Explorable three‐dimensional digital model of the female pelvis,pelvic contents,and perineum for anatomical education

The anatomy of the pelvis is complex, multilayered, and its three‐dimensional organization is conceptually difficult for students to grasp. The aim of this project was to create an explorable and projectable stereoscopic, three‐dimensional (3D) model of the female pelvis and pelvic contents for anatomical education. The model was created using cryosection images obtained from the Visible Human Project, in conjunction with a general‐purpose three‐dimensional segmentation and surface‐rendering program. Anatomical areas of interest were identified and labeled on consecutive images. Each 2D slice was reassembled, forming a three‐dimensional model. The model includes the pelvic girdle, organs of the pelvic cavity, surrounding musculature, the perineum, neurovascular structures, and the peritoneum. Each structure can be controlled separately (e.g. added, subtracted, made transparent) to reveal organization and/or relationships between structures. The model can be manipulated and/or projected stereoscopically to visualize structures and relationships from different angles with excellent spatial perception. Because of its ease of use and versatility, we expect this model may provide a powerful teaching tool for learning in the classroom or in the laboratory. Anat Sci Educ. © 2010 American Association of Anatomists.     

Browsing software of the Visible Korean data used for teaching sectional anatomy

The interpretation of computed tomographs (CTs) and magnetic resonance images (MRIs) to diagnose clinical conditions requires basic knowledge of sectional anatomy. Sectional anatomy has traditionally been taught using sectioned cadavers, atlases, and/or computer software. The computer software commonly used for this subject is practical and efficient for students but could be more advanced. The objective of this research was to present browsing software developed from the Visible Korean images that can be used for teaching sectional anatomy. One thousand seven hundred and two sets of MRIs, CTs, and sectioned images (intervals, one millimeter) of a whole male cadaver were prepared. Over 900 structures in the sectioned images were outlined and then filled with different colors to elaborate each structure. Software was developed where four corresponding images could be displayed simultaneously; in addition, the structures in the image data could be readily recognized with the aid of the color-filled outlines. The software, distributed free of charge, could be a valuable tool to teach medical students. For example, sectional anatomy could be taught by showing the sectioned images with real color and high resolution. Students could then review the lecture by using the sectioned and color-filled images on their own computers. Students could also be evaluated using the same software. Furthermore, other investigators would be able to replace the images for more comprehensive sectional anatomy.     

Three‐dimensional printing of X‐ray computed tomography datasets with multiple materials using open‐source data processing

Advances in three‐dimensional (3D) printing allow for digital files to be turned into a “printed” physical product. For example, complex anatomical models derived from clinical or pre‐clinical X‐ray computed tomography (CT) data of patients or research specimens can be constructed using various printable materials. Although 3D printing has the potential to advance learning, many academic programs have been slow to adopt its use in the classroom despite increased availability of the equipment and digital databases already established for educational use. Herein, a protocol is reported for the production of enlarged bone core and accurate representation of human sinus passages in a 3D printed format using entirely consumer‐grade printers and a combination of free‐software platforms. The comparative resolutions of three surface rendering programs were also determined using the sinuses, a human body, and a human wrist data files to compare the abilities of different software available for surface map generation of biomedical data. Data shows that 3D Slicer provided highest compatibility and surface resolution for anatomical 3D printing. Generated surface maps were then 3D printed via fused deposition modeling (FDM printing). In conclusion, a methodological approach that explains the production of anatomical models using entirely consumer‐grade, fused deposition modeling machines, and a combination of free software platforms is presented in this report. The methods outlined will facilitate the incorporation of 3D printed anatomical models in the classroom. Anat Sci Educ 10: 383–391. © 2017 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.     

