Chest 121 A: Talc
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.
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.
Grim Reaper series 3; Carnevale
In this image I wanted to explore the link between the Latin carne = meat and vale = farewell as carnevale or carnival. It means letting go of the flesh, your former self. This etymology is, disputed, however I like it. There are a lot of psychological theories about the institution of carnival, its value to produce an effect by focussing attention on conflict through senseless acts. Challenging the powerful through the medium of sex, gluttony and defaecation. Carnival may be fun, but whatever the psychology behind it has a deeply creepy side, hence the whole “Carnival of Death” genre which features masks, clowns, skeletons, aberrant behaviour, and bright abandonment of colour and harmony. Some carnival celebrations involve throwing around large quantities of talc powder.
The index chest X-ray is one from a male patient who suffered with a chronic pneumothorax for years. In order to seal the air leak, and to make the lung re-expand, surgeons performed a pleurodesis, in which a chemical irritant (in this case talcum powder) is introduced into the pleura. The resulting inflammation causes the pleural surfaces to stick together. The talc, and the resulting calcification, are clearly visible on a chest X-ray.
The layers in this image are made up entirely of colour (a reflection in the paint of a blue motorcar, the undulating red and yellow marks of a paving stone, and my own spray painted patches) superimposed on the skull bones and X-ray.
Chest 102; Cetoscarus
I have been tiring of the dark, sometimes sinister images that have been emerging from my stable. This picture was part of a determination to make something more cheerful and in keeping with the spirit of the season.
For my base image, from which the shapes were taken, I used a photo taken at Dale Chihuly’s glass art exhibition in Boston. Those shapes were blended with sunlight reflected onto a screen from a glassy surface which produced interesting shapes. The two sets of shapes interact to produce a conflicting pattern, stable, yet ever changing like waving underwater seaweed. In the centre a fishy shape can be seen blending into the background. I have named the image for the parrotfish Cetoscarus which is mostly blue with pink markings – my fish is pink with blue markings – it’s chimes with the Australian habit of nicknaming redheads “Bluey”. Interestingly parrotfish species start life as females and mature in a more colourful phase to become male.
The Chest X-ray is much fragmented and adds to the network of lines already present in the image. It comes from a person with barotrauma during a diving accident. As the diver ascended from a depth more rapidly than he should, the change in pressure inside the lungs caused the little alveoli to expand till they burst like tiny balloons. This lead to a pneumothorax (air in the chest cavity compressing the lung) and embolism of air into the heart and blood vessels.
One of the problems with accessing teaching file X-rays for this series of pictures is that the outcome of the case is seldom available because interpretation of the image is considered most important part of the teaching. It would be nice to know whether this patient survived and what treatment was given.
Since we’re so close to the festive season I wish my blogging friends Very Merry Christmas or, as they say in the U S of A, “Happy Holidays!”
Chest 52; Advance
This picture contains in the background the X-ray of a tiny baby with a pneumothorax. In the foreground, part of the image is renewed. The picture conveys a sense of Australia’s red centre and a perception of movement towards coastal plains. Between the layers comes a symbol of love in the form of a monumental wheel. The air in the thorax was recognised as a threat to the child’s well-being, easily drained, with a full recovery. It illustrates Martin Luther King’s words: “Darkness cannot drive out darkness; only light can do that”, his words continue: “Hate cannot drive out hate; only love can do that”, and so the voyage of the white man and the aboriginal together and their interdependence in outback Australia. It looks back to hateful political policies of the past now broken on the wheel of time, and forward as we move from darkness into enlightenment, from mutual ignorance to comprehension. I see this as an intensely optimistic Australian image.