotate that model. You just set it up in advance, you create the file, the file is set, rotation is what it’s set to, whatever the animator and you choose. But like, let’s say, like in the animation that I showed, we rotated around the skull and then we moved it But then the expert and then you pause it and the expert goes, Oh, well, can you just move it a little bit this direction?
Well, you can’t, it’s just part of the animation file. But if you have the skull in your hands, and your medical expert is holding on to it, they can show this any way they want. They can point to anything. So it just [00:32:00] kind of depends on the facts of the case, whether a case would warrant something like that or not.
Elizabeth Larrick: Yeah. Are you seeing, because with some, a lot of attorneys do a lot of the same cases, they’re seeing a lot of common injuries, I should say, like to the spine. Are you seeing any requests or is there any need or If there’s not a need, can we create the solution, which would be like a spine that can be taken apart or just the lumbar spine, like a lot of people just have the full skeleton.
Right. And that’s cool. But I think sometimes having the spine, the bones with the dish and then, yeah, yeah. With this, yeah, yeah. So like, can you create one of those, like just to have like,
Annie Gough: Yes, so there are some like stock ones that you can just order from an anatomical company that will have various, just like a standard lumbar spine.
And some of the [00:33:00] discs will be desiccated or dry. Some of them will be bulging. Some of them will be herniated and you can squish them and they go bloop, bloop, like little balloons. So yes, those do exist. We can find them. And if we can’t find them, we can make them, but it’s always better to just print it.
From your client’s CT. So if you have a good CT of their spine, you might as well make their spine. And then there’s no danger of it getting thrown out because it’s just a stock. Well, you can’t prove that this is a man or a woman or a child or a, an adult. Well, yeah, because this was printed directly from the client’s CT.
And then you just have the expert back that up. And then whatever you’re showing is exactly what you have. I did do a lumbar spine once for a client here in Denver, and it was so unusual. The disc bulge was so big that it looked like that was the spinal cord and the bulges on the other side, because the spinal cord was so squished and [00:34:00] compressed that it was like solid black and it looked like the disc bulge.
Wow. We did create that so you could see it in all dimensions and then you could pull it apart. And then we did the little laminectomy piece. So you could see where they went in to do the surgery and they ended up cutting the spinal cord instead of cutting a piece of herniated disc. Yeah, it was really ugly.
Elizabeth Larrick: I’m curious about people who, you know, cause these are super cool cases from a lawyer stand of my point of view, be everybody always remember we’re talking as lawyers in the sense of like unusual and different, and some people may not get. A case like that, but they may get a herniation or they may get an unusual situation with someone’s spine or that would be helpful to have even a 2D illustration or I mean, when I focus group, I see a ton of.
No ones with like the shots that are that way. And now all the injections. Yeah.
Annie Gough: Yeah. And that’s all I’m [00:35:00] curious, right? Yeah. So I like to illustrate those where you have the back kind of like this, right. And it’s just a drawing. And then you do like all the injections from October and then you add on all the injections from November and you go through the chronology and you just do them as a series of slides, but you add injections on top of like needles plus needles, plus needles.
to show like a voluminous set treatment.
Elizabeth Larrick: Right, and needles because people don’t like needles.
Annie Gough: No, and bring a needle. Have your expert bring a needle to court and talk about how long the needle is and how far it goes in for the skin.
Elizabeth Larrick: Please make sure you check with security before you do that because that would be a very big problem getting into the courthouse.
Just thinking practically here. Awesome. Okay. So I know like, as far as like literal, like kind of the differences, and one of the assumptions is like when having dealt with animations is they’re very difficult to change, [00:36:00] to make adjustments as compared to doing kind of what you’re talking about with the 2D.
So walk, walk us
Annie Gough: through that. So the 3D model has to be created in 3D software, right? And so then you have that model. Then that model goes on to a stage. The stage needs lighting, whatever the background is, and then you have camera movements. Then you create all those keyframes. And then you have to send that into the render.
And then once it goes into render, it could take an hour or three days to render to produce that final movie. That quick time movie. So if you have a change to the lighting, you change the entire movie, which means you might need another three days to render, there’s no way to shorten the time of the movie of what it takes to create whatever animation you’ve created.
But then if the change that you have is to the, one of the [00:37:00] models. Then you’re going all the way back to the original file. You’re changing the 3D model. Then you have to put it back into the scene. And then you have to re render. So changes, they might not be very difficult to just like, Oh, can you just move the tooth?
Well, yeah, everything has to be done. It could take three days to make a simple change. And that’s why you want to do animations well in advance of trial, get used to working with them because you can’t change something the night before trial in an animation, maybe, but most likely not, which means whoever your animator is, if you call them the night before trial, and you’re like, Oh, the car’s green, it’s not blue.