Learning of cross‐sectional anatomy using clay models

We incorporated clay modeling into gross anatomy and neuro‐anatomy courses to help students understand cross‐sectional anatomy. By making clay models, cutting them and comparing cut surfaces to CT and MR images, students learned how cross‐sectional two‐dimensional images were created from three‐dimensional structure of human organs. Most students in a clay modeling group responded positively to this approach, and their average score on CT examination was higher than that of a group that did not use clay models. Clay modeling appears to be a useful supplement to conventional anatomy or radiologic anatomy education. It can be applied to any part of human body, and its effectiveness will be greater when a more complicated understanding of cross‐sectional anatomy is required. Anat Sci Educ 2:156–159, 2009. © 2009 American Association of Anatomists.     

Automatic testing and assessment of neuroanatomy using a digital brain atlas: Method and development of computer‐ and mobile‐based applications

Preparation of tests and student's assessment by the instructor are time consuming. We address these two tasks in neuroanatomy education by employing a digital media application with a three‐dimensional (3D), interactive, fully segmented, and labeled brain atlas. The anatomical and vascular models in the atlas are linked to Terminologia Anatomica. Because the cerebral models are fully segmented and labeled, our approach enables automatic and random atlas‐derived generation of questions to test location and naming of cerebral structures. This is done in four steps: test individualization by the instructor, test taking by the students at their convenience, automatic student assessment by the application, and communication of the individual assessment to the instructor. A computer‐based application with an interactive 3D atlas and a preliminary mobile‐based application were developed to realize this approach. The application works in two test modes: instructor and student. In the instructor mode, the instructor customizes the test by setting the scope of testing and student performance criteria, which takes a few seconds. In the student mode, the student is tested and automatically assessed. Self‐testing is also feasible at any time and pace. Our approach is automatic both with respect to test generation and student assessment. It is also objective, rapid, and customizable. We believe that this approach is novel from computer‐based, mobile‐based, and atlas‐assisted standpoints. Anat Sci Educ 2:244–252, 2009. © 2009 American Association of Anatomists.     

Developing a hypothetical multi‐dimensional learning progression for the nature of matter

We describe efforts toward the development of a hypothetical learning progression (HLP) for the growth of grade 7–14 students' models of the structure, behavior and properties of matter, as it relates to nanoscale science and engineering (NSE). This multi‐dimensional HLP, based on empirical research and standards documents, describes how students need to incorporate and connect ideas within and across their models of atomic structure, the electrical forces that govern interactions at the nano‐, molecular, and atomic scales, and information in the Periodic Table to explain a broad range of phenomena. We developed a progression from empirical data that characterizes how students currently develop their knowledge as part of the development and refinement of the HLP. We find that most students are currently at low levels in the progression, and do not perceive the connections across strands in the progression that are important for conceptual understanding. We suggest potential instructional strategies that may help students build organized and integrated knowledge structures to consolidate their understanding, ready them for new ideas in science, and help them construct understanding of emerging disciplines such as NSE, as well as traditional science disciplines. © 2009 Wiley Periodicals, Inc. J Res Sci Teach 47:687–715, 2010     

A tool for teaching three‐dimensional dermatomes combined with distribution of cutaneous nerves on the limbs

A teaching tool that facilitates student understanding of a three‐dimensional (3D) integration of dermatomes with peripheral cutaneous nerve field distributions is described. This model is inspired by the confusion in novice learners between dermatome maps and nerve field distribution maps. This confusion leads to the misconception that these two distribution maps fully overlap, and may stem from three sources: (1) the differences in dermatome maps in anatomical textbooks, (2) the limited views in the figures of dermatome maps and cutaneous nerve field maps, hampering the acquisition of a 3D picture, and (3) the lack of figures showing both maps together. To clarify this concept, the learning process can be facilitated by transforming the 2D drawings in textbooks to a 3D hands‐on model and by merging the information from the separate maps. Commercially available models were covered with white cotton pantyhose, and borders between dermatomes were marked using the drawings from the students' required study material. Distribution maps of selected peripheral nerves were cut out from color transparencies. Both the model and the cut‐out nerve fields were then at the students' disposal during a laboratory exercise. The students were instructed to affix the transparencies in the right place according to the textbook's figures. This model facilitates integrating the spatial relationships of the two types of nerve distributions. By highlighting the spatial relationship and aiming to provoke student enthusiasm, this model follows the advantages of other low‐fidelity models. Anat Sci Educ 6: 277–280. © 2013 American Association of Anatomists.     

