IN THE CIRCUIT COURT FOR PINELLAS COUNTY, FLORIDA
CASE NO. 90-2908-GD-003

----------------------------------------X
:
IN RE: THE GUARDIANSHIP OF :
THERESA MARIE SCHIAVO, :
:
Incapacitated, :
:
MICHAEL SCHIAVO, as guardian of the :
person of THERESA M. SCHIAVO, :
:
vs :
:
ROBERT SCHINDLER & MARY SCHINDLER, :
:
Respondents. :
----------------------------------------X

BEFORE: THE HONORABLE GEORGE W. GREER
Circuit Court Judge

PLACE: PINELLAS COUNTY COURTHOUSE
315 Court Street
Clearwater, Florida

DATE: October 15th, 16th, 17th,
20th & 22nd, 2002

TIME: All Day

REPORTED BY: CHARLENE M. KOCH, RPR
Deputy Official Court Reporter
Sixth Judicial Circuit
Notary Public, State of Florida

__________________________________________________
HEARING TRANSCRIPT
__________________________________________________

Pages



ROBERT A. DEMPSTER & ASSOCIATES
OFFICIAL COURT REPORTERS
P.O. BOX 35
CLEARWATER, FLORIDA 34617-0035
(727) 443-0992






A P P E A R A N C E S


PATRICIA FIELDS ANDERSON, ESQUIRE
447 Third Avenue North
Suite 405
St. Petersburg, Florida 33701

Attorney for Mr. and Mrs. Schindler



GEORGE J. FELOS, ESQUIRE
FELOS & FELOS, P.A.
595 Main Street
Dunedin, Florida 34698

Attorney for Mr. Schiavo


































3



1 OCTOBER 15TH, 2002

2 P-R-O-C-E-E-D-I-N-G-S

3 THE COURT: Thank you. All right. Are

4 we ready to go with Dr. Maxfield?

5 MS. ANDERSON: Yes, Your Honor.

6 THE COURT: You may proceed.

7 THEREUPON,

8 WILLIAM STREETER MAXFIELD, M.D.

9 WAS ADDUCED AS THE WITNESS HEREIN WAS EXAMINED

10 AND TESTIFIED AS FOLLOWS:

11 DIRECT EXAMINATION

12 BY MS. ANDERSON:

13 Q. Dr. Maxfield, would you state your name

14 for the record and spell your last name for the

15 court reporter.

16 A. My name is William Streeter,

17 S-T-R-E-E-T-E-R, Maxfield, M-A-X-F-I-E-L-D, M.D.

18 Q. Can you describe your education to the

19 Court, please?

20 A. I graduated from SMU and that's

21 Southern Methodist University in Dallas, Texas

22 with a degree in psychology. I attended Baylor

23 University College of Medicine in Houston, Texas.

24 I graduated in 1954 with an M.D. degree.

25 My internship was a general rotating




4



1 internship at Southern Pacific General Hospital

2 in San Francisco, California. At the end of my

3 internship I asked to go on active duty with the

4 Navy, but that was the tail end of the Korean War

5 and they weren't taking people at that time.

6 So I returned to Dallas, Texas where my

7 brothers and my fathers operated the Maxfield

8 Clinic Hospital. I spent a year as a preceptor

9 in radiology and radiation therapy.

10 Q. What is a preceptor?

11 A. I'm sorry?

12 Q. What is a preceptor?

13 A. Just working in the field because they

14 did not have recognition as a formal -- formal

15 residency program that worked with them in the

16 field. They were on the cutting edge of radiation

17 therapy at that time as they installed it under

18 the third cobalt unit in the country.

19 They also had one of the very active

20 nuclear medicine laboratories in the country at

21 that time. So I worked with them for a little

22 over a year until August of 1956 when the Navy

23 called me to active duty.

24 And because of my experience in

25 radiology, in particularly in nuclear medicine, I




5



1 was assigned to Chelsea Naval Hospital in

2 Chelsea, Massachusetts to establish the nuclear

3 medicine program there.

4 Q. Now, was this at a time in the

5 development of medical technology that radiology

6 was relatively new?

7 A. The field of nuclear medicine was

8 relatively new. The field of radiology has been

9 around for a long time since Roentgen discovered

10 the x-ray in 1987. My father had his first x-ray

11 machine in 1903, so . . .

12 Q. I think you said 1987, but did you mean

13 1887?

14 A. Yes, that's correct.

15 Q. I didn't realize it had been around

16 that long.

17 A. Radiology had been in my family for

18 quite a long period of time. In fact, I've

19 worked as a nuclear medicine technologist for my

20 brothers during the time that I was in medical

21 school. And part of the time that I was in SMU,

22 having taken the course in Procreation Tendency

23 on Nuclear Medicine Procedures in 1948.

24 Q. So you went to the Chelsea Naval

25 Hospital in Chelsea, Mass to help set up their




6



1 nuclear medicine program?

2 A. That's correct, the nuclear medicine

3 section of the Department of Radiology. And I

4 was there until March of 1957 when I was

5 transferred to the Bethesda Naval Hospital in

6 Bethesda, Maryland.

7 In there I was initially cochairman of

8 the nuclear medicine department and then

9 eventually chairman of -- or chief of the nuclear

10 medicine section of the Department of Radiology.

11 Q. How long were you at the Bethesda Naval

12 Hospital?

13 A. I was at the Bethesda Naval Hospital

14 until July of 1959.

15 Q. Then where did you go?

16 A. At that time I returned -- I went to

17 Johns Hopkins Hospital in Baltimore, Maryland to

18 complete my radiology residency. The American

19 Board of Radiology reviewed my experience in the

20 Navy and for my three years of active duty in the

21 Navy they gave me the equivalence of 18 months of

22 radiology residency training program.

23 Q. Overall, how many months of residency

24 do you have in radiology?

25 A. I had actually 42 months.




7



1 Q. Is that an unusually long amount of

2 time?

3 A. At that time, the requirement was 36

4 months of radiology residency training program.

5 Q. Okay.

6 A. In the Navy I had the opportunity of

7 teaching nuclear medicine to physicians and

8 nurses and I also had the opportunity to work

9 with the first commercial brain scanner which was

10 incidentally a PET brain scanner.

11 Q. What is that?

12 A. That's a positron emission tomography

13 scanning.

14 Q. When did you do that?

15 A. That was in -- when I went to Bethesda

16 in 1957. They had just installed the first

17 commercial brain scan. So I was in the Navy and

18 I did approximately a thousand PET brain scans.

19 Q. Okay. And so how long were you at

20 Johns Hopkins in the radiology residency?

21 A. I was in the radiology residency for

22 two years. The second year I was an NIH fellow

23 in cancer at Johns Hopkins.

24 Q. Is that a singular distinction?

25 A. Yes.




8



1 Q. And I understand that is the National

2 Institute of Health?

3 A. That's correct.

4 Q. After you finished the second year of

5 your residency at Johns Hopkins, what did you do?

6 A. I joined the staff of the radiology

7 department at Johns Hopkins in the section of

8 radiation therapy initially as an instructor in

9 radiology. And then I became acting chief of

10 radiology in the radiation therapy section in the

11 Department of Radiation.

12 Q. Now, was that a joint faculty

13 appointment and then clinical staff appointment

14 in the hospital department?

15 A. That's correct, because we were

16 involved in teaching medical students and also

17 interns and residents, not only the radiology

18 residents, but also residents in the other fields

19 about the use of radiation therapy and radiation

20 effects and things of this type.

21 Q. How long did you stay at Johns Hopkins

22 as an employee, as a professor and administrator

23 of the department?

24 A. I stayed there until February of 1964

25 and after I passed my American College of




9



1 Radiology Boards. In December of 1961 I was

2 appointed as chief of radiation therapy on a

3 permanent basis and was made assistant professor

4 of radiology at Johns Hopkins.

5 Q. So you got a raise and you got a

6 promotion?

7 A. Correct.

8 Q. Okay. How long did you stay as

9 assistant professor at Johns Hopkins?

10 A. Until February of 1964 when I moved to

11 New Orleans, Louisiana, to become a chief of

12 radiation therapy at the Ochsner Clinic in

13 Ochsner Foundation Hospital and also cochairman

14 of their nuclear medicine program.

15 Q. How long did you stay at Ochsner?

16 A. I was at Ochsner for four years.

17 During that period of time I was also appointed

18 as a clinical professor of radiology at the

19 Tulane University School of Medicine.

20 Q. So you did both -- you worked at the

21 Ochsner Foundation Clinic Hospital and also held

22 an academic appointment at Tulane?

23 A. That's correct.

24 Q. And your academic appointment, was that

25 as an associate professor?




10



1 A. No, as a full professor.

2 Q. As a full professor?

3 A. Yes.

4 Q. So were you ever an associate proffer?

5 A. No, just--

6 Q. You skipped over that?

7 A. Kind of missed that, yes.

8 Q. And you were at Ochsner until '68.

9 A. That's correct. In 1968 I returned to

10 academic medicine and became the professor and

11 chairman of the Department of Radiology at LSU

12 Medical School in New Orleans. And because of

13 the medical conflict at that time I had to drop

14 my clinical appointment at Tulane.

15 Q. Right.

16 A. You couldn't hold both, unfortunately.

17 And I stayed at LSU Medical School until 1972.

18 At that time I elected to return to private

19 practice and moved to the Tampa Bay area where I

20 have practiced radiation therapy and diagnostic

21 radiology and nuclear medicine, hyperbaric

22 medicine and general and preventative medicine.

23 Q. When did you first become involved with

24 hyperbaric medicine?

