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Introduction

The primary method of learning the surface anatomy is by making the students mark structures on mummified bodies. The students feel that learning the surface anatomy on mummified cadavers is not interesting. The present project on learning the surface anatomy through the body painting method was undertaken to evoke interest among the students.

Materials and Methods

Physiotherapy and dental undergraduate students who volunteered were involved in this study. A few surface anatomy classes were conducted by using the traditional method and a few more by using the body painting exercise. Non toxic body paints of various colours and brushes of different sizes were used for the body painting.

Results

A feedback was obtained from the students by using a structured questionnaire. The students opined that the body painting method was advantageous to them in learning the human anatomy. They also felt that they could have more practice sessions in any setting other than in the classroom and that they did not need to rely upon the mummified bodies. They described the body painting method as self explanatory, which gave them the feel of live structures.

Conclusion

This project was successful in achieving its objectives as the students felt that the method was exciting, with lots of fun during the learning. The body painting method was well accepted by the students as an effective method for learning the surface and the clinical anatomy.

In April 1986, magnetic resonance imaging (MRI) of the thorax and shoulder girdle was presented to the 99th Annual Meeting of the American Association of Anatomists. These images were the authors' first attempt to correlate the magnetic resonance display of the muscles and soft tissues of the chest in the coronal plane with surface gross anatomy. The original purpose of this study was to introduce the role of magnetic resonance imaging to anatomists, medical students, and the specialty of radiology. However, this approach has been expanded by imaging other sections of the body and applying the display of surface anatomy to augment the teaching of anatomy to surgical oncology, pathology, and kinesiology. This three-part article will display magnetic resonance images and will explain how magnetic imaging of the soft tissues can visually augment the teaching of gross anatomy without dissecting surface tissues.

Images

In April 1986, magnetic resonance imaging (MRI) of the thorax and shoulder girdle was presented at the 99th Annual Meeting of the American Association of Anatomists. These images were the authors' first attempt to correlate the magnetic resonance display of the muscles and soft tissues of the chest in the coronal plane with surface gross anatomy. The original purpose of this study was to introduce the role of magnetic resonance imaging to anatomists, medical students, and the specialty of radiology. However, this approach has been expanded by imaging other sections of the body and applying the display of surface anatomy to augment the teaching of anatomy to surgical oncology, pathology, and kinesiology. This three-part article will display magnetic resonance images and will explain how magnetic imaging of the soft tissues can visually augment the teaching of gross anatomy without dissecting surface tissues.

Images

In April 1986, magnetic resonance imaging (MRI) of the thorax and shoulder girdle was presented at the 99th Annual Meeting of the American Association of Anatomists. These images were the authors' first attempt to correlate the magnetic resonance display of the muscles and soft tissues of the chest in the coronal plane with surface gross anatomy. The original purpose of this study was to introduce the role of magnetic resonance imaging to anatomists, medical students, and the specialty of radiology. However, this approach has been expanded by imaging other sections of the body and applying the display of surface anatomy to augment the teaching of anatomy to surgical oncology, pathology, and kinesiology. This three-part article will display magnetic resonance images and will explain how magnetic imaging of the soft tissues can visually augment the teaching of gross anatomy without dissecting surface tissues.

Images

Magnetic resonance imaging (MRI) demonstrates surface anatomy, nerves, and soft tissue pathology. Selective placement of the cursor lines in MRI displays specific anatomy. The MR images can then be used as adjunct in teaching surface anatomy to medical students and to other health professionals. Because the normal surface anatomy could be imaged at UCLA's radiology department, it was decided to image soft tissue abnormalities with MR to assist in patient care. Patients imaged were scheduled for special procedures of the chest or staging lymphangiograms. Patients were placed into categories depending on known diagnosis or interesting clinical presentation. The diagnostic categories included Hodgkin's disease, melanoma, carcinomas (eg, lung or breast), lymphedema, sarcomas, dermatological disorders, and neurological disorders. All images were orchestrated by the radiologist. This article discusses both the teaching and clinical impact on patient care.