The production of anatomical teaching resources using three‐dimensional (3D) printing technology

The teaching of anatomy has consistently been the subject of societal controversy, especially in the context of employing cadaveric materials in professional medical and allied health professional training. The reduction in dissection‐based teaching in medical and allied health professional training programs has been in part due to the financial considerations involved in maintaining bequest programs, accessing human cadavers and concerns with health and safety considerations for students and staff exposed to formalin‐containing embalming fluids. This report details how additive manufacturing or three‐dimensional (3D) printing allows the creation of reproductions of prosected human cadaver and other anatomical specimens that obviates many of the above issues. These 3D prints are high resolution, accurate color reproductions of prosections based on data acquired by surface scanning or CT imaging. The application of 3D printing to produce models of negative spaces, contrast CT radiographic data using segmentation software is illustrated. The accuracy of printed specimens is compared with original specimens. This alternative approach to producing anatomically accurate reproductions offers many advantages over plastination as it allows rapid production of multiple copies of any dissected specimen, at any size scale and should be suitable for any teaching facility in any country, thereby avoiding some of the cultural and ethical issues associated with cadaver specimens either in an embalmed or plastinated form. Anat Sci Educ 7: 479–486. © 2014 American Association of Anatomists.     

The skeletons in our closet: E‐learning tools and what happens when one side does not fit all

In the anatomical sciences, e‐learning tools have become a critical component of teaching anatomy when physical space and cadaveric resources are limited. However, studies that use empirical evidence to compare their efficacy to visual‐kinesthetic learning modalities are scarce. The study examined how a visual‐kinesthetic experience, involving a physical skeleton, impacts learning when compared with virtual manipulation of a simple two‐dimensional (2D) e‐learning tool, A.D.A.M. Interactive Anatomy. Students from The University of Western Ontario, Canada (n = 77) participated in a dual‐task study to: (1) investigate if a dual‐task paradigm is an effective tool for measuring cognitive load across these different learning modalities; and (2) to assess the impact of knowledge recall and spatial ability when using them. Students were assessed using knowledge scores, Stroop task reaction times, and mental rotation test scores. Results demonstrated that the dual‐task paradigm was not an effective tool for measuring cognitive load across different learning modalities with respect to kinesthetic learning. However, our study highlighted that handing physical specimens yielded major, positive impacts on performance that a simple commercial e‐learning tool failed to deliver (P < 0.001). Furthermore, students with low spatial ability were significantly disadvantaged when they studied the bony joint and were tested on contralateral images (P = 0.046, R = 0.326). This suggests that, despite limbs being mirror images, students should be taught the anatomy of, as well as procedures on, both sides of the human body, enhancing the ability of all students, regardless of spatial ability, to take anatomical knowledge into the clinic and perform successfully. Anat Sci Educ 10: 570–588. © 2017 American Association of Anatomists.     

Effectiveness of three‐dimensional digital animation in teaching human anatomy in an authentic classroom context

Three‐dimensional (3D) digital animations were used to teach the human musculoskeletal system to first year kinesiology students. The purpose of this study was to assess the effectiveness of this method by comparing two groups from two different academic years during two of their official required anatomy examinations (trunk and upper limb assessments). During the upper limb section, the teacher used two‐dimensional (2D) drawings embedded into PowerPoint^® slides and 3D digital animations for the first group (2D group) and the second (3D group), respectively. The same 3D digital animations were used for both groups during the trunk section. The only difference between the two was the multimedia used to present the information during the upper limb section. The 2D group surprisingly outperformed the 3D group on the trunk assessment. On the upper limb assessment no difference in the scores on the overall anatomy examination was found. However, the 3D group outperformed the 2D group in questions requiring spatial ability. Data supported that 3D digital animations were effective instructional multimedia material tools in teaching human anatomy especially in recalling anatomical knowledge requiring spatial ability. The importance of evaluating the effectiveness of a new instructional material outside laboratory environment (e.g., after a complete semester and on official examinations) was discussed. Anat Sci Educ 7: 430–437. © 2014 American Association of Anatomists.     

