Left Brain, Right Brain
Issue: Edition 2 2020

Left Brain, Right Brain

In the early part of the year, COVID-19 struck, and struck hard and fast. In a matter of a few months, this novel coronavirus infected close to 4.7 million people in the US alone, killing 160,000 of them as of early August, and those number continue to rise with each passing day.

Indeed, this microscopic monster has impacted the lives of people around the globe in ways we could never have imagined. And yet, it's safe to say that most of us have never seen this virus, although all of us can instantly recognize it on sight, thanks to the work of medical illustrators and animators. These specialized artists use illustrations and animations to help the medical community as well as scholars and the public accurately communicate complex information, and in the case of COVID-19, put a "face" to this invisible infectious agent.

The work requires significant education and training, both in the medical/science fields and in the arts - a left brain/right brain profession requiring a very specific type of skill. Here we look at three medical illustrators and how they are using the same type of 3D tools and techniques employed by filmmakers and others to ply their craft.

Medical animators Alissa Eckert and Dan Higgins of the CDC created this image of the COVID-19 virus.

Alissa Eckert and
Dan Higgins, CDC

Alissa Eckert and Dan Higgins are both medical illustrators at the CDC in Atlanta, and it was their work that led to the image of COVID-19 that is seen everywhere, from the covers of magazines, to charts and graphs used by medical experts, to the nightly news broadcasts.

Eckert initially planned to become a veterinarian, but has always taken art classes for fun. She started out studying biology for a few years and then switched to scientific illustration, an interdisciplinary study that combines science and art, after discovering that she could combine both those interests into one profession through medical illustration. She looked into it as a career and determined it was for her. She eventually earned a master of science degree in medical illustration, having had to complete classes alongside medical students, in addition to art classes that focused on illustrating scientific information. Right out of school, she began working at the Centers for Disease Control (CDC), where she has been employed for 14 years now.

For her colleague, Dan Higgins, his interest in art guided him into this career. He was working as a graphic designer until an interest in science led him down the road to a master's degree in medical illustration. He began his new career as a medical illustrator with WebMD before he migrated to the CDC, where he has been employed for the past 18 years.

"We're kind of like translators for the scientists when they're communicating with the public," says Eckert. "We take complex scientific information and turn it into visuals that people can easily understand." This could pertain to a wide range of topics at the CDC - from viruses and bacteria, to tuberculosis, AIDS, cancer, chronic health conditions, birth defects, and so much more.

While the work can be geared toward the general public, the two artists also do graphics, illustrations, and animations that are intended for the scientific community, including physicians and scientists on staff at the CDC for lectures, journal articles, and presentations, where they are conveying the information to fellow scientists and researchers.

Just as the subject matter is diverse, so, too, are the image formats used: 3D, 3D with animation, 2D and 2D animations, illustrations, 3D printing, and more. Eckert and Higgins use Autodesk's 3ds Max as their primary 3D software, along with Pixologic's ZBrush. They also utilize Adobe's Creative Suite as well as a number of plug-ins, including those from Red Giant (which now merged with Maxon) and Video Copilot.

The artists additionally employ specialized software called Chimera, an extensible modeling system for the interactive visualization and analysis of molecular structures and related data, including density maps, trajectories, and sequence alignments, from which high-quality images and movies can be made. Chimera is developed by the Resource for Biocomputing, Visualization, and Informatics (RBVI) at the University of California, San Francisco.

According to Eckert, she uses 3D as much as possible, which eases the workflow. "I find the process much faster, especially when small changes have to be made," she notes, whereas in the past when they were producing more hand-drawn illustrations, changes were time-consuming. In addition 3D, these medical illustrators have been utilizing 3D printing in their work, output on a 3D Systems' ProJet 460Plus or a FormLabs printer.

Eckert recalls making a 3D printed model a year ago that was used to train physicians in countries where a specific birth defect was prevalent, to teach them how to take accurate measurements. "It's a life-size model, so they can practice measuring techniques, which involves a very specific process," she explains. Other 3D printed models of viruses and so forth have been used for informational and educational purposes, sometimes for a conference or lecture.

"The tactile experience [from a 3D-printed model] really helps people learn about the structures," Eckert adds.

When the work involves an animation, the artists will consult with scientists throughout the project, making sure the science is accurately depicted.

Some projects take quite some time to complete. But, when COVID-19 struck so quickly, Eckert and Higgins had just one week to come up with an image for the virus. "We had to drop everything we were working on to focus on this one project," says Higgins, noting that in a typical scenario, the work would have taken at least three weeks of back and forth with the scientists. "We were granted access to the scientists much faster, and they were able to guide us on which proteins we needed to include and the quantity of the protein."

At the CDC, medical animators use a range of DCC software for their work.

In this instance, it was important to grab the viewer's attention. "This was a public health emergency, and we needed them to pay attention to this topic and hopefully go to the CDC's website to learn more information," explains Eckert.

In addition, the two medical illustrators were putting a face to this virus, taking something that is unfamiliar and invisible, and bringing it to life so people would realize that it is real and that it does exist. "We wanted people to take this seriously, so we created it in a certain way," adds Higgins. To this end, the artists created a gray sphere and then added bold red S-proteins - spiked proteins (which attach to a cell) that are a signature of the coronavirus and enable it to be identified and recognized.