Images

Transpedicular screw fixation provides rigid stabilization of the thoracolumbar spine. For accurate insertion of screws into the pedicles and to avoid pedicle cortex perforations, more precise knowledge of the anatomy of the pedicles is necessary. This study was designed to visualize graphically the surface anatomy and internal architecture of the pedicles of the thoracic spine. Fifteen vertebrae distributed equally among the upper, middle, and lower thoracic regions were used. For the purpose of mapping surface anatomy, each pedicle was cleaned, spraypainted white, and marked with more than 100 fine points. Using an optoelectronic digitizer, three-dimensional coordinates of the marked points and three additonal points, representing a coordiate system, were digitized. A solid modeling computer program was used to create three-dimensional surface images of the pedicle. To obtain cross-sectional information, each pedicle was sectioned with a thin diamond-blade saw to obtain four slices, 1 mm in thcikness and 0.5 mm apart. The pedicle slices were X-rayed and projected onto a digitizer. The internal and external contours were digitized and converted into graphs by a computer. The pedicles exhibited significant variability in their shape and orientation, not only from region to region within the thoracic spine, but also within the same region and even within the same pedicle. These variations are extremely significant in light of current techniques utilized in transpedicular screw fixation in the thoracic spine. Information documenting the three-dimensional complexity of pedicle anatomy should be valuable for surgeons and investigators interested in spinal instrumentation.

Computational human phantoms are computer models used to obtain dose distributions within the human body exposed to internal or external radiation sources. In addition, they are increasingly used to develop detector efficiencies for in-vivo whole-body counters. Two classes of the computational human phantoms have been widely utilized for dosimetry calculation: stylized and voxel phantoms, that describe human anatomy through mathematical surface equations and 3D voxel matrices, respectively. Stylized phantoms are flexible in that changes to organ position and shape are possible given avoidance of region overlap, while voxel phantoms are typically fixed to a given patient anatomy, yet can be proportionally scaled to match individuals of larger or smaller stature, but of equivalent organ anatomy. Voxel phantoms provide much better anatomical realism as compared to stylized phantoms which are intrinsically limited by mathematical surface equations. To address the drawbacks of these phantoms, hybrid phantoms based on non-uniform rational B-spline (NURBS) surfaces have been introduced wherein anthropomorphic flexibility and anatomic realism are both preserved. Researchers at the University of Florida have introduced a series of hybrid phantoms representing the ICRP Publication 89 reference newborn, 15-year, and adult male and female. In this study, six additional phantoms are added to the UF family of hybrid phantoms – those of the reference 1-year, 5-year, and 10-year child. Head and torso CT images of patients whose ages were close to the targeted ages were obtained under approved protocols. Major organs and tissues were segmented from these images using an image processing software, 3D-DOCTOR™. NURBS and polygon mesh surfaces were then used to model individual organs and tissues after importing the segmented organ models to the 3D NURBS modeling software, Rhinoceros™. The phantoms were matched to four reference datasets: (1) standard anthropometric data, (2) reference organ masses from ICRP Publication 89, (3) reference elemental compositions provided in ICRP 89 as well as ICRU Report 46, and (4) reference data on the alimentary tract organs given in ICRP Publications 89 and 100. Various adjustments and refinements to the organ systems of the previously described newborn, 15-year, and adult phantoms are also presented. The UF series of hybrid phantoms retain the non-uniform scalability of stylized phantoms while maintaining the anatomical realism of patient-specific voxel phantoms with respect to organ shape, depth and inter-organ distance. While the final versions of these phantoms are in a voxelized format for radiation transport simulation, their primary format is given as NURBS and polygon mesh surfaces, thus permitting one to sculpt non-reference phantoms using the reference phantoms as an anatomic template.

We describe a simple and efficient solution to the problem of reconstructing electromagnetic sources into a canonical or standard anatomical space. Its simplicity rests upon incorporating subject-specific anatomy into the forward model in a way that eschews the need for cortical surface extraction. The forward model starts with a canonical cortical mesh, defined in a standard stereotactic space. The mesh is warped, in a nonlinear fashion, to match the subject's anatomy. This warping is the inverse of the transformation derived from spatial normalization of the subject's structural MRI image, using fully automated procedures that have been established for other imaging modalities. Electromagnetic lead fields are computed using the warped mesh, in conjunction with a spherical head model (which does not rely on individual anatomy). The ensuing forward model is inverted using an empirical Bayesian scheme that we have described previously in several publications. Critically, because anatomical information enters the forward model, there is no need to spatially normalize the reconstructed source activity. In other words, each source, comprising the mesh, has a predetermined and unique anatomical attribution within standard stereotactic space. This enables the pooling of data from multiple subjects and the reporting of results in stereotactic coordinates. Furthermore, it allows the graceful fusion of fMRI and MEG data within the same anatomical framework.