A head in virtual reality: Development of a dynamic head and neck model

Advances in computer and interface technologies have made it possible to create three‐dimensional (3D) computerized models of anatomical structures for visualization, manipulation, and interaction in a virtual 3D environment. In the past few decades, a multitude of digital models have been developed to facilitate complex spatial learning of the human body. However, there is limited empirical evidence to guide the development and integration of effective computer models for teaching and learning. The purpose of this article is to describe the development of a dynamic head and neck model with flexible displays (2D, 3D, and stereoscopic 3D) and interactive control features that can be later used to design and test the efficacy of computer models as a means of improving student learning. The model was created using computer tomography scans of a human cadaver. Anatomical structures captured on the scans were segmented into discreet areas, and then reconstructed in three‐dimensions using specialized software. The final model consists of 70 distinct anatomical structures that can be displayed in 2D, 3D, or stereoscopic 3D. In 3D mode, a mouse can be used to actively and continuously interact with the model by manipulating viewer orientation, altering surface transparency, superimposing 2D scans with 3D reconstructions, removing or adding structures sequentially, and customizing animated scenes to show complex anatomical pathways or relationships. Anat Sci Educ 2: 294–301, 2009. © 2009 American Association of Anatomists.     

Take away body parts! An investigation into the use of 3D‐printed anatomical models in undergraduate anatomy education

Understanding the three‐dimensional (3D) nature of the human form is imperative for effective medical practice and the emergence of 3D printing creates numerous opportunities to enhance aspects of medical and healthcare training. A recently deceased, un‐embalmed donor was scanned through high‐resolution computed tomography. The scan data underwent segmentation and post‐processing and a range of 3D‐printed anatomical models were produced. A four‐stage mixed‐methods study was conducted to evaluate the educational value of the models in a medical program. (1) A quantitative pre/post‐test to assess change in learner knowledge following 3D‐printed model usage in a small group tutorial; (2) student focus group (3) a qualitative student questionnaire regarding personal student model usage (4) teaching faculty evaluation. The use of 3D‐printed models in small‐group anatomy teaching session resulted in a significant increase in knowledge (P = 0.0001) when compared to didactic 2D‐image based teaching methods. Student focus groups yielded six key themes regarding the use of 3D‐printed anatomical models: model properties, teaching integration, resource integration, assessment, clinical imaging, and pathology and anatomical variation. Questionnaires detailed how students used the models in the home environment and integrated them with anatomical learning resources such as textbooks and anatomy lectures. In conclusion, 3D‐printed anatomical models can be successfully produced from the CT data set of a recently deceased donor. These models can be used in anatomy education as a teaching tool in their own right, as well as a method for augmenting the curriculum and complementing established learning modalities, such as dissection‐based teaching. Anat Sci Educ 11: 44–53. © 2017 American Association of Anatomists.     

Effects of instructional strategies using cross sections on the recognition of anatomical structures in correlated CT and MR images

This research is an effort to best utilize the interactive anatomical images for instructional purposes based on cognitive load theory. Three studies explored the differential effects of three computer‐based instructional strategies that use anatomical cross‐sections to enhance the interpretation of radiological images. These strategies include: (1) cross‐sectional images of the head that can be superimposed on radiological images, (2) transparent highlighting of anatomical structures in radiological images, and (3) cross‐sectional images of the head with radiological images presented side‐by‐side. Data collected included: (1) time spent on instruction and on solving test questions, (2) mental effort during instruction and test, and (3) students' performance to identify anatomical structures in radiological images. Participants were 28 freshmen medical students (15 males and 13 females) and 208 biology students (190 females and 18 males). All studies used posttest‐only control group design, and the collected data were analyzed by either t test or ANOVA. In self‐directed computer‐based environments, the strategies that used cross sections to improve students' ability to recognize anatomic structures in radiological images showed no significant positive effects. However, when increasing the complexity of the instructional materials, cross‐sectional images imposed a higher cognitive load, as indicated by higher investment of mental effort. There is not enough evidence to claim that the simultaneous combination of cross sections and radiological images has no effect on the identification of anatomical structures in radiological images for novices. Further research that control for students' learning and cognitive style is needed to reach an informative conclusion. Anat Sci Ed 1:75–83, 2008. © 2008 American Association of Anatomists.     

