Medical Illustration Research Articles

Improving the educational accessibility of sinonasal and skull base anatomy: A novel virtual tool for otolaryngology trainees

AbstractBackgroundUnderstanding the complex three‐dimensional (3D) anatomy of the nasal cavity, paranasal sinuses, and skull base, is difficult but essential for otolaryngology trainees, especially for endoscopic techniques. There is no effective teaching tool at the junior resident or medical student level allowing visualization and manipulation of these structures in 3D.ObjectiveTo create an interactive 3D app modeling the sinus and skull base for use by junior trainees learning surgical anatomy.MethodsUsing Adobe Photoshop, Cinema 4D, and ZBrush, surgeon and medical illustration teams collaborated to develop a tool combining schematic representation of relevant anatomy with radiologic and endoscopic correlates. This was then incorporated into a web application. Twenty‐one junior residents and medical students were recruited to use the app, and pre‐and post‐app self‐assessments and experience surveys were conducted to assess didactic efficacy.ResultsWe created an online‐compatible fully manipulatable schematic 3D representation of the nasal cavity, paranasal sinuses, and anterior skull base that is capable of anatomic layering. This schematic is presented alongside representative de‐identified radiologic images and surgical principles with corresponding highlighted diagrammatic structures to demonstrate clinically relevant radiologic and endoscopic anatomy. There was a statistically significant improvement in anatomical knowledge in all 13 questions assessing didactic efficacy, with 85.7% of participants providing overall positive feedback.ConclusionsAcknowledging the didactic utility in an early validation study with junior trainees, this sinus anatomy teaching tool offers a low‐cost and highly accessible modality capable of demonstrating complex anatomical relationships to trainees learning sinus and endoscopic endonasal skull base surgery.

Anatomic maps of erogenous and aversive sensation zones of the breasts, vulva, and vagina: a questionnaire-based study.

Erogenous sensation zones (ESZs) elicit sexual pleasure upon stimulation. General ESZ maps exist, but they do not assess internal areas of the body, differentiate between individual structures, or quantify the importance of individual ESZs to sexual pleasure. Maps of aversive sensation zones (ASZs), or bodily areas individuals dislike having touched during sex, have not been described. To create detailed erogenous and aversive sensory maps of the vulva, vagina, and breasts, and assess the importance of each erogenous structure to sexual pleasure. An anonymous online questionnaire was administered to 441 sexually active cisgender women (mean age 48.9 ± 15.5years) from March to June 2020 via Qualtrics. Respondents selected ESZs and ASZs from anatomic illustrations and rated each ESZ's importance to their sexual pleasure. Respondents' reasoning for choosing each ASZ was queried. Heat maps of ESZ and ASZ selection frequency, ESZ importance ratings, and ASZ reasoning. More respondents selected ≧1 areas of the vulva as erogenous (82.0%), in comparison to the breasts (77.4%) and vagina (59.4%). The two most erogenous areas of the breast were also the most aversive: breast tissue (57.8% ESZ selection; 5.4% ASZ) and nipples (42.7%; 6.5%). Respondents most commonly reported these areas as aversive due to: "It's overly sensitive" and "It hurts."The most frequently selected ESZs of the vulva were the vaginal introitus (50.8%), periurethra (42.6%), and glans clitoris (41.3%). The top ASZs were the anus (34.0%) and perineum (7.9%), with primary reasons being: "It's gross," "It hurts," and "I'm ashamed/embarrassed."Of the five ESZs of the vagina, the superficial anterior (48.1%) and superficial posterior (32.9%) regions were the most selected. The cervix (6.8%), superficial posterior (5%), and deep posterior (3.4%) regions were the top ASZs due to "It hurts" and/or "It's overly sensitive." Erogenous and aversive sensory maps could help identify sexual concerns, inform preoperative counseling, and track sensory changes. This study captured detailed maps of internal and external ESZs and ASZs of the breasts, vulva, and vagina. Limitations include recall bias and inclusion of only cisgender women, rather than all people who share the same anatomy, irrespective of gender identity. Erogenous sensation was most prominent in the vulvar structures, including the vaginal introitus and glans clitoris, followed by the superficial surface of the vaginal canal. Aversive sensation associated with the anus primarily came from feelings of judgment and shame, while other ASZs were reportedly due to pain and sensitivity.

