Web-delivery of anatomy video clips using a CD-ROM

Until recently, anatomists had no doubt that the teaching of anatomy had to include cadaver dissection. However, due to a changing academic environment as well as challenged financial institutional resources, computer-assisted instruction was introduced into medical curriculum in an attempt to reduce the cost and the time committed to cadaver dissection. Computer-assisted instruction included locally created or commercially available anatomy software, Internet sites, and databases of digital images of cadaveric structures such as the Virtual Human Project. However, until now, bandwidth limitations have not allowed effective visualization in real-time over the Internet of recorded videos or 3D animations reconstructed from a database. We describe how to successfully link and display large video clips stored on a CD-ROM in support of lectures saved in HTML format on the Internet. This process, described in its totality, allows students to access audiovisual files on a CD-ROM through the Internet, from any location, with either Macintosh or Windows computers, using the Netscape browser. This process allowed us to circumvent one of the most significant limitations of the computer-assisted instruction on the Internet by delivering full audio and visual information on demand, as it would happen in a traditional classroom.     

Implementing and integrating computer‐based activities into a problem‐based gross anatomy curriculum

A problem‐based learning curriculum in gross anatomy was begun for a limited number of students to address unsuccessful methodology inherent in a traditional instructional approach. To eliminate some concerns associated with the laboratory component, computer‐based instruction and other computer‐ related activities were actively integrated into the total instructional process. Prosections, directions, quizzes, images, and grades were provided in lab at table‐side computer workstations, in the library, and on the web. Results were assessed through questionnaires in which students rated their learning experience according to a Likert‐type scale. Success was measured by quantitative improvements in student perception. In this three‐year study, observations and measurements have suggested increasingly positive student attitudes toward educational technology, for networks as a faster and more effective method of student/faculty communication, and in the utilization of computer‐based instruction for greater flexibility and efficiency in learning. This allowed a rethinking of the structure and content of the curriculum by the faculty, which permitted reduced laboratory time, more small‐group activity, and less reliance on staff. Clin. Anat. 12:191–198, 1999. © 1999 Wiley‐Liss, Inc.     

Near‐peer driven dissection selective: A primer to the medical school anatomy course

In the anatomy laboratory, skill remains a critical component to unlocking the true value of learning from cadaveric dissection. However, there is little if any room for provision of instruction in proper dissection technique. We describe how near‐peer instructors designed a supplemental learning activity to enhance the dissection experience for first‐year medical students. This study aimed to evaluate the efficacy of this curriculum in improving participants' understanding of dissection technique and its impact on perceived challenges associated with the anatomy course. Curriculum was designed under faculty guidance and included didactic sessions, low‐fidelity models, dissection, student presentations, and clinical correlations. Participants' (n = 13) knowledge of basic dissection techniques and concepts were assessed before the selective, and both participants' and nonparticipants' (n = 39) knowledge was assessed at the end of week one and week seven of the anatomy course. Scores were compared using repeated measures ANOVA followed by post hoc t‐tests. Thirteen deidentified reflective essays were reviewed by four independent reviewers for themes that aligned with learning objectives. Participants in the selective course scored higher on assessment of dissection techniques and concepts one week after the selective compared to both nonparticipants and their own baseline scores before the selective. Analysis of student reflections resulted in four themes: confidence with dissection skill, sharing resources and transfer of knowledge, learning environment, and psychological impact of perceived challenges of the anatomy course. Near‐peer driven supplemental exercises are effective in facilitating dissection skills. This dissection primer increases student confidence and alleviates apprehension associated with anatomy courses. Clin. Anat. 28:985–993, 2015. © 2015 Wiley Periodicals, Inc.     

Three‐dimensional demonstration of the lymphatic system in the lower extremities with multi‐detector‐row computed tomography: A study in a cadaver model

Sentinel lymph node biopsy (SLNB) has had a great impact on the staging and treatment of cancer. The purpose of this study was to study the lymphatic anatomy of the lower extremities by constructing three‐dimensional images using multi‐detector‐row computed tomography (MDCT). To select appropriate contrast media for MDCT lymphatic imaging in a cadaver, we tested four kinds of contrast media by injecting them into fresh swine kidneys. After the suitable contrast medium was selected, 10 lower extremities from 5 fresh cadavers were studied. After injection of the contrast medium, each lower extremity was scanned with high‐spatial‐resolution MDCT. The zinc oxide mixture was found to be the most appropriate contrast formula for MDCT imaging of cadaver lymphatics in terms of CT value and no extravasation. The high‐resolution MDCT imaging revealed two different superficial lymphatic pathways in the legs. One lymphatic pathway accompanying the great saphenous vein had a constant course and was connected to the superficial inguinal lymph nodes. However, another pathway, along the small saphenous vein, was variable. Some of the deep lymphatic vessels bypassed the inguinal lymph nodes. Using a new protocol, we were able to construct three‐dimensional images of the lower extremity lymphatics in a cadaver model. MDCT imaging provided novel information about two different superficial lymphatic pathways in the lower extremities. Clin. Anat., 2013. © 2013 Wiley Periodicals, Inc.     

