三维重建上肢解剖结构的计算机模拟手术

探索三维重建后计算机模拟手术过程的实现。将上肢新鲜标本经ＣＴ扫描后连续切片,把ＣＴ图像和大体断面图像同时输入计算机,用Ｂｏｒｌａｎｄ Ｃ＋＋语言编制三维重建和模拟手术程序,建立上肢三维解剖数据模型,将临床实际手术操作过程转化为计算机可接受的指令,实现模拟手术操作。结果表明：上肢模拟手术可分三段进行,手术部位及切口方向可任意选择,逐层“切开”并三维显示,因此,模拟手术系统可运用于手术方案的设计、选择     

Improved dissection efficiency in the human gross anatomy laboratory by the integration of computers and modern technology

The need to increase the efficiency of dissection in the gross anatomy laboratory has been the driving force behind the technologic changes we have recently implemented. With the introduction of an integrated systems-based medical curriculum and a reduction in laboratory teaching hours, anatomy faculty at the University of North Texas Health Science Center (UNTHSC) developed a computer-based dissection manual to adjust to these curricular changes and time constraints. At each cadaver workstation, Apple iMac computers were added and a new dissection manual, running in a browser-based format, was installed. Within the text of the manual, anatomical structures required for dissection were linked to digital images from prosected materials; in addition, for each body system, the dissection manual included images from cross sections, radiographs, CT scans, and histology. Although we have placed a high priority on computerization of the anatomy laboratory, we remain strong advocates of the importance of cadaver dissection. It is our belief that the utilization of computers for dissection is a natural evolution of technology and fosters creative teaching strategies adapted for anatomy laboratories in the 21st century. Our strategy has significantly enhanced the independence and proficiency of our students, the efficiency of their dissection time, and the quality of laboratory instruction by the faculty.     

Interpretation of multi-detector computed tomography images before dissection may allow detection of vascular anomalies: a postmortem study of anomalous origin of the right subclavian artery and the right vertebral artery

The Graduate School of Medicine at Chiba University is planning to introduce computed tomography (CT) images of donated cadavers to the gross anatomy laboratory. Here we describe an anomaly of the right subclavian artery that was detected by interpretation of CT images prior to dissection. The anomaly was verified to be the right subclavian artery, as the last branch of the aortic arch, by subsequent dissection of the cadaver. We also identified an anomalous origin of the right vertebral artery by dissection. This anomaly was also visible on CT images, although it had not been recognized in the first interpretation of the CT images. Our results suggest that branching anomalies of arteries with a diameter of >1?cm are detectable on CT images even without the injection of contrast medium. We also discuss the utility of interpreting CT images prior to dissection as a means by which medical students can gain a better understanding of human body during the gross anatomy laboratory.     

蝶鞍区薄层横断面解剖与MRI对照研究

目的 研究蝶鞍区的薄层断层解剖与对应的MRI图像,探讨该区域结构在薄层断层解剖上的变化规律.为影像学诊断及临床开展该区手术提供详细的形态学资料.方法取2例成人头部标本,用1.5T MRI以眦耳线为基线进行扫描获取薄层MRI图像,经冷冻包埋后采用铣削精度为0.001mm的SKC500型数控机床由下往上铣削层厚为0.1mm的薄层标本,其中蝶鞍区层厚为0.05mm.从标本中选取典型断面,与相应的MRI图像相对照,观察蝶鞍区的重要解剖结构. 结果 共获得MRI图像T1加权40幅和41幅,T2加权40幅和41幅,薄层断层图像304张和310张.在薄层断层标本上进行连续追踪,并与相应的MRI图像对照,总结其规律.在垂体层面能清楚地显示海绵窦内结构及其相互关系:1.颈内动脉弯曲走行于海绵窦内,且与海绵窦之间形成几个间隙;2.第Ⅲ、Ⅳ、Ⅵ脑神经以及三叉神经的眼神经支、上颌神经支在海绵窦外侧壁由前向后依次排列.在视交叉层面能够清楚地看到垂体柄穿过鞍膈与垂体相连.结论冷冻数控铣削技术获得的超薄断面与MRI图像对照能精确显示蝶鞍区的微细解剖结构,为该区病变的断层影像诊断和临床治疗提供实用的亚毫米断层解剖学依据.     

