Beyond Vesalius: an
interactive
program for teaching sectional anatomy
Gary L. Nieder and Frank Nagy
Department of Anatomy - Wright State University School of
Medicine
Dayton, Ohio 45435
Abstract
Due to the widespread use of modern imaging techniques, sectional
anatomy
has become an essential element in the study of gross anatomy. At
the same
time, gross anatomy courses in many medical schools have faced
increasing
time constraints within the medical curriculum. Since time for
traditional
instruction in sectional and radiological anatomy was not
available in our
course, we decided to develop a program which would facilitate
independent
instruction of this material. In addition we wished to provide
the students
with tools for self testing in all areas of gross anatomy, using
test questions
written by our faculty. Early in the development process the
Visible Human
Dataset became available from the National Library of Medicine.
The VHP
Dataset provided an excellent source of high quality raw images
for the
this project. Selected VHP sectional and CT images from each body
region
(head and neck, thorax, abdomen, pelvis, upper extremity and
lower extremity)
were downloaded from the VHP database.These images were processed
for color
correction, size and placed on a uniform background using
standard photo-imaging
software (Adobe Photoshop®). Processed images (16 21 sections
per region)
were assembled into an instructional program using the
SuperCard® authoring
system on a Macintosh platform. Programs for each body region can
be accessed
from the graphical menu of a front-end program (Fig. 1) or can be
used independently.
Figure 1
Figure 2
Figure 3
The programs allow for navigation between the cross-sections
(Fig. 2) and
their matching CT images (Fig. 3) as well as composite images of
section
and CT (Fig 4). A floating palate provides an alternate means of
navigating
between levels of section, relating the level to surface or MRI
views of
the body (Fig. 5). Major structures are labeled in each section
and CT.
Clicking on a label opens a window of text-based data for the
labelled structure
(Fig. 6).
Figure 4
Figure 5
Figure 6
Two self-testing modes are included in the program. The first is
a simple
identification mode where structures must be selected in the
image. The
second is a set of multiple choice questions, each related to a
structure
highlighted in the image (Fig. 7). The program provides for an
automatic
tally of questions attempted and percent correct. X-ray images in
each body
region are similarly presented with text-linked labels and a
self-testing
mode (Fig 8). Finally, another portion of the program administers
a practice
multiple choice examination, similar to course written
examinations.
Figure 7
Figure 8
These programs were integrated into the Fall 1995 gross anatomy
course.
The computer laboratory consisted of 16 Power Macintosh 6100 and
7100 computers
with 16 MB of RAM and 15 inch monitors. To obtain maximum
performance, the
programs were run from the hard drives, where they occupied 46 MB
of disk
space. To supplement the students' self-study, 4 hours per week
of scheduled
class time was devoted to the computer lab, during which time a
faculty
member or graduate teaching assistant was present to assist the
students.
The students' response to the program remained enthusiastic
throughout the
course. Some students had difficulty making the correlation
between 2 dimensional
cross-sections and the 3-dimensional experience in the dissection
lab. As
the course progressed, this difficulty was overcome. In a mid
course evaluation,
students reported using the program about 14 hours for each body
region.
Students responded very favorably to the self-testing modes, with
93% stating
that the program helped them correlate sectional and radiological
anatomy
to their dissection. In addition, 86% felt that the program also
helped
them perform better on portions of written and practical exams
that did
not specifically address sectional anatomy.
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Accessing the Beyond
Vesalius
program on this CD
The abdomen portion of the Beyond Vesalius program is
included on
this CD. This is a Macintosh 'fat' program (i.e., can be used on
680x0 or
PowerPC Macintoshes). To use, just find the folder
"BVsample"
on this CD and copy to your hard drive.
Beyond Vesalius is fully copyright protected. This sample
is provided
for use only by those attending the of the Visible Human
Conference, and
may not be generally distributed in whole or in part, or modified
in any
way, without the express written consent of the Wright State
University
School of Medicine.
For optimal results consider the following:
The entire "BVsample"folder should be copied to a hard
drive and
the program run from there rather than from the CD. The program
can be run
from the CD, but performance will be degraded somewhat.
Video: Although the program runs in 8-bit video (256
colors), because
of the way the SuperCard system handles color, 16-bit (thousands)
or 24-bit
(millions) is highly recommended. If you run the program in 8-bit
video,
you will experience a 'flashing' of the images as the system
changes its
color palette for the next screen. This doesn't affect the
usefulness of
the program, but it can be somewhat annoying.
Operating system: Requirements are System 6.0.4 or later
for 680x0
machines and System 7.1.2 for PowerPC machines.