Using ATP‐driven bioluminescence assay to monitor microbial safety in a contemporary human cadaver laboratory

Introduction: The objective of this study was to utilize a cost‐effective method for assessing the levels of bacterial, yeast, and mold activity during a human dissection laboratory course. Nowadays, compliance with safety regulations is policed by institutions at higher standards than ever before. Fear of acquiring an unknown infection is one of the top concerns of professional healthcare students, and it provokes anti‐laboratory anxiety. Human cadavers are not routinely tested for bacteria and viruses prior to embalming. Human anatomy dissecting rooms that house embalmed cadavers are normally cleaned after the dissected cadavers have been removed. There is no evidence that investigators have ever assessed bacterial and fungal activities using adenosine triphosphate (ATP)‐driven bioluminescence assays. Methods: A literature search was conducted on texts, journals, and websites regarding bacterial, yeast, and mold activities in an active cadaver laboratory. Midway into a clinical anatomy course, ATP bioluminescence assays were used to swab various sites within the dissection room, including entrance and exiting door handles, water taps, cadaver tables, counter tops, imaging material, X‐ray box switches, and the cadaver surfaces. Results: The results demonstrated very low activities on cadaver tables, washing up areas, and exiting door handles. There was low activity on counter tops and X‐ray boxes. There was medium activity on the entrance door handles. Conclusion: These findings suggest an inexpensive and accurate method for monitoring safety compliance and microbial activity. Students can feel confident and safe in the environment in which they work. Clin. Anat. 28:164–167, 2015. © 2014 Wiley Periodicals, Inc.     

On behalf of tradition: An analysis of medical student and physician beliefs on how anatomy should be taught

Human anatomy, one of the basic medical sciences, is a time‐honored discipline. As such, it is taught using traditional methods, cadaveric dissection chief among them. Medical imaging has recently gained popularity as a teaching method in anatomy courses. In light of a general tendency to reduce course hours, this has resulted in a decrease of dissection time and intense debates between traditional and modern approaches to anatomy teaching. In an attempt to explore trends in the attitudes of medical professionals toward the various methods of anatomy teaching, medical imaging in particular, the authors constructed a questionnaire and conducted a nationwide survey among medical students (in all stages at medical school), residents, and specialists in all fields of medicine. The survey results demonstrated indisputable appreciation of traditional methods of anatomy teaching, particularly cadaveric dissection, and showed that specialists believe significantly more strongly than clinical or preclinical students that anatomy and medical imaging should be taught separately. Strong correlations among the components of the traditional approach to anatomy instruction were also found. In light of the results, it was recommended that imaging should be incorporated into anatomy courses with caution, and, as far as possible, not at the expense of dissection time. It was advised that medical imaging has to be taught as a separate course, parallel to a traditional anatomy course. This will allow anatomical principles to be appreciated, which in turn will serve the students when they study radiology. “And we proceed in the following order: in front walks Nikolai with the slides or atlases, I come after him, and after me, his head humbly lowered, strides the cart horse; or else, if necessary, a cadaver is carried in first, after the cadaver walks Nikolai, and so on. At my appearance, the students rise, then sit down, and the murmur of the sea suddenly grows still. Calm ensues.” —From “A Boring Story: From the Notebook of an Old Man” by Anton Chekhov. Clin. Anat. 28:980–984, 2015. © 2015 Wiley Periodicals, Inc.     