ABSTRACT

Objective: Skull base anatomy is complex and subject to individual variation. Understanding the complexity of surgical anatomy is faster and easier with virtual models created from primary imaging data of the patient. This study was designed to investigate the usefulness of virtual reality in image guidance for skull base procedures. Design: Primary volumetric image data from 110 patients was acquired using magnetic resonance, computed tomography (CT), and CT angiography. Pathologies included lesions in the anterior, middle, and posterior skull base. The data were transferred to an infrared-based image-guidance system for creation of a virtual operating field (VOF) with translucent surface modulation and optional “fly-through” video mode. During surgery, the target registration error for anatomical landmarks was assessed and the VOF was compared with the patient's anatomy in the operative field. Results: Complex structures like the course of the sigmoid sinus, the carotid artery, and the outline of the paranasal sinuses were well visualized in the VOF and were recognized by the surgeon instantly. Perception was greatly facilitated as compared with routine mental reconstruction of triaxial images. Accurate assessment of the depth of field and very small objects was not possible in VOF images. Conclusion: Supported by sound anatomical knowledge, creation of a virtual operating field for a surgical approach in an individual patient offers a déjà vu experience that can enhance the capabilities of a surgical team in skull base approaches. In addition, application of this technique in image-guided procedures assists in targeting or avoiding hidden anatomical structures.

Estimation of internal mouse anatomy is required for quantitative bioluminescence or fluorescence tomography. However, only surface range data can be recovered from all-optical systems. These data are at times sparse or incomplete. We present a method for fitting an elastically deformable mouse atlas to surface topographic range data acquired by an optical system. In this method, we first match the postures of a deformable atlas and the range data of the mouse being imaged. This is achieved by aligning manually identified landmarks. We then minimize the asymmetric L2 pseudo-distance between the surface of the deformable atlas and the surface topography range data. Once this registration is accomplished, the internal anatomy of the atlas is transformed to the coordinate system of the range data using elastic energy minimization. We evaluated our method by using it to register a digital mouse atlas to a surface model produced from a manually labeled CT mouse data set. Dice coefficents indicated excellent agreement in the brain and heart, with fair agreement in the kidneys and bladder. We also present example results produced using our method to align the digital mouse atlas to surface range data.

For pre-clinical bioluminescence or fluorescence optical tomography, the animal's surface topography and internal anatomy need to be estimated for improving the quantitative accuracy of reconstructed images. The animal's surface profile can be measured by all-optical systems, but estimation of the internal anatomy using optical techniques is non-trivial. A 3D anatomical mouse atlas may be warped to the estimated surface. However, fitting an atlas to surface topography data is challenging because of variations in the posture and morphology of imaged mice. In addition, acquisition of partial data (for example, from limited views or with limited sampling) can make the warping problem ill-conditioned. Here, we present a method for fitting a deformable mouse atlas to surface topographic range data acquired by an optical system. As an initialization procedure, we match the posture of the atlas to the posture of the mouse being imaged using landmark constraints. The asymmetric L2 pseudo-distance between the atlas surface and the mouse surface is then minimized in order to register two data sets. A Laplacian prior is used to ensure smoothness of the surface warping field. Once the atlas surface is normalized to match the range data, the internal anatomy is transformed using elastic energy minimization. We present results from performance evaluation studies of our method where we have measured the volumetric overlap between the internal organs delineated directly from MRI or CT and those estimated by our proposed warping scheme. Computed Dice coefficients indicate excellent overlap in the brain and the heart, with fair agreement in the kidneys and the bladder.