They’re going to be up all night for probably 48 hours trying to fix that for you. It’s not fair. You might accrue a rush charge. All kinds of bad things can happen. So you definitely always do your visual exhibits well in advance. [00:38:00] Plus, if you have them before the depositions and you use them in the depositions, they are already exhibits to your case.
So they’re already demonstrative evidence. The jury can look at them. There’s no reason not to do them. in advance and have them be part of your case. You don’t want to just spring them on somebody the day of trial. Cause if you’re not well prepared to use them, then you’ve kind of wasted your money.
Elizabeth Larrick: Yeah.
Okay. Let’s get your opinion on this. Okay. What’s better for an animation. medical stuff or like the event itself, like the injury causing event. So what’s your opinion, Annie?
Annie Gough: Ooh, I like to crash cars. I think it’s fun to see the actual crash, to understand from a bird’s eye view, who was where I feel like crashing vehicles makes sense.
It puts the jury at the scene. They’ve actually seen the crash. And then the surgery in an [00:39:00] injury case, I don’t think ever needs to be animated. It’s very expensive and animating a surgery can be done with 2d illustrations. But if we’re talking medical malpractice. and the surgery is really complex and the anatomy is really complex and we’re talking about how long it took to do something or how something was situated behind something where you like need to rotate or you need to talk about time then you might want to animate that surgery so that you can see it in different angles as opposed to just a flat drawing and I have an example of that.
Let’s see it. Okay. All right. This is a liver case. We’re just going to start with that. This is a 2D illustration and we’re going to take off the rib cage and we’re going to zoom into the liver. These are just 2D illustrated slides. This is all the hepatic system. Hepatic [00:40:00] means liver. So the hepatic system is all the vessels and it’s the inner workings of the liver and how it creates bile, which is a digestive enzyme that breaks down fat, which It’s all about like bile is stored in the gallbladder and eat really fatty foods.
The gallbladder squishes out the bile and it helps you digest and all these things. It also has arterial supply. So there are hepatic arteries that come off the aorta that supply the liver. Yes, blood oxygen. And then there is also the portal system, which are the veins that take everything out from not only your intestines and help you digest food, but also takes blood back to the heart.
So anyway, this is anatomy, just very straightforward anatomy with 2D illustration. And you can see what we’ve done is this is our client’s condition. So her gallbladder has been removed. She has [00:41:00] an arterial pump for chemotherapy, and you can see these two yellow dots are liver tumors. And so if we fade the anatomy away, you can see the tumors back there.
And so I’m going to show you what we illustrated in this case. So this is just an illustration of the anatomy, but you can see how being able to rotate the liver is helpful. So now I’ve rotated to the back of the liver and you can see where those tumors are. We go by the side, we look underneath the bottom of the liver.
Is it helpful or is it too complex? This is something that you might want to think about. As an attorney, is this animation beneficial for showing where these tumors are?
Elizabeth Larrick: Okay, my lawyer brain is like, I don’t want to answer that question. Yes, what is your answer? I think it just depends on what ends up happening to her because if it really, if the position of the tumors doesn’t have anything to [00:42:00] do with, then it’s not a big deal.
But I liked you doing all that just because, I mean, truthfully, I think most people And I’ll put myself in this, like, we don’t know how big our organs are. Like, we don’t know how big our livers are, or we know where things kind of are in our bodies. But I like the idea of just like, just showing like, this is a really big organ and it’s really important to us as human beings, I just like that.
Yeah. How big you showed it was. Cause even if this 2d animation and I’m not actually touching it, like I still got a good impression that this is a really big organ. Okay. Fantastic.
Annie Gough: Now we’re gonna talk . No, that’s a great answer. And it’s important ’cause the jury has no idea either. No. How big their liver is or how significant it is.
What we really wanted to express was how close the tumors are to the critical structures to, I missed that, the arteries. Exactly. But anyway, , now we’re gonna [00:43:00] talk about what happened to her. So the surgeon in question,
Elizabeth Larrick: and we’re back to 2D by the way, we’re back, like she showed us the animation, now we’re back with the regular slides.
Yes, we’re back
Annie Gough: to 2D. So this entire case was done in 2D slides and animations. There was both available throughout the trial. So what happened was the tumors line up to the PET scan. And then when they did the treatment of these tumors, everything is axial. So all of a sudden you’ve gone from everything looking like our client, the patient is standing up and now everything’s going to be axial because she’s in a CT machine, laying down, she’s laying down her feet or closest to the viewer, and you are looking up the nose.
