A novel three-dimensional tool for teaching human neuroanatomy

Three‐dimensional (3D) visualization of neuroanatomy can be challenging for medical students. This knowledge is essential in order for students to correlate cross‐sectional neuroanatomy and whole brain specimens within neuroscience curricula and to interpret clinical and radiological information as clinicians or researchers. This study implemented and evaluated a new tool for teaching 3D neuroanatomy to first‐year medical students at Boston University School of Medicine. Students were randomized into experimental and control classrooms. All students were taught neuroanatomy according to traditional 2D methods. Then, during laboratory review, the experimental group constructed 3D color‐coded physical models of the periventricular structures, while the control group re‐examined 2D brain cross‐sections. At the end of the course, 2D and 3D spatial relationships of the brain and preferred learning styles were assessed in both groups. The overall quiz scores for the experimental group were significantly higher than the control group (t(85) = 2.02, P < 0.05). However, when the questions were divided into those requiring either 2D or 3D visualization, only the scores for the 3D questions were significantly higher in the experimental group (F_1,85= 5.48, P = 0.02). When surveyed, 84% of students recommended repeating the 3D activity for future laboratories, and this preference was equally distributed across preferred learning styles (χ² = 0.14, n.s.). Our results suggest that our 3D physical modeling activity is an effective method for teaching spatial relationships of brain anatomy and will better prepare students for visualization of 3D neuroanatomy, a skill essential for higher education in neuroscience, neurology, and neurosurgery. Anat Sci Educ. © 2010 American Association of Anatomists.     

Building virtual models by postprocessing radiology images: A guide for anatomy faculty

Radiology and radiologists are recognized as increasingly valuable resources for the teaching and learning of anatomy. State‐of‐the‐art radiology department workstations with industry‐standard software applications can provide exquisite demonstrations of anatomy, pathology, and more recently, physiology. Similar advances in personal computers and increasingly available software can allow anatomy departments and their students to build their own three‐dimensional virtual models. Appropriate selection of a data‐set, followed by processing and presentation are the key steps in creating virtual models. The construction, presentation, clinical application, and educational potential of postprocessed imaging techniques including multiplanar reformats, minimum intensity projections, segmentation, volume‐rendering, surface‐rendering, fly‐throughs, virtual endoscopy, angiography, and cine‐loops are reviewed using examples created with only a personal computer and freeware software. Although only static images are presented in this article, further material is available online within the electronic version of this article. Through the use of basic and advanced image reconstruction and also paying attention to optimized presentation and integration, anatomy courses can be strengthened with appropriate radiological material. There are several key advantages for the anatomy department, which is equipped with the ability to produce virtual models using radiology images: (1) Opportunities to present anatomy using state‐of‐the‐art technology as an adjunct to current practices, (2) a means to forge an improved relationship with the local radiology department, and (3) the ability to create material locally, which is integrated with the local curriculum avoiding the problem of information overload when using the internet or other commercially available resources. Anat Sci Educ 3:261–266, 2010. © 2010 American Association of Anatomists.     

The cranial nerve skywalk: A 3D tutorial of cranial nerves in a virtual platform

Visualization of the complex courses of the cranial nerves by students in the health‐related professions is challenging through either diagrams in books or plastic models in the gross laboratory. Furthermore, dissection of the cranial nerves in the gross laboratory is an extremely meticulous task. Teaching and learning the cranial nerve pathways is difficult using two‐dimensional (2D) illustrations alone. Three‐dimensional (3D) models aid the teacher in describing intricate and complex anatomical structures and help students visualize them. The study of the cranial nerves can be supplemented with 3D, which permits the students to fully visualize their distribution within the craniofacial complex. This article describes the construction and usage of a virtual anatomy platform in Second Life?, which contains 3D models of the cranial nerves III, V, VII, and IX. The Cranial Nerve Skywalk features select cranial nerves and the associated autonomic pathways in an immersive online environment. This teaching supplement was introduced to groups of pre‐healthcare professional students in gross anatomy courses at both institutions and student feedback is included. Anat Sci Educ 7: 469–478. © 2014 American Association of Anatomists.     

Criss-cross heart three-dimensional printed models in medical education: A multicenter study on their value as a supporting tool to conventional imaging

The utility of three-dimensional (3D) printed models for medical education in complex congenital heart disease (CHD) is sparse and limited. The purpose of this study was to evaluate the utility of 3D printed models for medical education in criss-cross hearts covering a wide range of participants with different levels of knowledge and experience, from medical students, clinical fellows up to senior medical personnel. Study participants were enrolled from four dedicated imaging workshops developed between 2016 and 2019. The study design was a non-randomized cross-over study to evaluate 127 participants' level of understanding of the criss-cross heart anatomy. This was evaluated using the scores obtained following teaching with conventional images (echocardiography and magnetic resonance imaging) versus a 3D printed model learning approach. A significant improvement in anatomical knowledge of criss-cross heart anatomy was observed when comparing conventional imaging test scores to 3D printed model tests [76.9% (61.5%–87.8%) vs. 84.6% (76.9%–96.2%), P < 0.001]. The increase in the questionnaire marks was statistically significant across all academic groups (consultants in pediatric cardiology, fellows in pediatric cardiology, and medical students). Ninety-four percent (120) and 95.2% (121) of the participants agreed or strongly agreed, respectively, that 3D models helped them to better understand the medical images. Participants scored their overall satisfaction with the 3D printed models as 9.1 out of 10 points. In complex CHD such as criss-cross hearts, 3D printed replicas improve the understanding of cardiovascular anatomy. They enhanced the teaching experience especially when approaching medical students.     