25 A. That actually goes back to the time




11



1 that I was on active duty with the Navy because I

2 was part of the plutonium decontamination team of

3 the Navy which was responsible for any nuclear

4 accidents. And at that time we were activating

5 our first nuclear sub.

6 And, in fact, we taught at Bethesda the

7 radiation safety and other factors to the foreman

8 and to the physician that went on at Nautilus

9 which was our first nuclear sub.

10 And understanding that we had to go and

11 get somebody off the sub we were exposed to the

12 decompression chambers and problems in the bends

13 and things like that.

14 Q. So you actually have been interested in

15 the study of hyperbaric principles since the

16 early 50s?

17 A. Well, that was actually in the late --

18 Q. Late 40s?

19 A. Late 50s.

20 Q. Late 50s?

21 A. Yes.

22 Q. Okay.

23 A. Then when I was at Ochsner we designed

24 our new radiation therapy program. At that time

25 there was significant work coming out of England




12



1 showing that hyperbaric oxygen was an adjunct for

2 radiation therapy.

3 So as a design at our new facility we

4 provided for two hyperbaric -- two monoplace

5 hyperbaric chambers to be used in conjunction

6 with radiation therapy.

7 Q. Now, by monoplace that simply means

8 that one person gets into the chamber, correct?

9 A. That's correct.

10 Q. Would you explain briefly to the Court

11 what a hyperbaric chamber is?

12 A. A hyperbaric chamber is a chamber that

13 can increase pressure. So that in a hyperbaric

14 chamber you provide the patient oxygen and with

15 the increased pressure you push oxygen into the

16 fluids of the body and you can increase

17 oxygenation by as much as 1200 percent depending

18 on the pressures that you use.

19 The technique has been used for over

20 100 years. When it was first used it was using

21 just air, compressed air, to try to treat

22 infection because at that time we had no

23 antibiotics and it was somewhat successful, but

24 it's taken us 100 years to really understand what

25 hyperbaric does, to recognize the benefits of




13



1 hyperbaric oxygen therapy.

2 Q. Since you've been in the Tampa Bay area

3 what types of work have you done?

4 A. When I initially came to Tampa Bay I

5 practiced radiation therapy at the University

6 Community Hospital and then established my

7 freestanding radiation therapy facility just

8 south of the radiation therapy facility in Tampa.

9 And I also worked at that period of

10 time in nuclear medicine, using nuclear medicine

11 as a screening in a procedure to look at the

12 major organs of the body through a laboratory

13 that we had in Bradenton, Florida.

14 Then I had an episode of barium

15 pneumonia in '74 from the steroids that I got for

16 the barium pneumonia I ended up with a septic

17 process of the hips and had to get off my feet

18 for a period of time.

19 So I went back to doing diagnostic

20 radiology at that period of time. And then I

21 came back to radiation therapy after I had core

22 decompression of my knees and also my hips, which

23 gave me temporary relief from the aseptic

24 necrosis that I had developed in the hips and

25 knees.




14



1 Eventually I had to get hip

2 replacements and the first went on the left and

3 then on the right. And then recently have had

4 to -- two years ago I had to have my left

5 re-replaced.

6 Q. Incidentally, did you have any

7 hyperbaric therapy in conjunction with that

8 sepsis?

9 A. Not with the sepsis, but with the--

10 Q. With the necrosis, I'm sorry?

11 A. With the radiation therapy, yes, for

12 the problems that I had because I used hyperbaric

13 before my re-replacement of my hip. And I was

14 fortunate that I did because I had set aside that

15 three units of blood for the operative procedure

16 and through a clerical error two of my units were

17 thrown out.

18 So when I came into the hospital for an

19 operation I only had one unit of blood for the

20 hip replacement. And because my blood count was

21 quite good at that time they elected to go with

22 the operative procedure so it was carried out

23 without problem.

24 Q. Because of the effects of the

25 hyperbaric, you mean?




15



1 A. Even though I had donated three units

2 of blood, I still had a completely normal blood

3 count.

4 Q. I see.

5 A. And I attribute this to the hyperbaric.

6 Q. Okay.

7 A. And then through the use of hyperbaric

8 after my surgery the physical therapy people at

9 the Johns Hopkins where I had these surgeries

10 done, actually Good Samaritan Hospital which is a

11 branch of Johns Hopkins where they do their

12 reconstructive surgery, were setting me up for

13 six weeks of physical therapy after I went back

14 home. I ran to the hospital and told them I

15 didn't need that and I was back to work in a

16 week.

17 Q. In a week did you say?

18 A. Correct.

19 Q. One week?

20 A. One week after the surgical procedure.

21 Q. Are you presently working?

22 A. Yes.

23 Q. Have you worked continuously since you

24 moved to the Tampa Bay area?

25 A. Except for the period of time when I




16



1 had to be out for the surgical procedures.

2 Q. Right.

3 A. Plus a couple of episodes of pneumonia.

4 Q. And you're presently practicing today?

5 A. Correct.

6 Q. In radiology?

7 A. In radiology. Actually I work at two

8 facilities. Predominantly one of them is Manatee

9 Diagnostic Center in Bradenton, Florida, which is

10 a freestanding imaging procedure that has MRIs,

11 CT, ultrasound, mammography and general

12 radiology.

13 Then I also am the chief of radiology

14 and the national medical director for CAT Scan

15 2000, which is based in Clearwater which is a

16 mobile CT screening unit. At the current time we

17 are operating in, I believe, it's 10 states.

18 Q. I'm sorry, you're doing what?

19 A. This is the mobile CT screening--

20 Q. Oh, I see.

21 A. -- where we do coronary artery --

22 Q. I see.

23 A. -- looking for systems of myocardial

24 disease. We also do the CT of the lung looking

25 predominantly for early cancer, but we've also




17



1 found that it's very effective when you have a

2 smoker and you can show them holes in their

3 lungs. This is a good incentive to get off the

4 cigarettes.

5 And then we also do the CTs of the

6 abdomen and pelvis. And we found quite a number

7 of very small kidney cancers, two centimeters,

8 two-and-a-half centimeters, that could be cured.

9 So my concept in what we're doing is

10 we're converting future cancer victims to cancer

11 victors in finding the early cancer. This,

12 again, goes back to my more than 30 years of

13 experience as a radiation therapist.

14 And it's, in my opinion, no question if

15 you find the cancer early and you can cure it.

16 It's much more cost effective to do it that way

17 than it is to treat metastatic disease.

18 Q. Dr. Maxfield, are you board certified

19 in any areas of medicine?

20 A. I'm board certified by the American

21 Board of Radiology and, as I mentioned, I took

22 the nuclear medicine medallion because there was

23 no American Board of Nuclear Medicine.

24 In the early 70s the American Board of

25 Nuclear Medicine was established and they




18



1 reviewed my credentials and based on my

2 experience and training I was given the option to

3 take that board, which I did in 1973. Then I was

4 a cofounder of the American Board of Hyperbaric

5 Medicine.

6 Q. Are you certified by that board?

7 A. Yes.

8 Q. Okay. Are you licensed to practice

9 medicine anywhere?

10 A. Yes, I am. In Florida. My original

11 medical license was in Texas. And I'm currently

12 licensed in Georgia, Kentucky, Tennessee,

13 Arizona, New Mexico, Kansas and Nebraska. And

14 the need for those licenses because these are the

15 areas where our mobile CT units are currently

16 working or will be working.

17 Q. So those are all current licenses?

18 A. Those are all current licenses, yes.

19 Q. I see.

20 A. I have a California license which is

21 inactive because I did not renew it. And also I

22 had a license in Maryland which was active when I

23 was at the Johns Hopkins. I did not renew that.

24 Also I did not renew my Louisiana or Mississippi

25 licenses either.




19



1 Q. Can you tell the Court what a CT scan

2 is? First, what does CT stand for?

3 A. The term CT stands for computed

4 tomography and it's a technique that has

5 developed -- actually it's a spinoff of our space

6 program because of the computer technology that

7 permitted us to reconstruct images.

8 And what the CT is, is it takes a very

9 fine beam of radiation and goes through a section

10 of the body and on the other side we have an

11 array of detectors and these detectors pick up

12 the radiation that has come through the body.

13 And then with the computer program we

14 can actually reconstruct a slice of the different

15 areas of the body. This technology came into

16 clinical use in the early 1970s. I think in '72

17 was when it was first presented at RSNA Society

18 of Nuclear Medicine -- I mean, in Chicago.

19 And at that time the technology could

20 be used only for the brain. And through the

21 years we have expanded it so that we have the

22 technology to look at all of the different areas

23 of the body. With the newer techniques we very

24 shortly will be able to take a virtual tour down

25 the coronary arteries.




20



1 Q. Okay. And is a CT scan the same as a

2 CAT scan?

3 A. That's another way of saying it.

4 Q. And --

5 A. CT is -- when you say CAT scan you're

6 saying computed axial tomography, which is

7 another synonym for computed tomography.

8 Q. Now, Dr. Maxfield, does a CT scan

9 entail any invasive procedures of the body?

10 A. It can and it cannot. The standard CT

11 can be done without contrast administration, if

12 you're looking for concern areas, you want to see

13 if it enhances or not. For instance, if we found

14 a lung nodule on our non-contrast CT, then the

15 next step is usually to do a CT with contrast and

16 see if this area enhances.

17 Q. What does that mean, with contrast?

18 A. That's done with iodinated contrast

19 material which is opaque to the radiation energy.

