3D Visualization of Cardiac Anatomy: New Approaches for Patient Education

3D Visualization is a growing field in medicine. It is used for diagnosis, intervention design, and patient education. Medical students and physicians have little difficulty picturing a heart in their mind. Most physicians and medical students can envision an anatomically correct heart, and also congenital heart defects. Patients and their families, however, do not always have this extraordinary ability. Objective: It is this potential disadvantage that provides motivation to develop innovative 3D tools that can be used to educate patients in clinical and hospital settings. Design: The primary focus of this study is to recover 3D structures and images from CT Data. The data were acquired from a number of sources, including Cardiology Radiologists at St. Vincent Hospital Cardiovascular Imaging Department and the National Institutes of Health Cancer Imaging Archive. Setting: The study was performed in the Marian University College of Osteopathic Medicine 3D Visualization Laboratory. Methods: The CT data sets were analyzed with the 3D analytical software FEI Amira, and relevant anatomical structures, landmarks, and anomalies were identified and discriminated. Results: The researchers present two 3D projects: one of an anatomically correct heart, and the other of a heart after corrective surgery for the Tetralogy of Fallot congenital anomalies. Conclusions: We find that by developing our skills in 3D Visualization, we can create more accurate, interactive, and detailed images of cardiac anatomy. Our 3D Visualizations show great potential in advancing patient education and better enable us to care for our patients, both in clinical and hospital settings

3D Visualization of Brainstem Anatomy in Relation to Lateral Medullary (Wallenberg) Syndrome

Context: The purpose of this project was to design a 3-dimensional method for visualizing structures within the brainstem with special attention to those involved in Lateral Medullary (Wallenberg) Syndrome. Wallenberg syndrome is a neurologic disorder involving an infarct in blood supply of the Posterior Inferior Cerebellar Artery. Around 60,000 new cases of Wallenberg syndrome occur each year in the U.S. resulting in a multitude of symptoms and often permanent impairment. Objective: The objective of this project was to observe the brainstem including the lateral medulla in its connection to Wallenberg syndrome. A secondary objective was to provide a resource to medical students as they learn the structure and function of the human brainstem. Design: This project was created using Amira software to extract a 3D model of the brainstem from a freely available CT data-set of a randomized patient. This model was used to create videos demonstrating key structural elements affected in Wallenberg Syndrome and made into a YouTube video available for public use. Setting: The scan data selected for this project was chosen based solely on image quality in order to provide the amount of resolution needed to extract the targeted structures. Methods: Amira is an analytical tool used to highlight anatomical structures in CT (and other imaging) scans within desired tissue parameters and interpolating the selections together to create a 3D structure. Results: The final structure extrapolated from Amira was a completed brainstem with cranial nerve nuclei, sensory and motor tracts, and other important structures impacted by Wallenberg syndrome. We believe these data will be helpful in visualizing other brainstem infarcts and injuries as well as a teaching tool for students in the medical field. Conclusions: Future expansions of this study will include extracting additional structures taken from the CT data as well as descriptions of other normal and abnormal anatomical conditions

Limitations of Visualization Technology and Virtual Instruction in Medical Education

Traditional medical education has recently seen major changes due to the coronavirus (COVID-19) pandemic. New pedagogical methods, including augmented reality (AR) and virtual reality (VR), are on the rise as alternatives to traditional teaching methods. While AR enhances real world experiences by overlaying information, VR immerses users in a computerized world rather than enhancing reality. It is crucial to understand the limitations of these learning modalities and that at best these modalities should be used to supplement and not replace traditional medical education

Aesculapius: Adding a Dimension of Instruction Through Integrating Spatial Knowledge