Surface Rendering of Cross-Sectional Imaging and Medical Illustration for Perinatal Planning in Conjoined Twins

Introduction: Surface rendering of diagnostic imaging data can reveal hidden conditions with an almost life-like realism. However, early gestation images alone are often insufficient to accurately predict postnatal anatomy. Yet, time-sensitive decisions may have to be made before detailed imaging becomes possible. In this case series, we evaluate how combining medical illustration with cross-sectional diagnostic imaging can enhance the accuracy and clinical value of early visualization of conjoined twins. Methods: Early gestation magnetic resonance imaging scans underwent semiautomated computerized post hoc manipulation to allow the medical illustrator to create the most effective images of the twins. Results: Four sets of conjoined twins were diagnosed before 17 weeks. Surface modeling allowed spatial manipulation of the twins to highlight their anatomic connections. Further volumetric enhancement and critical interpretation of the models assisted the illustrator in creating life-like, accurate images of the twins. These illustrations allowed parents to visualize the likely presentation at birth and helped the multidisciplinary team to plan postnatal management. Conclusion: Surface rendering and surface modeling can be combined with medical illustration to create realistic, informative images of developing fetuses, using a level of detail that is tailored to the intended audience. This may be particularly useful in visualizing complex anomalies like conjoined twins.

The impact of different radiology report formats on patient information processing: a systematic review.

Since radiology reports are primarily written for health professionals, patients may experience difficulties understanding jargon and terminology used, leading to anxiety and confusion. This review evaluates the impact of different radiology report formats on outcomes related to patient information processing, including perception, decision (behavioral intention), action (actual health behavior), and memory (recall of information). PubMed, Web of Science, EMBASE, and PsycInfo were searched for relevant qualitative and quantitative articles describing or comparing ways of presenting diagnostic radiology reports to patients. Two reviewers independently screened for relevant articles and extracted data from those included. The quality of articles was assessed using the Mixed Methods Appraisal Tool. Eighteen studies, two qualitative and sixteen quantitative, were included. Sixteen studies compared multiple presentation formats, most frequently traditional unmodified reports (n = 15), or reports with anatomic illustrations (n = 8), lay summaries (n = 6) or glossaries (n = 6). Glossaries, illustrations, lay summaries, lay reports or lay conclusions all significantly improved participants' cognitive perception and perception of communication of radiology reports, compared to traditional reports. Furthermore, these formats increased affective perception (e.g., reduced anxiety and worry), although only significant for lay reports and conclusions. Modifying traditional radiology reports with glossaries, illustrations or lay language enhances patient information processing. Question Identifying the impact of different radiology report formats on outcomes related to patient information processing to enhance patient engagement through online access to radiology reports. Findings Lay language summaries, glossaries with patient-oriented definitions, and anatomic illustrations increase patients' satisfaction with and understanding of their radiology reports. Clinical relevance To increase patients' satisfaction, perceived usefulness and understanding with radiology reports, the use of lay language summaries, glossaries with patient-oriented definitions, and anatomic illustrations is recommended. These modifications decrease patients' unnecessary insecurity, confusion, anxiety and physician consultations after viewing reports.

Integrating Art in Medical Visualization Techniques

The incorporation of art with medical visualisation techniques offers a significant improvement in the communication of medical information. Traditional methods of medical illustration were primarily concerned with anatomical precision, but introducing artistic aspects can expand knowledge, increase emotional resonance, and produce more effective visual storytelling. This study investigates how artistic principles such as composition, colour theory, and dynamic symmetry can enhance the clarity and effectiveness of medical images. Medical visualisation can go beyond simple representation by combining scientific rigour and artistic flair, resulting in a more profound link between the spectator and the medical facts, which improves patient understanding, physician communication, and educational outcomes. Case studies are offered to demonstrate the multidisciplinary approach’s potential, as well as the obstacles and opportunities it brings for future research. Keywords: Medical visualization, Medical illustration, Artistic integration, Data visualization, Visual communication in medicine

Practical Step-by-step SYNAPSE VINCENT Rendering of Three-dimensional Graphics in Horseshoe Kidney with Bilateral Varicoceles.

