Chest 124; Displacement

2 Oct
Chest 124 C

Chest 124; Displacement

It has been a while since I last was able to produce any images for this blog. My time has been taken up making an animated video for a local festival – Light on the Fringe. That has been shown a few times both during the festival, and at events afterwards.  I have also been involved in making two new lectures, one on indications for radiological investigations for Physiotherapists, and the other about my digital artworks, to be given next week for doctors at our local hospital. It was also a time of importance to me – my first solo exhibition at the Umbrella Gallery. This is a publically funded gallery set up to encourage emerging artists like myself. At the same time my son has asked me to make him a dining table! This is a long-term project. I’m using recycled hardwood from an old work-bench (with rusty nail holes and saw-cuts to be included) and am setting four beautifully figured sand-stone slabs into the top. All these projects require acquisition of new skills, whether in animation techniques, or in learning how to polish stone. So, my life in so-called retirement has been busy.

This dark image comes in mid-2015 at a time of crisis in the Middle East when millions of refugees have taken to the road. Over 5 million Syrian refugees registered with UNRWA. Syrians are migrating into Europe fleeing the war. Australia has offered to take a small number.

Other countries such as Sweden and Germany have opened their gates whilst others like Hungary have slammed them shut. This is ironic when Hungary who had so many refugees migrate to other countries in their time of need is turning its back. The Gulf State countries are ignoring the problem. Saudi Arabia, Qatar, the United Arab Emirates (UAE), Bahrain, Oman, and Kuwait are by far the richest nations in the region because of the gargantuan oil reserves they reside on. Yet they have not taken any refugees. Israel has refused to take a single refugee. The crisis has also emboldened racists to be open with their anti-Arab bigotry. German neo-Nazis have attacked refugees and shelters created for asylum-seekers. It is possible to draw historical parallels to both Europe and the US treatment of Jewish refugees before and during the Holocaust.

I attempted to produce an image showing how people are being torn apart by the terrible situation in which they find themselves. The original X-ray came from a young Ethiopian man, a refugee, accepted into Australia years before, who presented with lobar pneumonia. This is a condition caused by a bacterium, strep pneumonia, and can be quickly lethal.

The X-ray has been repeatedly copied and overlaid to impart depth and solidity to the central figure, it shows movement not from the frying pan into the fire rather from heat into the cold symbolising the way so many people seeking help have been turned back, shut out.

Even without the back story I find the fragmented solidity of this image personally disturbing.

Self Portrait 14; Recollection

3 Sep
Self-portrait 14 C

Self-portrait 14; Recollection

A nostalgic moment for me, the X-ray image came from a Zimbabwean man with Bantu haemo-siderosis. This is a condition in which a person ingests large quantities of iron. The excess dietary iron is deposited first in the skin giving the person a tanned colour. My patient complained that he had to stop drinking beer because his skin was getting too dark.

Bantu siderosis is caused by consuming large quantities of home-brewed beer made in ungalvanised steel barrels. The iron in the barrel oxidises and dissolves in the beer. The condition leads to liver cirrhosis, cancer of the liver, heart disease and diabetes. The condition was originally blamed entirely on beer brewed in rusty barrels, however genetics also plays a role in this disorder because it can also occur in non-beer drinkers, and of those that do, only some are affected. A genetic marker increases the risk of iron overload when excess iron is consumed.

Introduction of commercially brewed beer to rural areas in Zimbabwe in the 1960s dramatically reduced the incidence of the condition. It became illegal to brew beer at home.

However the law of unintended consequences came into play. In the villages people would brew beer as a communal event, often for the weekend, using maize meal, sorghum, and sometimes currants and raisins or marula fruit, and yeast. It was an important source of B group of Vitamins. The beer was consumed at home, and helped to bond families and the community.  It played an important part in family ritual, healing ceremonies, and some would always be reserved for the spirits. Menfolk stayed close to home, money stayed in the group. After the beer was consumed any the highly nutritious sludge at the bottom of the barrel was given to the children to supplement their diet.

After introduction of commercial beer, the males would go out to the beer-halls, drink away from home. Money was lost to the community, there was a problem with public drunkenness, family dynamics were irretrievably altered, and an important source of nutrition for children in poor communities was lost.

One wonders whether the government would have done better to sell stainless steel or even plastic containers cheaply for the purpose than to ban home brewing, and one suspects commercial considerations had a hand in the decision.

In this self-portrait, along with the X-ray I have included an African sunset (Mana Pools on the Zambezi).

