Real or "fake"?

I had an interesting interaction with a doctor that I work with quite often.  It really brought up the question, "Is what we do as medical artists real or fake?"

(At this point, I should take a moment to apologize for the over-use of quotation marks in this post.) 

I don't have an good answer for that question, especially in light of the reactions from said doctor.  Before observing her reactions, I would have said with 100% confidence - what we do is "real."  So, yesterday we were working on the project we have been collaborating on, and I was updating many (most) of the images.  One of the things that Stanford (and myself, especially) is very aware of is copyright. 

i.e. You can't just use images from Google in things you are offering outside of the University, and especially not for profit.  

I thought that this was common sense, but it seems that many a professor disagrees.  One of the things I have had to do on this project was replace images pulled from Google with original work. On a personal level, I know that I wouldn't want people ripping off my hard work, so I tend to lean towards the copyright enforcer role sometimes...

In any case, we needed an X-ray that depicted a CMC fusion.  I pulled one that I thought portrayed that surgery from her library... but I was wrong.  It was a hemitrapeziectomy with a k-wire pin, not a CMC fusion with a k-wire pin.  Darn and blast!  It turned out that she didn't have a CMC fusion with a k-wire pin example in her library.

Now, if this book wasn't due the day before yesterday, she could go off to her case library, strip all identifying data from a patient case example, and use an x-ray from there.  Especially since she has a ton of x-rays from patients that have agreed to let their data be used in studies and papers.  But... needs must.

So I modified an x-ray that we had available.  It was ours, nearly showed what we needed it to, and was fairly straightforward to edit.  Which is better than what might have happened- yep, google was the first place to turn to.  Now, she made the argument that an x-ray with identifying data stripped from it is actually in the common domain.  I have no idea, truthfully.  She could have been 100% correct and I spent my time on nothing.  But I would rather err on the side of legality, especially since it's my name on the artwork in this book.

Looks like a CMC fusion x-ray to me!

As I was exporting the book for final edits tonight, her reaction to my editing this x-ray really struck me.  She was unhappy that we didn't have the real thing, or access to one via the internet.  On the other hand, I was happy that we had a drawing that looked accurate and was from source photos that we owned.  I was really wondering why editing an x-ray was bad, but editing photos is okay (I did a fair bit of that as well).  Or even teaching via 3D models and line drawings... why does a "false" x-ray ring so much more on the 'not good' side than the 'teaching' side? 

I don't have an answer for that, but I found the idea of it intriguing.