The world now has a near complete genome map of the human species. This remarkable feat may facilitate cures for many life-threatening diseases, such as cancer and diabetes. Francis Collins, head of the Human Genome Project, said publicly, "We have caught a glimpse of an instruction book previously known only to God." To comprehend a topic as abstract as the human genetic code, one hopes for an instruction book full of colorful, 3-D pictures.

Since the earliest cave dwellers painted pictographs on the walls of their dwellings, people have communicated through the medium of art. Now, in the twenty-first century, illustrations or animations of spiraling, ladderlike DNA molecules accompany technical journals intended for scientists as well as explanations for viewers of the six-o'clock news. Pictures simply make concepts more visible.

The field of medical illustration bridges the disciplines of art, science, medicine, and communication. Medical illustrators create visual materials that communicate vital information to doctors, medical students, health educators, and patients who are better able to understand their conditions because of lifelike representations of the human body.

Illustrations are used to clarify complex anatomical, surgical, or scientific information involving 2-D images, 3-D digital images, computer modeling, animation, or an entire multimedia presentation. Illustrations may also demonstrate the interaction between the human body and technology. Consequently, biotechnology firms hire illustrators who give shape and substance to an engineer's vision, organizing for the human eye complicated biomedical devices. To create clear, informative images, medical illustrators must possess a thorough understanding of the subject matter.

History of the Profession

Evidence of medical illustration goes back to the beginning of recorded history. Scientific and medical illustrations have been found in the paintings, inscriptions, and sculptures of ancient China, India, Greece, Egypt, and Arabia. Perhaps the most famous medical illustration ever drawn is Leonardo da Vinci's Vitruvian Man, created about 1487. Leonardo has often been called the quintessential Renaissance man because as scientist, inventor, and artist he sought to understand and communicate the laws of nature through his unparalleled ability to create faithful renditions of life. His dissections, performed on expired prisoners or cadavers stolen from morgues, resulted in depictions of muscle and bone structures that defined the study of anatomy for the next several centuries. Leonardo once wrote: "The most praiseworthy form of painting is the one that most resembles what it imitates." This, above all, describes the mission of the medical illustrator, as true today as it was 500 years ago.

In 1894 Max Brödel, an artist at the Institute of Physiology at the University of Leipzig, Germany, was persuaded to join the staff of the Johns Hopkins School of Medicine in Baltimore, Maryland, as a medical illustrator. In 1911 he became the first director of the Department of Art as Applied to Medicine, the first school for medical illustrators in the world. During the twentieth century, graduates of the Johns Hopkins program trained new illustrators, and eventually new programs were formed.

At the beginning of the twentieth century, few hospitals and medical schools in the U.S. employed artists. Following World War I, a small number of artists were hired by medical institutions, although the profession as such was not fully established until after World War II when the Association of Medical Illustrators (AMI) was formed.

What Medical Illustrators Do

Today medical artists are employed by medical, dental, and veterinary schools; teaching hospitals, medical centers, and specialty clinics; research centers; private physicians; publishing companies; pharmaceutical and medical-device companies; advertising agencies; and law firms. Many illustrators form their own consulting companies, or they freelance.

Artwork is used for classroom instruction, professional journals, medical textbooks, television and film production, multimedia training materials, conference and lecture presentations, posters, exhibits, catalogs, medical and pharmaceutical advertisements, medical-device marketing literature, and patient education. Some medical illustrators design prostheses or anatomical replacement parts for plastic-surgery reconstruction. Renderings and animation are often used in courtrooms today to explain difficult medical concepts. Many personal-injury, medical-malpractice, and medical-product/drug-liability cases depend upon visual explications provided by medical illustrators, and experience has shown that visual props do sway juries and judges.

Medical illustrators use a variety of techniques, such as drawing, painting, and, more recently, computer modeling and animation, depending on the purpose of their artwork. Traditional media include pen and ink, watercolor, carbon dust, airbrush, acrylics, and mixed media; traditional techniques are often combined with computer-based renderings. Adobe Illustrator and Adobe PhotoShop are the most widely used digital tools, followed by QuarkXPress and CorelDraw.

Training Programs

To become a medical illustrator, an individual must have an aptitude for drawing and painting as well as a strong interest in science. There are a number of undergraduate programs in the United States; however, many medical illustrators have master's degrees from one of six programs in North America. The five accredited postgraduate training programs in the U.S. are those of the Johns Hopkins Medical School, the Medical College of Georgia, the University of Texas Southwestern Medical Center, the University of Illinois at Chicago, and the University of Michigan. The University of Toronto offers the only accredited graduate program for medical illustrators in Canada.

All six schools offer two- to three-year programs leading to a master's degree in medical illustration. In addition to the standard admission requirements for entering any graduate program, an applicant must have a portfolio consisting of 15 to 30 slides that establishes artistic talent in a variety of modalities. An ideal candidate has a bachelor's degree in applied art and design, commercial art, or fine art, with a minor in biology or premedical sciences. Each program admits from three to twelve students each year, with admission rates that range from 16 to 30 percent of applicants.

The curriculum is evenly divided between art classes and science classes. Study of human anatomy, physiology, embryology, cell biology, neurobiology, and pathology is combined with art courses in medical/surgical/biological illustration, graphic design, 3-D computer graphics and animation, multimedia production, interactive computer-assisted instructional design, and photography. Students typically specialize in one specific area, such as prosthetics, 3-D modeling, or computer visualization.

Professional Certification

Since 1945, the AMI has provided professional standards and ethical guidelines for medical illustrators. The Medical Illustrators Board of Certification is the certifying body of the AMI. To become certified, graduates of accredited programs, or illustrators with five years of full-time employment, take a two-part examination consisting of a written examination and a stringent portfolio review. To be certified, medical illustrators must successfully complete a full-body dissection course or its equivalent in human gross anatomy.

Certification, however, is not required. Some artists see certification as a way to demonstrate their professional competence, while others see the certification process as an expensive and lengthy diversion once their careers are underway. According to John Nyquist, chair of the Board of Medical Illustrators, out of 805 members of the AMI, 232 are certified.

The Future of Medical Illustration

With ready access to affordable, high quality, anatomically precise medical art through software packages and the Internet, some institutions are downsizing their medical illustration departments and outsourcing their assignments. The Internet, however, opens up many opportunities for medical illustration firms and freelancers.

As consumers of medical services and devices become more involved in their medical care, in part because of the Internet, the demand for original illustrations that demonstrate key patient-care concepts is increasing. Because hip-replacement surgery, for example, cannot be photographed easily, illustrations are needed to convey the principles involved in illness and treatment.

Benjamin B. Broome, medical content director for Medical Legal Art in Atlanta, states, "We have seen an explosion of the types of companies looking to employ medical illustrators in recent years. It is a completely different market than it was a decade ago. I believe there are more opportunities available for today's graduates than ever before." The challenge, as always, is to link talented artists with those who need their services. One thing is certain: as long as scientists continue to expand the universe of knowledge, illustrators - as part of the scientific team - will be used to translate complex subject matter into comprehensible pictures that speak a thousand words in any language.