Whole Courses of the Oculomotor,Trochlear, and Abducens Nerves,Identified in Sectioned Images and Surface Models

In medicine, the neuroanatomy of the oculomotor (III), trochlear (IV), and abducens nerves (VI) is learned essentially by cadaver dissection, histological specimens, and MRI. However, these methods have many limitations and it is necessary to compensate for the insufficiencies of previous methods. The aim of this research was to present sectioned images and surface models that allow the whole courses of III, IV, and VI and circumjacent structures to be observed in detail. To achieve this, the structures of whole courses of III, IV, and VI were traced on the sectioned images, and surface models of the structures were reconstructed. As a result, nucleus of III, Edinger‐Westphal nucleus, nucleus of IV, and nucleus of VI and their fibers were identified on brainstem in the sectioned images. In the sectioned images, III, IV, and VI passed both sides of the cavernous sinus and entered at the orbit through the superior orbital fissure. In the sectioned images, III, IV, and VI innervated extraocular muscles in orbit. In surface models, the whole courses of III, IV, and VI and circumjacent structures could be explored freely three‐dimensionally. The greatest advantage of the sectioned images was that they allowed the whole courses of III, IV, and VI and circumjacent structures to be observed as real colored in an unbroken line. In addition, the surface models allowed the stereoscopic shapes and positions of III, IV, and VI to be comprehended. The sectioned images and surface models could be applied for medical education purposes or training tools. All data generated during this study is available free of charge at anatomy.dongguk.ac.kr/cn/. Anat Rec, 298:436–443, 2015. © 2014 Wiley Periodicals, Inc.     

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.     

Three‐dimensional corrective osteotomies of mal‐united clavicles—is the contralateral anatomy a reliable template for reconstruction?

In computer‐assisted preoperative planning of corrective osteotomies, the unaffected contralateral bone often serves as three‐dimensional template for the reconstruction of mal‐united bones. Before applying this approach to new anatomy such as the clavicle bone, it is important to study asymmetry between the sides. The purpose of this study was to investigate bilateral symmetry of the clavicle in healthy cadavers using three‐dimensional measurement techniques. Bilateral symmetry of 102 clavicles (51 cadavers, mean age: 52.19 years, 37 male) was measured based on three‐dimensional models reconstructed from computed tomography. Besides length, volume, and surface, the side‐differences were evaluated by considering the mirrored left clavicle as the reconstruction template and the right clavicle as the one that will be realigned by osteotomy. The relative transformation between the aligned segments was measured to express the difference with to three‐dimensional translation and rotation. The same procedure was repeated using mean‐sized clavicles, one for each gender, as the template. The contralateral side was a significant more accurate reconstruction template compared to a mean‐sized clavicle (P < 0.001). Nevertheless, an average side‐differences with respect to rotation and translation of 8.79° ± 5.2° and 3.5 mm ± 2.7 mm, respectively. The left clavicles were significant (P = 0.001) longer with 154 mm compared to the right ones (151 mm). Three‐dimensional differences between the left and right clavicles exist, but can be considered as small. Therefore, the contralateral side appears to be a reliable reconstruction template, in particular compared to a mean‐sized clavicle. Clin. Anat. 28:865–871, 2015. © 2015 Wiley Periodicals, Inc.     

Segmentation and Surface Reconstruction of the Detailed Ear Structures,Identified in Sectioned Images

The structure of the ear, which intervenes between gross anatomy and histology in size, can be best understood by means of three‐dimensional (3D) surface models on a computer. Furthermore, surface models are the source of interactive simulation for clinical trials, such as tympanoplasty. The objective of this research was to elaborate the surface models of detailed ear structures, which contribute to learning anatomy or the practice of otology. We produced sectioned images of a cadaver head (pixel size, 0.1 mm; 48‐bit color). In the sectioned images, the external, middle, and internal ear structures and other related components were delineated on Photoshop to acquire segmented images at 0.5‐mm intervals. Segmented images of each structure were stacked, and the surface was reconstructed to generate a 3D‐surface model on commercial software. Thirty surface models showed fine ear topographic anatomy (e.g., semicircular ducts), as expected. Herein, we present the corresponding sectioned images, segmented images, and surface models of ear structures that will be released together. It is hoped that these image data will stimulate the development of medical simulations. The efficient technique of segmentation and surface reconstruction enables the manufacture of surface models from other serial images (e.g., CTs and MRIs). Anat Rec, 2011. © 2011 Wiley‐Liss, Inc.     