Fluoroscopic angiography in the gross anatomy dissection laboratory: visualizing the aortic arch and its branches in a cadaver

We present fluoroscopic images of the aortic arch and its branches obtained in a first year medical gross anatomy teaching laboratory after an aberrant right subclavian artery was discovered during dissection. The aortic arch and its branches in the cadaver were filled with contrast medium in molten agar. After the agar solidified, a portable fluoroscope was used to obtain radiographic images. These post-mortem images were then compared with computed tomography images obtained while the individual was living. The embryology, prevalence, and clinical findings of this arterial variation are reviewed, and the importance of recognizing the presence of an aberrant right subclavian artery before performing various procedures is discussed. This exercise gave students the unique opportunity to compare the three-dimensional anatomy seen in the dissection laboratory with the two-dimensional presentation of that same anatomy in the radiographic images that they will see in clinical practice.     

Back to basics.

The present study sought to establish findings and share views concerning the teaching of gross anatomy. The conclusions were drawn from feedback taken in 1995 from Year 1 (M1) through Year 5 (M5) (final year) medical students at the National University of Singapore. The survey was taken from two groups of students that had gone through two different curricula. The first group of M4 and M5 students studied under an old curriculum that taught anatomy over a period of three semesters. The second group of M1 through M3 students studied under a new curriculum of two semesters' duration. Altogether, 546 (M1: 147; M2: 120; M3: 78; M4: 107; M5: 97) completed questionnaires were analyzed. Throughout the years of study, the majority of students found dissection helpful (55.2-72. 7%) or very helpful (18.9-40.7%) in their understanding of gross anatomy. A minority of students (0-25.3%) found it not helpful. Taking all of the five years of students together, this would mean that 60.7% of the students found dissection helpful and 28% of them found it very helpful in their understanding of gross anatomy. Of the M3 students who had both dissection and demonstrations on prosected specimens, the majority of them found dissection helpful (55.2%) or very helpful (33.3%); they also found demonstrations on prosected specimens helpful (64.6%), or very helpful (27.8%). When asked whether dissection should be replaced completely by demonstrations on prosected specimens, 86.7% gave a resounding no. With regard to gross anatomy coverage, 11.7% of M4 and M5 students found it inadequate, 67.5% adequate, and 20.8% excessive. Only 1% of these students found that the gross anatomy they had learned was of no clinical relevance; 22.3% found it of little clinical relevance; and an overwhelming majority (76.7%) found it mostly clinically relevant. Most were grateful that they had been taught the basics of gross anatomy. These findings are discussed with an emphasis on the time needed and deep level approach required to gain conceptual understanding of anatomical organization.     

The physical therapy undergraduate students' responses to the gross human anatomy subjects

Instruction in gross human anatomy is one of the important items in the subject for co-medical students of the physical therapist course. The physical therapy undergraduate students are required to have a solid understanding of the structure and formation of the human body. Therefore, their good-understanding of the course on the gross human anatomy and their experience of the gross human anatomy laboratory (observation practice) are acquired to improve their knowledge of the human body. To clarify the student responses to the gross human anatomy course including the gross human anatomy laboratory, several questionnaires were administered to the freshman physical therapy undergraduate student for two years. We found that more than 80% of the students, who felt a negative attitude for gross human anatomy before the course started, had a positive attitude about the gross human anatomy after going through the course. The experience of the gross human anatomy laboratory increased the students' activity of learning and they thought more about the dignity of being human after the course than before viewing. In addition, the results suggested that the multiple experiences of the gross human anatomy course are useful for the physical therapy undergraduate students to improve the quality of their understanding of the human body.     

Teaching anatomy with surgeons' tools: use of the laparoscope in clinical anatomy.