Visualization of stereoscopic anatomic models of the paranasal sinuses and cervical vertebrae from the surgical and procedural perspective

Recent improvements in three‐dimensional (3D) virtual modeling software allows anatomists to generate high‐resolution, visually appealing, colored, anatomical 3D models from computed tomography (CT) images. In this study, high‐resolution CT images of a cadaver were used to develop clinically relevant anatomic models including facial skull, nasal cavity, septum, turbinates, paranasal sinuses, optic nerve, pituitary gland, carotid artery, cervical vertebrae, atlanto‐axial joint, cervical spinal cord, cervical nerve root, and vertebral artery that can be used to teach clinical trainees (students, residents, and fellows) approaches for trans‐sphenoidal pituitary surgery and cervical spine injection procedure. Volume, surface rendering and a new rendering technique, semi‐auto‐combined, were applied in the study. These models enable visualization, manipulation, and interaction on a computer and can be presented in a stereoscopic 3D virtual environment, which makes users feel as if they are inside the model. Anat Sci Educ 10: 598–606. © 2017 American Association of Anatomists.     

Computer‐based learning: Interleaving whole and sectional representation of neuroanatomy

The large volume of material to be learned in biomedical disciplines requires optimizing the efficiency of instruction. In prior work with computer‐based instruction of neuroanatomy, it was relatively efficient for learners to master whole anatomy and then transfer to learning sectional anatomy. It may, however, be more efficient to continuously integrate learning of whole and sectional anatomy. A study of computer‐based learning of neuroanatomy was conducted to compare a basic transfer paradigm for learning whole and sectional neuroanatomy with a method in which the two forms of representation were interleaved (alternated). For all experimental groups, interactive computer programs supported an approach to instruction called adaptive exploration. Each learning trial consisted of time‐limited exploration of neuroanatomy, self‐timed testing, and graphical feedback. The primary result of this study was that interleaved learning of whole and sectional neuroanatomy was more efficient than the basic transfer method, without cost to long‐term retention or generalization of knowledge to recognizing new images (Visible Human and MRI). Anat Sci Educ. © 2012 American Association of Anatomists.     

Web‐based interactive 3D visualization as a tool for improved anatomy learning

Despite a long tradition, conventional anatomy education based on dissection is declining. This study tested a new virtual reality (VR) technique for anatomy learning based on virtual contrast injection. The aim was to assess whether students value this new three‐dimensional (3D) visualization method as a learning tool and what value they gain from its use in reaching their anatomical learning objectives. Several 3D vascular VR models were created using an interactive segmentation tool based on the “virtual contrast injection” method. This method allows users, with relative ease, to convert computer tomography or magnetic resonance images into vivid 3D VR movies using the OsiriX software equipped with the CMIV CTA plug‐in. Once created using the segmentation tool, the image series were exported in Quick Time Virtual Reality (QTVR) format and integrated within a web framework of the Educational Virtual Anatomy (EVA) program. A total of nine QTVR movies were produced encompassing most of the major arteries of the body. These movies were supplemented with associated information, color keys, and notes. The results indicate that, in general, students' attitudes towards the EVA‐program were positive when compared with anatomy textbooks, but results were not the same with dissections. Additionally, knowledge tests suggest a potentially beneficial effect on learning. Anat Sci Ed 2:61–68, 2009. © 2009 American Association of Anatomists.     

