Evaluation of Human Dissection in Anatomy Teaching using an

Interactive Simulator

William John Pereira Brobouski

, Andrei Rafael Brongel

, Fabiano Utiyama

arcia Cristina Dadalto Pascutti

, Mozart Gonc¸alves

, Jo

ao Lu

ıs Verdegay de Barros

Carlos Jos

e Gomes

and Edson Jos

e Rodrigues Justino

Programa de P

os-Graduac¸

ao em Inform

atica - PPGIa, PUCPR, Curitiba, Paran

a, Brazil

Medical School, Pontif

ıcia Universidade Cat

olica do Paran

a - PUCPR, Curitiba, Paran

a, Brazil

Centro de Inovac¸

oes em Imagens M

edicas - CIIM, Pontif

ıcia Universidade Cat

olica do Paran

a - PUCPR,

carlos bio@yahoo.com.br, justino@ppgia.com

Keywords:

Visible Human Table, Simulator, Anatomy Dissection, Effective Learning.

Abstract:

The anatomy study is required in Life Science related courses. Nowadays, there are no instruments to replace

the real human bodies. Therefore, it was noticed the need of the development of a learning tool to assist the

anatomic study in laboratory which was able to dissect the organs for human anatomy study. Thus, the ultra-

high interactive simulator for human dissection (Visible Human Table – VHT) was created as a computational

tool for human anatomy study in classrooms. The main characteristic of the simulator is the fact that it is not

an anatomic atlas, but a dissection table based on real body models. That is what makes it stand out from

most same-purpose anatomic simulators and atlases. This article presents the results of a VHT evaluation

assessed by higher education learners in the health sector. The simulator promising potential becomes evident

through the answers obtained from the questionnaire, showing the signiﬁcant contribution in the anatomy

teaching-learning process.

1 INTRODUCTION

The technological development has enabled a lot

of digital image processing advancements which al-

lowed for innovations and improvements in a wide

range of sectors. In relation to the health sector,

projects are developed to increase resources to help

both skilled professionals and learners during qualiﬁ-

cation. The acquisition and image processing permit

the computational environment development in favor

of training, medical diagnosis and treatment as well

as, the anatomy teaching helps students and teach-

ers in the teaching-learning process (Beveridge et al.,

2013).

The study of anatomy is crucial in many courses

related to health. There is no book or computational

tool to replace the study of the real human body. The

corpse is the most similar to a living human being

the student can have as a study object. However,

educational institutions have been having difﬁculties

in obtaining bodies for this purpose due to the lack

of data from the population about the possibility of

corpse donation (Bassete, 2009) and legal procedures

involved.

A possible solution is the digital visualization of

this information; however, because of the complex-

ity of organic structures, the process of digital visu-

alization in high deﬁnition and the segmentation of

organs and human body systems is a complex task

and requires high computational capacity. From an

anatomic point of view, the division or separation of

systems is needed for the perfect understanding of its

parts. In the health sector, it is also important that

computational tools exhibit realistic models of human

body. Even though there are anatomy tools that allow

human dissection available, they present synthetic ar-

tifacts of the body that do not express the real color

and texture.

Based on this scenario, it was noticed the ne-

cessity of developing a learning tool to serve the

anatomic study needs in laboratory through the visu-

alization of artifacts in high resolution and with re-

alistic colors and textures. They would perform pro-

cedures such as the dissection of the body to assist

396

Brobouski, W., Brongel, A., Utiyama, F., Pascutti, M., Gonçalves, M., de Barros, J., Gomes, C. and Justino, E.

Evaluation of Human Dissection in Anatomy Teaching using an Interactive Simulator.

DOI: 10.5220/0009393103960403

In Proceedings of the 12th International Conference on Computer Supported Education (CSEDU 2020) - Volume 1, pages 396-403

ISBN: 978-989-758-417-6

students in their learning process.

This article presents the virtual dissection evalua-

tion in an ultra-high-deﬁnition simulator for human

anatomy teaching in the classroom. The simulator

consists of hardware and software developed for this

purpose (Brongel. et al., 2019). The device seeks to

respond the requirements of representation of high-

quality models, visual acuity, color, texture, depth

perception and touch interactivity.