The purpose of this study was to establish the feasibility of laparoscopy in embalmed cadavers to teach abdominal gross anatomy. One cadaver was selected based on body habitus and absence of previous abdominal operations. A standard trocar was used to enter the abdomen at the umbilicus. Two trocars were placed in the left upper quadrant. Pneumoperitoneum was achieved with continuous CO(2) pressure. Liver retraction was achieved percutaneously, exposing the porta hepatis and the gallbladder. The dissection was done with four first-year medical students using standard laparoscopic equipment. Following this, the demonstration was projected over multiple monitors so that all students could participate. Laparoscopic dissection in an embalmed cadaver is feasible and an excellent educational tool for both the medical student and the dissector. The dissector has the opportunity to manipulate laparoscopic tools in a human model closely paralleling operative experience, and the students have an opportunity to learn abdominal anatomy from a clinical perspective. Laparoscopic examination and dissection of fresh cadavers has been used for training surgeons on new procedures such as colon resection, antireflux procedures, and cholecystectomy. There is no report of this same technology used in embalmed cadavers to teach basic anatomy. This approach allows first-year medical students to learn the anatomy while exposing them to the technology currently used in surgical practice, and it affords surgical residents and students additional opportunities to practice laparoscopic skills.     

Transition from Film to Electronic Media in the First-Year Medical School Gross Anatomy Lab

For the benefit of the first-year gross anatomy students, we digitized and published on a Web site images that had been collected over a 30-year period. We provided a CD-ROM (compact disk, read-only media) containing the image set in higher quality format to students and faculty. We supplemented basic images with hot topics such as CT angiography, virtual colonography, computer-aided diagnosis, and 3D post-processing. Full motion video and moving JPEG (Joint Photo Expert Group) animations were integrated into the atlas. On the post course questionnaire medical students reported that the images on CD-ROM were helpful during the course and for review prior to examinations. Faculty and medical students used the CD-ROM for problem-based learning sections and facilitator training. The images were clear and easily projected during review sessions and were useful for the small group sessions, where they served as examples of normal anatomy.     

Gross anatomy: An outdated subject or an essential part of a modern medical curriculum? Results of a questionnaire circulated to final-year medical students

Final-year undergraduate medical students were given a questionnaire on the gross anatomy curriculum they had experienced in their first year at medical school 5 years earlier. They were asked to evaluate the relevance of the dissection course, lectures and seminars in gross anatomy for clinical courses, clerkships, and everyday practical work on the ward. About two-thirds of the students found the time spent on 10 different regions in anatomy to be adequate, and a considerable number of students would have liked even more details. The vast majority expressed a wish to repeat topographical anatomy during their clinical teaching. Furthermore, ～75% of the students showed interest in short, specialized dissection courses during the clinical curriculum. Medical students just before graduation ranked gross anatomy with the dissection course and integrated clinical topics as a keystone for their clinical courses. The results of such surveys should be taken into consideration when discussing modification to teaching gross anatomy or arguing about a balanced dissection course. © 1993 Wiley-Liss, Inc.     

Effects of an alternate dissection schedule on gross anatomy laboratory practical performance

The current medical curricula reform that is taking place in many medical schools throughout the world has resulted in less time for gross anatomy laboratory instruction. In response, anatomists are using a variety of approaches (e.g., peer teaching, prosections, plastinated anatomical models, etc.) to adapt to these changes. To accommodate recent curricular reform at the University of Health Sciences College of Osteopathic Medicine, an alternating dissection schedule was implemented. The purpose of this study is to examine the effects of the alternating schedule on gross anatomy laboratory practical performance. Using a Mann-Whitney Rank Sum test, back and upper limb (back-upper limb), and lower extremity laboratory practical performance for students who dissected in every laboratory (EL group; n = 227) is compared to students who dissected in every other laboratory (EOL group; n = 254). For the back-upper limb part of the anatomy laboratory practical, the mean percentage scores for the EL and EOL groups were 74.5% and 68.1%, respectively (P < 0.001). The mean percentage scores for the EL and EOL groups on the lower limb portion of the anatomy lab practical were 75.9% and 75.6%, respectively (P = 0.994). These data suggest that the use of an alternating dissection schedule had an equivocal effect on the students' gross anatomy laboratory practical performance for these two sections. The reasons for these conflicting results may have been related to regional complexity or volume of information, and the sequence in which the regions were taught.     