Establishing the correspondences of brain anatomy with function is important for understanding neuroimaging data. Regional delineations on morphological surfaces define anatomical landmarks and help to visualize and interpret both functional data and morphological measures mapped onto the cortical surface. We present an efficient algorithm that accurately delineates the morphological surface of the cerebral cortex in real time during generation of the surface using information from parcellated 3D data. With this accurate region delineation, we then develop methods for boundary-preserved simplification and smoothing, as well as procedures for the automated correction of small, misclassified regions to improve the quality of the delineated surface. We demonstrate that our delineation algorithm, together with a new method for double-snapshot visualization of cortical regions, can be used to establish a clear correspondence between brain anatomy and mapped quantities, such as morphological measures, across groups of subjects.

Emerging data supports a role for negative wall remodeling in the failure of vascular interventions such as vein grafts, yet clinicians/researchers currently lack the ability to temporally/efficiently investigate adventitial surface topography/total vascular wall anatomy in vivo. We established a strategy of immobilizing commercially available iron oxide magnetic nanoparticles (Fe-NPs) onto the surface of human vein conduits to facilitate high-throughput total vascular wall demarcation with magnetic resonance (MR). Binding of activated Fe-NPs to amine groups on the surface of the veins induced a thin layer of negative contrast that differentiated the adventitia from surrounding saline signal in all MR images, enabling delineation of total wall anatomy; this was not possible in simultaneously imaged unlabeled control veins. Under the conditions of this ex vivo experiment, stable covalent binding of Fe-NPs can be achieved (dose-dependent) on human vein surface for MR detection, suggesting a potential strategy for enhancing the ability of MRI to investigate total wall adaptation and remodeling in vein graft failure.

Emerging data supports a role for negative wall remodeling in the failure of vascular interventions such as vein grafts, yet clinicians/researchers currently lack the ability to temporally/efficiently investigate adventitial surface topography/total vascular wall anatomy in vivo. We established a strategy of immobilizing commercially available iron oxide magnetic nanoparticles (Fe-NPs) onto the surface of human vein conduits to facilitate high-throughput total vascular wall demarcation with magnetic resonance (MR).

Introduction

Fractures of the distal radius are among the most common fractures seen. They encompass a myriad of presentations and fracture patterns that often benefit from various open reduction and internal fixation techniques—including volar plating, dorsal plating, radial plating, intramedullary nailing, and fragment-specific fixation. In order to obtain optimal reduction of these fractures, surgeons require a thorough understanding of the anatomy and various surgical exposures.

Anatomy

The distal radius is surrounded by a soft tissue envelope rich in vascularity and cutaneous innervation. The osseous surface consists of two articular surfaces and three cortical sides covered almost entirely by soft tissue.

Surgical approaches

Approaches to the distal radius can be broadly divided into volar, radial, and dorsal. Visualization of the articular surface can be accomplished best arthroscopically. Arthroscopy can be performed alone or in conjunction with other open approaches to the distal radius.

Summary

This article will review the pertinent anatomy and various surgical approaches in order to facilitate the surgeon’s ability to safely expose a distal radius fracture.

We describe a new class of surface flows, diffeomorphic surface flows, induced by restricting diffeomorphic flows of the ambient Euclidean space to a surface. Different from classical surface PDE flows such as mean curvature flow, diffeomorphic surface flows are solutions of integro-differential equations in a group of diffeomorphisms. They have the potential advantage of being both topology-invariant and singularity free, which can be useful in computational anatomy and computer graphics. We first derive the Euler–Lagrange equation of the elastic energy for general diffeomorphic surface flows, which can be regarded as a smoothed version of the corresponding classical surface flows. Then we focus on diffeomorphic mean curvature flow. We prove the short-time existence and uniqueness of the flow, and study the long-time existence of the flow for surfaces of revolution. We present numerical experiments on synthetic and cortical surfaces from neuroimaging studies in schizophrenia and auditory disorders. Finally we discuss unresolved issues and potential applications.