The translucent cadaver: An evaluation of the use of full body digital x-ray images and drawings in surface anatomy education

It has been noted by staff at the Faculty of Health Sciences, Stellenbosch University that medical students neglect the study of surface anatomy during dissection. This study reports on the novel use of Lodox® Statscan® images in anatomical education, particularly the teaching of surface anatomy. Full body digital X‐ray images (Lodox Statscan) of each cadaver (n = 40) were provided to second year medical students. During dissection students were asked to visualize landmarks, organs, and structures on the digital X‐ray and their cadaver, as well as palpate these landmarks and structures on themselves, their colleagues, and the cadaver. To stimulate student engagement with surface anatomy, dissection groups were required to draw both the normal and actual position of organs on a laminated image provided. The accuracy of the drawings was subsequently assessed and students were further assessed by means of practical identification tests. In addition, students were asked to complete an anonymous questionnaire. A response rate of 79% was obtained for the student questionnaire. From the questionnaire it was gathered that students found the digital X‐ray images beneficial for viewing most systems' organs, except for the pelvic organs. Although it appears that students still struggle with the study of surface anatomy, most students believed that the digital X‐rays were beneficial to their studies and supported their continued use in the future. Anat Sci Educ. © 2012 American Association of Anatomists.     

“Let's Get Physical”: Advantages of a physical model over 3D computer models and textbooks in learning imaging anatomy

Three‐dimensional (3D) information plays an important part in medical and veterinary education. Appreciating complex 3D spatial relationships requires a strong foundational understanding of anatomy and mental 3D visualization skills. Novel learning resources have been introduced to anatomy training to achieve this. Objective evaluation of their comparative efficacies remains scarce in the literature. This study developed and evaluated the use of a physical model in demonstrating the complex spatial relationships of the equine foot. It was hypothesized that the newly developed physical model would be more effective for students to learn magnetic resonance imaging (MRI) anatomy of the foot than textbooks or computer‐based 3D models. Third year veterinary medicine students were randomly assigned to one of three teaching aid groups (physical model; textbooks; 3D computer model). The comparative efficacies of the three teaching aids were assessed through students' abilities to identify anatomical structures on MR images. Overall mean MRI assessment scores were significantly higher in students utilizing the physical model (86.39%) compared with students using textbooks (62.61%) and the 3D computer model (63.68%) (P < 0.001), with no significant difference between the textbook and 3D computer model groups (P = 0.685). Student feedback was also more positive in the physical model group compared with both the textbook and 3D computer model groups. Our results suggest that physical models may hold a significant advantage over alternative learning resources in enhancing visuospatial and 3D understanding of complex anatomical architecture, and that 3D computer models have significant limitations with regards to 3D learning. Anat Sci Educ 6: 216–224. © 2013 American Association of Anatomists.     

Effects of image‐based and text‐based active learning exercises on student examination performance in a musculoskeletal anatomy course

Research on the benefits of visual learning has relied primarily on lecture‐based pedagogy, but the potential benefits of combining active learning strategies with visual and verbal materials on learning anatomy has not yet been explored. In this study, the differential effects of text‐based and image‐based active learning exercises on examination performance were investigated in a functional anatomy course. Each class session was punctuated with an average of 12 text‐based and image‐based active learning exercises. Participation data from 231 students were compared with their examination performance on 262 questions associated with the in‐class exercises. Students also rated the helpfulness and difficulty of the in‐class exercises on a survey. Participation in the active learning exercises was positively correlated with examination performance (r = 0.63, P < 0.001). When controlling for other key demographics (gender, underrepresented minority status) and prior grade point average, participation in the image‐based exercises was significantly correlated with performance on examination questions associated with image‐based exercises (P < 0.001) and text‐based exercises (P < 0.01), while participation in text‐based exercises was not. Additionally, students reported that the active learning exercises were helpful for seeing images of key ideas (94%) and clarifying key course concepts (80%), and that the image‐based exercises were significantly less demanding, less hard and required less effort than text‐based exercises (P < 0.05). The findings confirm the positive effect of using images and active learning strategies on student learning, and suggest that integrating them may be especially beneficial for learning anatomy. Anat Sci Educ 10: 444–455. © 2017 American Association of Anatomists.