20 Q. It's not radioactive, is it?

21 A. No, it's not radioactive. It's an

22 iodinated compound and this permits us then to

23 see blood vessels more clearly because they have

24 a denser pattern on the CT.

25 Q. And how does CT scans differ from MRIs?




21



1 A. The MRIs is a completely different

2 technology. It doesn't use radiation. It uses a

3 very strong magnet and you shift the magnetic

4 field. And in the process of doing this, you

5 cause different elements in the body to give off

6 a very specific radiation which is then picked

7 up. This is, therefore, a completely different

8 technology.

9 Q. Okay.

10 A. And has the advantage that it can more

11 clearly delineate certain areas of the body and

12 can make a better differentiation between

13 different tissues in the body. And going now to

14 the technology of doing what we call spectroscopy

15 with the MRIs so that we can actually look at the

16 chemicals in the different areas of the body and

17 then measure how much edema there is, how much

18 swelling there is, how much iron there is, how

19 much chlorine or lactate and some of the other

20 chemicals.

21 Q. Can you estimate for the Court over the

22 course of the years how many brain scans have you

23 read?

24 A. I would have to break that down into

25 two categories. For the nuclear medicine brain




22



1 scans I would say probably in the range of

2 20,000. And for CT scans of the brain, I would

3 say that that's in the thousands also.

4 Q. What's a -- what information does a CT

5 scan yield?

6 A. The CT scan without contrast provides

7 predominantly anatomical information about the

8 area that you're scanning. As I said, it has the

9 ability to make a transsectional image through

10 the body at that level and you can differentiate

11 between air and bone and different levels of soft

12 tissue, and also different areas of fluid

13 accumulation in the CT process.

14 You have the ability to go in and

15 measure areas very accurately with essentially

16 calipers that you could superimpose on the CT

17 scan. And then there's also the technology that

18 you can go in and look at the actual density of

19 the tissues that you're looking at.

20 Q. How could you tell that?

21 A. That's by measuring what we call the

22 Hounsfield units, which is named for the

23 individual who initially developed the CT scan.

24 Q. How do you spell that?

25 A. H-O-U-N-S-F-I-E-L-D. Hounsfield.




23



1 Q. Okay.

2 A. This gives us the ability, then, to

3 look at different areas. For instance, if you're

4 looking at the kidney and you see an area and

5 you're not sure whether it's a cyst or not, then

6 you can get the measurements and if it's less

7 than 20 Hounsfield units the odds are it's a

8 cyst. If it's more than 20 the odds are it's a

9 solid mass.

10 Q. And with regard to the brain, a CT scan

11 would be a structural analysis of the brain?

12 A. Without contrast then that gives a

13 structural analysis of what is there.

14 Q. Okay.

15 A. With contrast then you can see the

16 areas of vascularity and you can see if something

17 increases in density, enhances, as we would say,

18 after the contrast administration, but the

19 contrast administration does have certain

20 potential side effects. That it is somewhat

21 toxic to the brain and even in normal

22 individuals, we have people that die after

23 contrast administration.

24 And even with our newer what we call

25 nonionic contrast media that when this first came




24



1 out we had opened that we would decrease the

2 mortality and severe morbidity over our older

3 chemical formula that was for the ion was

4 a ionized form, but more experience has shown

5 that we have decreased the small reactions with

6 the non-ionic, but we still have severe reactions

7 and occasional death.

8 Q. In addition to the structural studies

9 of the brain, are there any studies that show

10 actual brain function?

11 A. There is work that's being done now

12 with the MRI to look at the spectroscopy of the

13 brain so that you can tell what chemicals and

14 things are in the brain area, but this is still

15 in the research category.

16 At the present time, the most accurate

17 way of looking at brain function on a practical

18 level, in my experience, is the SPECT brain scan.

19 Q. Now, is that technology similar to the

20 PET scan?

21 A. The PET scan is similar, but it uses a

22 different type of radioactive material. The PET

23 scan means a positron emission tomography and to

24 do a PET scan you're using a radioactive material

25 that emits a positron which is a small atomic




25



1 particle.

2 And when this travels a few

3 micromillimeters it then disintegrates and in the

4 process of disintegrating, it gives off two

5 electromagnetic radiation to come out at 180

6 degrees from each other.

7 So that your PET scan uses technology

8 that looks for radiation so that it hits the

9 detectors that you have on each side of the body

10 at exactly the same incidents. And if you have

11 that, then this is a positron emission, a

12 coincidence pattern and, therefore, you use these

13 simultaneous hits at 180 degrees from the source

14 of origin to map the area.

15 With a SPECT scan you're using usually

16 a Technetium tagged radioactive material which

17 gives only a single set of photons that come out

18 usually at about 140 KV. So you're looking and

19 just measuring the localization of these

20 radioactive materials.

21 Q. What do you mean by localization?

22 A. That means that the radioactive

23 material is staying in one spot or it is in one

24 spot.

25 Q. How does it get there on the SPECT




26



1 scan?

2 A. For both PET scans and for SPECT scans

3 you actually administer the radioactive material

4 intravenously. Then you take and give a period

5 of time for the material to accumulate or

6 localize in the area of interest and then you do

7 your scanning procedure.

8 Q. So it's carried by the blood into the

9 brain?

10 A. It's carried by the blood into the

11 brain for both SPECT scans and PET scans.

12 Q. Does the radiological tracer enter the

13 brain tissue?

14 A. Yes, it does. It has to have adequate

15 blood supply to get to the brain, but then once

16 it gets there, there's a localization process

17 that occurs for the tracer that we use for the

18 SPECT scanning.

19 Well, there are several tracers that we

20 use, and if the brain cell is functioning

21 normally, then there's an increased localization

22 of this radioactive tracer.

23 Q. So you can -- by measuring localization

24 of the tracer in both the PET and the SPECT scan

25 you'll be able to calculate the blood flow?




27



1 A. To -- not the way that both of them are

2 used we don't really see blood flow per se. If

3 you're interested in blood flow per se then you

4 have to do scanning at the time that you

5 administer the radioactive material so that

6 you're actually seeing the transit of the

7 radioactive material through the blood vessels.

8 And what you're seeing at the later

9 scans is really the accumulation of the

10 radioactive tracer in the area. So it's a

11 combination of having blood flow to the area plus

12 the ability of the tracer to locate in the

13 tissues that you're scanning.

14 Q. What are SPECT scans used for?

15 A. SPECT scans are used to evaluate the

16 pattern of function in the brain tissue and also

17 to monitor response to different forms of medical

18 therapy.

19 Q. Is it used in hyperbaric therapy?

20 A. Yes. There has been significant use of

21 this SPECT scan to follow the patients receiving

22 hyperbaric oxygen therapy initially getting a

23 scan before the hyperbaric oxygen and then

24 repeating it from time to time after the

25 hyperbaric oxygen therapy has been administered.




28



1 You might go back a little bit of

2 history and that is that the SPECT scan has been

3 available since the mid 70s and has been more

4 readily available because the technique and the

5 equipment for a SPECT scan is what has been used

6 in the cardiac stress testing so that the

7 technology has been and the equipment has been

8 more readily available.

9 The PET scan is a much more

10 sophisticated and more costly equipment.

11 Q. PET did you say?

12 A. PET, P-E-T.

13 Q. Okay.

14 A. And also the radio pharmaceutical for

15 it is more expensive than for the SPECT scan.

16 Q. And what is a PET scan used for?

17 A. The PET scan in research has been used

18 to clinically map the different areas of the

19 brain as to function, but in the process of doing

20 that you're using very short half-life materials

21 unlike radioactive oxygen and nitrogen in looking

22 at where things goes into the brain.

23 With the half-lives of a few seconds

24 you could put someone in front of a PET scan and

25 give them the radioactive oxygen and ask them to




29



1 blink their eyes and you'll see where it goes.

2 Then you can ask them to think about a math

3 problem and see where it goes.

4 So the PET scan has been the research

5 technique that has given us a large amount of

6 information about the actual functional areas of

7 the brain.

8 Q. Now --

9 A. Recently, the PET scan has come into

10 clinical utilization, but the predominant use of

11 it has been for oncology for staging cancer. And

12 this is why you have had a significant increase

13 in the availability of PET scanning over the past

14 eight to ten years because it's now becoming the

15 gold standard for evaluating a patient prior to a

16 surgical procedure.

17 For instance, in lung cancer they found

18 that even though you've done CAT scans and MRIs,

19 that if you add the PET scan that you can make --

20 you can determine that 40 percent of the patients

21 that seem to be eligible for operation on their

22 lung -- for their lung cancer, are actually at

23 metastatic disease that's not been detected by

24 the other techniques.

25 Q. So the PET scan, though, is useful in




30



1 cancer patients?

2 A. That's correct. The radioactive

3 material that we use for the PET scans

4 predominantly in clinical medicine today is

5 Fluorine-18, which has about an hour-and-a-half

6 half-life and it's tagged onto deoxyglucose that

7 we're essentially measuring glucose.

8 And the PET scan is also more sensitive

9 because if the patient is talking at the time

10 that you make the injection you'll get a

11 completely different pattern than if they're

12 completely quiet.

13 Q. Now, Dr. Maxfield, have you lectured

14 and published in the area of radiology?

15 A. I have articles in the field of

16 radiation predominantly in nuclear medicine. And

17 also some radiobiology research. I was the

18 coauthor of the first paper to show a synergism

19 between carcinogens and this was estrogen and

20 radiation. And this does fit into my interest in

21 radiobiology.

22 MS. ANDERSON: Excuse me, did you need

23 to take a break?

