Anatomical Reality Research Articles

Decision Making and Management of Anterior Knee Pain in Young Patients With Pathological Femoral Anteversion: A Critical Analysis Review.

Pathological femoral anteversion (FAV) or femoral maltorsion is often overlooked as a cause of anterior knee pain (AKP). Therefore, it should be routinely evaluated during physical examination of the patient with AKP. FAV is a problem because it changes the direction of the quadriceps and thereby the force acting on the patellofemoral joint. The Murphy CT method comes closest to showing the anatomical reality when FAV is evaluated. The treatment of choice in a patient with AKP with symptomatic excessive FAV is the femoral derotational osteotomy. Before doing a derotational osteotomy, the hip joint should be evaluated to avoid hip pain. Currently, no scientific evidence supports the cutoff point at which derotational femoral osteotomy should be the treatment of choice in young patients with AKP with symptomatic pathological FAV. Furthermore, no evidence exists regarding the level at which the osteotomy must be done.

A Virtual Reality Anatomy Model of the Temporal Bone in ORL Residency Training-Gain or Gadget?

Virtual reality (VR) appears to be a promising educational tool for otorhinolaryngology (ORL) residency training, as it allows for safe and effective practice immediate feedback and potential improvements in patient outcomes. Despite these advantages, VR has not yet been incorporated into residency training in ORL, which may be due to limited availability or validation and skepticism toward incorporation of new training methods. This study investigates whether a VR model of the temporal bone improves learning success for ORL residents in comparison to standard plastic models and whether it depends on surgeon's experience. We also included a subjective evaluation of the learning experience with both models. ORL residents and specialists at 2 German university hospitals were tested on their knowledge of temporal bone anatomy after training with either VR or standard plastic models. In addition, we compared knowledge of the temporal bone anatomy before- and after-VR training. Lastly, a subjective survey on the benefits and limitations of VR was conducted to assess participants' views on this new technology. About 85% of the participants considered VR to be better than conventional models and agreed that VR was a useful tool for teaching complex anatomy. Objective evaluation showed significant improvement in knowledge after using VR (before/after comparison), especially in participants with a higher level of preexisting knowledge. Direct comparison to conventional plastic models showed no superiority of the VR model. VR models in ORL are not only appealing and motivating for residents, but also objectively improve their anatomical knowledge, especially in advanced residency. In addition, VR-in contrast to the plastic model-offers opportunities for further development and optimization.

AR Mobile Application for Human Anatomy

Abstract: Anatomy is the main topic of human biology. The study of interior body organs, from cells to organ systems, is known as human anatomy. Studying the 2D model of the internal structure is difficult and tiresome. The purpose of this study is to develop a 3D Augmented Reality anatomy of human learning system. When learning anatomy through textbooks, puppets, or 2D models, it might be difficult to understand the internal structure. One solution that has been developed is an Android app that uses augmented reality. An interactive menu in the program allows you to scan an image and see a 3D version of a model in actual space. This study uses Augmented Reality technology to create a human body learning system. It is hoped that by using this approach, students will be able to visualize the human body's parts in 3D with ease. Students can learn more quickly with the use of AR technology.

Evaluation of cognitive load for a mixed reality anatomy application

BackgroundAsynchronous learning is becoming more prevalent in medical education. Mixed reality applications are interactive tools that may be used to study 3D anatomical relationships outside of the classroom. However, learners may face challenges when using new technologies that are unfamiliar to them and require significant mental effort that distracts from learning. This study investigates learner cognitive load for a mixed reality (MR) application developed as an asynchronous resource to study heart anatomy subsequent to classroom learning. MethodsThe Cognitive Load Component questionnaire was administered to first-year medical students (n = 18) to measure intrinsic, extrinsic, and germane cognitive load. Responses were collected after classroom and laboratory instruction on heart anatomy and repeated after learners completed an MR-based learning activity asynchronously on the same topic. ResultsCognitive load differed between classroom and MR-based learning. Classroom learning was reported to be more difficult and complex and required greater intrinsic cognitive load. Learners found the MR activity to be more relevant to their studies and expressed reduced extrinsic load in comparison to classroom learning. Learners indicated the MR application had high germane load, allowing for a greater focus on their learning, but the volume of learning was greater in the classroom and laboratory. ConclusionsAsynchronous MR instructional activities are a viable tool to supplement synchronous learning of 3D structure-function relationships of the heart without overburdening cognitive resources of the learner.

