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The Visible Human Project Phase I was completed in 1995 with the release of nearly 13,000 pictures on the Internet. The segmentation and classification of the thorax followed with the addition of anatomical information to the photographic data. Both of these portions of the Visible Human Project were funded by the National Library of Medicine (NLM). Now the NLM has partnered with other organizations to incorporate this image data into an educational program and prepare for the production of next generation datasets. The Head and Neck was chosen as the starting point for this next phase in the development of the Visible Human Project as it best serves the current NLM partners which include: the National Institute of Dental and Craniofacial Research (NIDCR), the National Eye Institute (NEI), the National Institute of Deafness and other Communication Disorders (NIDCD), the National Cancer Institute (NCI) and the National Science Foundation (NSF).
The NIDCR developed interest in this new phase through a workshop designed to identify the opportunities presented by the available Visible Human data and to explore the feasibility and need for a next generation Visible Human. As a result of that workshop, inter- and intra-NIH partners were identified and a roadmap for utilizing the present data and preparing for future data was developed. A web site for functional anatomy of the head and neck was proposed as a means to explore the utility of this type of data for creating learner-centered educational materials. The Head and Neck consortium also developed a strategy for improving specimen preparation and cutting technology and for the development of better computer tools for aligning, enhancing, extracting and identifying anatomical detail in Visible Human type photographic image data.
The objective of The Visible Human Project ATLAS of Functional Human Anatomy, Version 1.0 is to develop a world wide web based framework for an atlas of human head & neck anatomy which circumvents the barriers of classic anatomic teaching. The web site is not designed to be complete on delivery, but rather to accommodate continual revision and addition which will someday make it an encyclopedic collection. The ATLAS will begin with modules covering the functional anatomy of six processes including: mastication, deglutition, phonation, hearing, vision and facial expression. Each of these functions will be illustrated with Visible Human anatomy in cross section and three- dimensional models. Each of the functions will also be illustrated with two clinical cases that relate to relevant aspects of the anatomy. These cases will certainly highlight the anatomy of the region but will also provide the student with relevant physiology, pathology, clinical symptoms and available therapies for the function under study. Additionally, two surgical approaches will be included with each functional area. These surgeries will illustrate the importance of a thorough understanding of the regional anatomy of the associated function and indicate the problems that would result from a disregard of that anatomy
The web site is also designed to be rich with hyper-links to related information from other sites that already demonstrate the details of some aspect of the functional anatomy under study.
Most important to the design of this web site is scalability that will allow and encourage additional clinical cases and surgeries involving the initial functional areas of the head and neck as well as all others. Demonstration of the Visible Human anatomy and function is also designed in a scalable fashion so that first generation Visible Human data can easily be replaced with data of resolution and fidelity from the next generation Visible Human.
The site will be designed at the level of first year medical school gross anatomy students. However, the user will be able to define paths at either high or lower levels of experience or education. There will eventually be sufficient content to provide for resident education in specialty areas such as ophthalmology, otolaryngology, dentistry and radiology.
There will also be a mechanism for reducing the complexity of the information for more introductory explanations and expectations. This variation in pathways for different levels of expertise is facilitated through dynamic construction of the web site in response to a user profile.
The illustration of specific functions with currently available Visible Human data will require compromise in some areas. Specifically, in the area of mastication (Figure 1), the muscular action involved in jaw motion will be stressed. The dynamics of the TMJ will be modeled but the anatomic detail of the joint space is beyond the resolution of the current dataset. Likewise, the dentition will not be included in the masticatory process but the web site will accommodate all these details when they become available in future data. The function of vision will primarily address ocular motion because the extraocular muscles of the Visible Human are sufficiently large to render in reasonable detail.
Hearing presents a special problem because the ossicles of the Visible Humans are not imaged at low resolution, they are completely absent. Therefore, ossicles from other specimens have been imaged for inclusion in the middle ear of the Visible Human. The function of ossicles is the primary objective and this will be accomplished with these transplanted ossicles. Deglutition presents a prohibitively difficult process for three dimensional motion modeling. Consequently, animation of the process will be limited to 2D and applied to the mid-sagittal cross-section. The muscles of facial expression are being developed as 3D models with individual control over each muscle. Surgical approaches and VII palsies will demonstrate the effects of denervation of specific muscles and muscle groups. Phonation will include clinical laryngoscopic views in addition to cross section navigation (Figure 2). One of the surgeries to illustrate the critical anatomy will be a surgery to mediate unilateral vocal cord paralysis.
It is anticipated that web site management will provide for the site to be used as the curriculum for a structured course. Teachers will be able to define required pathways through the site and mandatory questions to be answered. Of course, free form navigation by any user will always be available. Utilization by people with different levels of expertise will increase as the content grows to include popular issues, controversial approaches to clinical management and encyclopedic coverage of all aspects of the anatomy. The web site will be integrated with other databases such as Medline to facilitate this growth and The site is anticipated to grow in content, in Visible Human resolution and in body coverage through future versions.
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