Medical illustration
Medical illustration combines anatomical knowledge and visual communication to explain structures, procedures and scientific concepts to professional and public audiences.
The illustrator's role and preparation
Medical illustrators use scientifically informed observation and technical and aesthetic skills to portray subjects accurately and communicate complex information visually. They should have advanced education in anatomy and visual communication, whether they begin in art and learn science or begin in science or medicine and learn illustration. Specialist or accredited training is generally regarded as best practice. In UK usage, medical illustration covers both medical photography and artistic illustration, also called medical art.
In 2020, UK illustrators were encouraged to join the Academy for Healthcare Science Medical Illustrator Register, which required an accredited degree programme, while the US Commission on Accreditation of Allied Health Education Programs accredited medical illustration programmes in North America. Professional bodies included the US Association of Medical Illustrators and the UK's Institute of Medical Illustrators and Medical Artists' Association. Membership offered community, networking and continuing professional development, which registers such as the Academy's required. Registers allow the public to check practitioners' registration and standards, and provide routes for concerns, action and sanctions.
Professional practice includes responsibilities arising from direct access to patients or their data, making understanding of data protection and anatomy legislation essential. The Institute of Medical Illustrators' guidance in 2020 covered patient confidentiality, working with transgender patients, cultural diversity and ethical social media use.
Illustrators work for health services, private hospitals, medical schools, research institutions, publishers and specialist illustration companies, or directly for clients as self-employed practitioners. By 2020, employers also included e-learning companies, software and app developers and virtual-reality developers. Detailed images may require a professional illustrator or designer, while simpler visuals can often be created using basic rules, icons or stock images.
Media and visual style
Traditional media can provide tactile feedback and effects that may be difficult or impossible to reproduce digitally. Watercolour can soften graphic or sensitive images and make them less disturbing for patients and lay audiences. In one patient-animation project, graphite pencil was chosen to give images of an intrauterine device, its insertion and female anatomy a softer, more appealing appearance.
Two-dimensional digital illustration is a staple of many illustrators' work, ranging from black-and-white line drawings to realistic colour images, cartoons and graphic-medicine comics, with style and realism adapted to the audience.
Three-dimensional models
Three-dimensional models can be built from magnetic resonance imaging (MRI), computed tomography (CT) or surface scans, or created from scratch in modelling software. Interactive models let users rotate, zoom and read annotations in webpages, virtual learning environments, e-books and interactive PDFs. Models can also be reused as assets in animations, educational games and applications, viewed interactively in virtual reality or 3D printed.
By 2020, improved medical and surface scanning captured greater detail, while packages such as ZBrush, Maya and Cinema 4D handled more complex models and realistic material properties. These imaging and modelling developments were being combined with e-books, interactive PDFs, online models and mobile applications.
Medical schools were investigating virtual and augmented reality for learning from models in 2020. Virtual reality uses a head-mounted display for an immersive experience in which a user can move around a digital object, view it at life size or enlarged a hundredfold, or explore it from within, such as a beating heart. Enlarging models can help with small structures such as the inner ear. Augmented-reality headsets such as HoloLens overlay digital scenes on reality, allowing interaction with digital and real environments together. QR codes can launch additional web-based images and models on mobile devices.
In 2020, immersive technologies were considered promising for anatomical education and potentially for patient information and medico-legal exhibits, although most students lacked good-quality headsets at home. More affordable standalone headsets such as the recently released Oculus Quest were expected to broaden access.
Applications
Medical and anatomical education
Medical and anatomical education is a primary application of illustration, with illustrated anatomy textbooks remaining a mainstay. Vesalius's De humani corporis fabrica is an example whose artwork is arguably better known than its text. By 2020, textbooks usually used digital 2D images, while software, apps, e-books, websites and in-house resources increasingly offered interactive models and animations with touchscreens, gamification and self-testing. E-learning provides remote access to approved resources, and some medical schools employ e-learning technologists alongside illustrators. An interactive model of hand muscles created for the University of Dundee illustrates this use.
Illustrators should work closely with subject specialists to understand the learning objectives, and those working in medical education should understand research on learning styles and theories.
Patient information
Patient information is another primary application, using posters and leaflets as well as digital and online formats. Illustrations, animations and 3D models can make online patient resources easier to understand and more accessible to different audiences. The audience, including adults, children, older people and people with visual impairment, affects the choice among formats such as paper leaflets, interactive PDFs, e-books and websites, as well as style and detail.
Legal, industry and scientific communication
Medico-legal exhibits use illustrations, models and animations to clarify complex information for judges and juries. Body mapping places injuries on a digital model to reduce distress and direct attention to their cause and impact, while radiographs and scans can be enhanced through colour or an illustrated interpretation.
Pharmaceutical and device companies use illustrations in brochures, websites and trade-show materials to explain product capabilities and use, often to specialist medical audiences. Illustrations, models and animations also communicate research in scientific reports, journal articles and conference presentations and can engage the public with medical and life-science research.
Illustrators help surgeon authors explain new operative techniques and show surgical steps, and have also helped plan and carry out complex operations such as separating conjoined twins.
Development of techniques
Sixteenth-century artists attended dissections and operations to learn anatomy for accurate depictions. Earlier drawing techniques combined pen and ink with carbon dust on a sticky clay-coated surface, scraping dust away to create highlights and dimension. At Mayo Clinic, one illustrator began with carbon dust and later used coloured pencil. By 2008, medical illustrators predominantly used computers for drawing and animation.
Mayo Clinic began its medical illustration programme in 1907, recruiting students of Max Brödel after unsuccessfully trying to recruit him from Johns Hopkins. By its first public illustration exhibition in 2008, the collection contained approximately 60,000 items.
Representation of patients
A 2017 analysis of 17 anatomy textbooks containing 6,004 images found that only 36% of images with identifiable sex were female. Other biases included stereotyped gendered emotions, roles and settings, limited ethnic, age and body-type diversity, and near-total adherence to a sex and gender binary. Because these materials educate future healthcare workers, everyone involved in their production, including illustrators, should address representation so learners are prepared for diverse patients.