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A visible human online reference for medical education
and research:
the detailed, free of charge www-atlas of human
cross sections of the
Workshop Anatomy for the Internet
Introduction
In the present ‘information society’ with high-speed computers and increasing
network connections throughout the whole world, medical education and particularly
anatomy cannot do without the new media. In this context the internet seems
to be the best place to offer easily accessible, interactive teaching modules
for acquisition of a three-dimensional functional picture of the human
body. The detailed, free of charge www-atlas of human cross sections of
the Workshop Anatomy for the Internet
is a valuable contribution to world-wide anatomy learning and teaching.
Methods
The atlas is based on digitised sections of the Visible
Human male and female as, at present, the most important international
source for free high quality images of human gross anatomy including CT
and MRI ([1],[2]).
In regions of special clinical interest like the head and with many small
details more sections were selected than in others with less evident changes
between the slices (Table
1). Further, corresponding axial radiological images were included.
Image data were obtained from the NLM
or its mirror
sites. Decompression and conversion into JPG files were necessary to
put the images at disposal in the internet. Thereby the original resolution
was maintained. 12-Bit greyscale CT- and MR images were reduced to 8-Bits
of grey. The JPG compression resulted in a strong reduction of the file
size without naked-eye detectable loss of colour contrast (Figure
1). The converted pictures were oriented according to radiological
standard, trimmed and prepared to appear on a black background (Figure
2). For labelling black margins were added in order not to cover the
pictures by the letters. Labelling was performed mostly by instructed students
attending the workshop according to the present international terminology,
Terminologia Anatomica, by using different anatomical atlases and books,
e.g.([3]).
After thorough checks, revision, correction and trimming, internet pages
(Figure 3) were composed.
As many structures as possible and reasonable were labelled on the pages
with marked sections. When a structure was not labelled, it was either
not clearly visible or there was not sufficient space available. In that
case, the structure was labelled on the neighbouring sections. There is
no strict uniformity in the layout, thus all labelled images reflect the
individuality of the involved student whose name is given below the picture.
Images are presented in full original pixel resolution in all pages of
original sections in the head, neck and lower limb regions. Prepared sections,
available corresponding CT and MR-images, and in some cases icons of details
enlarged on linked pages (Figure
4) were arranged with further links using the Netscape Composer™. The
images of pages with sections of the thoracic, abdominal and pelvic regions
were reduced to half size with a link to the full-sized picture in order
not to push the CT scans out of the screen (Figure
5). CT-Scans are shown below the original sections for optimal space
management in web pages with sections of the lower limb (Figure
6).
The motion pictures Movie
1 of the web atlas were created from stacks of
trimmed, aligned, cleaned and equally sized images of all the anatomical
or radiological sections mainly of the VH-male provided by the NLM. They
were produced using Ulead
Media Studio™ or MainActor™
software in either AVI™ or Quicktime™ format, both in Cinepack Radius™
compression. Only some of the motion pictures of the original sections
are reduced in size due to the enormous amount of data involved. One motion
picture even runs through the scaled down total of the complete sections
of the VH-male. In Figure
7 shows links to the motion pictures on three of five pages providing
a total of over 120 movies ready for download that were mainly produced
from the VH-male data set.
Results
The atlas of visible human sections is one of some
anatomy web-teaching modules of the Workshop
Anatomy for the Internet of the Johannes Gutenberg University of Mainz,
Germany. These modules are linked to each other as shown in Figure
8. Those already available in English are accessible from the English
homepage of the workshop, which is shown in Figure
9. Apart from the extensive electron
microscopic atlas and the other teaching modules it leads to the atlas
of visible human sections in the internet which is presented here.
When choosing the upper “List of sections”, the index
page of this atlas (Figure
10) is loaded.
This index page provides miniaturised transverse
overview sections for each region of the body, linked to pages with browsed
overviews of the chosen sections. Further one section is labelled with
terms of orientation providing a link to an appropriate page of a vocabulary.
Additional icons provide links to this vocabulary
of gross anatomy, motion pictures,
language selection and conditions of use.