This article is structured as follows. The related

works are described in Section 2. Section 3 presents

how VHT was implemented based on the data used

in it and the use of a tool in active methodologies for

anatomy teaching. The method used to evaluate is

described in Section 4. Section 5 shows the results

of this evaluation which was carried out by students

from degree courses using the simulator. Section 6

reports the conclusions.

2 RELATED WORKS

The project known as The Voxel-Man, uses the low-

resolution database developed by the Hamburg Uni-

versity. It was known as The Segmented Inner Organs

(SIO) (Voxel-Man, 2019). This image database is

synthetic and was created by computational addition

and corrections from Visible Human Database. Syn-

thetic images result in some problems for anatomic

study such as, quality reduction in representation be-

cause of the manual corrections which do not repre-

sent the real organic structures.

Another example is the Anatomage Table. It is in

the seventh version and it has some colored bases in-

cluding the VHP base (Anatomage Inc., 2018). So,

as the models are rendered, they are committed to

the quality resulting in more artiﬁcial appearance of

the structures. A comparative study was carried, to

evaluate the qualitative efﬁciency and experience of

the learning of pelvis and perineum and skeletal mus-

cle system general anatomy by cadaveric dissection.

The purpose of this study was to learn these same

anatomic parts using Anatomage Table whose results

showed that students were more motivated and no-

ticed greater learning (Baratz et al., 2019). Other

study about this table highlighted that there is a re-

duction in the use of the cadaver in teaching and it re-

vealed the importance of the cutting tool (Fyfe et al.,

2013).

Other environment developed for teaching

through stereoscopy is presented by (Olsen. et al.,

2018), in which the acquisition of the images is done

by means of Full Frame Semi-spherical Scanner

(F2S2). And the learning objects can be used in

different knowledge ﬁelds promoting an educational

environment with interaction and dynamism. An

evaluation of the learning impact of the F2S2 was

carried, and the results showed that the interactive

material is an alternative which can motivate teachers

and students because they consider the visualization

represents the real object properly and it can help in

teaching-learning process (Silva et al., 2019).

3 MATERIAL

For the simulator development was need acquisition

and segmentation of color images, a hardware which

attended on the requirements of usability and perfor-

mance which enabled to accommodate the totality of

the bases of The Visible Human Project, besides an

interactive software which made feasible signiﬁcant

learning providing the teacher an active teaching tool.

3.1 Database

The database used in the simulator comes from The

Visible Human Project made available on November

28, 1994 for the male body and one year later, the

female body images (Ackerman, 1998) and (Spitzer

et al., 1996). The base is composed of Magnetic Res-

onance Imaging (MRI), Computed Tomography (CT)

and color images. For the male body, the MRI images

were acquired in 6 subsets: head in the axial form and

chest, abdomen, pelvis, thighs and foot in the coro-

nal form. The images were acquired in three different

modalities, T1, T2 and proton density images, shown

in Figure 1 (a,b,c) with resolution of 256x256 pixels

at 4-mm-intervals (Ackerman, 1998).

Figure 1 shows a CT with a resolution of 512x512

at 1-mm-intervals in the axial plane, and Figure 1

(e) displays a color axial image in 2048x1216 pixels

(2k). Each high-deﬁnition image takes 7.5 megabytes

with 1871 color images, all available to be used in re-

search. The whole process of image acquisition and

body preparation to generate the database is described

in (Spitzer et al., 1996).

The female data set presents a larger amount of

images than the male ones with 5189 images, due to

the 0,33-mm-intervals with a resolution of 2048x1216

pixels (2k) and 4096x3061 pixels (4k). Figure 2

shows the images that illustrate the male and female

bodies reconstituted in the coronal plane. The process

of freezing the cadavers was performed by blocks and

they did not exceed 51 cm in length. So, it is ob-

served that the images presented are not continuous

(U.S. National Library of Medicine, 2019).

Evaluation of Human Dissection in Anatomy Teaching using an Interactive Simulator

397

Figure 1: Images available on the website of The Visible Human Project: (a) MRI T1-; (b)MRI T2-; (c) proton density images;

(d) CT; (e) color axial image (U.S. National Library of Medicine, 2019).

