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September 24 , 2007

The X-Ray Project — Diagnostic Scan Exhibit Documents the Human Toll of Terrorism
By Beth W. Orenstein
Radiology Today
Vol. 8 No. 19 P. 18

Physicians use x-rays and CT scans to diagnose and treat patients. But Boston-area artist Diane Covert is using x-rays and CT scans to show the terrible pain and suffering that terrorists cause worldwide—and to say it must stop.

Covert, who describes herself as a documentary photographer, has taken 70 diagnostic images from two of the largest hospitals in Jerusalem and turned them into the moving exhibit “Inside Terrorism: The X-RAY Project.”

The exhibit, which receives positive reviews wherever it goes, has been touring the country since opening in October 2006 at Harvard Medical School in Boston.

Several x-rays on display show shrapnel—hex nuts, bolts, nails, metal—lodged in various parts of victims’ bodies: legs, arms, necks. Other images show the damaged feet of a child aged 8 to 10, a head injury to a child aged 4, and the nail in the chest wall of an anonymous victim. Some are single images while some are series.

Covert has done little to alter the images other than enlarge them and print them on Duratrans film, which is used mainly for background material in studios or film sets. “Duratrans is very similar to x-ray, but it has a milky background, so it doesn’t have to be backlit the way an x-ray does,” Covert says.

Nevertheless, the images she selected are mounted on four-sided kiosks made of hollow aluminum tubing; the 4- X 4-foot kiosks have lights inside them that illuminate the images.

Plenty of Material
Covert had hundreds of images from which to choose. When she requested them from the hospitals in Israel, they sent her disks full of them. No patients whose images were used in the project were identified by name.

A Boston radiologist, Rebecca Schwartz, MD, helped Covert understand what she was looking at. “I spent about three hours with her going through every single one,” Covert recalls.

Covert took notes on pieces of sticky paper during their conversation and then attached the notes to the images. She used the information she had gathered to write artistic captions to accompany the images she selected for the exhibit.

Covert’s poignant captions are what she believes the unintended victims may have been thinking at the time they were injured. For example, one image of a watch embedded in a woman’s neck titled, “I Was Riding the Bus,” reads: “I was in college then, riding the bus to campus. When he exploded, his watch blasted into my neck. Some of the shrapnel tore through my carotid artery, which carries blood to my brain.”

Covert says she chose black and white x-rays and CT scans—some are subtraction images—rather than news film of the victims of terrorist bombings for two reasons. One is that x-rays and CT scans would be the perfect metaphor for her purpose, which is to look inside terrorism and see what happens to innocent bystanders when terrorists blow themselves up on a bus or in a crowded marketplace. The other is that she thought stills of people on the street after a bombing would have been too graphic. “News footage would have been easy to acquire,” she says, “but most people don’t have the stomach for it. They can’t look at soft tissue or blood.”

When she decided to create something about terrorism, Covert says she eventually realized that “the best way to document what was going on had already been done in the hospitals by doctors and nurses and x-ray technicians.”

Covert became determined to do something about terrorism when she was running errands a few years ago and heard a report on National Public Radio about the first female suicide bomber. The report focused on the gender of the bomber and failed to mention her victims. Covert remembers feeling outraged that “they didn’t tell me about the people she injured.”

She started the project on her own because she wasn’t sure whether it would work. “I wasn’t even sure this was going to go anywhere. It could, potentially, have gone nowhere and just been an idea that failed,” she says.

Later, she was able to secure grants from The David Project Center for Jewish Leadership, a Boston-based non-profit organization which has as its mission to promote a fair and honest understanding of the Arab-Israeli conflict.

Emergency Department Images
Covert says it occurred to her that “modern medicine draws not with the visible light spectrum that we use in photography but with electromagnetic radiation of x-rays and CT scans and with this, we can see inside the human body.”