A Shoulder Musculoskeletal Model with Three-Dimensional Complex Muscle Geometries.

Muscle structure is an essential component in typical computational models of the musculoskeletal system. Almost all musculoskeletal models represent muscle geometry using a set of line segments. The straight-line approach limits models' ability to accurately predict the paths of muscles with complex geometry. This approach needs knowledge of how the muscle changes shape and interacts with fundamental structures like muscles, bones, and joints that move. Moreover, the moment arms are supposed to be equivalent to all the fibers in the muscle. This study aims to create a shoulder musculoskeletal model that includes complex muscle geometries. We reconstructed the shape of fibers in the entire volume of six muscles adjacent to the shoulder using an automated technique. This method generates many fibers from the surface geometry of the skeletal muscle and its attachment areas. Highly discretized muscle representations for all muscles were created and used to simulate different shoulder movements. The moment arms of each muscle were calculated and validated against cadaveric measurements and models of the same muscles from the literature. We found that simulations using the developed musculoskeletal models generated more realistic geometries, which expands the physical representation of muscles compared to line segments. The shoulder musculoskeletal model with complex muscle geometry is created to increase the anatomical reality of models and the lines action of muscle fibers, and to be used for finite element investigations.

Student Perceptions of Superimposed Mixed Reality Anatomy: A Bridge Between the Virtual and Physical.

A prototype mixed reality model was developed in which three-dimensional holograms of musculoskeletal anatomy were superimposed over a physical skeleton model, conferring tactile sensation to the bony attachments of virtually observed muscles. Fifty-three second-year medical students piloted this innovative format and provided feedback on its effectiveness as a learning modality.

Comparative validity of three simulation platforms for objective assessment of otoscopy skills.

To assess the face, construct and content validity of three different platforms for otoscopy skills assessment, using a traditional otoscope with manikin, digital otoscope (Tympahealth) with manikin, and traditional otoscope with a low-cost model ear (SimEar). Prospective mixed methods study. Tertiary hospital. Postgraduate trainees and expert assessors. Face and Content validity based on expert assessor ranking on each model and their feedback from semi-structured interviews. Construct validity based on Objective Structured Clinical Examination scores. Each platform differed in face, construct and content validity scores, with no one platform consistently outperforming others. Three main themes were identified during thematic analysis of expert assessor interviews: ability to assess what is seen, anatomical reality, and ease of use. The low-cost model showed greatest potential, where modification to include a silicone ear could lead to high validity with marginal increase in cost. Several modalities for assessing otoscopy skills exist, each with advantages and disadvantages. Modifications to a low-cost model, for use with either a traditional or digital otoscope, could prove to be the best model.

11 PRINTING 3D MODELS OF THE HEART: CAN IT HELP IN UNDERSTANDING THE COMPLEX ANATOMY?

Abstract The use of 3D printing in the medical field is widespread especially in the dental clinic as a support to orthodontic / implant therapy. In the training of personnel relating to cardiological diagnostic methods, can it be useful to shorten the learning curve of human anatomy? A light-curing liquid resin 3D printer was used to obtain anatomical models that faithfully reproduce the real anatomy of the individual patient. The starting model was obtained from CT with contrast medium performed on patients. Depending on the diagnostic question, CT may contain complete information on both the arterial circulation and the venous circulation of the heart and the epiaortic vessels. From this information a 3D surface reconstruction is obtained which, once reworked, can be used directly for printing. The model size is limited by the print volume of the printer which may vary depending on the printer model. The model to be printed obtained from CT acquisitions the 3D model will be the representation of the lumen of the vessels and cavities of the heart. The models obtained faithfully represent the anatomical reality of the patient who underwent CT with contrast medium. Actual size is affected by the print volume size of the printer model. In my experience in university teaching, the models obtained with 3D printing have been found to be very useful for understanding the complex spatial configuration of the anatomy of the heart and great vessels

M1, M2: Time to Bid Adieu!

M1, M2: Time to Bid Adieu!