When clicking the head 1 icon you the first
region overview of the head (Figure
11) providing small icons of all sections chosen here comes forth.
When an icon of an image is selected the page with the full sized section
and its corresponding radiological images, in the head region MRI and bone
CT come up. A tick on the section number below opens the page with this
section labelled. Further down the beginning of the list of the most important
structures of the sections is shown.
The linked vocabulary
of gross anatomy (Figure
12) provides over 850 Latin anatomical terms and their corresponding
expressions in English and German. The terms are arranged according to
subject as well as alphabetically. Thus unclear labelling can be looked
up easily.
Discussion
The atlas intends to be a useful online reference
for medical education and research by a hierarchic structure of pages and
links, overviews providing scaled down images, motion pictures through
all sections, original sections in high resolution and quality, a selection
of sections regarding clinical relevance, detailed labelling according
to the international terminology, including corresponding CT / MRI next
to all sections, a structured vocabulary to look up terms, offering interactive
choice of interesting features and the possibility of printing images and
pages. The users gain a realistic picture of the whole human body from
head to feet and are able to make a visual journey through the whole body
showing all relevant structures of gross anatomy. In so far the atlas contributes
to a three-dimensional understanding of topographic relationships. All
important structures of gross anatomy are labelled using the official terminology
to make the atlas ideal for use throughout the world. By giving representative
views of all relevant structures of all body regions next to corresponding
radiological images a valuable reference for correlation of radiological
and anatomical structures has been created.
The present atlas is published the internet as
the most important medium of today and future times to retrieve and present
knowledge. Namely, the web offers possibilities that partly even CDs cannot
provide and that are of great advantage in comparison to printed media.
These advantages are prompt and easy world-wide access for everyone, interactive
choice of interesting subjects, possibility of printing and downloading
only material of personal interest, integration of motion pictures, sound
and interactive 3D-models, performance and automatic evaluation of self-assessment
tests, possibility of quick correction, update and extension, web-wide
linking, easy user feedback by E-mail, possibility to check what is most
interesting for the users by web counters, nothing has to be carried or
to be installed on a PC but a web browser and there is ‘unlimited’ space.
Further the web is environmentally friendly. Due to world-wide efforts
network connections will improve significantly in the nearer future so
that download time will be less and less a problem. Since it is the aim
to offer entirely correct labelling, the users of the atlas are requested
to inform the author of imperfections via E-mail, as, in contrast to a
book, publication in the internet offers the possibility of quick and easy
correction.
Many people can benefit from the internet atlas
since the offered material can be used for teaching as well as learning
gross anatomy in general: medical students, doctors and staff; university
teachers of anatomy and related subjects; specialists in anatomy; dissection
courses; anatomical museum collections; teachers and students of health
care subjects; schools for nurses, physiotherapists, medical technicians
and health related professions; teachers and attendants of biology lessons
in high schools and colleges and everybody interested in gaining insight
into the own body. In brief, the spectrum reaches from university, health
care related schools and colleges to lay people. The students who help
to create teaching material for others by labelling the images in the workshop
benefit in many ways: they markedly improve their knowledge in anatomy
which is most important for their later work as medical doctors, learn
how to handle PCs, gather experience how to deal with the internet and
acquire skills in digital image processing. Further they are named below
the images they worked on and receive a certificate of attendance useful
when seeking positions.
The offered material is suitable for study and
instruction of anatomy in general. Printouts of the non-labelled sections
can be used in examinations due to their high quality and resolution and
for self assessment of anatomical knowledge in combination with the labelled
images. Printouts of the labelled sections can help
as reference for scientific purposes. In
dissection courses medical and dental students already use them to identify
structures in many places, especially when studying other original body
sections. Further such printouts serve students for preparation of examinations;
are used for anatomy teaching in general, e.g. in biology lessons in colleges
or high schools and serve radiologist to recognize structures on similarly
oriented CT- or MRI of patients. In addition, the provided material is
an online supplement of anatomical museum collections. Interesting sections
as well as motion pictures for topographical instruction can be projected
on a screen directly from the www during dissection courses if a video
beamer is available. The vocabulary can be used to understand the labelling
and to get a structured overview of human organs and systems. The motion
pictures help to gain a 3D picture of structures allowing to follow them
through the sections to elucidate topographical relationships. In the training
of medical students and doctors it is essential to correlate anatomical
structures of the human body with radiological images. For this reason
sections are presented next to corresponding radiological images that also
can serve radiologists as a reference or in clinical anatomy instruction.