Medical illustration serves as a cornerstone for understanding intricate anatomical anomalies, with three-dimensional (3D) rendering emerging as a pioneering tool for emphasizing basic medical concepts and clinical practices. In Japan, the SYNAPSE VINCENT software package (SVSP; Fujifilm Medical Co., Ltd., Tokyo, Japan), internationally known as "SYNAPSE 3D," is a widely embraced solution for 3D rendering. However, despite its prevalence, resources elucidating its practical usage and offering insightful tips are scarce. In this review, we focus on the use of SVSP for 3D rendering of complex anatomical anomalies, particularly in the field of urology. We demonstrate a step-by-step process of 3D rendering. 3D rendering was performed in a sample case of a patient with horseshoe kidney and coexisting bilateral varicoceles through inputting of multiphase contrast-enhanced CT images into the application, followed by segmentation of the renal parenchyma, image registration, and segmentation of the arterial and venous systems as well as the upper urinary tract. Manual adjustments were made using the "Mask edit" and "Diameter setting" tools to ensure accuracy, particularly in cases of significant anomalies. Then, color-coded structures appeared, including the renal parenchyma, arterial and venous systems, and upper urinary tract, which provided a comprehensive visualization of the anatomical anomalies. This review highlights the effectiveness of the SVSP in visualizing complex anatomical abnormalities and detailing the practical rendering process, which could promote wider adoption of the application among urologists despite the challenges associated with the software.

Development and evaluation of an online training tool to aid in the diagnosis of chronic plaque psoriasis

AbstractBackgroundChronic plaque psoriasis (CPP) is underdiagnosed, undertreated and mistaken for other skin conditions such as eczema, tinea corporis and pityriasis rosea.ObjectivesTo develop and evaluate an online training tool to improve the diagnostic skills of nondermatologists for CPP.MethodsThe study involved: (i) developing an online training tool to improve CPP diagnosis by nondermatologists; and (ii) evaluating the performance of the newly developed training tool by conducting a before‐and‐after exploratory investigation. Participants included three groups of primary care health professionals: general practitioners (GPs); nurses; and pharmacists. The tool contained written recommendations for the diagnosis of CPP in different skin colours and a medical artist's illustrations of psoriasis to overcome the lack of representative images of the disease in skin of colour and to illustrate the salient features more clearly than clinical photographs.ResultsIn total, 60 participants completed the study (20 per participant group). The training tool improved participants' diagnostic skills for CPP. The diagnostic ability of GPs was, on average, higher than nurses and pharmacists before and after training. Participants found the training valuable and relevant to CPP diagnosis in primary care settings.ConclusionsOur findings show that a training tool, using medical illustrations, for nondermatologists can be beneficial in terms of recognition of CPP. This may lead to more timely diagnosis and treatment of psoriasis and support relevant and faster referral to specialist dermatology clinics.

Frontiers in Medical Illustration: From Netter's Naturalism to a Representation Revolution.

Netter’s oeuvre has been the go-to reference for generations of anatomy students and practitioners. His ability to depict diseases through the experience of everyday people makes his illustrations relatable, albeit largely focused on the white middle-class. While this he may have been a product of his era, we now recognize how a lack of representation in medical illustration leads to health disparities. An inclusive approach to visual communication promotes empathy, cultural humility, humanism – all qualities that make for better doctors.

Publisher's Comments

Welcome to the Journal of Biocommunication, the professional journal of the Association of Medical Illustrators (AMI) and the BioCommunications Association (BCA). This JBC, issue 48-1, represents our first issue of the 2024 publishing year. We would like to thank our Management Board, our editors, our advisors, and our authors for their contributions to the success of our Journal. We appreciate the ongoing support from our JBC community around the world. In particular, we acknowledge the support of the AMI and the BCA. It's a privilege to be chosen as the professional academic journal of these two organizations.

A comparative analysis to assess anatomical illustrations via three AI-Driven Text-to-Image generators

A comparative analysis to assess anatomical illustrations via three AI-Driven Text-to-Image generators

Mildred Codding (1902–1991): Neurosurgery Medical Illustrator at Harvard Medical School, Peter Bent Brigham Hospital, and Boston's Children Hospital