Figure 2: Reconstruction of male and female bodies of The

Visible Human Project (Ackerman, 1998).

3.2 Interactive Simulator

The interactive dissection simulator for anatomy

study is consisted of two parts, hardware and soft-

ware. The hardware is formed by a computer with se-

lected components with the purpose of executing the

work satisfactorily. To attend the requirements of us-

ability in anatomy classes, it is presented dynamically

and it has a user-friendly interface. It also has an in-

teractive screen that supports resolutions of up to 4k

and about 1.70-m-human body, as shown in Figure 3.

Concerning the software, it is an application with

support for input by multiple touches on the screen,

enabling the dynamism and interactivity desired in a

computational application. The system has two main

areas, shown in Figure 4. In the ﬁrst one the hu-

man body is visualized in a volumetric way and in

the second one the image in ultra-high deﬁnition of

the anatomical plane is selected by the user.

The interface between the user and the application

is made, mainly, with a dynamic dial, shown in Figure

5. It operates as a virtual mouse and can be positioned

anywhere on the screen to enable the mobility around

the high-resolution table.

The dial includes several tools. They allow the ex-

change of the visualization plane, manipulation and

selection of the volumetric model. Also the creation

of notes by means of a digital chart and content upload

to the study environment of the institution through In-

ternet.

Also in Figure 5, it is possible to observe that the

interaction with the images in an ultra-high-deﬁnition

is made through buttons and colored lines. They can

be dragged to apply anatomical cuts in the volumetric

model and to determine the cut displayed in the main

frame.

CSEDU 2020 - 12th International Conference on Computer Supported Education

398

Figure 3: Visible Human Table.

For each anatomic plane, there are indexed win-

dows of MRI and CT scans which can be maximized

and positioned at any point on the screen creating the

desired corresponding association with the color im-

ages.

3.3 Active Learning

The Educational ﬁeld is going through major changes

especially, concerning conceptions and teaching tech-

niques. So, new teaching-learning process under-

standing and alternative teaching operationalization

proposals have been elaborated. It is considered they

must admit an ethic, critic, reﬂexive and transform-

ing pedagogic practices, transposing merely technical

training limits to reach the man education as a historic

being (Mitre et al., 2008) and (Paiva et al., 2016).

Students must read, write, ask, discuss or engage

on problems solving and projects development in or-

der to make the active learning process happen. They

are encouraged to build the knowledge instead of re-

ceiving it from the teacher in a passive way. Thus, the

active learning strategies can be described as activi-

ties which keep students occupied in doing something

and, at the same time, help students think about what

is being done (Bonwell and Eison, 1991) and (Silber-

man, 1996). In an active learning environment, the

teacher acts as mentor, supervisor, learning process

facilitator and not just as the single source of infor-

mation and knowledge.

The active methodologies, serving to this educa-

tional revision, consist of alternatives to teaching-

learning process with beneﬁts and challenges.

Flipped Classroom, Blended Learning, Peer Instruc-

tion, PBL (Problem Based Learning), GTD (Get-

ting Things Done), Think-pair-share, Just-in-time

teaching this is called “Customized Teaching” by

(Elm

or Filho et al., 2019). They are some of the active

methodologies application possibilities. They aim to

put students in the middle of the learning process in

order to develop their own autonomy.

An active learning environment should create the

possibility to apply activities which will develop crit-

ical reﬂections through discussions to promote the

construction of meanings to an enduring learning.

Thus, students can understand the skills and compe-

tences acquisition needed to deal with professional

challenges of their training area. Apprenticeship

learning is built in action whose spontaneity is en-

hanced when it has meaning and it is noticed as neces-

sary (Piaget and Caixeiro, 1983). In the face of these

conditions, it is possible to raise questions to provoke

reﬂections because knowledge is built when students

appropriate of their thoughts.

