A/D/O by MINI | Body language: the rise of biomedical visualization

Body language: the rise of biomedical visualization

The quiet, yet revolutionary, field of biomedical visualization allows medical illustrators to communicate universally through specialist imagery.

From Leonardo Da Vinci to augmented reality, the visual depictions of medicine and the complexities of the human body have evolved immensely, due in part to the growth of parallel design industries – illustration, graphic design, animation, 3D modeling and software engineering – as well as research advances in the fields of ethnography, psychology, and of course, medicine. Artists since the time of Da Vinci have continuously lent their hand and talent to the depiction of medical environments and phenomena, and today, thanks to advanced rendering tools and visualization techniques, medical imagery has the ability to empower and engage its audiences in completely new ways, while communicating complex happenings in ways that are easier to digest and respond to.

Da Vinci is considered to be the first medical illustrator in the contemporary sense, though early instructional illustrations of anatomy, surgery, obstetrics and medicinal plants date back to Hellenic third century BC. Since then, regularly edited anatomical atlases have become incredible resources for studying the evolution of medical visualization across centuries. Today, illustrators continue to update these great compendiums – such as Grant’s Atlas of Anatomy, which stems from the University of Toronto – with more accurate and digestible imagery, by applying compiled findings from years of student and faculty research, prototyping and fine tuning.

The field of biomedical visualization is not as widely known as traditional medical careers, but it is a perfect destination for both young scientists with an artistic flair, and young artists with a desire for a data-oriented career path. Accredited programs have been around to offer specialized courses for many years. Nicole Ethen, a recent graduate of the Biomedical Visualization Graduate program (BVIS) at the University of Illinois in Chicago, remarked that the program is close to celebrating its 100th anniversary. In fact, at the time of the first graduate in 1921 – a woman named Mary Dixon Elder – the course called itself the “Academic Program of Medical Illustration.”

Leah Lebowicz created this illustration to show fetal blood circulation in the placenta

The programs balance out design theory and data visualization with graduate-level science courses, that include “full cadaver dissection, pathology, neuroanatomy, molecular biology,” explained Jodie Jenkinson, an associate professor and the incoming director of the University of Toronto’s Master of Science in Biomedical Communications. The UofT program was born in the 1940s as a certificate program to train medical illustrators and developed from an undergraduate to a graduate program over the years, largely powered by women at the university.

With Science Vis Lab, Jenkinson’s research focuses on improving the communication of complex molecular environments to undergraduate students, which she evaluates thanks to attention cueing devices and visual complexity thresholds. “In a textbook, illustrations of cells are simplified and water is empty space or gel,” she said. “Simplification communicates structures but generates misconceptions about the organization [when] it’s actually chaos and rapidity.” In this case, videos and 3D animations can be a helpful solution.

Using iterative design and advanced representation techniques – think ZBrush, Maya, AfterEffects for visualizations, as well as Unity, Leap Motion Controller and 3D printing to create gaming environments, simulations and interactive setups – biomedical visualization artists create improved renderings on the topic of medicine, making them more comprehensible and educational for the eye and the brain. The subjects range from anatomy, cell biology and embryology to more narrative-driven visuals such as surgical procedures, biological phenomena and interactive environments. From UoT, Ashley Hui’s Masters Research Project, Spine Sim, built an anatomically accurate three-dimensional model of the thoracic and lumbar spine on which one could practice performing neuraxial anesthesia. Brendan Polley, also from UofT, developed an application with a distinctive “mouse/touch-free interface that allows students with filthy hands in the dissection lab to manipulate teaching aids.”

Lebowicz's illustrations of embryos, based on Stephen Gilbert’s Pictorial Human Embryology

Following the methodology of iterative design, the majority of the designers’ work consists of research: from finding accurate, expert resources and understanding the target audience, to determining the pertinent information and learning goals of the final design object. Understanding the learning goals of a visual item determines whether the end product should be static or dynamic, how it should be labeled, and how complex it should be in terms of the amount of information it presents. “Audience is key,” said Ethen, outlining that there might be “more creativity when addressing a lay audience,” but that there is also “more of a challenge to bridge the gap” between finding a new way to portray something and not overwhelming the receiver with information.

Biomedical visualization artists have the power to build more comprehensive educational resources, particularly for people with literacy issues, who are instead great visual learners. “We had the advent of photography and technology,” concluded Ethen, “so why are textbooks not full of pictures,” when a simplified image is the best tool to point out important information for early learners.

Medical visualization also raises questions of inclusive representation. In the context of patient education, it is valuable to portray a figure that bears similarity with the target audience, in order to facilitate the clear transmission of information and to respect the sensitivity of those directly and indirectly concerned with the health condition in question. Ethen cited the common error of medical illustrators rendering eyes with blue irises – when the majority of the population actually has brown eyes – and the issue is equally perceived in the standardization of body morphologies. The conceptualization of medical visualization is most accurate when the process is localized so that it can be adapted to regional language preferences, as well as physical and genetic archetypes.

Nicole Ethen's work includes renders of microscopic anatomy, like this chromosome

The field of biomedical visualization is striving to make itself better known, by engaging with students at a younger age – through educational visits to high schoolers to present the profession – as well as participation in conferences to raise awareness on industry-wise conversations. “Medical conferences need to include us,” claimed Leah Lebowicz, Associate Program Director for UIC’s BVIS, “so we’re not just seen as service providers.”

Lebowicz’s practice and research focuses on 3D modeling, particularly in the study of embryology. At UIC, in addition to teaching software courses, she directs a class on visual learning and visual thinking. This course trains students to experiment with story-telling mechanisms, audience profiling and persona building. Whether the target is a physician, a client, a student or the general public, the information in the final visualization, and the medium in which it is created, will vary accordingly. The communication of medical information can be done visually at a 2D or 3D scale – with anything from a line drawing to a sculpted model – and can also be animated with movement in a video or immersive environment where audio can be inserted. As teaching and learning methods evolve towards a more digital classroom, new mechanisms are introduced to enhance the attractiveness of scientific subjects, from smartphone applications to virtual and augmented reality.

This screenshot was taken from Ethen's animation representing Nephrotic Syndrome – a kidney disorder

Though quiet, the field of biomedical visualization is buzzing with innovations globally, with researchers like Gael McGill who built a specialized plug-in and molecular toolkit to help designers in their work (Clarafi), Stockholm entrepreneurs imagining a planetarium project to explore the brain (Neurodome), and the great collaborations made possible by open source platforms. As the population of trained biomedical visualization artists expands, and as subjects they are working on become more mainstream to the general discourse of medical practice, their ability to impact how we think about and visualize our body will surface an empowering message for science.

Text by Chloé Vadot.

Main image copyright Naveen Devasagayam, Science Vis Lab.