24 THE COURT: I neglected to swear this

25 witness in.


31



1 MS. ANDERSON: Yes, you did.

2 THE COURT: Sir, would you raise your

3 right hand for me, please.

4 (Thereupon, the witness was duly sworn on oath.)

5 THE WITNESS: I do.

6 THE COURT: Thank you, Mr. Bailiff.

7 MS. ANDERSON: Thank you.

8 THE WITNESS: I didn't mention this

9 because I wasn't sure whether this was a

10 continuation of the previous testimony that

11 I had given.

12 MS. ANDERSON: That's true because you

13 had testified once before to the Court in

14 the July 10th hearing, correct?

15 THE WITNESS: That is correct.

16 BY MS. ANDERSON:

17 Q. Okay. So you have published in

18 radiology. And what was it called, radiobiology?

19 A. Radiobiology is one of my areas of

20 interest. I am an author of two chapters on

21 Acute Radiation Syndrome and, as I mentioned, the

22 paper on the synergism between carcinogens and

23 production of breast cancer in the breast.

24 Q. You say that was the first paper that

25 showed that synergism?




32



1 A. This was the first paper to document

2 synergism production of cancer.

3 Q. And you've also lectured?

4 A. Yes.

5 Q. In different areas?

6 A. Yes. Even though I don't have a

7 clinical appointment in a medical school at the

8 present time, I still give lectures. Just this

9 last week I was in San Francisco at the

10 International Congress of Hyperbaric Medicine. I

11 presented a lecture on the SPECT brain scans in

12 the CP kids and also a scientific exhibit on the

13 use of hyperbaric oxygen therapy in cancer care.

14 Q. Now, did you have occasion to examine

15 Theresa Schiavo in this case?

16 A. Yes, I have.

17 Q. Before you examined her you had also

18 observed her, had you not, back in the spring?

19 A. I had observed her, correct. And prior

20 to that, I had reviewed a videotape and also some

21 medical records on it.

22 Q. Okay. That was last year?

23 A. That was last year, correct.

24 Q. Let's confine ourselves to your contact

25 with her this year.




33



1 How many separate days did you see her?

2 A. As I remember, I observed her on three

3 different days. And then I had another day when

4 I went in and examined her or watched her

5 actually perform certain functions which was

6 videotaped.

7 Q. Now, when you observed her and when you

8 examined her, were any family members present?

9 A. Yes, they were.

10 Q. Who were they?

11 A. Initially it was her mother and her

12 father and then when the videotape was made her

13 father was there and she talked -- her mother

14 talked to her on the telephone.

15 Q. Her mother spoke with her on the

16 telephone?

17 A. Correct.

18 Q. Did she have a visible reaction?

19 A. In my opinion, yes.

20 Q. Did she have a visible reaction to her

21 mother when you observed her in the spring time?

22 A. Yes.

23 Q. What did you observe?

24 A. That when her mother came into the room

25 and came up to her bedside that she turned




34



1 towards her and tried to make sounds like she was

2 trying to communicate with her.

3 Q. Did her facial expression change?

4 A. In my opinion, yes.

5 Q. How did Terri's facial expression

6 change?

7 A. You could say that she essentially

8 smiled.

9 Q. Was that a reflex; in your opinion?

10 A. No.

11 Q. Did her expression, her smiling

12 expression, if you will, last for more than a

13 second?

14 A. Yes, off and on during the time that

15 her mother was right beside her bedside and

16 talking to her. And she turned to that side and

17 stayed to that side as long as her mother was

18 there.

19 Q. Did you observe her reaction, if any,

20 to live piano music being played?

21 A. The first day that I observed Terri

22 there was a pianist that played some of her

23 favorite songs and she did react to these. And,

24 in my opinion, almost as if she was trying to

25 sing.




35



1 Q. Describe to the Court, since it was not

2 videotaped, what you observed.

3 A. Terri's bed was brought out, not her

4 bed, but her cart that she was on was brought out

5 into the hall and behind her was a piano with a

6 pianist that was playing. And when they started

7 playing she gave a very marked reaction to the

8 music and you could see that she was reacting to

9 it.

10 Q. Did her facial expression change?

11 A. Yes, and also she did more facial

12 movement.

13 Q. Did she move her head?

14 A. Not so much moving her head, but making

15 as if she was trying to make sounds.

16 Q. Is there any doubt in your mind that

17 she was reactive to the piano music?

18 A. None at all.

19 Q. And this was -- all of your

20 observations have been of Terri while she's at

21 Hospice, correct?

22 A. That's correct.

23 Q. Okay. Have you likewise had occasion

24 to view any brain scans of Terri?

25 A. Yes, I have.




36



1 Q. And have you drawn any -- well, first

2 of all, what scans have you looked at?

3 A. I have looked at the CT scan that was

4 done in 1996 and also the one that was done in

5 July of this year. And the SPECT brain scan that

6 was done, I believe, in August.

7 Q. I want you -- I have a blowup and I

8 want you, before the Court, now I want you to

9 tell me if these are the two CT scans that you

10 examined?

11 A. Yes. Those are blowups of the images

12 that I examined.

13 Q. Now, in addition to the blowups that

14 are on the easles here in the courtroom, were you

15 also provided with cell-by-cell blowups of the

16 two CT scans?

17 A. Yes, I have reviewed the ones of the

18 first ones, and the second set of scans I haven't

19 had a chance to directly compare.

20 Q. Okay.

21 A. The second set of blowups, I mean.

22 Q. Have you formed any opinions, within a

23 reasonable degree of medical certainty, about any

24 changes in these scans?

25 A. Yes, I have.




37



1 Q. Can you tell the Court what you have

2 concluded? And, if you would, Doctor, it would

3 be helpful for the purposes of the record if you

4 are referring to a specific cell that you

5 identify the date of the scan and the cell image

6 that you're looking at. Each one of these is

7 given a number.

8 A. I'll have to come up there. My vision

9 isn't quite that good.

10 MS. ANDERSON: Is it all right, Your

11 Honor, if the witness approaches these

12 exhibits?

13 THE COURT: Well, yes.

14 MS. ANDERSON: This microphone is on.

15 Okay.

16 BY MS. ANDERSON:

17 Q. Okay.

18 A. The exhibit that I'm standing in front

19 of is the images that were made in May of 1996.

20 And the images are numbered so that there's a

21 number one, two, three, and so forth on through

22 the images.

23 What these are are essentially slices

24 that are taken through the patient's head with

25 the CT technology. So these are serial ones.




38



1 You have what you would call your scanogram,

2 which is here, which shows the anatomical area

3 where each of these slices is taken.

4 Q. Is that first cell up there basically

5 like a table of contents to the total image?

6 A. That's correct. That is what we call

7 it as a scanogram. So that it can be used two

8 ways; one, it is just an x-ray of the area of the

9 body that you're looking at, and then

10 superimposed on that you can actually put the

11 little markers that show the exact anatomical

12 area where the image is being taken.

13 For instance, this first Image Number 1

14 is at the base of the brain and this is number

15 one and this is down through the base of the

16 brain, so--

17 THE COURT: Counselor, would you define

18 the word cell for me.

19 BY MS. ANDERSON:

20 Q. The CT scan consists of a number of

21 slices of the brain, correct? Scans of slices of

22 the brain? And then they appear in individual

23 numbered images on the CT scan, correct?

24 A. That is correct.

25 Q. And can we agree that we'll refer to




39



1 each separate image on the CT scan as a cell?

2 A. In more common--

3 Q. How do you want to refer to it?

4 A. The more common terminology is simply

5 to say image number.

6 Q. Okay.

7 A. When you say -- I think you're using

8 the -- I would interpret what you're saying is

9 cell, you're talking about the whole area?

10 Q. Yes.

11 A. Which includes also the writing as well

12 as the image itself.

13 THE COURT: So it's not like a single

14 cell in the body when we use that word?

15 MS. ANDERSON: No, it would be like a

16 frame.

17 THE COURT: That's why I was confused.

18 Frame or an image--

19 MS. ANDERSON: Right. Sorry.

20 THE COURT: -- and then you have

21 apparently 11 for this particular CT scan?

22 THE WITNESS: Actually there are more

23 than that because down in the bottom image

24 down here they combine several into one.

25 THE COURT: So that's three separate




40



1 ones?

2 THE WITNESS: Yes. Actually we've got

3 13 slices through the brain on this.

4 MR. FELOS: Your Honor, if the witness

5 is going to refer to the substance of these

6 exhibits, then they should be marked number

7 one for identification and they should be

8 introduced into evidence.

9 And, also, if we're not seeing the

10 complete CT scan, then I think it would be

11 appropriate to have the Respondents submit

12 into evidence the entire scan.

13 THE COURT: So you want me to take this

14 big poster into evidence?

15 MR. FELOS: Not the poster. I believe

16 these are blowups of the original scans.

17 MS. ANDERSON: I think that is the

18 complete scan, Your Honor. I'm not sure

19 what Mr. Felos is talking about.

20 THE COURT: Well, do you intend to

21 introduce this?

22 MS. ANDERSON: Actually, the original

23 film was introduced by Mr. Felos and is -- I

24 think it's over in Lakeland now, to tell you

25 the truth. If you wish, I can introduce




41



1 another copy of the scan. It's pretty big

2 and --

3 MR. FELOS: Your Honor, I request that

4 not these blowup exhibits, but we

5 introduce -- have introduced into evidence

6 the actual films, and copies are acceptable,

7 so we know what we're referring to and it's

8 a part of the record.