Dual‐extrusion 3D printing of anatomical models for education

Two material 3D printing is becoming increasingly popular, inexpensive and accessible. In this paper, freely available printable files and dual extrusion fused deposition modelling were combined to create a number of functional anatomical models. To represent muscle and bone FilaFlex^3D flexible filament and polylactic acid (PLA) filament were extruded respectively via a single 0.4 mm nozzle using a Big Builder printer. For each filament, cubes (5 mm³) were printed and analyzed for X, Y, and Z accuracy. The PLA printed cubes resulted in errors averaging just 1.2% across all directions but for FilaFlex^3D printed cubes the errors were statistically significantly greater (average of 3.2%). As an exemplar, a focus was placed on the muscles, bones and cartilage of upper airway and neck. The resulting single prints combined flexible and hard structures. A single print model of the vocal cords was constructed which permitted movement of the arytenoids on the cricoid cartilage and served to illustrate the action of intrinsic laryngeal muscles. As University libraries become increasingly engaged in offering inexpensive 3D printing services it may soon become common place for both student and educator to access websites, download free models or 3D body parts and only pay the costs of print consumables. Novel models can be manufactured as dissectible, functional multi‐layered units and offer rich possibilities for sectional and/or reduced anatomy. This approach can liberate the anatomist from constraints of inflexible hard models or plastinated specimens and engage in the design of class specific models of the future. Anat Sci Educ 11: 65–72. © 2017 American Association of Anatomists.     

Evaluation of the effectiveness of 3D vascular stereoscopic models in anatomy instruction for first year medical students

The head and neck region is one of the most complex areas featured in the medical gross anatomy curriculum. The effectiveness of using three‐dimensional (3D) models to teach anatomy is a topic of much discussion in medical education research. However, the use of 3D stereoscopic models of the head and neck circulation in anatomy education has not been previously studied in detail. This study investigated whether 3D stereoscopic models created from computed tomographic angiography (CTA) data were efficacious teaching tools for the head and neck vascular anatomy. The test subjects were first year medical students at the University of Mississippi Medical Center. The assessment tools included: anatomy knowledge tests (prelearning session knowledge test and postlearning session knowledge test), mental rotation tests (spatial ability; presession MRT and postsession MRT), and a satisfaction survey. Results were analyzed using a Wilcoxon rank‐sum test and linear regression analysis. A total of 39 first year medical students participated in the study. The results indicated that all students who were exposed to the stereoscopic 3D vascular models in 3D learning sessions increased their ability to correctly identify the head and neck vascular anatomy. Most importantly, for students with low‐spatial ability, 3D learning sessions improved postsession knowledge scores to a level comparable to that demonstrated by students with high‐spatial ability indicating that the use of 3D stereoscopic models may be particularly valuable to these students with low‐spatial ability. Anat Sci Educ 10: 34–45. © 2016 American Association of Anatomists.     

Evaluation by medical students of the educational value of multi‐material and multi‐colored three‐dimensional printed models of the upper limb for anatomical education

For centuries, cadaveric material has been the cornerstone of anatomical education. For reasons of changes in curriculum emphasis, cost, availability, expertise, and ethical concerns, several medical schools have replaced wet cadaveric specimens with plastinated prosections, plastic models, imaging, and digital models. Discussions about the qualities and limitations of these alternative teaching resources are on‐going. We hypothesize that three‐dimensional printed (3DP) models can replace or indeed enhance existing resources for anatomical education. A novel multi‐colored and multi‐material 3DP model of the upper limb was developed based on a plastinated upper limb prosection, capturing muscles, nerves, arteries and bones with a spatial resolution of ～1 mm. This study aims to examine the educational value of the 3DP model from the learner's point of view. Students (n = 15) compared the developed 3DP models with the plastinated prosections, and provided their views on their learning experience using 3DP models using a survey and focus group discussion. Anatomical features in 3DP models were rated as accurate by all students. Several positive aspects of 3DP models were highlighted, such as the color coding by tissue type, flexibility and that less care was needed in the handling and examination of the specimen than plastinated specimens which facilitated the appreciation of relations between the anatomical structures. However, students reported that anatomical features in 3DP models are less realistic compared to the plastinated specimens. Multi‐colored, multi‐material 3DP models are a valuable resource for anatomical education and an excellent adjunct to wet cadaveric or plastinated prosections. Anat Sci Educ 11: 54–64. © 2017 American Association of Anatomists.     