That’s how you best describe a CT or MRI positioning. So you understand why right is left and left is right. So basically we’re looking up into her liver and these probes come in from the outside and [00:44:00] they’re going to ablate with microwave ablation. They’re going to basically burn her tumors. So these are just two dimensional slides from her.
intraoperative ablation in the machine. And I’m just clicking through these slides, but it looks like the probes are moving. Yeah. And you can see how many probes there are. Yeah. And it’s like, wow, once we put this together, we’re like, wow, they ablated, they microwave ablation her a lot. And so this is obviously medical malpractice is always much more complex than just an injury.
So these are two dimensional slides. breaking down how long they use the ablation probe on each tumor. So I’m just going to click through these really quick. We used a clock because it’s important to talk about which probes we’re in for how long. So we have 57 minutes of ablation. Yeah, [00:45:00] so here, let’s try it on this one.
This one better is an animation, so we’re going to actually show the timing of the ablation. Obviously, it’s faster than 57 minutes. Thank you.
Elizabeth Larrick: Yes. This podcast is not supposed to last that long.
Annie Gough: No, but see the clocks are moving. The ablation, you can actually zoom into the tumor. You can see the changes in the liver.
It’s matching all of the fluoroscopy radiology images, which is evidence in the case. So this is able to be approved of, created with the expert. So the testifying expert was with us all along in the creation of this animation. And this was able to be introduced as evidence. And so what we’re watching is we’re watching these probes come into the liver and burn the tumors.
Just destroy
Elizabeth Larrick: it. You’re just [00:46:00] destroying the liver. That’s what we’re supposed to be seeing, right?
Annie Gough: Yes. The amount of ablation that happened in this case is absolutely obscene and completely negligent, not the standard of care. These probes, the ablation I think is supposed to be a maximum of 10 minutes.
Elizabeth Larrick: Oh my gosh.
Annie Gough: And they used four probes for 57 minutes.
Elizabeth Larrick: Wow.
Annie Gough: Yes. And this animation was critical in the jury understanding what they did to this patient. Sure. And if I recall correctly, she, her liver completely shut down. The hepatic arteries started bleeding, the portal vein completely clotted off, and I think she passed away while she was on the liver transplant list.
Elizabeth Larrick: Oh. Yeah. Annie. I know. That’s a very cool animation because while it’s showing you [00:47:00] the probe is like lighting things up and it’s like yellow and red, like the liver is turning black, which is like pretty cool. So that would make sense as far as like, cause I think medical malpractice and like showing people what went wrong is, Oh my gosh.
I think that would help medical malpractice like tenfold because those are the hardest trials, like hands down. Like if you’re doing them now, like. Anybody else can try and come to me like, well, this is so hard. I’m like, no, statistically speaking, like med mal trials are the hardest. So, yeah. So that’s definitely like, what a good, and I’ve seen one of those thermal cases before, and it’s just like, it blows me away.
And like, shouldn’t use them on people just yet. I mean, cause this is a whole nother case that I, you know, the ones that I’ve had experience with where I’m just like, wow, how is this even like, we should we really be allowing people to use these things on our bodies? I don’t know. Yeah. That’s a probably a whole different podcast.
Annie Gough: Yeah, go ahead. No, you go [00:48:00] ahead. Oh, I was just going to say the mediation for this case, we use like a bag of microwave popcorn to show how, if you use the right timing, you make popcorn. But if you go in even 30 minutes or 30 seconds, too long, um, everything’s fried in black. So burn popcorn was part of the case.
It’s always fun to use analogies of things that people do every day.
Elizabeth Larrick: Well, yeah. And someone’s definitely burned the popcorn and it definitely has a very distinct smell. So it’s like, Oh yeah.
Annie Gough: Yeah. You’re throwing that out.
Elizabeth Larrick: That liver is coming out. That liver is going. That’s right. Awesome. Okay. So let’s do a little summary.
Cause okay. And again, If you’re listening to this, I really encourage you to go watch the YouTube so you can actually see all of the visuals that Annie has shared with us today. So, animation, showing things that are complicated, that are hard to describe, easier to picture.
Annie Gough: Mm hmm.
Elizabeth Larrick: Illustrations, though, can become 2D with [00:49:00] movement.
Annie Gough: Mm hmm.
Elizabeth Larrick: And those are quick, much quicker, much faster to produce. Typically. Typically. Right. Typically. Is there anything we’re missing? If people are sitting there thinking, well, so what’s better, animation or 2D illustration?
Annie Gough: It totally depends on your case. A lot of people ask me, well, how much does it cost to have medical illustration?
I’m like, well, that depends on a million different things. You know, do you have good radiology files? Do you have bad radiology files? What kind of. Anatomy are we talking about? Like, are you able to tell the story from one view or are we going to have to show it from the front and the side? Cause then you have two sets of illustrations.