Integrating gross anatomy into a clinical oncology curriculum: the oncoanatomy course at Duke University School of Medicine.

The amount of time devoted to teaching gross anatomy to medical students is declining. This topic remains critically important for some medical students, especially those seeking training in anatomy-laden specialties. The authors describe a course currently offered in the department of radiation oncology in the Duke University School of Medicine, developed in 2005, that expands anatomy education into the medical school clinical years.The aim of the course is to help reinforce anatomy knowledge in the clinical context of radiation oncology priorities and concerns, as well as to provide direct visualization and palpation of human cadavers, thus enabling the understanding of complex three-dimensional and anatomic principles. The audience for this course consists of medical students rotating through and the residents and clinical faculty in the department of radiation oncology. Anatomists and radiation oncology residents together present monthly didactic lectures, clinical case presentations, and cadaver-based demonstrations about the relationships between a tumor's anatomic location and its symptoms, patterns of spread, and treatment considerations.Anonymous surveys were distributed to course participants to assess the three components of the course. Survey results indicate that the participants found the anatomy lectures, clinical case presentations, and dissection presentations all to be interesting, relevant, and of high quality. This course is therefore favored by students, residents, and faculty as a way to supplement gross anatomy education during training for a specialty in which anatomy knowledge is essential.     

Integration of clinical problems in teaching gross anatomy: living anatomy, X-ray anatomy, patient presentations, and films depicting clinical problems

In addition to lectures and the dissection course, four supplements are described to stimulate first-year medical students to learn gross anatomy. All topics are coordinated with the dissection course. The additional options are living anatomy, X-ray anatomy by a roentgenologist, presentation of patients by clinicians, and films on clinical problems. This integrated curriculum of basic and applied anatomy generates a high level of student interest in gross anatomy.     

The evolving ethics of anatomy: Dissecting an unethical past in order to prepare for a future of ethical anatomical practice

Anatomical practice has arguably one of the most ethically challenging histories in the medical sciences. Among the oldest scientific disciplines in medicine, dissection of the human body for scientific purposes occurred as early as the third century Before the Common Era. Throughout the history of anatomical practice, human dissection has occurred in ways that cross the line from progressing medical science to violating the sanctity of the human body. The dissection of the human body creates ethical dilemmas which stem from the need for anatomical science to gain medical knowledge in juxtaposition with prevailing religious and moral views surrounding anatomy as a threat to the sanctity of the human body. This article examines the unethical history of human dissection throughout the ages and explores the rationale behind the unethical practices. In addition, this article explores imperative modern day ethical standards in anatomy including, the ethical handling of human bodies, respecting human life, and ensuring informed consent for dissection of bodies that are donated. Finally, this article explores the question of which ethical prism we should use when dealing with anatomy collections or works of the past. Learning both the history of unethical practices in anatomy and the rationale behind them is imperative so that the discipline can prepare for an ethical, diverse, and inclusive future. This article provides a foundation for understanding the evolution of ethics in anatomical practice and is a valuable resource for students and anatomists alike.     

The relationship between premedical coursework in gross anatomy and histology and medical school performance in gross anatomy and histology

Many premedical students enroll in courses whose content will be encountered again during their medical education. Presumably, students believe this practice will lead to improved academic performance in corresponding medical school courses. Therefore, this study was undertaken to determine whether a premedical gross anatomy and/or histology course resulted in increased performance in corresponding medical school courses. A second aim of the study was to examine whether the type of premedical gross anatomy and/or histology course differentially affected medical school performance. A survey that assessed premedical gross anatomy and histology coursework was administered to 440 first-year medical students. The results from this survey showed that students with premedical gross anatomy (n = 236) and/or histology (n = 109) earned significantly more points in the corresponding medical school course than students without the premedical coursework (P < 0.05). Analysis of premedical course types revealed that students who took a gross anatomy course with prosected specimens (n = 35) earned significantly more points that those students without premedical gross anatomy coursework (P < 0.05). The results from this study suggest: 1) premedical gross anatomy and/or histology coursework improves academic performance in corresponding medical school courses, and 2) a premedical gross anatomy course with prosected specimens, a specific type of undergraduate course, significantly improves academic performance in medical gross anatomy.     

