Stuart D. Inglis, PhD, left, and Scott T. Doyle, PhD, are developing a model for a hybrid gross anatomy curriculum that integrates digital scans with cadaveric dissection.

Published August 10, 2017

Department ofPathology and Anatomical Sciences researchers are studying waysto develop a hybrid gross anatomy curriculum that fuses digitizedCT scans with actual cadaveric dissection.

Hybrid Program Offers Best of Both Worlds

Gross anatomy programs are expensive and extremelyresource-intensive, requiring a lot of infrastructure to set up andoperate.

The Jacobs School of Medicineand Biomedical Sciences is fortunate to have a productive andgenerous AnatomicalGift Program, but many institutions do not have the necessaryresources and are looking at replacing their cadaver programs withan entire digital way of learning using standard CT datasets or downloads from the Internet as a way of learning humangross anatomy.

Students benefit from a tactile and kinesthetic mode oflearning, says ScottT. Doyle, PhD, assistant professor of pathology and anatomicalsciences. Dissection, the process of learning through doing,is really important and we think its critical for studentsto learn that while they are going through theirtraining.

The amount of raw data that digital scans provide can be used tobuild upon the inherent value that exists in cadaveric dissection,he says.

Scans Help Students Learn About Human Variation

Doyle and StuartD. Inglis, PhD, instructor of pathology and anatomicalsciences, are co-principal investigators on a 2017 SeedGrant for Promoting Pedagogical Innovation through the Center for EducationInnovation, that will study the best ways to integrate the datafrom CT scans into a gross anatomy curriculum.

The medical school receives about 600 donations a year throughits anatomical donation gifts program, and initiated a CT scanproject in 2014 in order to create a database.

RaymondP. Dannenhoffer, PhD, director of the anatomical gift program,felt that high-resolution scans of some of the cadavers comingthrough the gross anatomy program would be useful for teachingstudents not only about the human form, but also about humanvariation.

That often doesnt come through if you are using aclassic textbook example because in that instance you get oneexample of what the human form is like and you dont reallyget an appreciation for all the things you might see in clinicalpractice or the real world, Doyle says.

Digital Images Provide Useful Roadmaps

As part of their gross anatomy lab, medical students are givenCT scans on USB drives to refer back to throughout the course.

Inglis notes there are several advantages to using CT scans in agross anatomy setting.

Being able to look at scans prior to dissection, studentscan identify some interesting pathologies, he says.They can see kidney stones, pacemaker units or jointreplacements. When they are about to dissect, it gives them abetter perspective on what they are about to find.

Inglis says it also allows students to start to make directcomparisons between the dissected body and the radiologicalimages.

Its one experience to dissect, but as they move onin their careers they will be looking at digital representations ofproblems they see in MRIs and CT scans, he adds.

Visualizing Data in 3-D Space Extremely Useful

In its gross anatomy labs, the medical school utilizes a devicecalled a visualization table that is manufactured by Sectra, aSwedish company.

It has a giant touchscreen, a computer inside it and USBports on the side. Students can plug in a USB drive and uploadtheir scan, Doyle says. It allows you to visualizethe CT scans in 3-D. It takes a certain range of CT values andmakes them look solid, and then renders them, so you can spin itaround and zoom in and look at the data that way.

Inglis says the best analogy is thinking of the CT scans asslices of bread and the visualization table putting them togetherto present the whole picture.

When you look at the literature on replacing cadavericdissection with digital models, you see the students find thedigital models more convenient because they dont have tocome to a physical lab and deal with all of the technicalities ofperforming a dissection, but they value the education they get fromactual dissection, Doyle says.

There is inherent value in both of these modes ofteaching and that is why we are thinking about this as a hybridprogram that uses traditional cadaveric dissection as well asdigital modeling of the CT scans.

For this project I am interested in looking at thevariation structure from a quantitative standpoint, Doyleadds. From an engineering standpoint, all the data for these3-D models is contained in these grayscale images and the questionis how best to represent them in 3-D space.

User Feedback Key Component of Study

As part of the study, the researchers plan to seek studentfeedback, Doyle says.

We definitely want to know how they are using it.Students are very good at prioritizing what they are going to spendtheir time on, he says. They want to excel in thecourse so they are going to find the most efficient way of usingthe data.

One of the big concerns we have is to make sure we aredoing this in a way that is not going to inconvenience them or notgoing to hamper their ability to learn.

Diverse Data Set Most Desirable

Inglis notes that many institutions that are thinking aboutadopting the digital-only model intend to use a single, unifiedbody for teaching purposes.

In recent years, there have been scans of two bodies thathave been used from school to school, but it has been documented inthe literature that in those cases, there have been a number ofanatomical variations identified in these bodies that are now beingpresented as the norm, which is problematic.

In some cases, there are advantages to all medicalstudents from around the country learning from the same sort ofcontent map, but at the same time there are also some very seriousissues with that, he says.

Whereas, if a more diverse data set were available, studentscould gain a better sense of appreciation for variation, Inglissays.

3-D Models Aid in Finding Anatomical Landmarks

Looking at the human body in 3-D form is extremely helpful forstudents trying to find different anatomical landmarks oranatomical structures they need to know, Doyle says.

A good example that is a problem for students are cranialnerves, which tend to have loops and insert into the skull indifferent ways so they are often difficult to see, both on a flatCT scan and during dissection, he adds.

Having a 3-D model where they can identify those nervesand where they enter the skull and how they move is going to bevery useful.

Potential Applications in Surgical Planning Procedures

While the grant is focused on the educational side of theequation, Doyle notes other researchers working in areas such as3-D printing and surgical planning are interested in the study.

In the course of figuring out how to work with this data,we anticipate there are different directions this could go from aresearch standpoint, he says.

One example is a project they are undertaking with a hepaticsurgeon who is interested in the biliary tree that lies between thegallbladder and the liver.

The way in which the ducts connect the gallbladder to the maintrunk of the biliary tree can have implications for how a surgeongoes in to remove a tumor.

In about two-thirds of individuals, the artery to thegallbladder lies behind the duct that needs to be cut, which meansthat in one-third it lies in front, Inglis says.

If you go in and are not precise as to where it is and ifthe artery is severed first, that becomes a medical emergencybecause that creates a massive internal hemorrhage.

Being able to take a scan of a patient and reconstructing a 3-Dstructure before printing it out to provide to a surgeon is goingto be very useful in terms of planning, Doyle says.

At the end of the day, what we are trying to do isimprove patient care by making better doctors on the education sideor by using the data in a way to help practicing physicians treattheir patients better, he says.

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