This historical account reviews the life and times of Mildred Codding (1902-1991) in neurosurgery and medical illustration. The writing of this project was sparked by the discovery of original scientific and bibliographical information about Codding, testimony on personal relationships, and viewpoints after comprehensive compilation of information. Mildred Codding learned the carbon dust technique from Max Brödel at the Johns Hopkins Hospital (JHH) (Baltimore, Maryland USA), and worked at Peter Bent Brigham Hospital, now Brigham and Women's Hospital (Boston, Massachusetts, USA). Codding was Dr. Cushing's medical illustrator, colleague, and friend. She provided photographs, diagrams, and sketches for the majority of Cushing's collection of intracranial tumors from 1929 to 1932. A 1991 interview of Codding was hosted by Brigham and Women's Hospital and Boston Children's Hospital for the permanent collection of the Archives of the American Association of Neurological Surgeons and provides additional photographs and insignia, drawings with pen and ink method, multi-stepped layering, and illustration implements. Importantly, the Brigham Surgical Alumni insignia showing a surgeon's hand with scalpel was modeled after Codding's left hand. Outside of the operating room, Codding's interests included Pediatrics, Zoology and Genetics, atlantes of surgical operations, teatime, and paint with watercolor, particularly seascapes, lighthouses and dunes. This article provides glimpses into the personality and marked influence of Mildred Codding on neurosurgery and medical education and adds to the growing literature on her person.

Assessment of Generative Artificial Intelligence (AI) Models in Creating Medical Illustrations for Various Corneal Transplant Procedures.

This study aimed to task and assess generative artificial intelligence (AI) models in creating medical illustrations for corneal transplant procedures such as Descemet's stripping automated endothelial keratoplasty (DSAEK), Descemet's membrane endothelial keratoplasty (DMEK), deep anterior lamellar keratoplasty (DALK), and penetrating keratoplasty (PKP). Methods: Six engineered prompts were provided to Decoder-Only Autoregressive Language and Image Synthesis 3 (DALL-E 3) and Medical Illustration Manager (MIM) to guide these generative AI models in creating a final medical illustration for each of the four corneal transplant procedures. Control illustrations were created by the authors for each transplant technique for comparison. A grading system with five categories with a maximum score of 3 points each (15 points total) was designed to objectively assess AI's performance. Four independent reviewers analyzed and scored the final images produced by DALL-E 3 and MIM as well as the control illustrations. All AI-generated images and control illustrations were then provided to Chat Generative Pre-Trained Transformer-4o (ChatGPT-4o), which was tasked with grading each image with the grading system described above. All results were then tabulated and graphically depicted. The control illustration images received significantly higher scores than produced images from DALL-E 3 and MIM in legibility, anatomical realism and accuracy, procedural step accuracy, and lack of fictitious anatomy (p<0.001). For detail and clarity, the control illustrations and images produced by DALL-E 3 and MIM received statistically similar scores of 2.75±0.29, 2.19±0.24, and 2.50±0.29, respectively (p=0.0504). With regard to mean cumulative scores for each transplant procedure image, the control illustrations received a significantly higher score than DALL-E 3 and MIM (p<0.001). Additionally, the overall mean cumulative score for the control illustrations was significantly higher than DALL-E 3 and MIM (14.56±0.51 (97.1%), 4.38±1.2 (29.2%), and 5.63±1.82 (37.5%), respectively (p<0.001)). When assessing AI's grading performance, ChatGPT-4o scored the images produced by DALL-E 3 and MIM significantly higher than the average scores of the independent reviewers (DALL-E 3: 10.0±0.0 (66.6%) vs. 4.38±1.20 (29.2%),p<0.001; MIM: 10.0±0.0 (66.6%) vs. 5.63±1.82 (37.5%), p<0.001). However, mean scores for the control illustrations between ChatGPT-4o and the independent reviewers were comparable (15.0±0.0 (100%) vs. 14.56±0.13 (97.1%); p>0.05). AI is an extremely powerful and efficient tool for many tasks, but it is currently limited in producing accurate medical illustrations for corneal transplant procedures. Further development is required for generative AI models to create medically sound and accurate illustrations for use in ophthalmology.