Objective: A proof-of-concept for a platform designed to provide simulations modeling, in three dimensions, anatomical pathology/dysfunctions(as defined by osteopathic diagnostic criteria). Design/Methods: Data from a two dimensional Computerized Tomography (CT) image stack, uploaded to the Amira software, was analyzed and interpolated (slice-by-slice) to render individual three-dimensional bones and muscles. These data were used to construct educational simulations of kinetic three-dimensional movements—movements that are most often taught to be manifestations of musculoskeletal pathology in osteopathic medical schools in the United States. The movements modeled were: forward and backward rotation of the left innominate, and Fryette motion (Type I and Type II) in the first and second lumbar vertebrae. The rotation of the left innominate was paired with muscular attachments to a static right innominate, femur, and sacrum. The attachments are used as a reference to better demonstrate the etiology of bony dysfunctions caused by muscular hypertonicity in the lower limbs. The narrated simulations were uploaded unto the Sketchfab website as hyperlinks and plotted unto a spatially manipulatable, three dimensional, static, skeletal model of pathology. The plotted points hold information relevant to the pathology at bony landmarks with links to recordings of the techniques used to treat the pathology. The techniques are modeled and explained by medical students at Marian University College of Osteopathic Medicine (MUCOM). Results: three dimensional models of dysfunctions that are represented statically, three dimensional models of dysfunctions that are represented kinetically with narration, and human models that describe and portray the techniques used to treat the dysfunction. Conclusions: the proof-of-concept elucidates the merit of utilizing the technology available, to aid in a restructured adjunctive approach to early osteopathic training. modeling, in three dimensions, anatomical pathology/dysfunctions(as defined by osteopathic diagnostic criteria). Design/Methods: Data from a two dimensional Computerized Tomography (CT) image stack, uploaded to the Amira software, was analyzed and interpolated (slice-by-slice) to render individual three-dimensional bones and muscles. These data were used to construct educational simulations of kinetic three-dimensional movements—movements that are most often taught to be manifestations of musculoskeletal pathology in osteopathic medical schools in the United States. The movements modeled were: forward and backward rotation of the left innominate, and Fryette motion (Type I and Type II) in the first and second lumbar vertebrae. The rotation of the left innominate was paired with muscular attachments to a static right innominate, femur, and sacrum. The attachments are used as a reference to better demonstrate the etiology of bony dysfunctions caused by muscular hypertonicity in the lower limbs. The narrated simulations were uploaded unto the Sketchfab website as hyperlinks and plotted unto a spatially manipulatable, three dimensional, static, skeletal model of pathology. The plotted points hold information relevant to the pathology at bony landmarks with links to recordings of the techniques used to treat the pathology. The techniques are modeled and explained by medical students at Marian University College of Osteopathic Medicine (MUCOM). Results: three dimensional models of dysfunctions that are represented statically, three dimensional models of dysfunctions that are represented kinetically with narration, and human models that describe and portray the techniques used to treat the dysfunction. Conclusions: the proof-of-concept elucidates the merit of utilizing the technology available, to aid in a restructured adjunctive approach to early osteopathic training

3D visualization in medical-student training

Visualizing the spatial relationships of anatomical features, gross pathologies, and diagnostic findings is a fundamental part of the training of medical students and other learners in health-professions curricula. But to what extent can we augment the conventional training opportunities (e.g. Gross dissection, interpretation of sectional imagery, interpretation of histological sections) with 3D enhanced visualizations of anatomic, histologic, and diagnostic data-sets? Here we present a case study of medical-students at Marian University College of Osteopathic Medicine utilizing 3D visualization and printing techniques as part of a summer training opportunity. Medical students, in the summer between their first and second year of medical school training, self-identified an interest in the interpretation of sectional imagery. These students were then encouraged to design a project with the aim of presenting a 3D visualization of an anatomic or pathologic study that could be better understood in a 3D format than conventional imaging formats. The students also identified the target audience for these studies— these included student-doctors, medical residents, and clinical patients. Case studies the students completed included visualizations of maxillofacial surgical interventions, pediatric cardiac defects, neurological tracts, cerebral basal ganglia, and paranasal sinuses, among others. The resulting 3D interpretations were then presented as either 3D prints (utilizing stereolithography), YouTube videos, interactive 3D PDF files, or some combination of these media. It is possible to develop case studies to a high degree of maturity during a summer program. The next step in this study is to identify the efficacy of these presentations in various learning environments