In brief, the atlas is a source of images and information for medical education
and research. Its pictures can be integrated in lectures, seminaries and
practical studies. Either direct internet access or printouts of the images
are applicable.
Unfortunately, high quality anatomy software
is often not affordable for students, in places with poor library facilities
especially in Third World countries. In contrast, the present offer, even
though no freeware, allows everybody to benefit from the excellent material
offered by the NLM by being easily accessible in the Internet (no registration
required) and at no charge for personal use. In so far it contributes to
the realisation of the goals of the Visible Human Project providing the
data sets to serve as a common public domain reference for the study of
human anatomy ([4]).
A page with the conditions of use informs
about legal aspects and explains how to obtain printouts of the images.
It is apparent that the present atlas is the
most comprehensive one in the internet offering most detailed labelling
of sections in the web. Otherwise, comparable detailed labelling, usually
in English, is only present in few commercial CDs and books, e.g.([3]).
The present contribution surveys other web-anatomy atlas projects since
there are no further www offers with a comparable number of full sized
VH sections, only some have few motion pictures, there is no similar extensive
vocabulary of anatomical terms in www and very few other web pages provide
sections with correlated CT/MRI. With its further anatomy teaching offers
the Workshop Anatomy for the Internet
represents a unique concept of presenting anatomy to specialists as well
as to the general public. The commercial CDs providing more sections (usually
unlabelled) or reconstructions are in most cases rather expensive for students.
Commercial software offering 3D-reconstructions with detailed labelling
of greater amounts of structures and sections is even much more expensive.
Prospect
The present atlas is constantly extended by including
further original and labelled sections of the VH male and -female
aiming
at a maximal intersection distance of 5 millimetres in all regions. Due
to presently still considerable download time, especially for the motion
pictures, it is planned to offer them on a student affordable CD-ROM with
as many sections as possible. Apart from the extension of the vocabulary
and its links, it is planned to offer computed coronal and sagittal sections,
3D reconstructions of organs and structures and
self assessment tools. Further the clinical anatomy shall be considerably
extended and linkage between the different modules of the workshop is planned
to be improved significantly. With these goals it is intended to contribute
to world-wide improvement of three-dimensional understanding of anatomy
in pre-clinical and clinical medicine.
Conclusions
The internet atlas of visible human sections of the
Workshop
Anatomy for the Internet provides easy and free access to 338 axial
high resolution and quality sections of the visible human male and female
shown next to corresponding CT- / MR-images. Presently 184 sections are
labelled in detail according to the international Terminologia Anatomica.
Over 120 motion pictures and an extensive vocabulary of gross anatomy as
well as further anatomical www teaching offers contribute to a structural
and functional three-dimensional understanding of the human body. The broad
spectrum of usability spans from university instruction of specialists
and reference for scientific purposes over education of medical students,
doctors and staff, teachings of clinical anatomy to biology lessons in
college and high school.
Acknowledgements
I am very grateful to the National
Library of Medicine for the permission to work on and publish the digitised
sections of the VH-male and -female. I thank Roman Böhmer for co-operation
composing the vocabulary and following students for their help in labelling
(arrangement according to amount of contribution):
M. Glas, B. Zieger, D. Gustavus, U. Hämmerer, L. van den Abeelen,
M. Nagata, K. Levent, J. Stewen, O. Nitsche, T. Jöckel, V. Jovanovic,
M. Kiefer, T. Görres, M. Hirschmann, L. Beine, K. Rützel, A.
Kerner, M. Hainz, H. Albrecht, E. Wagner, N. Ritter, D. Meirer, A. Schafia,
B. Janipour, H. Tymiec, M. Weindel, A. Schneider, P. Rotter, E. Lubos and
C. Popp.
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