Mobile Gyro Control for Intuitive Manipulation of Virtual Anatomy Specimens

The VanVR APP (Vancouver Virtual Reality Anatomy and Pathology Project) is an anatomy educational tool developed as a response to the Covid‐19 pandemic. The web app provided 3D models of scanned prosections to accommodate students with their virtual anatomy lab courses at UBC. The web interface means that interactions with the 3D specimens are controlled by mouse movements, which can be less intuitive and confusing. We have developed a technology that allows students to manipulate and turn the 3D specimens with 6 degrees of freedom using their mobile phones as a controller.The VanVR APP was created using multiple development tools such as Unity Engine for the overall environment setup and UI implementation, C# scripts for the interactive functionalities, 3D photogrammetry for specimen visualization, MongoDB for database, render Unity built WebGL and deployed the web app on Azure app service. To improve the interactivity and increase the intuitive design of the application, a new functionality of mobile gyro control was implemented using Photon to connect with the 3D specimens in WebGL using generated pairing code to match the web app and the mobile device in a virtual room. The orientation of the phone is transmitted to a spherical model in WebGL, which accordingly transforms the coordinates of any chosen specimen displayed in front of the user. This means that simply by tilting a phone like a gyro controller, users will be able to intuitively mirror how the specimen rotates in the virtual lab with significantly more freedom than the traditional mouse movement control. Along with the functionality of zooming in/out and comparing different models side by side, the app simulates the feeling of handling a specimen physically. In addition, learners can view the documented annotations tailored to each specimen illustrating details of various regions on the model.The addition of the mobile gyro control gives a more natural way to examine the specimen. This new feature highlights our student‐centred approach with an emphasis on intuitive and accessible design approaches.The acceleration in the use of virtual technologies during the pandemic has increased the use of related tools and their acceptance in anatomy education. The further development of technologies to improve the student learning experience in AR/VR will certainly broaden accessibility. Some future implementation includes haptic touch feedback on mobile phones which better simulates physical labs, and a mobile AR function that extends the current gyro controller feature, deploying AR rendered specimens assigned from the WebGL end on multiple mobile devices, which can be utilized in a classroom setting.

Design Principles for VanVR APP: a Virtual Anatomy Lab

The VanVR APP (Vancouver Virtual Reality Anatomy and Pathology Project) is a virtual anatomy lab with 3D anatomy dissection scans, which in the post‐pandemic learning environment is a “digital twin” to the physical lab. The principles of this re‐design are based on instructors' need to offer an alternate supplemental teaching environment, and students’ need to access high‐quality anatomy scans preparing for the dissection lab experience.VanVR was created using Unity and WebGL offering two separate user interfaces (UI): one for students and one for instructors. The student UI leads to a virtual anatomy lab (VAL) of interactive 3D models. The instructor UI; the Lab Maker (LM), allows instructors to customize their courses from a wide database of fully‐labeled specimens, images, and videos. VanVR’s user experience (UX) of the VAL was designed to mimic a lab’s environment including anatomy code of conduct and many control functions. UI and UX designs intend to meet student needs with a focus on intuitive interfaces and interactions to maximize attention on the anatomy content rather than navigating technological difficulties.VanVR was designed as an accessible web app using a traditional and universal design layout that allows for seamless future mobile/tablet expansion. In the student portal and the LM, organized by importance, the main bulk of the course material was centrally placed in common sections to allow for an effective tree hierarchy and smooth accessibility. The student UI visual hierarchy was highlighted via a checklist to track weekly learning progress supplemented by course material, lab manuals, specimens, videos, and images. The login information, content menu, and sub‐menus were then distributed around the main grid. This layout helped to convey easy navigation, accessibility, and uniform connectivity. The anatomy content menu was sorted by body regions (atlas or textbook hierarchy). The aim of VanVR's layout was to mimic familiar apps for a smooth user experience. Moreover, to attain user seamless transition, VanVR’s layout matched UBC’s learning management system; Canvas features such as student checklists, content upload, and editing course material in the LM.Equal principles were used in the UX, the VAL design resembles an actual anatomy lab, this mimicry principle induces learnability. The user control shows the main elements in a simple hierarchy, design, colors, and text font granting intuitive and seamless navigation. To deliver flexibility and redundancy, we added multiple logical routes to finish tasks and bypass system lags. For more student‐instructor interaction, instructors were given the feature to control the number of labels on the specimens or pose question labels to match the learning objectives. As a result, VanVR UI and UX design followed basic aesthetics aiming for an efficient and accessible learning/teaching tool.Our future plan includes adapting the UI and UX to smartphone/tablet screen size and features. For more accessibility and redundancy, a search feature will be added to allow users to rapidly find specimens.