9 MS. ANDERSON: Yeah, that's fine. We

10 can also, of course, introduce into evidence

11 the individual images that we blew up into

12 eight-by-tens.

13 THE COURT: Okay. What form do we want

14 this to take? I guess technically I can

15 take this whole thing and let Mrs. DeBlaker

16 worry about where to house it.

17 MS. ANDERSON: I discovered, Judge,

18 that the clerk's office, in a case that was

19 up on appeal, the clerk's office here did

20 not send the scan simply because they mailed

21 the record to the appellate court and the

22 scan is about -- well, what are dimensions

23 of a CT scan?

24 THE WITNESS: It's about 14 by 17 is

25 the usual size of the film that it's printed




42



1 on.

2 MS. ANDERSON: So the appellate court

3 issued an order asking that the scan itself

4 be brought from Clearwater taken to

5 Lakeland. So whatever form they're entered

6 into the record, I don't have any problem.

7 MR. FELOS: Your Honor, I don't have

8 any objection to Respondent's copy of the

9 scan films being introduced into evidence.

10 All I'm saying is if we have copies of

11 the scan, the scan film, let's introduce

12 them into the evidence so they're a part of

13 the record so as this witness is referring

14 to the scans, he's referring to items that

15 are in evidence and we know we have the

16 complete scans in evidence as well.

17 MS. ANDERSON: Let me get a copy of my

18 exhibit list, Your Honor.

19 THE COURT: Fine. Is it in your book?

20 MS. ANDERSON: Yes, it's right in the

21 beginning. Your Honor, I would have to add

22 the '96 at the end. I have a category of

23 all exhibits offered by Mr. Felos. I didn't

24 have the '96 scan on my list, but we can add

25 it, I suppose, at Mr. Felos' requests.




43



1 THE COURT: Okay. So it's not in your

2 book?

3 MS. ANDERSON: Not the '96.

4 THE COURT: I guess the question is

5 what's on this easel represents blowups

6 of --

7 MS. ANDERSON: Let me show you. The

8 scan, the film itself.

9 THE COURT: Okay.

10 MS. ANDERSON: I do not have a copy of

11 the film since I wasn't involved in the

12 case. I don't have a copy of the film for

13 the '96 scan. That's what I'm saying. That

14 film is in Lakeland in the appellate court.

15 The film itself.

16 THE COURT: When this witness is done

17 we can disassemble this; can we not?

18 MS. ANDERSON: I guess. See, we have

19 the individual image blowups frame by frame

20 by frame in eight-and-a-half by eleven

21 format and that might be the better media to

22 use to introduce them into evidence.

23 THE COURT: Well, let's do this:

24 Mr. Felos has no objection. Let me accept

25 this into evidence.




44



1 MS. ANDERSON: The blowup itself?

2 THE COURT: Then permit you to

3 exchange--

4 MS. ANDERSON: Okay.

5 THE COURT: -- what you're talking

6 about with this bulky exhibit when you do

7 get them, which I assume will be before we

8 conclude on Tuesday.

9 MS. ANDERSON: Actually I have them

10 right here. Dr. Maxfield has them in his

11 possession.

12 MR. FELOS: Your Honor, I said I had no

13 objection to the introduction of the

14 original film. One of my concerns is that

15 it's my understanding that there are

16 numerous slices or frames in which the

17 blowups are only a portion of the actual

18 1996 CAT scan.

19 THE WITNESS: Not to my knowledge.

20 They list the 13 images and I believe all 13

21 are displayed here. What we were talking

22 about earlier is that they took three of the

23 images and put them into one square to save

24 film. Rather than printing it on separate

25 film that all 13 images are here as recorded




45



1 from the scanogram.

2 THE COURT: I don't know what you've

3 used, correct? I'm not sure it matters. I

4 think if this witness is using a portion of

5 an exhibit you're entitled to bring in the

6 balance of the exhibit.

7 But I don't think a witness has to use,

8 for instance, all 100 pages of a deposition.

9 If they want to introduce parts of it you

10 have the absolute right to introduce the

11 rest of it.

12 MS. ANDERSON: To my knowledge, this is

13 an accurate representation of the '96 CT

14 scan that's in the possession of the Second

15 District right now.

16 MR. FELOS: Then I have no objection to

17 its introduction subject to my ability to

18 provide supplemental parts of the exhibit --

19 THE COURT: There is no question you

20 have that right, Mr. Felos. I will

21 certainly underscore that.

22 MS. ANDERSON: If he does that, of

23 course, I will have to object because I

24 haven't been furnished those.

25 THE COURT: Well --




46



1 MS. ANDERSON: But I don't think there

2 are different ones because--

3 THE COURT: Let's not start throwing

4 rocks.

5 MS. ANDERSON: Right.

6 THE COURT: This wasn't on your exhibit

7 list either, so--

8 MS. ANDERSON: Right, it's being used

9 for comparative purposes.

10 THE COURT: But he's allowing this to

11 come in and if there are some more to that

12 out there I think that the totality of it

13 would make sense.

14 So I'm going to allow him, if there is

15 more of this, if it is properly identified,

16 we will bring that in.

17 MR. FELOS: Thank you, Judge.

18 MS. ANDERSON: Okay.

19 THE COURT: So the Court will accept

20 this as Exhibit Number 96; is that right?

21 MS. ANDERSON: That would be the next

22 number on the list.

23 THE COURT: Subject to your being kind

24 to our clerk by ultimately substituting a

25 eight by ten or something.




47



1 MS. ANDERSON: Yes. What we'll do is

2 96A, 96B, 96C image by image.

3 THE COURT: Well, why don't we do --

4 are they numbered like that?

5 MS. ANDERSON: Yes, they're just

6 blowups of --

7 THE COURT: Well, if they're numbered

8 like this let's do 96-1, so it ties right

9 back to the record.

10 MS. ANDERSON: All right.

11 THE COURT: Because I think that's what

12 Mr. Felos' concern was being able to tie in

13 the typed record with the documents.

14 MS. ANDERSON: The record of the

15 original trial is very difficult to follow

16 Mr. Barnhill's testimony because he's not

17 identifying what he's looking at.

18 So that's a good system, Judge.

19 THE COURT: Okay.

20 THE WITNESS: May I put in a technical

21 point and that is that the scanogram is also

22 listed as number one, so you have to list it

23 as 1A and 1B.

24 THE COURT: That's fine.

25 THE WITNESS: The rest of them have




48



1 individual image numbers.

2 THE COURT: Thank you, Doctor.

3 MR. FELOS: Is there anything on the

4 2002 CAT scan so that we can identify that?

5 I believe that is your Exhibit --

6 THE WITNESS: Each one has an

7 individual image number.

8 MR. FELOS: So that was your exhibit

9 number, what, it would be the 2002 CAT scan.

10 MS. ANDERSON: Ten.

11 MR. FELOS: So perhaps the witness--

12 MS. ANDERSON: The 2002 is the Exhibit

13 10, Judge.

14 MR. FELOS: So perhaps we could also

15 identify the individual frames in the same

16 manner, Your Honor.

17 THE COURT: Certainly. Anything that

18 will make it easier for whoever wants to

19 review this.

20 MS. ANDERSON: And Exhibit 10 then is

21 the 2002 CT scan. And at the conclusion of

22 Dr. Maxfield's testimony I will move these

23 eight by ten blowups into evidence so that

24 we're clear.

25 THE COURT: Ten blowups or Exhibit 10?




49



1 MS. ANDERSON: Exhibit 10.

2 THE COURT: Okay.

3 MS. ANDERSON: And Exhibit 96 as well.

4 THE COURT: Well, I think by

5 stipulation that's already in.

6 MS. ANDERSON: Okay. So 96 is the 1996

7 CT scan and Exhibit 10 is the 2002 CT scan.

8 THE COURT: Exhibit 96 is in evidence

9 and I think the 1996 CT scan, Exhibit 10,

10 has been identified.

11 MS. ANDERSON: Right, I'll move that

12 into evidence.

13 MR. FELOS: I have no objection to

14 Exhibit 10 being received into evidence.

15 THE COURT: By stipulation it's in.

16 MS. ANDERSON: Thank you.

17 THE COURT: Thank you.

18 MS. ANDERSON: Okay. Now, where were

19 we?

20 BY MS. ANDERSON:

21 Q. First of all, can you point out to the

22 Court using the 1996 scan where the sinus cavity

23 is in Image Number 4?

24 A. The sinus cavity. These are the

25 maxillary sinuses on Image Number 4. You have




50



1 your nasal septum coming in here. And I would

2 make one little comment and that is that on the

3 '96 study we have 13 slices. These were taken at

4 essentially one centimeter slices through the

5 brain area.

6 And on the more recent studies we have

7 more slices because in the interim there has been

8 a little change in the difference of techniques

9 and that is that we take more slices through the

10 bottom part of the skull than we did on the

11 earlier dates.

12 But the upper part of the brain where

13 most of the function is and where the thought

14 processes is and things like that are essentially

15 the same.

16 Q. Now, the sinus cavity appears on these

17 scans as virtually black; is that right?

18 A. That is correct because they're filled

19 with air under normal circumstances.

20 Q. And so air offers very little

21 resistence to the beam that is passed through the

22 skull?

23 A. We would term it as a very minimal

24 absorption of the radiation energy, correct.

25 Q. And what is the area that is white on




51



1 the scans?

2 A. The area that is white on Image Number

3 4 is the bony structure. This is the temporal

4 bones and part of the occipital bones coming out

5 here. As I mentioned, the nasal septum you see

6 around the bony structure around the sinuses. So

7 the pure white area using this set of settings

8 that turns out to be bone density.