Clinical anatomy as the basis for clinical examination: development and evaluation of an Introduction to Clinical Examination in a problem-oriented medical curriculum

Clinical anatomy is usually defined as anatomy applied to patient care. The question is asked whether students of a new horizontally and vertically integrated medical curriculum recognize the subject as the basis for clinical examination. A clinical anatomy practicum was developed in the special activity, "Introduction to Clinical Medicine," held in the second year of the Pretoria medical curriculum. The practicum was conducted on a station basis to anatomically prepare the student for the inspection, palpation, percussion, and auscultation of the cardiovascular, respiratory, abdominal, and urogenital systems. A total of 23 stations consisting of eight cardiovascular, seven respiratory, and eight abdominal/urogenital stations were designed. Standardized patients, cadavers, skeletons, prosected specimens, x-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI), multimedia programs, and clinical case studies were used as resources. A Likert-type questionnaire was used for student evaluation of the practicum. Most students realized the importance of surface anatomy for a family physician. More than two-thirds thought the practicum improved their understanding of the anatomical basis for clinical examination. The minority of students were stimulated to do further reading on clinical examination. The students' response to their ability to integrate the clinical examination with the radiological anatomy was average. Most students were continuously aware of the appropriateness of the practicum for their future career. We conclude that medical students recognize the importance of anatomy as the basis for clinical examination when exposed to an appropriate integrated presentation format.     

斑马鱼3D解剖互动系统的制作

目的制作斑马鱼三维(3D)解剖互动系统软件。方法采用光学显微镜和微计算机断层扫描技术(Micro-CT)研究斑马鱼的组织构造,并收集其形态结构图像。使用Photoshop对获得的连续切片(HE染色)的图片进行校正,使用Autodesk 3ds Max 2012 64-bit-English软件进行三维模型建立。结果获得了斑马鱼骨骼的3D成像和连续切片图像(雄鱼144张,雌鱼179张),实现了斑马鱼重要器官的3D重构,建立了斑马鱼3D解剖互动系统(V 1.0),获得了计算机软件著作权登记证书(证书号:软著登字第0989966号)。结论斑马鱼3D解剖互动系统软件制作的完成为研究斑马鱼立体形态学奠定了基础。     

New views of male pelvic anatomy: role of computer-generated 3D images

There is considerable controversy concerning the role of cadaveric dissection in teaching gross anatomy and the potential of using 3D computer-generated images to substitute for actual laboratory dissections. There are currently few high-quality 3D virtual models of anatomy available to evaluate the utility of computer-generated images. Existing 3D models are frequently of structures that are easily examined in three dimensions by removal from the cadaver, i.e., the heart, skull, and brain. We have focused on developing a 3D model of the pelvis, a region that is conceptually difficult and relatively inaccessible for student dissection. We feel students will benefit tremendously from 3D views of the pelvic anatomy. We generated 3D models of the male pelvic anatomy from hand-segmented color Visible Human Male cryosection data, reconstructed and visualized by Columbia University's in-house 3D Vesalius trade mark Visualizer.(1) These 3D models depict the anatomy of the region in a realistic true-to-life color and texture. They can be used to create 3D anatomical scenes, with arbitrary complexity, where the component anatomical structures are displayed in correct 3D anatomical relationships. Moreover, a sequence of 3D scenes can be defined to simulate actual dissection. Structures can be added in a layered sequence from the bony framework to build from the "inside-out" or disassembled much like a true laboratory dissection from the "outside-in." These 3D reconstructed anatomical models can provide views of the structures from new perspectives and have the potential to improve understanding of the anatomical relationships of the pelvic region (http://www.cellbiology.lsuhsc.edu/People/Faculty/Venuti_Figures/movie_index.html).