The Basal Ganglia: Pathways and Movement Disorders

Context: Though anatomy is a vital part of a medical student’s education, three-dimensional visualization often ends in the laboratory, months into a medical student’s journey to becoming a physician. Many physicians would agree, continuing to apply both the physiology and anatomy to clinical situations is fundamental to one’s knowledge base of disease. Using three dimensional visualizations in medical student’s education may help to create a set of tangible clinical knowledge. The purpose of this study is to bridge the gap between physical and clinical anatomy pertaining to a somewhat difficult concept: the basal ganglia. Though small and tucked away, the basal ganglia are a source of many movement disorders. This project depicts both the normal function of the direct and indirect basal ganglia pathways, as well as Parkinson and Huntington Disorders for the education of medical students. We acquired CT data sets from the National Institute of Health\u27s Cancer Imaging Archive and analyzed them using Amira, a three-dimensional analytical software suite available at the Marian University College of Osteopathic Medicine 3D Visualization Laboratory. We exported the result of this project, the three-dimensional visualization of the basal ganglia and visual diagrams, to YouTube for presentation purposes

3D Visualization of Lung Anatomy: New Approaches to Medical Education

Context 3-Dimensional (3D) imaging is utilized in a variety of ways in medicine, including ultra-sound facial scanning in utero, breast cancer detection, and mapping blood vessels. 3D imaging can also be used to educate both students and patients. Oftentimes, it can prove difficult to visualize the spatial relationships between blood vessels and territories they supply or drain, but through the use of 3D-image rendering software we can improve the way this information is presented to enhance medical student and patient education. All images and videos produced in this research project were produced at Marian University College of Osteopathic Medicine in the 3D Visualization Laboratory. Anony-mized CT image studies were evaluated with the 3D analytical software Amira. This allowed for the identification and discrimination of anatomical structures such as blood vessels, lung tissue, and airways. Using the video and animation editing software Camtasia Studio, the 3D images were composed into an educational video to be presented for further clarity. This research project used CT images to provide a clear demonstration of the pulmonary vasculature and its corresponding territories. In anatomy lab, students may find it difficult to find basic anatomical structures. For example, visualization of the pulmonary artery’s branches and vascular territories within the lung requires tedious dissection. Figures generated throughout the project show the paths of the various pulmonary artery branches which supply the different lobes of the lung, allowing viewers to appreciate the vascular territories much more easily. This project includes a YouTube video, complete with 3D imaging for each pulmonary artery and vein branches, to help portray functional pulmonary anatomy and vascular territories so as to mitigate any confusion students or patients may have

3D Visualization of Pancreatitis: New Approaches for Diagnosis

3D visualization research is useful as a learning tool for medical students learning human anatomy and as a diagnostic tool for practicing physicians. Here we explore the use of this application of medical imaging in recognizing pancreatic cancer. One important problem is that pancreatic cancer is most commonly diagnosed in later stages which leads to a poor prognosis for survival. Pancreatitis presents with indistinct upper gastrointestinal symptoms, making it sometimes difficult to diagnose in clinical examination. The difficulty of early diagnosis and possible application of 3D visualization to the problem is the focus of our study. Using 3D imaging methods, we present the anatomy of the pancreas, pathologies related to pancreatic cancer, and comment on why it is so often unrecognized or misdiagnosed. The pancreas can be difficult to view, even by trained physicians and technicians. 3D imaging allows students to practice visualizing the pancreas in the same format they will with a future patient. Anonymized CT scans were obtained of a healthy patient and a patient with pancreatitis. Amira Software, a 3D imaging analytical tool, was used to measure structural density and generate an outline for research. Using Amira, we interpolated the 2D image and provided a 3D image for analysis and comparison between the healthy and unhealthy pancreas. Several surrounding organs were generated to help ascertain size and location of the pancreas. The result of this project is that the pancreas is not always well visualized with CT technology and could possibly be overlooked, even by a well-practiced physician. Different techniques should be utilized and taught to medical students to help in the early detection of pancreatic diseases

3D Modeling of a Kidney Transplant: Pre-Operative Patient Education

Kidney transplantation is a major surgical intervention and patients undergoing counseling for this procedure do not always fully understand the essentials of this procedure. We present an improved way to facilitate patient education by creating a visual aid that can be used to supplement physician counseling in patients considering kidney transplantation. We used anonymized CT scans and image analysis software to compute anatomical renderings of normal kidney anatomy as well as the anatomical differences in a patient before and after a kidney transplant. These 3D renderings were animated to create a basic educational video explaining the procedure to candidate patients