Magnetic resonance (MR) imaging augmented with 3-D MR reconstruction provides an excellent display of the soft tissues and surface anatomy of the human body. The excellent anatomical detail of MR images makes this radiographic modality an ideal tool to teach anatomy to all health-care professionals. Previous studies of the lung and liver in swine revealed that the hepatic lymphatics communicated with the visceral pleural lymphatics via the so-called pulmonary ligament, which appears as a sheet of visceral pleura containing lymphatics and small blood vessels in the swine model. A review of the surgical operative reports at the UCLA School of Medicine revealed that the hepatic lymphatics are not connected or even ligated during hepatic resections and transplantations. Therefore, the authors hypothesized that the unattached lymphatics may be a cause of postoperative complications and that interruption of these important lymphatic pathways may specifically result in immediate ascites and right pleural effusions. Cannulation of the hepatic lymphatics is proposed as a method to reduce postoperative complications. The purpose of this research is to demonstrate the visual and radiographic display of the hepatic lymphatics in a swine model and to provide a means to teach anatomical-pathological correlation.

Images

Fascial planes between tissues are separated by connective tissue, fat, and blood vessels. Magnetic resonance imaging displays surface anatomy and soft tissues. Our team has been successful in demonstrating brachial plexus nerves as a model of magnetic resonance anatomy. Radiologists have devised methods to increase the resolution of images by suppressing noise and increasing the sharpness of the image. We added water bags to a 0.3 tesla permanent magnet suppressing the noise and increasing the signal to image our patients. The images proved to be sharper.

Images

Computational Functional Anatomy (CFA) is the study of functional and physiological response variables in anatomical coordinates. For this we focus on two things: (i) the construction of bijections (via diffeomorphisms) between the coordinatized manifolds of human anatomy, and (ii) the transfer (group action and parallel transport) of functional information into anatomical atlases via these bijections. We review advances in the unification of the bijective comparison of anatomical submanifolds via point-sets including points, curves and surface triangulations as well as dense imagery. We examine the transfer via these bijections of functional response variables into anatomical coordinates via group action on scalars and matrices in DTI as well as parallel transport of metric information across multiple templates which preserves the inner product.

Intra-articular abnormalities of the hip, such as labral tears, loose bodies, chondral lesions, ligamentum teres tears and femoral acetabular impingement are increasingly being recognized in the pediatric age group. Evaluation for these abnormalities starts with a good history and physical exam. Radiographic imaging with plain films and magnetic resonance imaging help confirm the clinical impression. Arthroscopy of the hip can be utilized to diagnose and treat these abnormalities. Arthroscopy of the hip is a challenging procedure with a learning curve that requires a thorough knowledge of the anatomy of the hip. The hip is a deeply recessed joint that has a large muscular envelope, thick joint capsule and convex and concave surfaces of the femoral head and acetabulum, respectively. The normal anatomy may be distorted due to childhood developmental disorders such as hip dysplasia, Legg–Calve–Perthes Disease and Slipped Capital Femoral Epiphysis that adds additional challenges to the arthroscopist. Isolated intra-articular abnormalities occur rarely and an underlying morphologic abnormality should be identified which also requires management. Complications can be minimized with attention to detail.

Methylmethacrylate casting model of the temporal bone simulating the translabyrinthine approach from the bone surface down to the internal auditory canal was developed in order to help to understand the complex anatomy that is often encountered during skull base surgery. Using a cadaver temporal bone and applying dental impression technique, fine structures, such as semicircular canals and facial nerve, were precisely reproduced in a life-size resin casting model. This simple cost-effective modeling method would facilitate both anatomical research and medical education by improving our understanding of the complex anatomy of the temporal bone.

Images

The cortical column has been an invaluable concept to explain the functional organization of the neocortex. While this idea was born out of experiments that cleverly combined electrophysiological recordings with anatomy, no one has ‘seen’ the anatomy of a column. All we know is that when we record through the cortex of primates, ungulates, and carnivores in a trajectory perpendicular to its surface there is a remarkable constancy in the receptive field properties of the neurons regarding one set of stimulus features. There is no obvious morphological analog for this functional architecture, in fact much of the anatomical data seems to challenge it. Here we describe historically the origins of the concept of the cortical column and the struggles of the pioneers to define the columnar architecture. We suggest that in the concept of a ‘canonical circuit’ we may find the means to reconcile the structure of neocortex with its functional architecture. The canonical microcircuit respects the known connectivity of the neocortex, and it is flexible enough to change transiently the architecture of its network in order to perform the required computations.