Computer visualizations: factors that influence spatial anatomy comprehension

Computer visualizations are increasingly common in education across a range of subject disciplines, including anatomy. Despite optimism about their educational potential, students sometime have difficulty learning from these visualizations. The purpose of this study was to explore a range of factors that influence spatial anatomy comprehension before and after instruction with different computer visualizations. Three major factors were considered: (1) visualization ability (VZ) of learners, (2) dynamism of the visual display, and (3) interactivity of the system. Participants (N = 60) of differing VZs (high, low) studied a group of anatomical structures in one of three visual conditions (control, static, dynamic) and one of two interactive conditions (interactive, non-interactive). Before and after the study phase, participants' comprehension of spatial anatomical information was assessed using a multiple-choice spatial anatomy task (SAT) involving the mental rotation of the anatomical structures, identification of the structures in 2D cross-sections, and localization of planes corresponding to given cross-sections. Results indicate that VZ had a positive influence on SAT performance but instruction with different computer visualizations could modulate the effect of VZ on task performance.     

Development and implementation of a three-dimensional (3D) printing elective course for health science students

Three-dimensional (3D) printing technology has become more affordable, accessible, and relevant in healthcare, however, the knowledge of transforming medical images to physical prints still requires some level of training. Anatomy educators can play a pivotal role in introducing learners to 3D printing due to the spatial context inherent to learning anatomy. To bridge this knowledge gap and decrease the intimidation associated with learning 3D printing technology, an elective was developed through a collaboration between the Department of Anatomy and the Makers Lab at the University of California, San Francisco. A self-directed digital resource was created for the elective to guide learners through the 3D printing workflow, which begins with a patient's computed tomography digital imaging and communication in medicine (DICOM) file to a physical 3D printed model. In addition to practicing the 3D printing workflow during the elective, a series of guest speakers presented on 3D printing applications they utilize in their clinical practice and/or research laboratories. Student evaluations indicated that their intimidation associated with 3D printing decreased, the clinical and research topics were directly applicable to their intended careers, and they enjoyed the autonomy associated with the elective format. The elective and the associated digital resource provided students with the foundational knowledge of 3D printing, including the ability to extract, edit, manipulate, and 3D print from DICOM files, making 3D printing more accessible. The aim of disseminating this work is to help other anatomy educators adopt this curriculum at their institution.     

Visuospatial anatomy comprehension: The role of spatial visualization ability and problem‐solving strategies

The present study explored the problem‐solving strategies of high‐ and low‐spatial visualization ability learners on a novel spatial anatomy task to determine whether differences in strategies contribute to differences in task performance. The results of this study provide further insights into the processing commonalities and differences among learners beyond the classification of spatial visualization ability alone, and help elucidate what, if anything, high‐ and low‐spatial visualization ability learners do differently while solving spatial anatomy task problems. Forty‐two students completed a standardized measure of spatial visualization ability, a novel spatial anatomy task, and a questionnaire involving personal self‐analysis of the processes and strategies used while performing the spatial anatomy task. Strategy reports revealed that there were different ways students approached answering the spatial anatomy task problems. However, chi‐square test analyses established that differences in problem‐solving strategies did not contribute to differences in task performance. Therefore, underlying spatial visualization ability is the main source of variation in spatial anatomy task performance, irrespective of strategy. In addition to scoring higher and spending less time on the anatomy task, participants with high spatial visualization ability were also more accurate when solving the task problems. Anat Sci Educ 7: 280–288. © 2013 American Association of Anatomists.     

The impact of stereoscopic imagery and motion on anatomical structure recognition and visual attention performance

Gross anatomy is located in a three‐dimensional space. Visualizing aspects of structures in gross anatomy education should aim to provide information that best resembles their original spatial proportions. Stereoscopic three‐dimensional imagery might offer possibilities to implement this aim, though some research has revealed potential impairments that may result from observing stereoscopic visualizations, such as discomfort. However, possible impairments of working memory such as decreased visual attention performance due to applying this technology in gross anatomy education have not yet been investigated. Similarly, in gross anatomy education the impact of stereoscopic imagery on learners’ recognition of anatomical‐spatial relationships and the impact of different presentation formats have only been investigated in a small number of studies. In this study, the performance of 171 teacher trainees working on the anatomy of hearing was examined, either with non‐stereoscopic or stereoscopic imagery. Static and dynamic picture presentations were applied. Overall, benefits for stereoscopic imagery on estimating anatomical‐spatial relations were found. The performance on a visual attention test indicates that the impact of stereoscopic visualizations on the human cognitive system varies more from person to person compared to non‐stereoscopic visualizations. In addition, combinations of temporarily moving pictures and stereoscopic imagery lead to decreased visual attention performance compared to combinations of moving pictures and non‐stereoscopic imagery. Anat Sci Educ 11: 15–24. © 2017 American Association of Anatomists.