2276 IN REACH. It’s everyone’s responsibility. Improving inpatient access to food and drink.

Abstract Background ‘IN REACH’ was established, having identified a significant need to improve nutrition for cognitively and physically frail hospital inpatients, admitted to the Complex Medical Units (CMU) at the John Radcliffe Hospital. The IN REACH team includes the CMU multi-disciplinary team (MDT), representatives from patient and volunteer groups, caterers and medical illustrators. Introduction IN REACH identified that food and drink is often unreachable by inpatients. The project’s aim is to ensure food and drink is always within patient reach, improving nutritional intake, avoiding dehydration, reducing weight loss, reducing family anxiety, promoting independence and improving health outcomes. Method MDT members, patients and their families were engaged in the design. Baseline observational data included whether both food and drink were in reach and whether the patient had cognitive impairment. Interventions to be evaluated by Plan-Do-Study-Act (PDSA) methodology include: Focussed education, presenting observational data to MDT and catering team; raising awareness at daily MDT meetings, emphasising shared responsibility. Prompting by signage, physical and digital. IN REACH Champions to be introduced. PDSA cycles 1 and 2 were completed. 3. and 4. are planned. Improved inpatient nutrition will be correlated with data on length of stay and health outcomes, monitored by repeat PDSA cycles. Improved rates of return to baseline function and independence are anticipated, by keeping food and drink, in reach. Results Out of 319 inpatients, 33% had both food and drink within reach. 67% had cognitive impairment; 73% of those were unable to reach their food and drink. Following PDSA cycles 1–2, 34% of patients had food and drink within reach, a negligible change. Conclusions Most CMU patients have food and drink left out of reach. Patients with cognitive impairment are particularly at risk. Changing ward culture is challenging. Further and repeated interventions are necessary.

The central neck in 3 dimensions: a digital model derived from radiology, peer-reviewed literature, and medical illustration

This project aims to create a 3-dimensional (3D) digital model of central neck anatomy, including muscles, neurovasculature, and viscera. The neck was segmented from a CT angiogram of a healthy 29-year-old female, and then transferred into 3D illustration software after removing imaging artifact. To enhance anatomical accuracy, details not captured by imaging or unclear from the study were added and refined with relevant peer-reviewed literature. These structures were later incorporated into the head and neck model. Following segmentation, the 3D models was refined in 3D CAD software. Structures not identified by segmentation were designed by a medical illustrator and all structures were refined from peer-reviewed anatomic literature. Where discrepancies were found in the literature, the size, source, and methodology of the studies were considered to determine the most common variants of each structure. Finally, the 3D model was uploaded to MedReality for online viewing. Technological progress in illustration software, patient specific anatomic modeling, and precise 3D CAD modeling has allowed the most accurate 3D surgical anatomy model to be created when combined with existing literature. The associated 3D model and manuscript will serve as a helpful tool for medical professionals regardless of academic level. To our knowledge, this literature-based model of the central neck combined with 3D anatomic modeling from real patient data is unprecedented and should aid in surgical anatomy education.

The lateral neck in 3 dimensions: A digital model derived from radiology, peer-reviewed literature, and medical illustration

ObjectivesTo develop an anatomically accurate 3-dimensional (3D) digital model of the lateral neck anatomy, including musculature, neurovasculature, and other associated structures such as lymphatics Materials and MethodsLateral neck anatomy, emphasizing level 1-4 structures, were segmented from a CT angiogram of a healthy 29-year-old female which was later transferred into a 3D illustration software after removal of imaging artifacts. To enhance anatomical accuracy, details not captured by imaging or unclear from the study were refined with relevant peer-reviewed literature. These structures were incorporated into the head and neck model. ResultsFollowing segmentation, the 3D models was refined in 3D CAD software. Structures not identified by segmentation, including vagus and phrenic nerves and lymphatics beyond the scan resolution, were designed by a medical illustrator and all structures were refined from peer-reviewed anatomic literature. Where discrepancies were found in the literature, the sample size, source, and methodology of the studies were considered to determine the most common variant of each structure. Finally, the 3D model was uploaded to MedReality® for online viewing. ConclusionThis study demonstrates the critical anatomic structures, landmarks, and surgical relationships relevant to the lateral neck. The associated 3D model and manuscript will serve as a helpful tool for a broad range of clinicians and trainees in search of a detailed 3D anatomic description of the lateral neck. This literature-based model of the central neck combined with 3D anatomic modeling from real patient data should aid in surgical anatomy education.