A 3-dimensional airway model for tracheobronchial surgery.

A 3-dimensional airway model for tracheobronchial surgery.

Extended reality anatomy undergraduate teaching: A literature review on an alternative method of learning

BackgroundThe majority of undergraduate anatomy learning has shifted online, or to a mixture of virtual and face-to-face teaching, due to the COVID-19 pandemic. Cadaveric shortages have also influenced the need for alternative methods of anatomical education. This study examines the current literature on the use of extended reality technologies (XR) such as Virtual reality (VR), Augmented reality (AR), and Mixed reality (MR) for anatomy teaching and explores its potential for implementation in medical education. MethodsA literature review was performed of PubMed, ProQuest, Science Direct, and Springer databases. Included studies were assessed for user satisfaction, perceived effectiveness, cost, acceptability and side effects. ResultsThe database search identified 1687 papers, of which 45 papers were included in this review. Both AR and VR had high rates of satisfaction and acceptability as a supplementary teaching aid amongst undergraduate participants. AR was found to have higher effectiveness than VR. VR is more expensive than AR. Results and comparisons were limited due to short length of study. ConclusionsVR is a popular choice with undergraduates as an aid to supplement teaching, in spite of the associated cost and side effects such as nausea. AR has shown the most potential for independent study. Larger and long-term studies are required to determine true effectiveness, and consideration of the clinical relevance of these technologies.

Visual display for surgical targeting: concepts and usability study

PurposeInteractive image-guided surgery technologies enable accurate target localization while preserving critical nearby structures in many surgical interventions. Current state-of-the-art interfaces largely employ traditional anatomical cross-sectional views or augmented reality environments to present the actual spatial location of the surgical instrument in preoperatively acquired images. This work proposes an alternative, simple, minimalistic visual interface intended to assist during real-time surgical target localization.MethodsThe estimated 3D pose of the interventional instruments and their positional uncertainty are intuitively presented in a visual interface with respect to the target point. A usability study with multidisciplinary participants evaluates the proposed interface projected in surgical microscope oculars against cross-sectional views. The latter was presented on a screen both stand-alone and combined with the proposed interface. The instruments were electromagnetically navigated in phantoms.ResultsThe usability study demonstrated that the participants were able to detect invisible targets marked in phantom imagery with significant enhancements for localization accuracy and duration time. Clinically experienced users reached the targets with shorter trajectories. The stand-alone and multi-modal versions of the proposed interface outperformed cross-sectional views-only navigation in both quantitative and qualitative evaluations.ConclusionThe results and participants’ feedback indicate potential to accurately navigate users toward the target with less distraction and workload. An ongoing study evaluates the proposed system in a preclinical setting for auditory brainstem implantation.

Lessons Learned: Medical Library Pilot Testing of a Virtual Reality Anatomy Lab

In recent years many schools have begun to incorporate virtual reality tools and programs into their curriculum. This paper relates the results of a library pilot project on the usefulness of virtual reality headsets and programming for graduate students studying physical therapy and medicine. Authors review the existing literature on virtual reality use in education with a specific focus on libraries. This information is incorporated into lessons learned by researchers regarding hardware and software choice, attracting students, and potential deterrents or safety issues relating to virtual reality use in libraries.

Tissue-equivalent materials used to develop phantoms in radiation dosimetry: A review

Present paper provides a review on different types of phantom materials. Radiotherapy phantom is to simulate as closely as possible the human body for improving the accuracy and measurements of radiation dosimetry. It also helps in determining the amount of radiation is being absorbed in various layers by the human body. Water was the first tissue equivalent material which was used for radiation measurement as water had unit density similar to human body; in reality anatomy of human body is completely different. It is made up of heterogeneous medium of different densities like bone, tissue, muscle, air cavities and teeth. These heterogeneities in human body produce perturbation in dose-distribution during radiation therapy. Therefore, the exact evaluation of energy imparted to the human body may not be feasible by water based measurements which is highly desirable for understanding the effect of energy absorbed. Thus, there is need to develop a phantom composed of such materials which could absorb radiation like human body structures and the selected phantom material also remains stable. Its overall efficacy is to improve the accuracy of dosimetry and hence radiation treatment outcomes.

Impact of virtual reality anatomy training on ultrasound competency development: A randomized controlled trial.