Operation in a shared environment: The programs are set to
be multi-
launching from a server. As of this release, the performance
characteristics
of the programs in various shared environments has not been
thoroughly tested.
RAM requirements: The preset minimum memory requirements
is 5643
KB, so you should be able to use the programs on a Mac with 8 MB
total RAM,
as long as no other programs are running and all unnecessary
extensions
are turned off. As stated in the programs' Info boxes, the
minimum RAM can
be decreased by 643 KB by turning virtual memory on. If the
program crashes
with any kind of 'insufficient memory' error message or your
computer locks
up during screen fades you may need to increase the RAM
partition.
Instructions:
Our students find the operation of Beyond Vesalius fairly
straightforward.
Instructions are provided here, but you can probably just play
with the
program to discover its features and controls.
Double click on the "Beyond Vesalius Abdomen" icon to
launch the
program. The main menu presents 4 options:
1. Sections: The main screen will show a cross-section,
its corresponding
CT scan, or a composite of the two images. The Control Bar at the
top of
the screen contains navigational controls, turns labels on and
off, and
controls the testing functions of this part of the program.
Navigation: The program open at the most
superior section
(section 1) 1 of the abdomen. You can navigate to other levels in
two ways.
First you may use the up and down arrows under the 'Level'
heading in the
top control bar. Clicking these will move you up or down one
level. Secondly,
you may open the Level Chooser by clicking on the 'Chooser'
button. A floating
window will appear showing a frontal view of the body and a red
line marking
the approximate location of the current level shown on the main
screen.
Use the up and down arrows to change levels; the center box on
the control
bar shows the number of the level you have chosen. Once you have
selected
the level you desire, click OK to bring up that section on the
main screen.
The Chooser control bar also lets you switch the frontal view
between surface
anatomy and an MRI image. Both images may be helpful in
understanding the
3-dimensional relationship of structures seen in the sections and
CT's.
The chooser window can either be closed when not in use or
dragged out of
the way.
Labels: Labels on the sections are linked to a text window
with information
regarding the chosen structure. Just click on a label to open the
text window.
To close the text window, click anywhere on the main screen.
Labels can
be turned off and on by clicking the buttons on the top control
bar.
Testing: Clicking the 'Test' button on the top control bar
puts you
into testing mode. The 'Identify' button starts a test in which
you are
requested to click on particular structures in the current image.
Correct
response are shown by a flash of the selected structure and by
sound. Negative
responses do not flash the structure and play a different sound.
You may
continue to seek the correct answer as long as you wish. To go to
the next
question, click on the 'Next' button. You may, at any time,
navigate to
a different section or CT image and continue the Identification
test on
that image. To totally exit the Identify test, click on 'Exit'.
The 'Secondary'
button starts a test in which you are asked a series of multiple
choice
questions about structures which are indicated on the image. You
may guess
at the question as many times as you want and you may see the
flashing structure
again by clicking on the 'Flash' button. Go to the next question
by clicking
on 'Next'. As in the Identify test, you may navigate to different
sections
and CT images at any time and continue the test.
Grader: In the testing mode, you may turn on a 'Grader'
which automatically
keeps track of the number of questions you have attempted, how
many were
answered on the first try, and the percentage answered correctly.
The grader
only counts your first attempt to answer a question, so you can
continue
to find the right answer after your first attempt without
penalty. The Grader
can be turned off or reset to zero at any time.
2. X-rays: X-ray images can be selected from a graphical
menu called
the 'Chooser'. Each x-ray is labelled with linked text
information just
as in the 'Sections' portion of the program. A single testing
mode of 'secondary'
questions is available by clicking the 'Test' button. This test
works just
as it does in the 'Sections' portion of the program. The Grader
is also
available.
3. Written test: This is a 50 question multiple-choice
test over
the abdomen. This is fairly self-explanatory - follow the
instructions as
the test begins. The Grader automatically opens as the test
starts, but
may need to be reset. Here too, the grader only counts your first
attempt
at a question. You may exit the test at any time, but you will
always re-enter
the test at the beginning.
4. Quit: Quits Beyond Vesalius and returns to the
Finder.
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Contacting the
Authors
For more information on Beyond Vesalius :
The
Beyond Vesalius home page
Dr. Gary L. Nieder
Department of Anatomy
Wright State University School of Medicine
Dayton, OH 45435
email: gnieder@desire.wright.
edu
Phone: 937-873-2547
Fax:937-873-3391
Dr. Frank Nagy
Department of Anatomy
Wright State University School of Medicine
Dayton, OH 45435
email: fnagy@desire.wright.edu<
/I>
Phone: 937-873-2253
Fax: 937-873-3391
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