Medical illustration in the 21st century and beyond Caroline Erolin It is the role of the medical illustrator continuing professional development (CPD), Centre for Anatomy and Human Identification, to communicate often complex scientific which is essential to those wishing to join a University of Dundee, Dundee, Scotland information and concepts to a broad range of register such as that held by the AHCS. The audiences through visual media. To this end, the registration of medical illustrators has been modern medical illustrator should be educated welcomed within the profession as it recognises Correspondence to: to an advanced level in both anatomy and visual and promotes the specialist skills required and Dr Caroline Erolin communication. While some train first as artists thus helps to raise professional standards. In Centre for Anatomy and Human and illustrators, others come from backgrounds addition, such registers help to safeguard the Identification in science and medicine, with each typically public by allowing anyone to search them and University of Dundee learning the other when they go on to specialise check that practitioners are registered and meet Dow Street in medical illustration. While there is no legal the required standards. It is also possible for Dundee, DD1 5EH requirement in the UK or elsewhere to undertake concerns to be raised against a registrant and [email protected] specialist or accredited programmes, it is ultimately for actions and sanctions to be taken generally regarded as best practice. In the UK, where necessary. Most professional bodies also medical illustrators are encouraged to join the produce guidelines in terms of professional Abstract Academy for Healthcare Science (AHCS) practice and ethics. The IMI, for example, This paper provides an overview of Medical Illustrator Register, which requires the provides a large number of guidelines to their contemporary medical illustration; the role of completion of an accredited degree programme. membership on topics as diverse as; patient the modern medical illustrator is examined, Similarly, in the US, the Commission on Accred - confidentiality, working with transgender including who they are likely to work for itation of Allied Health Education Programs patients, cultural diversity, and the ethical use of and with, as well as the range of media (CAAHEP) accredits a number of medical social media (to name just a few). These are of and technology employed. The various illustration programmes in North America. utmost importance as this is a profession whose applications of medical illustration are It should be noted that in the UK, medical members often have direct access to patients described with a focus on looking at how illustration is an umbrella term for both medical and/or their data. An understanding of the these are likely to change and develop in the photography and artistic illustration, which is responsibilities and laws around subjects such as near future. also referred to as medical art. For the purposes data protection and anatomy legislation are of this article, the terms medical illustration and therefore essential. medical illustrator will be used in place of art and Medical illustrators work for a variety of The modern medical artist. employers including organisations such as illustrator There are several professional bodies that various governmental health services, private “As art reflects culture, scientific illustration medical illustrators can join, such as the hospitals, medical schools, research institutions, reflects the findings of science and tech nol - Association of Medical Illustrators (AMI) in the publishers, as well as specialised medical illus - ogy. Science illustrators are artists in the service US and the Institute of Medical Illustrators (IMI) tration companies. More recently, medical of science. They use scientifically informed and Medical Artists Association (MAA) in the illustrators are also being employed by e-learning observation, combined with technical and UK. There are many advantages to joining a companies, software and app developers, and aesthetic skills to accurately portray a subject. professional organisation, including the sense of even VR developers. In addition, a sizeable Accuracy and communication are essential.” community and networking that comes about proportion of the profession is self-employed, Guild Handbook of Science Illustration, through conferences and regional meetings. Such working with clients such as medical profes - ©GNSI 1989, 2003 face-to-face events also provide opportunities for sionals and publishers directly. 6 | March 2020 Medical Writing | Volume 29 Number 1 Erolin – Medical illustration in the 21st century and beyond Media and technology Traditional media Despite the proliferation of digital media, many medical illustrators still incorporate traditional media into their work. Those who use traditional media for all or a part of their work, often cite a preference for it because of the tactile feedback it can provide along with certain effects that can be difficult if not impossible to replicate with digital media. In addition, using a medium such as watercolours can be beneficial when depicting partic - ularly graphic or sensitive material as it can “soften” the image and make it less disturbing, especially for a lay or patient audience. Medical illustrator Joanna Culley frequently uses both watercolour and pencil media in addition to digital. Figure 1 shows an example where the client requested the illustration be created in pencil so it could be used within an animation to “reflect a softer look and ‘feel’ to the illus trations… Graphite pencil was the preferred choice to depict the properties of the intrauterine birth control device and the insertion procedure along with the female anatomy so that it would seem more appealing to the Figure 1. Illustration by Joanna Culley, demonstrating the use of graphite pencil to depict the IUD and its patients watching the animation.” 1 insertion procedure along with the female anatomy in a style that would be more appealing to patients watching the animation 2D digital illustration and animation Two-dimensional digital illus tra - tions are the staple work for many medical aid in highlighting important features. e-books and iBooks, as well as in interactive PDF illustrators. They can be produced in a variety of documents. In addition, they can be used as styles and at different levels of realism for various 3D digital modelling and animation ‘assets’ (i.e., individual components that can be target audiences. They can range from simple Over the past two decades, there has been a re-purposed) when creating animations or black and white line illustrations to full-colour proliferation of 3D software enabling the creation educational games and applications. They can be realistic depictions, or even cartoons and “graphic of complex 3D models and animations. 3D viewed and interreacted within virtual reality medicine” comics. 2 models can either be based on scan data, such as (VR) and even 3D printed. In addition to 2D illustrations, 2D animations magnetic resonance imaging (MRI), computed 3D animations are very popular and, when are also useful for conveying information that tomography (CT), and surface scans or created done well, have the potential to convey a large does not require 3D spatial relationships, or for from scratch within the software itself. 3D digital amount of information in a short space of time. conveying complex concepts in a simpler models have a range of uses; they can be They are particularly useful for topics that require manner. Animations (both 2D and 3D) are best embedded as interactive models (that allow the an understanding of 3D spatial relationships and combined with a voice-over (as opposed to user to rotate, zoom, and read annotations) in for which a narrative or a sequence of events is subtitles) as this can help guide the narrative and webpages, virtual learning environments, important. www.emwa.org Volume 29 Number 1 | Medical Writing March 2020 | 7 Medical illustration in the 21st century and beyond – Erolin Applications of medical resources, medical illustrators work closely with website, etc.) to use for patient information, the illustration subject area specialists in order to understand the medical illustrator needs to consider who the Medical and anatomical education key learning objectives that need to be target audience is, i.e., adults, children, the elderly, Medical and anatomical education is one of the communicated. Medical illustrators working in visually impaired, etc., since this may affect both primary applications of medical illustrations. medical education should also the format and style chosen, as well 6 Traditionally, medical illustrations have featured have a good understanding of the In terms of what the as the level of detail provided. prominently in anatomy and medical textbooks. research surrounding learning styles It could even be argued that some of these books and theories in order to apply these future holds for Other applications (such as Vesalius’s De humani corporis fabrica ) are to their work. medical illustration, In addition to the two primary known more for their artwork than for the New technologies such as one of the major applications described above, other accompanying text. Such textbooks are still a virtual and augmented reality have drivers will be types of applications also use mainstay of medical education, featuring modern also made their way