"You would see a similar shape when you look at it on the electron micrograph, though they [the virus] are always kind of fuzzy and hard to read. We're just making it more clear, because they are really, really tiny," Eckert says.

The main goal in this case was communication, and as such, the artists had to balance the colors so that the image was bold, vibrant, attractive, and noticeable without being too playful, so it would be taken seriously without scaring people. "We wanted people to look at the image and become interested in it," says Eckert, noting she and Higgins created a number of variations of the image before settling on this very popular graphic.

"We were intending it to be an educational opportunity, and it just blew up. I never thought it was going to do that," says Eckert of the image's widespread popularity.

Higgins agrees, adding, "We've seen our work out there before, but this just exploded. I even saw it on SNL, which was pretty crazy."

Veronica Falconieri Hays, Falconieri Visuals

Veronica Falconieri Hays is a certified medical illustrator specializing in medical, molecular, cellular, and biological visualization, encompassing still media and animation, at her company, Falconieri Visuals, based in the Washington, DC, area.

Falconieri Hays received her undergraduate degree in biology from Smith College, with a minor in art, before earning a master of art degree in medical illustration, "which covered a lot of the basics of how to create accurate illustrations and the general techniques that are used in a lot of the medical and scientific visualizations today," she says.

After graduating in 2014, Falconieri Hays worked at the National Cancer Institute as an illustrator and animator before launching her own company in 2017.

In order to become certified in this field, Falconieri Hays has to meet continuing education requirements and pass an exam by illustrating art, medical, and business knowledge.

"Everything I do translates scientific information, research, understanding, and concepts into visuals. This means doing a lot of research and having a fair amount of literacy in the underlying concepts, and then adapting that visually to the appropriate audience, whether to experts or the public," she explains. "It's about making that connection between complex ideas and translating it visually to the right audience."

Naturally, Falconieri Hays was always interested in both science and art, and heard about this field while she was in high school. "When I was pondering my future career and college choices, I initially thought that I either had to choose science or art. Fortunately, I heard about medical illustration and realized it would enable me to incorporate both into a career," she notes.

Falconieri Hays' client list comprises communications agencies that work with biotech companies which have complex science they need to explain to investors, for instance. Others are researchers and scientists themselves who need help with visuals to explain the work on a research project. She also produces imagery for publications, such as Scientific American (a recent issue cover image and main article image contains an illustration the artist did of SARS-CoV-2, the COVID-19 virus, in 3D).

Depending on the audience, the imagery can be scientifically precise, or such that Falconieri Hays can play with scale or use metaphor. It just has to be clear and understandable to the audience for which it is intended.

"I focus on molecular and cellular visualization, using 3D," Falconieri Hays says. In particular, she employs Maxon's Cinema 4D - which she learned in grad school - because "it has a plug-in, ePMV, that allows me to directly pull molecular data. I also use [Pixologic's] ZBrush for organic modeling."

Once the modeling and animation is completed, Falconieri Hays uses various Adobe tools "to bring it together." Rendering is done either with the Cinema 4D's standard renderer or with the Redshift renderer, depending on the look she is going for. For compositing, she uses Adobe After Effects.

When creating her work, Falconieri Hays will spend a great deal of time collaborating with scientists and researchers, who will identify the scientific concept and story they want to convey, as well as their audience for the project. They will also identify the format they need, whether it's video or still images. Then she begins sketching with pencil and paper. Once the client agrees that all the important points are covered and correct, she begins the creation process, whether it's in 3D or 2D.

Medical illustrator Veronica Falconieri Hays created this image of the SARS-CoV-2 virion, the COVID-19 virus, in 3D.

As the recent pandemic was developing, Falconieri Hays, along with colleagues at the Association of Medical Illustrators, created a shared reference document, which included an illustration summarizing the 3D structural features of the SARS-CoV-2 Spike (S) protein structure (SARS-CoV-2 is the virus that causes COVID-19). "Research was coming out so fast; it's a lot to keep track of. So, we decided to collaborate and help one another by crowd-sourcing a lot of our reference to help medical illustrators as a whole," she explains. "And because I have a particular expertise in the 3D molecular structure, I wanted to create something to give back to my colleagues if they were asked to visualize the spike protein, for example. This way, they'd have a better understanding of how it works because it's pretty complicated."

For this particular illustration, Falconieri Hays looked closely at the 3D structure of the spike proteins, which are the hook-like pieces that project out from the surface of SARS-CoV-2. This work required a great deal of research. In fact, out of the approximately 27 hours it took for Falconieri Hays to do the project, at least half of that was spent conducting research, "just making sure I understood the basis of the virus structure and the unique details about the spike structure, because it's a target for vaccine development," she explains. "It's an area that an antibody, for instance, could bind to and block the virus from interacting with human cells."

According to Falconieri Hays, animations are becoming a larger part of the work she is asked to do, often to show how a therapeutic works.

While Falconieri Hays may not be creating visuals for the next blockbuster, the work she does is extremely important. "I do a lot of illustrations that are scientifically communicating to other scientists, but I also do projects that are more public-based," she says. "It's really important having amazing visuals because the subject matter is so complicated. You're asking a lot of your viewer to step in and really take the time to understand the science you're communicating. If you attach an enticing visual to it, you get a little more buy-in. You can communicate more science to the viewer if you have a visual that hooks them and piques their interest."

Karen Moltenbrey is the chief editor of CGW.