In this respect, the interactive simulator ﬁts per-

fectly because it allows the exploratory study of a

real human body anatomy. It is possible to visualize

image details with visual acuity, organs scale com-

pliance, texture, color and depth perception that are

not obtained at anatomy laboratories. Consequently,

students are stimulated to build knowledge instead of

receiving it from the teacher passively. The simula-

tor enables the teacher organize exploratory activities

Evaluation of Human Dissection in Anatomy Teaching using an Interactive Simulator

399

Figure 4: Interface of the Visible Human Table (Brongel. et al., 2019).

Figure 5: Dial visualization, volumetric section, and MRI

and CT exams.

into anatomy studies or problem resolution through

organs or human body systems observation whose re-

sults come from discussions involving all students.

Among many options which can also be con-

sidered in future works with the simulator usage,

the ﬂipped classroom approach was chosen for this

work. Its application process is divided in three

stages: pre-assignment activities, pre-activities and

post-activities. These stages are applied to the pro-

posed experiment using the simulator. First, students

did previous research of anatomy contents. Second,

students had contact with the simulator under teacher

supervision, whereby it was possible to identify char-

acteristic such as color, depth, texture and anatomic

arrangement of previously studied organs. Third, they

were inquired about their perception of the simula-

tor’s contribution to the learning process. The experi-

ment’s results are presented in the following section.

4 METHOD

The simulator was evaluated during the anatomy

classes by students from different courses, such as

Biological Sciences, Dentistry, Physical Education,

Physiotherapy, Nursing and Nutrition. The ﬂipped

classroom approach was chosen and the three stages

were carried out with teacher supervision. In the ﬁrst

stage previously mentioned, students carried out stud-

ies on anatomy contents to recognize the organs, their

characteristics and spatial location in the human body

using a cadaver. On the stage, students explored the

resources of VHT visualizing images in the several

ways the environment allows. They applied cuts all

organs, checked colors and textures during the class.

The ﬁnal stage, after all simulator functionalities were

presented to students, they were supposed to answer

an online questionnaire evaluating their experience

with the anatomy learning tool usage as after class

activity. Figure 6 shows in which course each student

respondent was.

The questionnaire above was composed by 7

close-ended questions and a ﬁve-point Likert scale

(Likert, 1932) with the following choices: I totally

agree (TA), partially agree (PA), indifferent (IN), par-

tially disagree (PD) and totally disagree (TD). The

questionnaire was applied through Google Forms in

order to obtain the degree of satisfaction and learn-

ing from students. According to (Wainerman, 1976),

the measurement instrument proposed by Likert aims

to verify the agreement level of the subject with sev-

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400

Figure 6: Distribution of students by course.

eral statements which express something favorable or

unfavorable in relation to an object. The questions

elaborated for the applied questionnaire were:

1. Would you use the digital table for further study

outside of school hours?

2. Do you consider that the corpses available on the

digital table contribute towards the proper assimi-

lation of organ positioning in the human body and

understanding of their structures, scale, color and

texture?

3. Do you believe that the possibility of visualizing

various axial, sagittal and coronal views using the

digital table contributes to your learning in your

anatomy studies?

4. Do you believe that the increased visual magni-

tude provided by the digital table provides a better

understanding of the structural details of an organ

and its relationship to others?

5. Do anatomical studies using only the digital table

meet your learning expectations?

6. Does the anatomy class using the digital table

combined with other resources available in the

anatomy lab contribute positively to your learn-

ing?

7. Does the use of manipulable volumetric digital

models of real bodies, such as the digital table

contribute positively to your learning?

Data collection was carried out on June, 2019 and

the online questions were answered by students vol-

untarily.

5 EVALUATION AND RESULTS

Table 1 shows the number of answers counted in each

proposition. The sum of the values should result in

the total of the participants.

Table 1: Survey Data.

Question T.A. P.A. I.N. P.D. T.D.

1 24 7 0 0 0

2 21 7 1 2 0

3 30 0 1 0 0

4 23 8 0 0 0

5 9 9 0 9 4

6 27 3 1 0 0

7 27 2 1 1 0

The result of the ﬁrst question showed that the

virtual table is considered a very useful resource for

complementary studies outside of class hours by the

students. The answers highlighted an index of 77%

approval of the table use in this sense.

