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 Table of Contents  
Year : 2017  |  Volume : 3  |  Issue : 3  |  Page : 133-137

Digital anatomy using the surface models in portable document format file for self-learning and evaluation

1 Department of Anatomy, Dongguk University College of Medicine, Gyeongju, Republic of Korea
2 Department of Anatomy, Ajou University School of Medicine, Suwon, Republic of Korea

Date of Web Publication7-Dec-2017

Correspondence Address:
Min Suk Chung
Department of Anatomy, Ajou University School of Medicine, 164 World cup-ro, Suwon 16499
Republic of Korea
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/digm.digm_29_17

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Background and Objectives: This study examined the learning effect of surface models made from the sectioned images of a male cadaver. Materials and Methods: The first author guided 46 medical students to study with a portable document format (PDF) file containing hundreds of surface models of a whole body. Their level of anatomy knowledge gained was evaluated by a digital examination on the tablet computers using the captured movies of PDF file. Results: The medical students' grades on the surface models were positively correlated with those on the remainder of the anatomy quiz. More than half of the students reported that the PDF file was helpful in anatomy learning and cadaver dissection. Conclusions: Digital anatomy learning is under continuous development in many ways. This report shows that surface models of the human body can be effective for self-learning and in the evaluation of anatomy knowledge.

Keywords: Anatomic models, learning, tablet computers, three-dimensional imaging, Visible Human Projects

How to cite this article:
Park JS, Chung BS, Chung MS. Digital anatomy using the surface models in portable document format file for self-learning and evaluation. Digit Med 2017;3:133-7

How to cite this URL:
Park JS, Chung BS, Chung MS. Digital anatomy using the surface models in portable document format file for self-learning and evaluation. Digit Med [serial online] 2017 [cited 2023 Mar 24];3:133-7. Available from: http://www.digitmedicine.com/text.asp?2017/3/3/133/220128

  Introduction Top

Electronic devices, such as laptops, tablet computers, and smartphones, are commonly used in medical learning.[1] The medical students have a positive perception toward smartphone use; and many medical schools are encouraging the use of medical applications on the devices.[2],[3],[4] With regard to anatomy, the time spent on anatomy coursework is decreasing in medical schools;[5] situation of cadaver donation is variable according to the nations.[6] Those are why digital anatomy learning becomes more and more significant.

For digital anatomy, the hardware should go together with the anatomy contents. The key contents are the three-dimensional (3D) models of the human body structures. Among 3D models, the volume models can be cut in an arbitrary plane to reveal the internal appearance of body structures.[7],[8],[9] On the other hand, surface models with a small file size can be manipulated in real time in common devices.[10],[11],[12]

As part of an ongoing interest in surface models, the authors used these models for digital anatomy learning. Surface models were made from the outlines of structures which were drawn on the serial sectioned images of a male cadaver.[13] The portable document format (PDF) file, which contains the surface models, was chosen for the educational platform. With the PDF file, 642 surface models of anatomic structures and their systematic name list were linked; the original sectioned images, which were overlapped on the resulting surface models, could be displayed simultaneously. The PDF file could be opened either on Adobe Reader version 9 (Adobe Systems, Inc., San Jose, CA, USA) for a personal computer or on 3D PDF Reader (Tech Soft 3D, Berkeley, CA, USA) for a mobile device. The PDF file could be obtained from the homepage (anatomy.co.kr) for free and without registration. The PDF file eventually allows individual students to browse the surface models on their computers offline.[10]

If the PDF file were helpful to the medical students requiring the high level of anatomy, its quality would be approved. Further, the PDF file would be recommended to the allied health professional students and even to the children. Thus far, how much the medical students could learn from the PDF file has not been investigated.

Another issue was how to evaluate the medical students' acquisition of anatomy knowledge by means of the PDF file. The digital examination on tablet computers using the captured movies of the PDF file was decided. Subsequently, their scores and their responses to the PDF file would be collected and analyzed.

The purpose of this study was to assess the medical students' learning effect of the surface models of the human body in the PDF file. In addition, it was intended to suggest the practically desirable method for digital anatomy.

  Materials and Methods Top

The participants were Korean medical students (30 men, 16 women) who were learning gross anatomy from the first author. They had graduated from 3- to 4-year course colleges.

The first author explained the meaning of this study to the volunteer students. In succession, the author introduced how to download the PDF file of the male whole body, how to utilize the PDF file for self-learning, and how the students' study would be evaluated using tablet computers. The introduction took 15 minutes.