PurposeThe use of Virtual Reality (VR) in health professions education has increased dramatically in recent years, yet there is limited evidence of its impact on educational outcomes. The purpose of the study was to assess the impact of VR anatomy instruction on the ultrasound competency of novice learners participating in a ultrasonography workshop.MethodWe designed a VR-enhanced ultrasonography training program and utilized a plane transection tool to interact with a three-dimensional (3D) VR model of the human body which facilitated the 3D conceptualization of the spatial relationship of anatomical structures, leading to faster and better development of ultrasonographic competency. This was a randomized control study which enrolled third-year medical students (n = 101) without previous exposure to formal or informal ultrasonography training. The participants were randomly divided into an intervention and control group. We assessed participants’ competency through ultrasound performance stations on live subjects, we also measured anatomical and ultrasound image identification ability using multiple choice tests.ResultParticipants in the intervention group (median = 16; interquartile 13 to 19) had significantly higher scores in ultrasonography task performance tests than the control group (median = 10; interquartile 7 to 14; Mann-Whitney U = 595; P < 0.01). In sub-group analysis, the intervention group performed significantly better in the six out of ten ultrasound tasks. Participants in the intervention group also had greater improvement in ultrasonographic image identification MCQ tests than the control group (Mann-Whitney U = 914; P < 0.05).ConclusionThis study suggests that VR-enhanced anatomical training could be of significant benefit in ultrasonography training by promoting a better understanding of the spatial relationships of anatomical structures and the development of early psychomotor skills transferable to the handling of ultrasonographic probes.

The coracoglenoid notch: anatomy and clinical significance.

The superior surface of the anatomical neck is presented in the classification of scapular fractures as a 2-cm-long structure, which does not correspond to reality. This issue has not yet been adequately addressed in the literature. The aim of the study was to assess the variability of a notch between the upper rim of the glenoid and the coracoid base, the so-called coracoglenoid notch (CGN), and its clinical significance. The study was based on the examination of 204 dry bone specimens of adult scapulae (92 male and 112 female). We have determined quantitative criteria for the evaluation of the CGN type, measuring the offset of anatomical neck using a digital caliper. The findings were compared with 3D CT reconstructions of fractures of the scapular anatomical neck. Three basic types of CGN have been identified: type A-a well-developed notch in 31%, type B-a shallow notch in 53% and type C-an absent notch in 16%. No significant difference in CGN was found between the sexes, or between the right and left sides. When compared with our six cases of the anatomical neck fracture of the scapula, two patients displayed CGN type A and type B, respectively; but in four patients, it was impossible to distinguish between types A and B. The study has documented a high variability of CGN. Its presentation in the classification schemes does not correspond to anatomical reality. The presence of a deep, or shallow, notch may constitute an anatomical predisposition to a fracture of the anatomical neck.

Letter to the Editor on the Article: "Mixed Reality Anatomy Using Microsoft HoloLens and Cadaveric Dissection: a Comparative Effectiveness Study".

Letter to the Editor on the Article: "Mixed Reality Anatomy Using Microsoft HoloLens and Cadaveric Dissection: a Comparative Effectiveness Study".

Exploration of temporal bone anatomy using mixed reality (HoloLens): development of a mixed reality anatomy teaching resource prototype

Mixed reality (MR), a technology which supplements the real world with virtual objects, is increasingly becoming available as a teaching tool in medical education. The Microsoft HoloLens device allows operators to experience MR using a head-mounted device without interfering with their physical reality, stimulating a realistic learning experience using virtual objects. This project aimed to develop a MR anatomy teaching application with HoloLens for exploring the anatomy of the temporal bone. The educational application was developed from a multidisciplinary collaboration between undergraduate and postgraduate students across several academic disciplines with Medtronic, a medical technology company. 3D anatomical models were built using ZBrush and Blender, while the HoloLens1 application was developed using Windows 10, Visual Studio 2017, Unity and Mixed Reality Toolkit (MRTK). Modules developed within the application included a basic HoloLens tutorial, a virtual temporal bone with surgical anatomy landmarks and free drilling of the temporal bone. The basic tutorial allows the operator to adapt to the MR environment prior to exploring the anatomical landmarks of the 3D temporal bone. The free drilling of the temporal bone using vertex displacement and texture stretching replicates a real-time bone drilling experience and allows the operator to explore the anatomical relationship between different otological structures.