Significance of the role of self‐study and group discussion

The study of anatomy is experiencing a reduction in course duration and content, lecture and dissection hours, and number of lectures and examinations. This necessitates that medical students develop skills for self‐study. Toward that end, a self‐study module in basic anatomy was tested. Fifty‐seven new entrants were given a pretest (Pretest A) containing a questionnaire on basic anatomy. Then, in three groups each of 11 and two groups each of 12, they learned basic anatomy from recommended books in the library by self‐study for 2 hours. They discussed what they had learned among their group members during a practical exercise, followed by a posttest (Posttest A). A control group of 57 new entrants during another year was given the same pretest (Pretest B) and a lecture on basic anatomy. Then, without opportunity for self‐study, they were given a posttest (Posttest B). The answers were scored out of 40. The students' mean mark in Pretest A was poor. All the groups performed well in the practical exercise. In Posttest A, the mean mark increased significantly (P < 0.001), by 9.4. It shows that self‐study and group discussions significantly helped the students in construction of core anatomical knowledge as well as the acquisition, assimilation, and application of anatomical concepts and content. The mean mark in Pretest B was also poor. In Posttest B, the mean mark increased significantly (P < 0.001), by 14.2. This indicates that the traditional teaching session is also useful and serves to advance student knowledge. Thus our innovative study module can create a positive learning environment and can become an alternative to traditional instruction in teaching anatomical terminology and basic anatomy. Clin. Anat. 12:277–280, 1999. © 1999 Wiley‐Liss, Inc.     

Classic versus millennial medical lab anatomy

This study investigated the integration, implementation, and use of cadaver dissection, hospital radiology modalities, surgical tools, and AV technology during a 12‐week contemporary anatomy course suggesting a millennial laboratory. The teaching of anatomy has undergone the greatest fluctuation of any of the basic sciences during the past 100 years in order to make room for the meteoric rise in molecular sciences. Classically, anatomy consisted of a 2‐year methodical, horizontal, anatomy course; anatomy has now morphed into a 12‐week accelerated course in a vertical curriculum, at most institutions. Surface and radiological anatomy is the language for all clinicians regardless of specialty. The objective of this study was to investigate whether integration of full‐body dissection anatomy and modern hospital technology, during the anatomy laboratory, could be accomplished in a 12‐week anatomy course. Literature search was conducted on anatomy text, journals, and websites regarding contemporary hospital technology integrating multiple image mediums of 37 embalmed cadavers, surgical suite tools and technology, and audio/visual technology. Surgical and radiology professionals were contracted to teach during the anatomy laboratory. Literature search revealed no contemporary studies integrating full‐body dissection with hospital technology and behavior. About 37 cadavers were successfully imaged with roentograms, CT, and MRI scans. Students were in favor of the dynamic laboratory consisting of multiple activity sessions occurring simultaneously. Objectively, examination scores proved to be a positive outcome and, subjectively, feedback from students was overwhelmingly positive. Despite the surging molecular based sciences consuming much of the curricula, full‐body dissection anatomy is irreplaceable regarding both surface and architectural, radiological anatomy. Radiology should not be a small adjunct to understand full‐body dissection, but rather, full‐body dissection aids the understanding of radiology mediums. The millennial anatomy dissection laboratory should consist of, at least, 50% radiology integration during full‐body dissection. This pilot study is an example of the most comprehensive integration of full‐body dissection, radiology, and hospital technology. Clin. Anat. 27:988–993, 2014. © 2014 Wiley Periodicals, Inc.     

An anatomical ultrasound study of the long posterior sacro‐iliac ligament

The long posterior sacro‐iliac ligament (LPSL) is directly posterior to the sacro‐iliac joint and a potential source of lower back and pelvic pain. Its sonographic anatomy has not been described in detail. The aim of this study was to define and measure the ligament in healthy young women using ultrasound (US). The LPSL was scanned in 30 healthy women (median age, 22 years; range, 20–34) using a high‐resolution linear transducer (7.5–10 MHz). The ligament was consistently visualized as a hyperechoic laminated linear structure between the posterior superior iliac spine and the lateral aspect of the third transverse sacral tubercle. Its length, thickness, and the angle between it and the posterior superior iliac spine were measured by an experienced sonographer bilaterally in both semiflexed standing and lateral decubitus positions. Four female cadaver pelves (age range, 57–93 years) were also scanned and dissected to validate US observations. In the semiflexed standing position, mean LPSL length was 37.9 ± 2.4 mm, mean thickness 1.57 ± 0.38mm, and median angle 18.5°. There was no statistically significant difference with equivalent values in the lateral decubitus position. Intrarater repeatability was fair to substantial in both positions (intraclass correlation coefficient, 0.39–0.66), improving to moderate to substantial (intraclass correlation coefficient, 0.57–0.80) using the mean of two measurements. There was good overall agreement between LPSL length and thickness in cadavers measured by US and dissection. These findings document the sonographic appearance, length, and thickness of the LPSL and provide useful normative data for understanding potential LPSL pathology, particularly in relation to pregnancy‐related pelvic girdle pain. Clin. Anat. 23:971–977, 2010. © 2010 Wiley‐Liss, Inc.     

