Story by Madi Kirkman
Photography by Claire Jessen
Graphics by Bonnie Zhang
One UNC-Chapel Hill medical resident is researching a Saran Wrap-looking membrane at the base of the brain called the lilliquist membrane. It is tucked under the temporal lobes and basically invisible. The other residents struggled to visualize it outside of a textbook.
Enter the Department of Neurosurgery’s medical illustration team. The group made an interactive visual of the structure to help residents see it from any perspective. To them, it was a fun challenge.
This advanced teaching technique is just one example of how medical illustrators like Mark Schornak and his team can act as visual translators, drawing on their in-depth understanding of both medicine and art to simplify ideas for doctors and patients.
“The medical terminology and the complexities of anatomy and procedures, we have so many billion words,” Schornak said. “The main purpose is just to simplify understanding, to cut through all that, show me what this is about.”
More recently, Schornak’s team helped Vibhor Krishna, UNC-CH associate professor of neurosurgery, create visuals for his landmark study examining a noninvasive treatment that targets soundwaves at a specific area of the brain to help patients with Parkinson’s Disease.
For the project, the team created a “through-the-head” view of a patient that showcases the liquid-filled helmet used in the treatment. They also helped researchers convey the study’s message visually by illustrating the anatomy of a specific part of the brain called the globus pallidus.
“Then the team also created an animation showing you how the ultrasound beams converge together into this target in the brain,” Krishna said.
The materials were all part of a UNC Health press release and were included in an informative video on the procedure.
Krishna said medical illustrations can help an audience understand the nuances of treatment. They can also teach neurosurgeons themselves.
“We all grew up, a lot of us at least, learning from Mark’s illustrations,” he said.
Schornak grew up learning from someone else.
“If you ask any physician to name the medical illustrator who taught them the most, the answer is likely to be Frank Netter,” Schornak said.
Netter’s daughter, Francine Mary Netter, authored a biography of her father and his career, “Medicine’s Michelangelo: The Life and Art of Frank H. Netter, MD”.
Netter learned a lot about medical illustration from her father’s work that Schornak’s team must also be aware of, including what an illustration can offer that a photograph cannot.
“The camera creates a true image, but it doesn’t know a vein from a nerve or a sinew or an artery. It doesn’t know these things” Netter said. “But an illustration can emphasize one thing and fade out another part of it depending on the message of the picture.”
However, photography does play an important role in the process of developing medical illustrations. For example, Kurt Nolen, a medical photographer and videographer on Schornak’s team, often captures detailed images to serve as reference material for the rest of the team’s illustrations or models.
“Figuring out on their end how to accurately show the anatomy while not making it overly anatomically complex to communicate specific things, it’s really fascinating,” Nolen said.
While creating the materials for Krishna’s recent study, Nolen worked closely with Schornak and Xian Boles, the team’s 3D medical animator.
“Just very involved, collaborative teamwork effort on that, and it was fun to dig into my coworkers’ skillsets and come out with something collectively that we were also happy with,” Nolen said.
In addition to press release materials like the team created, illustrations can be used for doctors in journal articles and workshop or meeting presentations. They can also help educate patients.
“If you’re that patient and you’re coming in for a procedure, you may care partly about that stuff that was published, but what you really care about is, ‘What are they going to do to me?’” Schornak said.
Another role of a medical illustrator is to provide visual instructions for patients and their families for care after surgery, which Schornak said must be clear.
Medical illustrations also appear in publications like textbooks, but this brings new challenges for illustrators as they shift to digital formats.
Kimberly Moss, the director of the Biological/Pre-medical Illustration Program at Iowa State University, said recent and rapid advances in both science and information make visual communication critical. In the courses she teaches, students still do traditional pen and ink projects, but she blends in digital technology too.
“There is tremendous power in visual communication, and so I think this is just going to become more and more important as the modes of communication continue to increase,” Moss said.
For Schornak, that means shifting from pen, pencil, ink and watercolor illustrations to Photoshop and 3D computer modeling. The School of Medicine is also in the process of building a virtual reality lab that will incorporate models from the animations Boles creates.
“We hope to be able to take our models that she is making and go over there and put on the headset and you can explore the anatomy,” Schornak said. “You can be a couple of people with the professor and you can be in the middle of the brain and be looking around at the different structures inside it.”
A difficulty for Schornak arises when he’s developing visuals for a cutting-edge neurosurgical advance because it often means less reference material for him to use in the illustration process. He faced this exact issue as he developed materials for Krishna’s research.
“Sometimes you can go and look up patents for things and figure it out that way,” he said. “In this case, I did some sketches and sent them to the company that manufactured it.”
Despite the challenges, Schornak’s team gets to witness amazing medical science and technology like the noninvasive treatment for Parkinson’s Disease every day. And when an article with their illustrations is accepted for publication, there’s excitement in the air and high-fives all around.
“It is an even greater thrill when my illustration is singled out of many and honored by the editors by being selected to be the cover art of a journal or textbook,” he said. “It represents our authors and institution on the national stage.”
Schornak ultimately sees his work as a privilege, getting to translate science into artwork that is going to train surgeons and ultimately save lives.
“It makes a person feel like they are contributing something useful to the world,” he said.