Through acquaintances, Covert contacted the emergency departments (EDs) at Shaare Zedek Medical Center and Hadassah Medical Center in Jerusalem, where the physicians were more than willing to help her. She requested the images of those who had been treated because they were victims of terrorist attacks. She did not want images of soldiers. “I was very interested in ordinary people living their lives who get caught up in this, and that is what this show is about,” she says.

The project would have been completed sooner, but one of the doctors who was helping her, David Applebaum, MD, head of the ED at Shaare Zedek, was killed by a terrorist along with his daughter, Naava, aged 20, on the eve of her wedding. They were having a father-daughter chat in a café in Jerusalem when a terrorist walked in and exploded himself.

Ironically, Covert says, Applebaum had been known for helping victims of terrorism and was often the first physician on the scene of an attack.

Although the diagnostic images are from two hospitals in Jerusalem, the exhibit is not just about the Arab-Israeli conflict, Covert says. It is about terrorism in general, which sadly is on the rise around the world, she says.

Anonymous Victims
Covert purposely doesn’t identify the victims in the exhibit, suggesting that they could have come from Iraq, London, Madrid, Thailand, or even the United States. “When I started figuring out how to do this [in February 2002], the epicenter of terrorism was in Israel. So it wouldn’t have occurred to me to go anywhere else, but that’s no longer the case.”

Jerusalem is an international, multicultural city, she says. As a result, roughly one quarter of the exhibit’s subjects are Muslims. The rest are Christians and Jews. But what is ideal about the x-rays, Covert says, is that no one can tell the victims’ skin color.

The first image in the exhibit is also meant to be a metaphor. Covert has taken eight images—including of a skull, torso, arms, legs, hands, and feet—and created a full-body skeleton from them. Anatomically, she says, the person is not correct, but that’s her artistic license. The piece is titled, “I Was Eating Pizza.”

Surgery Photography
Covert, who has photographed former presidents Gerald Ford and Jimmy Carter, says she was comfortable working with x-rays and CT scans because her first job after art school was at a dental school in Kansas City working as a photographer. “I did all their photography needs,” she says. “I wasn’t an x-ray technician, but I saw a lot of that material, and I photographed surgeries and things that you would not be allowed to do today.”

She is not, she says, the first artist to use existing objects to create art. While the practice goes back to ancient times, “it gained prominence in the early part of the 20th century when artists began to piece together common objects that didn’t belong together, examining new meanings from the new combinations,” she says. For example, she says, “Marcel DuChamp famously mounted a bicycle wheel onto a footstool, rendering them both useless. These were thought pieces, verbal and visual jokes.”

Covert says she is also following in a long tradition of artists who comment on the brutality of war. “[Francisco de] Goya’s portfolio, ‘The Disasters of War,’ is perhaps the most graphic, but there are examples from the ancient Greeks through [Pablo] Picasso’s ‘Guernica’ and beyond,” Covert says in her introduction to the exhibit.

War on Film
“Almost as soon as it became technically possible, the studio of the photographer Mathew Brady made a record of the Civil War, including hundreds of images of soldiers in battle and in death. This tradition has continued throughout every conflict to the present day,” she writes.

Covert says photography is a way of making an image by drawing with the very light that the objects reflect. “So when we look at photographs from the Civil War battlefield of Antietam, we see something very close to the horror of the scenes as they appeared to the photographer. We see records of actual events.”

Her project is similar, she says, only it looks at the inside of real events.

Covert often speaks before the exhibit opens and has a PowerPoint presentation on her work as well. Most showings have been at colleges and medical schools. Remaining tour stops are at Stanford University (October 28 to November 2) and San Jose State University (November 11 to 16).

She also created a Web site, www.x-rayproject.org, where she has posted 30 of the images and comments from people who have seen the X-RAY Project.

The comment from Jonathan Rhodes, MD, is typical: “This exhibit effectively conveys the horrors of terrorism. It is a ‘must-see’ for health workers, as well as lay people. It might even move those who, in the past, have been reluctant to condemn terrorist attacks…”

— Beth W. Orenstein is a freelance medical writer and regular contributor to Radiology Today. She writes from her home in Northampton, Pa.