Phoenix – for Light on the Fringe

8 Aug

This video has occupied most of my spare waking hours for a couple of months now and It can finally be presented for you to see. Hopefully you will like it.

It is part of a co-operation between eight artists for a fringe festival called Light on the Fringe associated with a North Queensland Art festival in Townsville.

I have always loved the story and symbolism of the Phoenix who dies and rises again from the ashes. I also have a fascination for colour and movement. Perhaps both are fulfilled here.

The dancer is my eight year old grandaughter. She was just given a beat and asked to just dance – and this is her spontaneous movement.

The feather is taken from a single photograph and animated as it appears to fall through the sky. The idea for the painting of the feather at the beginning and end comes from an artist who wets the paper with water and then allows ink to flow into it, I did about fifty paintings until I got one right!

The animations were done in Adobe Premiere which is a new program for me, and the bird flying away was rotoscoped using Adobe Flash.

Scenes of the bushfire were taken during a burning off – fuel reduction – exercise not far from my home in July 2015.

Chest 123; There and back again

12 Jun
Chest 123 C

Chest 123; There and back again

The picture contains two X-rays from the same man after a severe car accident, one taken in the Emergency department immediately after the event, and another on the day of discharge from hospital several months later.

Encounters with people like this make one realise how precious life is and how it can be taken away in a single minute. One mistake when driving a car can result in extreme injury, or death. This man was lucky to have survived his ordeal.

Despite improvements in road conditions, vehicle safety and driver education, over 3 million people are injured in road accidents each year. In the period after an accident when someone is injured the focus is on saving life, preventing life-threatening complications, healing and physical rehabilitation. Later there can be psychological consequences most notably post-traumatic stress disorder (PTSD), frequently not recognised. These disorders cause extensive lifestyle restriction. Mental healing is essential for the injured person to pick up life again.

Whether the person involved is a driver, passenger, pedestrian or even just an observer some people  struggle mentally in the days and weeks following a crash. Up to 30 per cent will deal with a negative psychological response. Although most recover from the anxiety which is a natural reaction to a stressful incident, others develop PTSD symptoms that can become chronic. Some will have no symptoms, some just minor symptoms, but others run the full gamut with disabling flashback memories, anxiety related to the trauma, hyper-activity, irritability, confusion, sleeplessness, lassitude, difficulty concentrating, and feeling upset, angry, helpless or ‘out-of-control’.

It’s been shown that it is not so much the severity of the crash, or injury that is important, but more, how that person perceives it. Children seem to do better than adults. It is interesting that a single counselling and debriefing session after a motor vehicle accident results in a worse outcome than if there has been no intervention.

In this picture I’ve contrasted a wild chaotic pattern in the background with regular square shapes attempting to illustrate the mental journey from the out-of-body sensation of the motor vehicle accident experience (It is happening. But it feels like it’s not happening to YOU) through injury, physical recovery, returning to the person they used to be, or possibly even a new updated person.

Chest 122; Anorexia

15 May
Chest 122 Anorexia C

Chest 122; Anorexia

The X-ray study for this picture comes from a girl with anorexia nervosa. The subject of anorexia has been widely discussed and there is a well formed philosophy around this condition. General opinion is that the anorectic is a person with seemingly contradictory beliefs. They believe they are too thin, they also believe they are too fat. There is a view that anorexia is a self-destructive act; the sufferer has a self-imposed death wish arising from a complex perception of body image.

A contrary philosophy has, however been put forward, arising from the link between food and pleasure. This opposite view is based on the consideration that it is a condition not just of the body, but also of the mind.

The reason people pay so much attention to eating is that it is a pleasure. Like addiction this pleasure drives a person to want to eat more. It could be claimed similarly; 1, pleasure derived from food is self-defeating because eating does not completely satisfy, and from each meal less pleasure is derived and 2, pleasure obtained is illusory because it depends on the body being in a disordered state – in hunger – and in need of repair.

Hunger is a physical condition and the enjoyment derived from eating and drinking (and also from sex) is a base pleasure that employs none of the higher faculties enjoyed by humans; cognition, abstract reasoning, and judgement.

Arising from the opinion that eating is merely a base (animal) need, voluntary starvation can be interpreted as an opposite, possibly even a superior, (human)  act. Extreme dieting could be explained as reaching for the very core of the human nature and starvation construed neither as mental illness nor “eating disorder”. On the contrary, in this way of thinking anorexia is a symptom of ordinary mortality, a viewpoint taken more seriously than usual; taken to its logical conclusion.