A meta‐analysis of the effects of internet‐ and computer‐based cognitive‐behavioral treatments for anxiety

Internet‐and computer‐based cognitive‐behavioral treatments have been introduced as novel approaches to deliver standard, quality treatment that may reduce barriers to care. The purpose of this review is to quantitatively summarize the literature examining the treatment effects of Internet‐ or computer‐based treatment (ICT) on anxiety. Nineteen randomized controlled ICT trials were identified and subjected to fixed and random effects meta‐analytic techniques. Weighted mean effect sizes (Cohen's d) showed that ICT was superior to waitlist and placebo assignment across outcome measures (ds=.49–1.14). The effects of ICT also were equal to therapist‐delivered treatment across anxiety disorders. However, conclusions were limited by small sample sizes, the rare use of placebo controls, and other methodological problems. In addition, the number of available studies limited the opportunity to conduct analyses by diagnostic group; there was preliminary support for the use of ICT for panic disorder and phobia. Large, well‐designed, placebo‐controlled trials are needed to confirm and extend the results of this meta‐analysis. © 2008 Wiley Periodicals, Inc. J Clin Psychol 65: 1–21, 2009.     

Time‐saving and fail‐safe dissection method for vestibulocochlear organs in gross anatomy classes

Because the vestibulocochlear organs are tiny and complex, and are covered by the petrous part of the temporal bone, they are very difficult for medical students to dissect and visualize during gross anatomy classes. Here, we report a time‐saving and fail‐safe procedure we have devised, using a hand‐held hobby router. Nine en bloc temporal bone samples from donated human cadavers were used as trial materials for devising an appropriate procedure for dissecting the vestibulocochlear organs. A hand‐held hobby router was used to cut through the temporal bone. After trials, the most time‐saving and fail‐safe method was selected. The performance of the selected method was assessed by a survey of 242 sides of 121 cadavers during gross anatomy classes for vestibulocochlear dissection. The assessment was based on the observation ratio. The best procedure appeared to be removal of the external acoustic meatus roof and tympanic cavity roof together with removal of the internal acoustic meatus roof. The whole procedure was completed within two dissection classes, each lasting 4.5 hr. The ratio of surveillance for the chorda tympani and three semicircular canals by students was significantly improved during 2013 through 2016. In our dissection class, “removal of the external acoustic meatus roof and tympanic cavity roof together with removal of the internal acoustic meatus roof” was the best procedure for students in the limited time available. Clin. Anat. 30:703–710, 2017. © 2017Wiley Periodicals, Inc.     

Computer‐assisted pathological immunohistochemistry scoring is more time‐effective than conventional scoring,but provides no analytical advantage

Ong C W, Kim L G, Kong H H, Low L Y, Wang T T, Supriya S, Kathiresan M, Soong R & Salto‐Tellez M
(2010) Histopathology 56 , 523–529 Computer‐assisted pathological immunohistochemistry scoring is more time‐effective than conventional scoring, but provides no analytical advantage Aims: Interpretation of immunohistochemistry is primarily done through human visual scoring while computer‐assisted scoring is relatively uncommon. This study aimed to examine (i) the level of agreement between human visual and computer‐assisted pathological scoring of immunoreactivity expression in colorectal cancers, (ii) whether computer‐assisted scoring affects the prognostic significance of biomarkers, and (iii) whether computer‐assisted pathological scoring provides any time‐saving or reproducibility advantages. Methods and results: Tissue microarray blocks were constructed from the primary colorectal adenocarcinoma specimens of 486 patients. Scoring of the six markers [cytokeratin (CK) 7, CK20, cyclooxygenase‐2, Ki67, p27 and p53] was done independently by a qualified pathologist, a trained scientist and the Ariol SL‐50 (Applied Imaging). Univariate analysis showed that human visual and computer‐assisted scoring were strongly correlated (all κ values >0.8). Both human visual and computer‐assisted pathological scoring identified the same set of biomarkers with significant association with survival. Computer‐assisted pathological scoring was shown to be a time‐effective means of scoring larger numbers of slides (for high‐throughput studies). Conclusions: Our results suggest that computer‐assisted pathological scoring can be a viable alternative to pathologist scoring in a manner that is more practical and time‐effective, but, interestingly, providing no analytical advantage.