Is it a car crash? Is it medical malpractice? Is it a broken ankle or is it a brain surgery or an aneurysm in a complicated part of the brain? Like, so ranging from simple to complex is the whole gamut. And that’s why it’s [00:50:00] best to just call and be like, this is what happened to my client. What do you think we want to show?
I was just talking to someone about a case with a retained sponge. Like, do we want to do a 3d print of the size of the wound and then actually take one of the sponges and stuff it in there to see size comparison? Or do we want to draw that? Or do we want to animate that? A lot of times you just want to sit and brainstorm it and talk it through.
Talk about budget, talk about timing. Do we have 30 days or do we have six months? Preferably we want six months because we want to make sure we have the right expert, and we want to make sure that they’re on board, and then we want to use it in their deposition so that then you are totally prepared to use it for the jury in teaching the story.
All varies. Like even just the anterior cervical discectomy, it depends on have they had a prior surgery, have they had prior injuries. Sometimes someone, have an attorney call me and say, Hey, I just have [00:51:00] an ACD. Can you illustrate this for me? Yeah, sure. Please send me some photographs of your client. So I can make it look like them and then send me the DICOM files, you know, the radiology scans, and they already have hardware all over their neck.
I’m like, whoa, whoa, whoa, whoa, wait a minute. Now we have to pull all the medical records from the beginning. Like, when did they start as normal? How many surgeries have they had? Then what happened in the crash? then what happens now. Otherwise, the other side is going to be like, it’s all pre existing. So it all varies,
Elizabeth Larrick: which they say no matter what we do.
So it was already there. Nothing was waiting. So you can help people like in just talking with somebody, like with your experience and like thinking through all that stuff and brainstorming, like you said, like you can be able to say, Hey, I would suggest just doing 2d, or I would suggest this is a case.
That [00:52:00] you could do not only a 3d model, but also do an animation,
Annie Gough: right?
Elizabeth Larrick: Okay, awesome. Cause I think sometimes that’s so helpful because we see things often infrequent and so it makes it difficult sometimes for us to know. Oh yeah, this is just a simple laminectomy. No big deal, Annie. And you’re like, well, wait, let’s slow down just a second and think about it in a different way.
And that’s why I always, I think having an outside perspective is always helpful, no matter what you’re doing, because you’re going to have a different point of view and bring in your experience and be able to say. Hey, Elizabeth, that’s not going to work really well with your particular client and here’s how come, or you’re going to be able to say, that sounds super complicated.
Have you thought about doing an animation? Because. I’m lost.
Annie Gough: If timing is important, or if movement is important, you want to have timing or movement. You want to [00:53:00] animate. But like sometimes you don’t need that. Sometimes educating the jury, simple is best. And the more clear you can be with your story, the more they’re going to understand your story.
So the more exact you can be, it’s just like they say, you only want one theme. You don’t want five themes. You want one theme. And you want to be able to tell your story. To a fourth grader as easily as possible. So, adding a million slides in an animation might not help clarify things. It might make things more complex.
So you really need to sit down and do each one case by case. Figure out how to best tell that story.
Elizabeth Larrick: Yeah, and we love to complicate things. And by we, I mean lawyers. We, oh my gosh, we love details. We love them. And we think every one of them has their own special place in the case, getting outside help. So, okay.
So Annie, if somebody wants to see more of your work, of course, they’re going to watch this lovely YouTuber putting together, but if they want to see more of your work, they want to learn [00:54:00] more about you. Where should they go? What should they do?
Annie Gough: They can go to the website, which is injuryillustrated. com, which is the same name as my book, Injury Illustrated.
There’s tons of stuff in the book and there are lots of examples on the website. And I will admit I’m not perfect about it, but if you want more up to date illustrations, I do add a lot to my Instagram page, so you can always follow there. For gross and unusual drawings. Oh, it’s your social media. So my Instagram is a G C M I or Annie Goff certified medical illustrator.
Elizabeth Larrick: Yeah. And we’ll put all the links in the show notes for anybody who’s driving down the road right now and thinking like, I want to see more. But your website is great. You know, you’ve got tons of examples there and they can reach out to you via email or your contact you through the website or even send you a DMN on Instagram.
Thank you so much for coming back on the podcast. [00:55:00] This has been something that I wanted us to talk about for a while. So I’m glad you came back.
Annie Gough: Yes. Thank you for having
Elizabeth Larrick: me. It’s wonderful to see you. All right. Thank you everybody for listening in today and don’t forget to go check out this video on YouTube.
Um, there’ll be a link in the show notes should be on my YouTube video. And if worst case scenario, we’re going to let Annie have a copy of a tune, put it on her YouTube as well. So Thank you so much. If you had or enjoyed this podcast episode, please rate, review, follow on your favorite podcast platform.
And if you really loved it, send a nice review. So, all right. Thank you all. And until next time, thank you. Thank you so much.