The quiz format on the tablet computers was the captured movies of the PDF file. The first author chose 5 structures to be assessed in the quiz. For each movie, the PDF file was manipulated as follows: the covering structures (e.g., semi-transparent skin or muscles) were shown and then erased to reveal the structure for the quiz, which was indicated by an arrow; the structure was zoomed-in and rotated [Figure 1]. This manipulation on the PDF file was recorded using Camtasia Studio version 6 (TechSmith, Okemos, MI, USA) and saved as a moving picture experts group 4 (MP4) format.
Figure 1: Captured movies to assess the vertebral artery (left column), inferior oblique muscle (center column), and supraspinatus (right column). From the initial feature (1st row), the covering structures are removed (2nd row). Subsequently, the asked structures, indicated by arrows, are zoomed-in (3rd row) and rotated (4th row)

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The captured movies and their correct answers were uploaded on a smart device-based test (SBT) system (nsdevil.com).[14] For the digital examination, the students were given individual tablet computers using Android 4.0. On the tablet computers, the students could watch each movie repeatedly and type the name of the anatomical structure as an answer [Figure 2]. Simultaneously, the students took the other quizzes (including a simple figure examination) on the tablet computers. In the SBT system, the students' answers were scored automatically based on the already inputted correct answers by the author.
Figure 2: Medical students taking a digital anatomy examination using the tablet computers

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The students' grades on the surface models (proportion, 5.7%), and those on the others (proportion, 94.3%) were analyzed statistically by calculating the Pearson's correlation coefficient. Statistical package for the social sciences (SPSS) version 20 (IBM Corp., Armonk, NY, USA) were employed in the analysis.

In the additional questionnaire, the medical students were asked to report how much the PDF file contributed to their anatomy learning and dissection practice. They were also asked to provide their overall opinions on the PDF file.

Concerning the source of the PDF file, the Institutional Review Board of Ajou University School of Medicine permitted the academic use of the sectioned images (AJIRB-CRO-06-23). The students' survey was approved by the first author's university government.

  Results Top

The usefulness of the PDF file including the surface models of anatomical structures was assessed. The results did show no sexual difference.

The students' grades on the surface models, and those on the others were positively correlated (Pearson's correlation coefficient 0.781; P < 0.05).

More than half of the students answered that the PDF file contributed positively not only to the anatomy learning (greatly 17.4%, fairly 47.8%) but also to the dissection practice (greatly 15.2%, fairly 45.7%) [Table 1].
Table 1: Objective responses from the students who experienced the portable document format file

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The feedback from the students was summarized to identify the strengths and weaknesses of the PDF file [Table 2].
Table 2: Narrative remarks from the students who experienced the portable document format file

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  Discussion Top

The hypothesis of this study was that the presented PDF file of surface models helps medical students learn anatomy. A questionnaire result directly supported this hypothesis: 65.2% of students replied the PDF file contributed to anatomy learning [Table 1]. A related remark was that the PDF file provided the stereoscopic view (7 students) [Table 2]. Anatomy is the subject to learn 3D human structures. If the PDF file contained only 2D pictures like an anatomy  Atlas More Details book, it would not be that satisfactory for students.[15]

The authors also paid attention to the result that PDF file contributed to the dissection practice (60.9%) [Table 1]. The students' response might be caused by the surface models that were reconstructed from the sectioned images of a cadaver.[10]

Surface models in the majority of software packages have been drawn stereoscopically based on the anatomy knowledge. As a result, the models appear to be excellent (zygotebody.com), but they are not as realistic as those made from actual cadaver. This is meaningful, considering that the digital anatomy supports cadaver dissection and may even substitute for it.

Two students answered that a strong point of the PDF file is no charge [Table 2]. Most software packages cost: an example of the commercial software is the VH dissector that contains the surface models made of the Visible Human Project data (toltech.net). A medical school can purchase a package, and the affiliated students can share it on the school computers. However, the students are not allowed to install it on their own computers for convenient self-learning. Free educational software is required to spread the digital anatomy learning, especially in the developing countries.

The students' grades on the surface models were correlated with those of the remainders (Pearson's correlation coefficient 0.781; P < 0.05). In other words, the examination using the PDF file was appropriate. One reason of this positive result seems to be the digital examination using the tablet computers [Figure 2] rather than the conventional paper examination. In the paper examination, the movies to show the zoomed-in and rotated models cannot be displayed [Figure 1].

In the SBT system employed, students are asked to write the names of the structures [Figure 1]. The students could also take the multiple choice test. The following further improvements may be helpful: students see the movies and click the asked structures on the surface models; students manipulate the PDF file as they like and click the asked structures on the surface models. If this improvement is achieved, the distribution of the spots clicked by students can be visualized to analyze the students' understanding of the questions. Likewise, digital examination using 3D models is expected to be improved considerably in the near future.

There were also negative remarks from the students; image quality was not good (4 students). There were fewer anatomical structures compared to the commercial anatomy software (1 student) [Table 2].

The authors have the experience to manufacture other PDF files of surface models.[16],[17],[18] Despite the authors' endeavors, the quality and quantity of surface models should be improved to meet the needs of students. The authors also suggest other investigators including anatomists to develop their particular surface models. Better surface models can be made of other data sets of the sectioned images, such as Visible Human Project [7] and Chinese Visible Human,[12] computed tomographs, or magnetic resonance images.

