From data-driven illustrations to gamified neuron mapping

Émilie Lacharité is Digital Content Editor at CMAJ and a graduate of the Biomedical Communications program at the University of Toronto

I attended the Association of Medical Illustrators’ (AMI) conference in Atlanta, GA, last week. Atlanta is home to Emory University Hospital (and its Ebola experts), the Centers for Disease Control and prevention - CDC - (where we can turn if there’s a zombiepocalypse) and the Coca Cola Headquarters Museum (where you go if you’re in the mood for serious brainwashing).

The members of the Association of Medical Illustrators work in a large variety of specialties. There are professors and lecturers, freelancers, researchers, animators, interactive storytellers, illustrators, virtual-reality developers, sculptors and so on. We all have the same goal: to visualize medical concepts.

The conference kicked off with Dr. Jay Varkey, infectious disease specialist and assistant professor at Emory University Hospital. He recounted the difficult times during which Emory’s Serious Communicable Diseases Unit received and treated the first two Ebola patients to arrive in the United States. Dr. Ian Crozier, one of the two patients and a physician himself, experienced multiorgan failure and had to be placed on a ventilator to help him recover. After “40 days and 40 nights” he was discharged from the hospital and declared free from the virus.

Dr. Varkey explained, however, that Dr. Crozier went on to have many residual symptoms, including vision problems like acute uveitis, vitritis and heterochromia (his eye colour in one eye went from blue to green). Eventually, Dr. Varkey and his team discovered that the ebola virus was not completely gone. In fact, it was hiding in plain sight. The virus had persisted in the eye, one of the organs that is effectively sheltered from the rest of the immune system.

Normal and Ebola-positive eye. Illustration by Michael Konomos.

Normal and Ebola-positive eye. Illustration by Michael Konomos.

To help visualize the various symptoms of the eye and help, eventually, to relate them back to the persisting Ebola virus, Michael Konomos, member of the Emory Visual Medical Education Team, developed an illustration for the medical team.

Next up, Issac Evans, chief of the Graphic Services Branch at the CDC , explained the role of his 60-strong team during a public health crisis. The so-called emergency risk communicators at the CDC often need to provide visuals in a very rapid timeframe. Oh, and they need to be scientifically accurate, engaging, informative, and culturally appropriate. Again, the Ebola crisis was centre-stage. Evans explained that at the height of the epidemic, his team was asked to work with partners such as the WHO to develop a full set of illustrations depicting symptoms of Ebola. These were used in African villages as educational resources.

The team on call that weekend (they have on-call illustrators! Seriously.) produced 24 illustrations, some of which are shown here. The full set of illustrated symptoms is on the CDC website.

Ebola symptom: bloody nose. © CDC

Ebola symptom: bloody nose. © CDC

Ebola symptom: skin rash. © CDC

Ebola symptom: skin rash. © CDC

Ebola symptom: vomiting. © CDC

Ebola symptom: vomiting. © CDC

3D printing is being used more and more for surgical planning and education. Laura Swan Roy, a recent graduate of the Johns Hopkins University Art as Applied to Medicine program, explained how she used CT, MRI, and echography data of congenital heart defects (CHDs) to produce 3D-printed heart models used to inform nervous parents about CHDs. As part of her graduate research, she developed a workflow protocol that could be used for other anatomical structures.

Dr. Ian McGilvray, transplant and hepatobiliary surgeon at Toronto General Hospital, collaborates (and is editor) with TVASurg, the Toronto Video Atlas of Surgery. He presented on the value and insight gained from the collaboration between surgeons and biomedical illustrators and animators. The visualizations allow him to plan tricky surgeries better and to learn from his mistakes.

Screen shot of video showing extended left hepatectomy for hepatocellular carcinoma. Copyright: Toronto Video Atlas of Liver, Pancreas and Transplant Surgery

Screen shot of video showing extended left hepatectomy for hepatocellular carcinoma. Copyright: Toronto Video Atlas of Liver, Pancreas and Transplant Surgery

In her talk Dr. Linda Lee, pediatric urologist from Victoria, BC, explained that she discovered the value of drawing and sketching when she was a resident trying to learn complex reconstructive surgical procedures. She now collaborates with the faculty at the Biomedical Communications program at the University of Toronto, and researches the benefits of getting medical residents to draw in surgical education. You can follow her adventures on her blog.

The anatomy of the spinal arterial supply at the neural foramen illustrated by Lydia Gregg

The anatomy of the spinal arterial supply at the neural foramen illustrated by Lydia Gregg

A big theme of the conference seemed to be data-driven illustrations. Research by Lydia Gregg and Jackie Kustan offers an example of this. Along with colleagues at Johns Hopkins, they have been studying the in vivo anatomical relationship of arterial supply and the vertebral column. Using spinal digital subtraction angiography data (a radiological procedure) and 3D flat-panel catheter angiotomography data, they illustrated the most likely location of the intersegmental arteries and other vascular supply of the spine. They hope this work will help with understanding areas susceptible to vascular injury, and anatomical shifts in aging. Jackie Kustan published her findings as part of her graduate thesis.

Still on the topic of using data to visualize anatomy, we heard from a group at Princeton and MIT who are literally revolutionizing neuroscience. Amy Sterling talked to us about Eyewire, a 3D puzzle game played by over 250,000 gamers all over the world. The goal is to build actual neurons of the brain. Neuroscientists have access to more data than they have ever had before, but were falling short in their big-data analysis of the brain's billions of neurons. Eyewire, with their game, is crowd-sourcing the data analysis portion and allowing gamers to contribute to a meaningful project.

Eyewire, A Game to Map the Brain.

Eyewire, A Game to Map the Brain.

We also heard about research happening at Science Vis Lab in Toronto. Students there, along with principal investigator Jodie Jenkinson, are investigating misconceptions in life sciences education and studying how visuals can help reshape those misconceptions. For example, many students have a hard time grasping the concept of random molecular motion. They think that insulin magically beelines toward its receptor, when in fact, the motion is random. The students at the Science Vis Lab are researching how best to use animations to break misconceptions such as this one.

There were so many more great talks, too many for one blog post. From data-driven illustrations to gamified neuron mapping, the Association of Medical Illustrators' conference showed once again that at the intersection of research, medicine and artistry there are many talented individuals helping to advance scientific knowledge.

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