9 Q. And that is because bone absorbs the

10 radiation at a different rate than air does?

11 A. Correct. The density of the bone is

12 greater than air, so it absorbs more of the --

13 has more mineral content and a greater

14 (inaudible) numbers so, therefore, it absorbs the

15 radiation more efficiently than the air does.

16 Q. Now, if bone and air are the two ends

17 of the continuum, are there any gradations of

18 absorption in between those two?

19 A. Yes, there are. This is what we were

20 talking about. There is the area -- going back

21 to Image Number 4 again, there are areas of gray

22 that are in the cerebella area of the brain which

23 is the level that we're dealing with here.

24 And in this area there are also some

25 areas that are not quite as black as the others.




52



1 These are areas where you have fluid in the brain

2 area so that you can differentiate between brain

3 tissue and brain fluid and its gradation between

4 the white of the bone and the black of the air.

5 Q. And so in addition to air and bone you

6 have brain tissue and fluids?

7 A. Correct.

8 Q. Are those basically the four elements

9 that are discernible on the CT scan?

10 A. On this particular CT scan also you

11 have the higher images. A density that's

12 essentially the same as bone and this is the

13 metal catheter that's in place.

14 Q. Because she has an implant in her

15 brain?

16 A. Correct.

17 Q. And can you point that out to the Court

18 by cell number or by image number?

19 A. Actually it appears in a number of

20 different images starting with Image Number 6 we

21 can see it showing up. Right here is an area

22 that's almost the density of adjacent bone. Then

23 we see it showing up in the next image. Here it

24 is producing one of the artifacts that we get

25 with CT scans on metal.




53



1 Q. What do you mean by artifact,

2 Dr. Maxfield?

3 A. You can see the streaking that is in

4 this area right here at the tip of the catheter.

5 We can see the catheter distinctly. But when you

6 image metal with the CT technique you can get a

7 star, an artifact, and this is the streaking that

8 we see coming off around this. We don't actually

9 see the little catheter itself quite as well.

10 We have it to varying degrees on the

11 other images so that it does produce a degree of

12 artifact. And bone also can produce some degree

13 of artifact and this is the reason we've gone to

14 the technique of doing multiple slices through

15 the cerebella area because you see some of this

16 streaking in this area.

17 This is on Image Number 3 and again on

18 Image Number 4 that we get from all of the

19 density of the bone around the cerebella area.

20 So by taking thinner slices through

21 there, we decrease some of the artifact in the

22 lower part of the brain.

23 Q. Now, can you point out to the Court

24 what -- where the ventricles of the brain are?

25 A. Yes. The ventricles are up in the




54



1 higher levels of the brain. And we see the

2 ventricle starting a little bit on Image Number

3 5. The left side of the patient is rotated a

4 little bit in doing the study. It's not

5 completely straight so that's why we don't see it

6 completely uniform of the two sides.

7 We can see the ventricles better on

8 Image Number 6, which is the areas that are

9 outlining here. And on Image Number 7 we can see

10 the ventricles showing up again on Image Number

11 8.

12 Image Number 9 the ventricles are

13 there. Number ten the ventricles are again here.

14 Number eleven the ventricles are -- you're

15 beginning to get to the top of the ventricular

16 system. Then on Image Number 12 you moved up

17 above where the ventricles are located.

18 Q. Now, Dr. Maxfield, is there brain

19 tissue visible on the 1996 CT scan?

20 A. Yes, there is brain tissue visible.

21 The ventricle system is significantly enlarged

22 which takes up a part of the area, but you do see

23 brain tissue as we were pointing out on Image

24 Number 4.

25 This is in the cerebella area. You've




55



1 got brain tissue showing up here. Actually, you

2 can see brain tissue going back all the way to

3 Image Number 1, which is down in the medulla area

4 of the brain coming up into the cerebellum.

5 So that on all of these you do see

6 brain tissue. When you get up into the upper

7 parts of the brain you can see brain tissue

8 that's outside the level of the ventricles.

9 And on this particular study in '96

10 these areas of the brain tissue are somewhat what

11 we would call homogeneous. They're spotty. Normal

12 brain tissue has a much more uniform pattern.

13 And we can see that there are good areas of the

14 visualization and then there's a light area.

15 MR. FELOS: Again, could you refer to

16 the specific frame that you're talking

17 about.

18 THE WITNESS: On that I was pointing on

19 frame number seven.

20 MR. FELOS: Thank you.

21 THE WITNESS: Image Number 7.

22 BY MS. ANDERSON:

23 Q. Now, Dr. Maxfield, let's turn to the

24 2002 scan.

25 A. Before we go to that--




56



1 Q. Yes.

2 A. -- I would come back again to the last

3 images and these are images that are up above the

4 ventricular system. You can see brain tissue up

5 in this area on these images. Again, it's

6 somewhat homogeneous on this '96 study.

7 Q. Now, in that last frame there that has

8 three images in it, would that be the top three

9 slices that are shown on the scanogram?

10 A. That is correct. This image is number

11 11. And when we look on the scanogram this would

12 be the level at number 11 here. And number 12

13 would be the next one up which would be here.

14 And then number 13 would be the last

15 one that was taken on this area. And on this

16 particular scan, they did not come all the way to

17 the top of the brain, so there's a little bit of

18 the area that based on the data that's here has

19 not been imaged on this study.

20 Q. Now, let's turn to Exhibit 10, which is

21 the 2002 CT scan.

22 A. Would it be okay if I come over and

23 stand besides you because I've got a glare in

24 this area?

25 Q. Yes. Shall we turn it towards you?




57



1 A. I think if we can move it down then I

2 could stand besides it.

3 Q. Would you like to move it?

4 A. Just move it closer. Move that one

5 down. Then move this one right beside it.

6 Q. Okay.

7 A. Let's angle it so we can turn it this

8 way so we can see it.

9 MS. ANDERSON: Can you see it, Your

10 Honor?

11 THE COURT: Now we have the glare off.

12 THE WITNESS: Yes, that works better.

13 The glare is off of this exhibit.

14 BY MS. ANDERSON:

15 Q. Now, with regard to the 2002 scan, is

16 there a precise one-to-one comparison available

17 between each of the images on that scan and the

18 images on the '96 scan?

19 A. These are relatively close. I can't

20 say unequivocably that they were in exactly the

21 same image because I don't have the scanogram for

22 the O2 image. But you can look at the certain

23 anatomical features and see that they are very

24 close.

25 As I indicated on the current




58



1 technology we take more slices through the base

2 of the brain so that we have more slices in the

3 lower part of the skull area than we do in the

4 upper part.

5 But then in the upper part we can look

6 at some of the anatomical areas. For instance, in

7 Image Number 2 is -- I take it so that we're

8 looking at the very bottom of the brain. That

9 would correlate with Image Number 1 on the '96

10 study.

11 The angle of the patient is a little

12 bit different. For instance, on the '96 study

13 you're seeing the mandible showing up here so

14 that it's angled a little bit different. You're

15 not seeing the mandible on this image of the '02

16 study.

17 Q. And is that Image Number 2?

18 A. That's Image Number 2 that we were

19 looking at there.

20 Q. Now, Dr. Maxfield, in Image Number 1

21 and Image Number 2 in the '02 study, which is

22 Exhibit 10, what is at the very top of these two

23 images? What is this area at the very top?

24 A. That is part of the facial bones in the

25 maxillary areas of the patient on the '02 image.




59



1 Q. If we look at Image Number 13--

2 A. I'm sorry, that's actually -- that's

3 looking at the mandible in here on Image Number

4 1.

5 Q. Okay. If we look at Image Number 13 on

6 the '02 scan, what is its closest approximate

7 image on the '96 scan?

8 A. The closest -- well, unfortunately

9 between the two scans they're angled at different

10 areas, so it makes it a little bit more difficult

11 to --

12 Q. Is there a better --

13 A. -- to directly compare. But this Image

14 Number 13 on the current study would be very

15 close to Image Number 6 because you can see the

16 part of the sphenoid sinus showing up and you can

17 see part of it showing up here.

18 Q. What's the--

19 A. And you can look at the overall bony

20 structure, but you have to remember also that on

21 the '96 scan the patient was rotated more than on

22 the '02 study.

23 Q. What's the sphenoid sinus?

24 A. Sphenoid sinus. That's one of the part

25 of the paranasal sinuses that are in the skull




60



1 area.

2 Q. Now, on the Image Number 13 on the 2002

3 scan, can you point out for the Court where the

4 brain tissue is?

5 A. Yes. Here we see the ventricles as the

6 dark areas. And on both sides we can see again

7 the density from the catheter. And you could see

8 the brain tissue off to the side and in the

9 center on both sides. And the brain tissue on

10 the '02 study, in my opinion, is more homogeneous

11 than it is on the study from '96.

12 Q. What do you mean by homogeneous?

13 A. That there's a more uniformed pattern,

14 that you don't have as much gradation of density

15 in this area as you did on the '96 study. And

16 when you look at the ventricular system the

17 ventricles have not enlarged really in the

18 six-year interval between the two studies.

19 Q. So the ventricles have remained

20 basically the same in size, correct?

21 A. In my opinion, yes.

22 Q. And the brain tissue on the 2002 scan

23 is more homogeneous in appearance than it was six

24 years ago?

25 A. That is my opinion, yes.



61



1 Q. What does that tell you as a

2 radiologist?

3 A. It tells me that the brain tissue on

4 the '02 study has a more normal appearance than

5 it did on the 1996 study.