Our method to build a PDF file without complicated programming can be repeated comfortably by other developers.[10] This method is strongly suggested because they can spend precious time not for programming but for developing good quality surface models. It is to be wished that the upcoming PDF files are distributed free of charge like the authors. Even if the developers cannot obtain financial reward, they will be acknowledged as the contributors. This kind of well-intentioned competition by anatomists will enhance the level of digital anatomy learning worldwide.

  Conclusions Top

The complimentary PDF file containing the surface models which are made from a cadaver's sectioned images facilitates the medical students' learning. The surface models and their examination on tablet computers are hopefully improved in quality and quantity to enhance the level of digital anatomy regardless of the various conditions of cadavers.

This study has the limitations. First, there was only study group without control group. Second, only short-term memory was investigated excluding long-term memory (e.g., medical licence examination). For obtaining the strong results, these limitations must be broken in the subsequent investigation.

Financial support and sponsorship

This research was financially supported by the Ministry of Trade, Industry and Energy (MOTIE) and Korea Institute for Advancement of Technology (KIAT) through the International Cooperative R&D program. (Grant number: N0002249).

Conflicts of interest

There are no conflicts of interest.

  References Top

Hui R, Leung S, Cheung T, Chu E, Fong J, Lau I, et al. Preclinical medical students' usage of electronic devices in lectures: A cross-sectional study. Digit Med 2016;2:64-71.  Back to cited text no. 1
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Lewis TL, Burnett B, Tunstall RG, Abrahams PH. Complementing anatomy education using three-dimensional anatomy mobile software applications on tablet computers. Clin Anat 2014;27:313-20.  Back to cited text no. 3
Rohilla J, Rohilla R, Rohilla A, Singh K. Academic use and attitude of the 1st year medical students toward smartphones in a North Indian city. Digit Med 2016;2:13-6.  Back to cited text no. 4
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Drake RL, McBride JM, Lachman N, Pawlina W. Medical education in the anatomical sciences: The winds of change continue to blow. Anat Sci Educ 2009;2:253-9.  Back to cited text no. 5
Riederer BM. Body donations today and tomorrow: What is best practice and why? Clin Anat 2016;29:11-8.  Back to cited text no. 6
Ackerman MJ. The visible human project ®: From body to bits. Conf Proc IEEE Eng Med Biol Soc 2016;2016:3338-41.  Back to cited text no. 7
Pflesser B, Petersik A, Pommert A, Riemer M, Schubert R, Tiede U, et al. Exploring the visible human's inner organs with the VOXEL-MAN 3D navigator. Stud Health Technol Inform 2001;81:379-85.  Back to cited text no. 8
Chung BS, Shin DS, Brown P, Choi J, Chung MS. Virtual dissection table including the Visible Korean images, complemented by free software of the same data. Int J Morphol 2015;33:440-5.  Back to cited text no. 9
Shin DS, Chung MS, Park JS, Park HS, Lee S, Moon YL, et al. Portable document format file showing the surface models of cadaver whole body. J Korean Med Sci 2012;27:849-56.  Back to cited text no. 10
Nowinski WL, Chua BC, Johnson A, Qian G, Poh LE, Yi SH, et al. Three-dimensional interactive and stereotactic atlas of head muscles and glands correlated with cranial nerves and surface and sectional neuroanatomy. J Neurosci Methods 2013;215:12-8.  Back to cited text no. 11
Fang B, Wu Y, Chu C, Li Y, Luo N, Liu K, et al. Creation of a virtual anatomy system based on Chinese Visible Human data sets. Surg Radiol Anat 2017;39:441-9.  Back to cited text no. 12
Shin DS, Park JS, Park HS, Hwang SB, Chung MS. Outlining of the detailed structures in sectioned images from Visible Korean. Surg Radiol Anat 2012;34:235-47.  Back to cited text no. 13
Roh H, Lee JT, Rhee BD. Ubiquitous-based testing in medical education. Med Teach 2015;37:302-3.  Back to cited text no. 14
Vernon T, Peckham D. The benefits of 3D modeling and animation in medical teaching. J Audiov Media Med 2002;25:142-8.  Back to cited text no. 15
Shin DS, Jang HG, Park JS, Park HS, Lee S, Chung MS, et al. Accessible and informative sectioned images and surface models of a cadaver head. J Craniofac Surg 2012;23:1176-80.  Back to cited text no. 16
Park HS, Chung MS, Shin DS, Jung YW, Park JS. Whole courses of the oculomotor, trochlear, and abducens nerves, identified in sectioned images and surface models. Anat Rec (Hoboken) 2015;298:436-43.  Back to cited text no. 17
Chung BS, Chung MS, Park JS. Six walls of the cavernous sinus identified by sectioned images and three-dimensional models: Anatomic report. World Neurosurg 2015;84:337-44.  Back to cited text no. 18


  [Figure 1], [Figure 2]

  [Table 1], [Table 2]

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