The results related to the second question indi-

cated that 67% of students totally agree that the bodies

available on the table contribute to the assimilation of

the structure, scale, color and texture of the human

body organs.

Third question showed that the visualization in the

axial, sagittal and coronal planes available in the tool

contributes to the learning in the anatomy studies with

96% of respondents totally agreeing with the afﬁrma-

tion.

The possibility of increasing the visual magnitude

provided by the digital table is understood as another

beneﬁt for learning. With this functionality it is easier

to visualize small structures. In this respect 74% of

the students completely approved this feature..

Students were asked if their learning expectations

of human anatomy would be met only when they used

the digital table. It was observed that 29% of them

partially disagree and 13% totally disagree, indicat-

ing how important the simulator is to complement the

anatomy learning. It was noticed that the real human

body is still needed and the table is not intended to

replace its usage. Although, it was also observed that

97% of all answers were in favor of using the table

as a complement. So, for students, the combined us-

ages of the table with the anatomy laboratories make

the learning more efﬁcient, they also highlighted the

interactive simulator usage importance to the learning

process.

Finally, the results of question 7 attest that the ma-

nipulable volumetric models of the table assist in the

assimilation of the contents with 87% of the respon-

dents fully agreed. Figure 7 shows the percentages of

each answer per questions answered.

The answers indicated with TC and PC, that is to-

tal and partial agreement, when they were compared

to the other options, in general, demonstrate that the

data showed low disagreement in relation to the use

of the simulator, in other words most students agree

Evaluation of Human Dissection in Anatomy Teaching using an Interactive Simulator

401

Figure 7: Percentages of each answer per question answered.

that the computer tool presented to them, the VHT is

promising for the learning process in human anatomy

studies.

6 CONCLUSIONS

This article presented the evaluation of an ultra-high-

deﬁnition simulator called VHT. Its purpose is for

dissection and teaching anatomy in classroom. The

difference from other anatomical tools and atlases is

the use of ultra-high-deﬁnition images and the use of

real human body images which provides visual acu-

ity, scale conformity with real human organs, texture,

color and depth perception.

The simulator complies with the precepts used in

the study of anatomy, that is, it presents the anatom-

ical planes of cut, visualization in the dissection pro-

cess. Another essential element of this learning tool

is the availability of imaging exams associated with

anatomical slices of images, the connectivity with

other online tools and the active blackboard.

The research also reported an experience with un-

dergraduate students which have the anatomy stud-

ies as a regular discipline. The ﬂipped classroom

approach was used in order to evaluate the simu-

lator usage on the learning process. The results

were achieved through close-ended-questions analy-

sis based on the Likert scale. The questionnaire was

answered by students at the third stage of the method-

ology application.

The Flipped classroom use with the simulator re-

source in anatomy studies has created an appropri-

ate environment for knowledge construction in which

students identiﬁed organs studied in previous activ-

ities and raised questions, discussed and discovered

organs that were near each other on their own as it

was expected. It was possible just because it is a real

human body in size, shape, color and anatomical ar-

rangement like a living body. And, because of the

easy usage of the table provided by the interface gen-

erated by the dial whose usage was extremely sim-

ple e intuitive. The magnetic resonance and comput-

erized tomography images integration were also ele-

ments that draw attention due to the easy access to

perform anatomy studies.

The research has indicated the simulator is a

promising tool in active teaching-learning method-

ologies. It was also observed the tool is not sup-

posed to replace the human body dissection, but to

complement anatomic studies. It was also consid-

ered this resource can be extra-class used, outside of

school hours. It allows students to explore the human

body and do research. The answers received from the

questionnaire show that with the simulator usage in

a Flipped classroom, there was a contribution in the

anatomy teaching-learning process.

ACKNOWLEDGEMENTS

We thank to the US National Library of Medicine for

the acquisition and distribution of images The Visible

Human Body Project and The Voxel-Man Group for

granting segmented images which have contributed

to some studies and researches, the Financiadora de

Estudos e Projetos (FINEP) for project funding and

the Center of Innovation in Medical Imaging of the

PUCPR (CIIM) for project management.

CSEDU 2020 - 12th International Conference on Computer Supported Education

402

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