6 Q. What would account for that?

7 A. This is what we have learned is that

8 there can be some regeneration of brain tissue.

9 When I was in medical school we were taught that

10 brain tissue never regenerated, but the

11 experimental animal data and also the current

12 clinical data is now telling us that that is not

13 true.

14 Q. Have you formed an opinion, within a

15 reasonable degree of medical certainty, that she

16 has more brain today as shown on this 2002 scan

17 than she did as shown on the '96 scan?

18 A. I wouldn't put it in terms of actually

19 more brain. I would say that the brain that we

20 see is more normal in pattern than on the '96

21 study. That we can look at other areas and see

22 the brain tissue and we can see a more uniformed

23 pattern.

24 I'm talking now on Image Number 16 and

25 that would correlate mostly with Image Number 10




62



1 on the '96 study and you can see the area where

2 the tissue is located.

3 MS. ANDERSON: Can you see that, Judge?

4 BY MS. ANDERSON:

5 Q. Could you point that out to the Court?

6 A. It's on the bottom. This area, this

7 little area of brain tissue that we're seeing

8 here are more inhomogeneous in pattern.

9 Q. That's on 10?

10 A. That is correct on Image 10. And then

11 on Image Number 16 when we look at the same areas

12 of brain tissue that the pattern is more

13 uniformed as to the grayness of the brain tissue.

14 Q. You're saying the grayness?

15 A. The grayness, G-R-A-Y.

16 Q. So a more uniformed appearance on the

17 scan image tells you that the brain is more

18 uniformly dense?

19 A. Correct. That, in my opinion, it does

20 not have as much inhomogeneity which is what we

21 see in injured brain tissue.

22 Q. Have you had occasion, Dr. Maxfield, to

23 review the scans of patients, previously other

24 patients, who have been diagnosed with anoxic

25 encephalopathy?




63



1 A. Yes, very frequently.

2 Q. Very what?

3 A. Very frequently.

4 Q. Typically what is the cause of the

5 encephalopathy in the patients that you've

6 examined?

7 A. The encephalopathy is not infrequently

8 hypoxia from various and sundry causes from near

9 drowning to episodes of cardiac arrest to

10 patterns of severe brain trauma which is

11 associated with edema that produces the hypoxia.

12 Q. Now, you have worked with specialists

13 in hyperbaric medicine; have you not, including

14 Dr. Richard Neubauer?

15 A. Yes, I have worked with Dr. Richard

16 Neubauer.

17 Q. Do you see brain scans of the patients

18 change over time as a result of the hyperbaric

19 therapy?

20 A. We have used the SPECT brain scanning

21 more to follow up the course of treatment, but I

22 have seen improvement in some of the CT scans

23 that I have reviewed.

24 Q. Is there any correlation between

25 improved cognitive functioning and changes in the




64



1 scans, whether they're SPECT scans or CT scans?

2 A. In the majority of the cases there is a

3 good correlation between the improvement in the

4 SPECT scan and the clinical improvement in the

5 patient.

6 Q. If a patient --

7 MR. FELOS: Excuse me, Your Honor. If

8 the witness is done referring to the

9 comparison chart perhaps he could retake the

10 witness box.

11 MS. ANDERSON: I don't think we're

12 finished yet.

13 BY MS. ANDERSON:

14 Q. If a patient's clinical symptoms

15 improve, would you expect to see changes in the

16 patient's brain scan?

17 A. The correlation has been better with

18 the SPECT brain scan from the patients that I

19 have dealt with. I have seen improvements in the

20 CT scan because you have the change that I have

21 mentioned here that the brain becomes more

22 uniform and more normal in appearance with a

23 clinical improvement.

24 That when you injure the brain you get

25 the development of swelling and edema in the




65



1 brain area. This becomes a problem because as

2 you get more swelling, then this interferes more

3 with the blood flow to the brain areas since the

4 brain is an enclosed vessel.

5 And if you have increased pressure then

6 your blood cannot flow into the brain as well.

7 But as time goes by, then people see this

8 improvement and this is what has been described

9 in the literature as the penumbra that occurs

10 around those areas of brain damage.

11 Q. Now, with regard to changes they might

12 see on the scan, of a SPECT scan, for example,

13 how would changes in the penumbra manifest

14 themselves on the scan?

15 A. The change in the penumbra would be by

16 seeing a more normal appearance to the brain

17 tissue, a more uniform appearance and not the

18 darker areas that we see on the scan.

19 Then in dealing with some of the

20 cerebral palsy children that we dealt with there

21 hasn't been significant pattern of change on the

22 CTs as we see on the SPECTs.

23 Q. Now, Dr. Maxfield, using the 2002

24 study, can you point out to the Court the various

25 structures of the brain, what are the occipital




66



1 lobes of the brain?

2 A. The occipital lobes of the brain are

3 the areas at the back of the brain where vision

4 is located. And the occipital lobes would be

5 back in this area posterior to the ventricles

6 that we're seeing here.

7 And you have some tissue that is back

8 in this area. Certainly not a normal pattern

9 because these ventricles are enlarged, but there

10 is tissue that is backed up in the area of the

11 occipital lobe --

12 Q. And what --

13 A. -- referring to Images Number 13, 14

14 and 15.

15 Q. Now, given your experience in the

16 appearance of Images 13, 14 and 15, would you

17 expect to see a clinical finding of blindness or

18 partial blindness in a patient with a CT scan

19 that looked like that?

20 A. That is the clinical pattern that

21 occurs in people with injury to the occipital

22 lobes because that is where the visual processing

23 occurs. So if you have damage to the occipital

24 lobes, they frequently have impaired vision.

25 Q. Now, where is the cerebellum structure




67



1 in the brain?

2 A. The cerebellum structure is down at the

3 bottom of the brain and that is what we're

4 looking at in here. We see that actually

5 starting on Image Number 3 and we see it in

6 three, four, five, six, seven. And we're kind of

7 moving out of it on eight.

8 Q. And what are the cerebral hemispheres

9 of the brain?

10 A. The cerebral hemispheres are the top

11 part of the brain that goes from the frontal part

12 of the brain, I'm going back now to the scanogram

13 image on Number 1 on the '96 study.

14 So that these cerebral hemispheres go

15 from the frontal area of the brain all the way

16 back into the back of the brain where the

17 occipital lobes are located. And also up to the

18 top of the brain. So it looks almost like two

19 great big peas that are put side by side.

20 Q. And so the cerebral hemispheres sit on

21 top of the cerebellum?

22 A. Correct.

23 Q. And they are in front of the occipital

24 lobes of the brain?

25 A. No. The cerebral hemisphere refers to




68



1 the whole top part of the brain area. The

2 occipital lobe is one of the segments of the

3 cerebral hemispheres.

4 Q. I see.

5 A. Then also you have the temporal lobe of

6 the brain which comes into the area by the

7 temporal bone. Then you have the frontal lobes

8 which are up in the front part of the brain where

9 most of your thought processes go.

10 And then your motor part of the brain

11 is in the parietal area of the brain of the

12 cerebral hemispheres which is the motor part.

13 And, again, I'm going back to image, scanner

14 image on the '96 study.

15 Q. So is the parietal part of the brain

16 that controls reason?

17 A. No. The parietal part of the brain is

18 a predominantly motor function.

19 Q. Where does that show up on the 2002

20 study?

21 A. On the 2002 study the parietal area

22 starts on about Image Number 15 and then comes

23 up. So it would be on Image 16, 17, 18, 19. It

24 comes all the way up to the top of the brain on

25 Image Number 20.




69



1 Q. On the 2002 scan, can you show the

2 Court where the frontal lobes are?

3 A. The frontal lobes are located starting

4 on Image Number 16 and coming on up then to about

5 Image Number 19. So the frontal lobes are up in

6 the front part of the brain then these are

7 superimposed on top of the temporal lobes of the

8 brain that we had mentioned before that you can

9 see on Image Number 12.

10 Q. Are her frontal lobes damaged?

11 A. There is diminished tissue in the

12 frontal lobe areas because, as I had mentioned,

13 the ventricular system is enlarged so you don't

14 have the normal amount, but when you look at

15 these images the tissue in the frontal lobes

16 again on the '92 -- on the '02 study has a much

17 more uniform type of pattern than looking there

18 on Image Number 17.

19 When you go over and look at the image

20 in this area on Image Number 10 on the '96 study

21 the brain tissue in the '96 study has a more

22 inhomogeneous or less uniform gray pattern that

23 you see in comparison to the gray pattern that

24 you see on the '02 study.

25 Q. So the areas that you have pointed out,




70



1 in terms of a layman's understanding, is that

2 part of her brain has fewer holes in it?

3 A. I can't really say they're unequivocal

4 holes, but when you look at a normal brain it has

5 a fairly uniform pattern. It's more like looking

6 at the top of the desk here so that you have a

7 density as opposed to looking at the carpet here

8 which is more inhomogeneous because you've got

9 more black areas, but you can't say unequivocally

10 that these are large holes.

11 But it's just the pattern that you

12 looked at again coming back to image in Number 10

13 on the '96 study that the brain tissue that is

14 here is outlined, but the grayness of the brain

15 tissue is not as uniform as is the grayness of

16 the brain tissue when you looked at the images in

17 the '02 study, for instance, on Image Number 17

18 and Number 18.

19 And also if you go back to Image Number

20 16 the same type of thing, these would be areas

21 of the brain tissue that you see have a more

22 uniform pattern are closer to what we would

23 consider a normal brain pattern.

24 Q. Are there other areas of Terri's brain

25 that you can identify look more homogeneous on




71



1 the '02 scan than on the '96 scan?

