A case for electronic manipulation of medical images?

Two ophthalmic case histories requiring differing techniques to document the long-term outcomes of ocular tumours are presented. In the first case, after documenting a treated choroidal melanoma it was necessary to intervene with digital manipulation to enhance the images for clinical interpretation. Conversely, after documenting an iris tumour over an eight-year period, it was considered that the original images were suitable for interpretation without intervention. This raises the issue of images presented as legal evidence when digital technology is used to manipulate and enhance the images. Are these images admissible as evidence in court, and should the original data also be archived to prevent conflicting interpretations by the legal system? In light of The House of Lords recommendations on digital images as evidence, it is suggested that both the manipulated and original images are archived to avoid debate on the extent to which an image has been altered.