Our goal is to determine an optimized image-guided setup by comparing setup errors determined by two-dimensional (2D) and three-dimensional (3D) image guidance for head and neck cancer (HNC) patients immobilized by customized thermoplastic masks. Nine patients received weekly imaging sessions, for a total of 54, throughout treatment. Patients were first set up by matching lasers to surface marks (initial) and then translationally corrected using manual registration of orthogonal kilovoltage (kV) radiographs with DRRs (2D-2D) on bony anatomy. A kV cone beam CT (kVCBCT) was acquired and manually registered to the simulation CT using only translations (3D-3D) on the same bony anatomy to determine further translational corrections. After treatment, a second set of kVCBCT was acquired to assess intrafractional motion. Averaged over all sessions, 2D-2D registration led to translational corrections from initial setup of 3.5 ± 2.2 (range 0–8) mm. The addition of 3D-3D registration resulted in only small incremental adjustment (0.8 ± 1.5 mm). We retrospectively calculated patient setup rotation errors using an automatic rigid-body algorithm with 6 degrees of freedom (DoF) on regions of interest (ROI) of in-field bony anatomy (mainly the C2 vertebral body). Small rotations were determined for most of the imaging sessions; however, occasionally rotations > 3° were observed. The calculated intrafractional motion with automatic registration was < 3.5 mm for eight patients, and < 2° for all patients. We conclude that daily manual 2D-2D registration on radiographs reduces positioning errors for mask-immobilized HNC patients in most cases, and is easily implemented. 3D-3D registration adds little improvement over 2D-2D registration without correcting rotational errors. We also conclude that thermoplastic masks are effective for patient immobilization.

Virtual endoscopy is a term used to describe computer simulated endoscopy procedures derived from high resolution images of patient anatomy. By simulating the endoscopic examination, the patient is spared the discomfort and possible complications of an actual examination. The physician also has more flexibility in a virtual endoscopic examination of 3D patient data in comparison to a real endoscopic examination. Virtual endoscopy removes the physical and physiologic constraints of real endoscopy and can create views that are not possible in an actual endoscopic examination. This may enhance the performance of actual endoscopic examinations. Virtual endoscopy may also be used to perform “numerical biopsies”; anatomic measurements such as size, distance, shape, and density. Virtual endoscopy allows the physician to comprehensively explore the patient anatomy using an intuitive and interactive interface. There are currently two technical approaches to performing virtual endoscopy: perspective volume rendering and surface rendering of polygonal models. Perspective volume rendering uses traditional volumetric rendering algorithms to create visualizations directly from the volumetric dataset. Polygonal models require a preprocessing step to convert the segmented volume information into a polygonal surface that may be displayed at real time frame rates. Both paradigms have inherent strengths and weaknesses. We illustrate and compare the methods on actual patient data, including simulated endoscopic examinations of the airways, colon and esophagus. Preliminary results in virtual endoscopy show promise and will continue to be an area of active research leading to useful clinical applications.

The mediastinal and cardiovascular anatomy is complex. We have developed a three-dimensional (3D) reconstruction system for the major mediastinal structures using magnetic resonance imaging data on a NeXT workstation. The program uses a combination of automatic and manual procedures to determine the contours of the cardiac structures. The geometric centers of the contours are connected by a 3D space curve, and the central axis of each cardiac structures is determined. The contours are projected on the perpendicular plane to the central axis and semiautomatically processed until the contours of one pixel are obtained. Then the surface rendering with transparency is performed. Compositing combines two images so that both appear in the composite, superimposed on each other. Demonstration of the various mediastinal lines and cardiovascular diseases by the composits of the partly transparent 3D images has promoted a better understanding of the complex mediastinal and cardiovascular anatomy and diseases.

Accurate and fast fusion and display of real-time images of anatomy and associated data is critical for effective use in image guided procedures, including image guided cardiac catheter ablation. We have developed a piecewise patch-to-model matching method, a modification of the contractive projection point technique, for accurate and rapid matching between an intra-operative cardiac surface patch and a pre-operative cardiac surface model. Our method addresses the problems of fusing multimodality images and using non-rigid deformation between a surface patch and a surface model. A projection lookup table, K-nearest neighborhood search, and a final iteration of point-to-projection are used to reliably find the surface correspondence. Experimental results demonstrate that the method is fast, accurate and robust for real-time matching of intra-operative surface patches to pre-operative 3D surface models of the left atrium.