2 A. Essentially all of the areas when you

3 look at the brain tissue look, in this cerebral

4 hemisphere looks more uniform. And we've talked

5 about the frontal lobes and the temporal lobes

6 and the occipital lobe and the motor areas so

7 that these areas have a pattern that is closer to

8 what you would see in a normal brain scan.

9 Q. Wouldn't you expect Terri's clinical

10 symptoms to be different as between; '96 and '02?

11 A. There probably has been some

12 improvement and this would relate to more ability

13 to see things and more recognition than things

14 around them.

15 Q. Okay. Is there anything else of note

16 in comparing these two scans?

17 A. Not really except to come back to the

18 point that there has really been no increase in

19 the degree of the enlargement of the ventricles.

20 Q. What would that tell you?

21 A. That there has been no progression of

22 her loss of brain tissue. And based on what I

23 see of the scans, the brain tissue that's

24 demonstrated appears more normal than it did on

25 the '96 scan.




72



1 Q. Now, to what extent, if at all, would

2 this brain, this electrical lead, this implant

3 that's in her brain, how would that in any way

4 affect function; if you know?

5 A. I would not expect it to undue any

6 functional problem because we put catheters into

7 the brain to relieve pressure and those stay in

8 place essentially the same place as this

9 electrical lead without producing significant

10 problems unless it would become infected.

11 Q. Is there any evidence on the '02 scan

12 that that lead has become infected?

13 A. There's really been no change in the

14 position of it. And you really would not see

15 infection right around the catheter I believe in

16 the scans. That would be more of a clinical

17 diagnosis that she has developed the pattern of

18 an infectious process. Whenever someone develops

19 a pattern of infection and you've got a catheter

20 in place then you have to be suspect that that is

21 the source of an infectious process.

22 Q. Have you seen catheters in the brain

23 used to drain fluid from the brain?

24 A. Yes. That is the technique of putting

25 a catheter into the brain to relieve the pressure




73



1 in hydrocephalus.

2 Q. Does Terri has hydrocephalus?

3 A. I don't think that she does. I don't

4 remember that they noted an increase of

5 ventricular pressure when they put the catheter

6 into the brain area. And if she had

7 hydrocephalus, you would expect the ventricles to

8 have significantly enlarged over a period of six

9 years and they have not enlarged during this

10 period of time.

11 Q. If the fluid and the ventricles were

12 drained from the brain surgically, based on your

13 experience, what would happen to her brain?

14 A. Well, if you took all the fluid out of

15 the brain, then you would change some of the

16 dynamics in the brain area. And part of the

17 nutrients to the brain itself is actually from

18 the fluid in the brain area. So that's not

19 something that you would do.

20 Q. How --

21 A. We used to do that years ago before we

22 had CT scans and we did pneumoencephalograms

23 where you took fluid out of the spinal cord and

24 put air into the brain that gave us the ability

25 to see what we have with our CT scans to look at




74



1 the ventricles and the amount of brain tissue,

2 but that was a much more invasive procedure and

3 some patients actually died during the course of

4 the procedure. So the availability of the CT

5 scan has been a major jump forward.

6 Q. Can anything be done to reduce the size

7 of the ventricles?

8 A. There's no way to guarentee that. We

9 have seen a decrease in the size of ventricles in

10 some of the cerebral palsy children that we've

11 dealt with that have received hyperbaric oxygen

12 therapy and some of the other hypoxic episodes in

13 children.

14 Q. Dr. Maxfield, we have the SPECT scan

15 that we can show on the elmo, right?

16 THE COURT: Let me just ask, how are we

17 doing down there?

18 THE COURT REPORTER: I'm fine.

19 THE COURT: How much longer do you have

20 with this witness, Ms. Anderson?

21 MS. ANDERSON: We might want to take a

22 break, but if we take a short break then I

23 could complete him and then we could go to

24 lunch. I don't think he's going to last all

25 day.




75



1 THE COURT: You've got, what, another

2 30, 40 minutes, perhaps?

3 MS. ANDERSON: Yes.

4 THE COURT: So let's go ahead and take

5 15 right now and then we'll come back and we

6 will resume with Dr. Maxfield.

7 During this break, sir, we will caution

8 you do not talk to anybody about the case,

9 the testimony you've given or the testimony

10 that you intend to give. You're still on

11 the witness stand technically, but you're

12 free to move about and do what you need to

13 do for the next 15 minutes.

14 THE WITNESS: I understand. Thank you,

15 sir.

16 THE COURT: Thank you. We will be in

17 recess for 15 minutes.

18 THE BAILIFF: All rise, please. The

19 Court stands in recess for 15 minutes by the

20 courtroom clock.

21 (Thereupon, Court was in recess for 15 minutes.)

22 THE COURT: Ms. Anderson, you may

23 proceed with your direct examination.

24 MS. ANDERSON: Thank you, Your Honor.

25 BY MS. ANDERSON:




76



1 Q. Dr. Maxfield, have you finished with

2 pointing out the significant matters that you

3 observed in comparing the '02 scan to the '96

4 scan?

5 A. I believe that I have, yes.

6 Q. Okay. Now did you likewise examine the

7 SPECT scan that was done on Terri Schiavo in

8 August of this year?

9 A. Yes, I did.

10 Q. Could we put the SPECT scan on the

11 screen, please? On the SPECT scan there are two

12 films; are there not?

13 A. I believe that there were, yes.

14 THE COURT: Have these been introduced?

15 MS. ANDERSON: Yes, I will introduce

16 the scan itself.

17 MR. FELOS: I have no objection, Your

18 Honor.

19 THE COURT: Thank you. It will be so

20 received as, do we have a number?

21 MS. ANDERSON: Hold up for a minute.

22 Number 11. It's Number 11.

23 THE WITNESS: All right. On a

24 technical basis, I think if we went to the

25 transaxial images first.




77



1 BY MS. ANDERSON:

2 Q. Okay. Is that the transaxial images?

3 A. No, that's the sagittal. I think it's

4 on the bottom of the first or it should be.

5 Q. It's on the bottom of the first one?

6 A. There's one labeled the transaxial.

7 Q. What's the image that's on the screen

8 now?

9 A. This is one set of images from the

10 SPECT brain scan. And this is the group that's

11 labeled as transverse or sometimes they label it

12 as transaxial, but in this case it's labeled as

13 transverse.

14 Q. Let's call that then Exhibit 11. Let's

15 call that 11A, that group of images. Okay. And

16 what does that image tell you? That group of

17 images?

18 A. This is the images that are taken after

19 injection of the radiopharmaceutical for the

20 SPECT brain scan usually anywhere from 30 to 60

21 minutes after injection. And you can do the

22 study up to six hours after injection.

23 And this shows the pattern of

24 localization of the radiopharmaceutical in the

25 brain area. And in doing the SPECT brain scan we




78



1 actually end up with three sets of images; one is

2 a transverse or transaxial as we are looking at

3 now. And that's the one that are in the same

4 plane of the brain as on the CT images that we

5 have been looking at.

6 And then as part of the process with

7 the SPECT you can also look at the brain and

8 other planes like the sagittal and the coronal,

9 which the sagittal is going from one side to the

10 other side and the coronal is going from the

11 front to the back of the head.

12 So that on this set of images we are

13 looking at the transverse which is started at the

14 base of the brain and gone to the top of the

15 brain in the same way that we're looking at the

16 CT images.

17 Q. Now, what does this tell you about

18 brain function in terms of that pattern in

19 localization?

20 A. The study shows that there is some

21 localization and we can see the large ventricular

22 system which is the white areas that we're seeing

23 in the mid images in the edge of the ones that

24 we're looking at right now.

25 Q. Now, when you say localization, does it




79



1 show up as a dark area on the scan?

2 A. Correct. And the degree of

3 localization shows up as the degree of darkness

4 on the SPECT scan.

5 Q. On these transaxial images, where is

6 the most localization?

7 A. The majority of the localization is

8 down in the cerebella area and also in the basal

9 gangliar area, but we are seeing localization in

10 the cerebral hemispheres and faint localization

11 back in the occipital areas where the degree of

12 localization in the posterior part of the brain

13 as we had looked at on the CT images is not as

14 good as it is in the frontal areas.

15 But in looking at the brain we do not

16 have any large areas of absent localization which

17 would indicate total non-function or -- and/or

18 absence of blood flow to that area.

19 Q. Now, in terms of blood flow,

20 Dr. Maxfield, is it going to flow into areas of

21 dead cells in the brain?

22 A. In the SPECT scan usually when you do a

23 study you do not get blood flow into the area

24 that's completely dead because --

25 Q. What happens to dead brain cells?




80



1 A. They atrophy and are absorbed by the

2 body and the blood vessels to that area also

3 deteriorate.

4 Q. So dead brain cells are simply not

5 visible on the scans?

6 A. They show up as a non-localizing area,

7 correct.

8 Q. Do you see any dead areas in her brain?

9 A. That was the point that I was making

10 that I do not see any large areas of completely

11 absent flow. Her SPECT brain scan is abnormal in

12 which we do not have the degree of localization

13 in the cerebral hemispheres that we would

14 normally expect.

15 On a standard normal brain scan, the

16 cerebella area, which we do see in this SPECT

17 scan, is showing up with good localization. It

18 is usually the hottest area, the area of greatest

19 localization.

20 Then the cerebral hemispheres are

21 slightly below that level of localization. And

22 then the normal brain scan we very faintly see

23 the area of the ventricles depending on the age

24 of the patient.

25 In the very young the ventricles are