The pterygopalatine fossa in three dimensions: a digital anatomical model derived from radiographic imaging, refined with peer-reviewed literature, and optimized with medical illustration

The pterygopalatine fossa in three dimensions: a digital anatomical model derived from radiographic imaging, refined with peer-reviewed literature, and optimized with medical illustration

Nineteenth-Century Intersex Bodies and the ‘Appearance of a Double Sex’: Nadar’s Medical Anti-Illustration

Abstract This essay demonstrates that Nadar’s 1860 ‘Hermaphrodite’ series disappeared from the famed French photographer’s oeuvre because it does not function as a medical illustration. It explains the relative obscurity of the series and reveals often-overlooked biases and distortions in medical illustrations. By placing the photographs in the context of nineteenth-century European medical theories about the intersex body, and the successful illustrations, often wood engravings, that accompanied those theories in texts, it reveals that Nadar’s series contradicted rather than supported existing anatomical teachings in an artistic medium renowned for its fidelity to nature, thus posing a threat to medical authority. Whereas doctors asserted that the hermaphrodite was a biological myth, an aberration obscuring natural male or female bodies that could be easily identified by experts, Nadar’s photographs, backed by the medium’s inherent claim to indexical truth, showed the intersex body as naturally integrated and complete and thus doomed themselves to obscurity.

Reconstruction of Knowledge and Medical Images in the Convergence of Chinese and Western Medicine ——Taking “Sweet Meat” as an Example

Abstract: The pancreas is neither part of the five Zang organs (五脏) nor the six Fu organs (六腑). Thus, it has received little attention in Chinese medical literature. In the late 19th century, medical missionaries in China started translating and introducing anatomical and physiological knowledge about the pancreas. As for the word pancreas, an early and influential translation was “sweet meat” (甜肉), proposed by Benjamin Hobson (合信). The translation “sweet meat” is not faithful to the original meaning of “pancreas”, but is a term coined by Hobson based on his personal habits, and the word “sweet” appeared by chance. However, in the decades since the term “sweet meat” became popular, Chinese medicine practitioners, such as Tang Zonghai (唐宗海), reinterpreted it by drawing new medical illustrations for “sweet meat” and giving new connotations to the word “sweet”. This discussion and interpretation of “sweet meat” in modern China, particularly among Chinese medicine professionals, is not only a dissemination and interpretation of the knowledge of “pancreas”, but also a construction of knowledge around the term “sweet meat”.

Book Review of Looking at Trauma: A Tool Kit for Clinicians

This book review looks at a clinical tool kit that provides a solid conceptual foundation in trauma care. The editors have drawn on the expertise of psychotherapists, psychological associates, psychiatrists, social workers, and a medical illustrator. The unique approach offers a resource to paraprofessionals, professionals, and anyone working in settings where trauma is a necessary consideration. The tool kit provides practice information for psychoeducation and guidance on how to develop strategies to manage the effects of complex trauma. The primary goal is to build community capacity in an already overburdened mental health system.

Lessons learned from rebranding a radiology education facebook page

In May 2009, we created a Facebook page for radiology education. While we shared a host of learning materials such as case images, quiz questions, and medical illustrations, we also posted world news, music, and memes. In February 2023, we eliminated everything from the site not related to radiology education. Our aim was to determine how focusing on radiology education alone would affect audience growth for our Facebook page. We exported our Facebook post data for the dates March 1, 2023 through February 29, 2024, to represent the full calendar year after we revised our content presentation, which we compared to data from November 1, 2020 to October 31, 2021. The mean and standard deviation for each post type's reach for 2023/24 were analyzed and compared against the 2020/21 statistics, and Wilcoxon rank sum tests were used to obtain p-values. Linear regressions for each year were performed to understand the relationship between reach and engagement. A total of 4,270 posts were included in our new analysis. Our average number of posts per day decreased from 24.8 to 11.71, reducing by more than half the amount of content shared to our social media page. Our posts had a mean overall reach of 4,660-compared to 1,743 in 2021 (p=0.0000). There was a statistically significant increase in reach for posts on artificial intelligence, case images, medical illustrations, pearls, quiz images, quiz videos, slideshow images, and both types of instructional videos (p<0.005). For both 2021 and 2024, the linear regression slopes were positive (y=0.0687x-65.0279 and y=0.006334x+21.3425, respectively). Facebook and other social media have been found to be helpful sources for radiology education. Our experience and statistics with radiology education via social media may help other radiology educators better curate their own pages. To optimize experiences for students, professionals, and other users, and to reach more people, we found that providing readily accessible radiology education is preferred to the social aspects of social media.