I do not adhere to this philosophy myself. It is however an interesting contrary point of view. It does not undermine the position that when a person with anorexia dies, that death is entirely avoidable. It does not take away from the distress of loved ones who find the death literally unbearable.

The picture includes quite prominently the image of the girl with two contrasting patterns arising from within her pulling in opposite directions.

Chest 121 A and B; Talc

6 May
Chest 121 A C

Chest 121 A: Talc

Chest 121 B C

Chest 121 B; Talc

I try not to publish more than one version of an image, although whilst going through the production of the picture it is tempting to save different renderings. In this instance I present two versions because they are so different and both appeal for different reasons. The only technical difference between them is a change in application of filters, but the outcome is strikingly different.

The chest X-ray in this image is a museum case of a man who suffered for years with recurrent pneumothorax, which is leakage of air into the chest cavity, causing the underlying lung to collapse. After several emergency admissions to hospital, they performed a procedure to prevent the lung collapsing by encouraging the lung to adhere to the chest wall known as pleurodesis. The pleura is the membrane that lines the chest cavity and can be stripped off in a major surgical procedure to make the layers stick together. However there are several non-surgical techniques for pleurodesis, all require induction of pleural inflammation. The method of choice at the time was to introduce talc; that is to puff finely ground talcum powder, into the chest cavity. This sets up a reaction and the two inflamed layers of pleura stick together.

This picture taken during a thorascopic procedure gives an idea of the talc as it flies into the chest cavity.

Thorascopic insufflation

Insufflation of talc thoroscopically. Image acknowledgement:

On an X-ray talc is visible as a white line, or plaque, around the lung. The radiologist only sees what appears to be pleural calcification that can have several possible causes including industrial lung diseases like asbestosis, previous bleeding, and infections like tuberculosis. It can be difficult to choose between them by appearance alone. It’s crucial to get the diagnosis right for on-going medical management, so to make a right diagnosis the radiologist relies heavily on a good medical history from the referring physician.

Both images show the X-ray and the talc can be seen over the right lung. I have tried to represent both the flying dusty talc and inflammatory reaction on the pleural surface artistically.

Chest 120: Etched in stone

1 May
Chest 120 Stone

Chest 120; Etched in Stone

The Chest X-ray in this picture was from a man, an ex-smoker, who was losing weight, with a cough and localised wheeze in his chest. An area of density in the lung on the X-ray was obscured by blood vessels and it was determined as normal. Because the test was described as normal, clinical signs and symptoms were disregarded, no further tests were done, and the man presented months later with a large inoperable cancer. A court case followed.
A radiological diagnosis is not etched in stone. Over a long career I have been involved with many cases of physical child abuse, and for many of these been called as an expert witness in a trial of the accused abuser. It was during these trials where I discovered that medical evidence and legal evidence are two entirely different things.
Medical evidence is often fuzzy relying on statistical likelihood of a diagnosis based on imperfect criteria – sounds heard through a stethoscope, lumps palpated with the hand for example. The art of medicine is about management of uncertainty. Legal requirements on the other hand are for precisely defined points. Lawyers, and many doctors, treat a radiological image as hard, clearly defined evidence; the experience of my career tells me it is anything but!
Paradoxically, as imaging becomes more sophisticated and sensitive the importance of clinical judgement in deciding both when to order a test and to assess the clinical relevance of an abnormal finding on that test becomes more important. Real but incidental sub-clinical anatomical disorders such as normal developmental variants and degenerative changes that are not symptomatic are frequently detected. These types of changes are present in a large proportion of people with no symptoms. It is therefore important to know that a test should not be ordered unless it is likely to influence or change the treatment of a patient (although there are a few exceptions even to that rule).
Many types of errors creep into diagnosis, and it can sometimes be difficult to trust one’s own judgement. This phenomenon has been extensively studied, but the following example will serve to illustrate just one type of error in which the context determines interpretation. In the top line most people read A B C. However, exactly the same letter B when inserted into another context now reads as 13. In this type of framework the image itself can be treacherous.


Adapted from: Kahneman D. Thinking, Fast and Slow. Farrar Straus & Giroux, 201

The Belgian surrealist painter, whom I greatly admire, René Magritte’s painting of a pipe “Ceci n’est pas une pipe” whose correct name is “The treachery of images” has fascinated me since I began studying radiology. It is about the relationship of an object and a representation of that object.

The word is not the thing; the map is not the territory (Alfred Korzybski). And so, the X-ray is not the patient. It is a well-known, but poorly understood , medical aphorism; “Treat the patient, not the X-ray”. And so it should be.


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