CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND TO THE STUDY

Historically, the teaching of human anatomy in medical and allied health curricula using

cadavers has been a source of significant social controversy, rivaling the most contentious

medico-legal and ethical debates across other scientific disciplines. One of the major recurring

controversies in anatomy education is whether dissection of cadavers is still a relevant and

appropriate component of a modern medical undergraduate training (Korf et al., 2008; Chambers

and Emlyn-Jones, 2009). Many hold the view that cadaveric dissection is the key component of

teaching anatomy (Ramsey-Stewart et al., 2010; Sugand et al., 2010) and the consequences for

trainees/practitioners not having competent anatomical knowledge has recently been emphasized

(Johnson et al., 2012). But however, some institutions in the United Kingdom and Europe have

abandoned dissection-based learning (McLachlan and Patten, 2006) and in the United States

many rely on combinations of prosection and dissection (Drake et al., 2009). The reduction in

dissection-based teaching in medical and allied health professional training programs in

developed countries has been in part due to financial considerations involved in maintaining a

cadaver bequest program, accessing cadavers and the cost of maintaining modern laboratories

and storage facilities that comply with current health and safety considerations for students and

staff is also a financial burden (Raja and Sultana, 2012).

Many medical schools and anatomy departments have sought alternatives or adjuncts to cadaver-

based instruction through the use of alternative techniques including plastination (von Hagens et

al., 1979), two-dimensional (2D) and three-dimensional (3D) imaging (Estevez et al., 2010), and

body painting (McMenamin, 2008). Rapid prototyping via 3D printing is a rapidly expanding

technology that is now a critical part of the iterative design process in engineering, producing

1
physical models quickly, easily and inexpensively from computer-aided design (CAD) and other

digital data (Pham and Dimov, 2001). Additive manufacturing or 3D printing is often promoted

as one of the most significant technological advances in our modern era. In the medical and

health care arena, 3D printing was identified as a technology with great promise as early as 1997

(McGurk et al., 1997) and has already had an impact in the domain of oromaxillary and facial

surgery (Cohen et al., 2009) and orthopedic surgery by allowing the production of bespoke

prefabricated bone models for presurgical planning or the creation of patient-specific prostheses

for implantation (Tam et al., 2013), surgical simulation or as a patient educational tools (Rengier

et al., 2010). The use of 3D printing in forensic medicine to create models of bone fractures,

vessels, cardiac infarctions, ruptured organs and bite-mark wounds has also been reported (Ebert

et al., 2011). As 3D prints can be generated from medical CT/MRI data, it is logically possible to

use 3D print outs from common imaging studies to augment the teaching of topographic and

applied clinical anatomy.

1.2 AIM & OBJECTIVES

The aim of this study is to provide 3D anatomical spleen models in Department of Anatomy to

enhance students study in preparation for Gross anatomy practical exams and to provide 3D

digital models for the development of Anatomy text and Atlas with models from cadaveric

specimen rather than drawings. The specific objective of this study is to convert prosected

cadaveric specimen to digital 3D models.

2
 CHAPTER TWO

LITERATURE REVIEW

2.1 A BRIEF HISTORY OF VIRTUAL 3D ANATOMY RESOURCES

The value of viewing anatomy in 3D has been appreciated for some time. Long before modern

digital models were developed, wax and more recently plastic models of anatomical structures

have been used in medical education alongside cadaveric specimens and two-dimensional (2D)

illustrations (Aziz, 2002). In addition, techniques have been developed to allow depth perception

of otherwise 2D illustrations and photographs. The technique of stereoscopy (which creates 3D

depth perception by simultaneously showing two slightly different views of a scene to the left

and right eye) dates back to the mid-19th century when ‘stereoscopes’ were used in medical

education to depict anatomy and medical conditions (Chakraborty and Cooperstein, 2018). The

appearance of most stereoscopes was not unlike the ‘View-Master’ toys of the 1980’s and 90’s,

and indeed also bore more than a passing resemblance to modern virtual and augmented reality

headsets. Doctors published ‘stereo-cards’ which depicted anatomical structures, diseases and

even surgical procedures. Such devices appear to have fallen out of use sometime after the

1920’s however, perhaps due to the rise of other technologies, and the increasing availability of

cadavers (Cramer et al., 2017).

Throughout the 20th Century, various technologies have been developed which have allowed

researchers and clinicians, as well as medical artists/illustrators to create digital 3D models.

Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI) were developed in

the 1970’s and had an enormous impact on the diagnosis of and treatment of numerous

conditions. The final decade of the 20th century saw a rapid development in 3D software,

enabling artists to create digital models from scratch. 3D Studio Max was released to the public

3
in 1990 with Maya following in 1998. Over the subsequent 20 years there has been a

proliferation of such software which has developed considerably over just a few decades to allow

artists to create and animate highly complex models.

2.2 CREATING VIRTUAL 3D INTERACTIVE MODELS

There are several means of creating your own 3D models. These can broadly be split into two

categories; working with scanned data and creating models from scratch using a variety of 3D

modeling software. There is considerable overlap between the two however, and it is common

practice to combine multiple approaches in a single project. For example, you may use CT data

to reconstruct the basic geometry of a structure and then refine this and add colour using a 3D

modeling package.

Below are outlined some of the most commonly used approaches to creating 3D models,

highlighting the advantages and disadvantages of each.

2.3 SURFACE SCANNING

There are a wide range of surface scanners commercially available ranging greatly in quality and

price. Hand-held scanners tend to be more versatile than fixed and desktop scanners. However, it

must be remembered that they are not usually wireless and still need to be connected to a

computer and power source. There are exceptions however, with some scanners including

batteries and onboard processors. Most hand-held and desktop surface scanners used in this field

are based on either laser or structured light technology. Laser scanners typically create 3D

images through a process called trigonometric triangulation. A laser is shone on the object and its

reflection caught by one or more sensors (typically cameras), which record the changing shape

and distance of the laser line as it moves along the object (Park et al., 2006). The distance of the

sensors from the laser’s source is known, and as such accurate measurements can be made by

calculating the reflection angle of the laser light. Advantages of laser scanners include that they

4
are generally very fast, usually highly portable, and are less sensitive to changing and ambient

light (than structured light scanners). Disadvantages include that not all lasers are ‘eye safe’

when scanning living subjects, and they are usually less accurate than structured light scanners.

Structured light scanners work by projecting a known pattern onto an object and taking a

sequence of images. The deformation of the pattern is measured to determine the objects shape

and dimensions. Advantages of structured light scanners include that they are highly accurate,

generally very fast, ‘eye safe’, and usually highly portable. The main disadvantage of structured

light scanners is that they can be sensitive to changing and ambient light (Henn et al., 2002).

When making a scan, the user should endeavour not to move the scanner or object too fast, as

this can create errors or cause the scanner to lose tracking. Turntables can be a useful tool for

ensuring a smooth movement and accessing all sides of an object. In many cases it may also be

necessary to turn the scanned object over to access the underside. In these cases, the scanner

software will usually be able to align multiple scans (either automatically if there is sufficient

overlap, or manually) allowing the full 3D form to be captured (Henn et al., 2002).

2.4 PHOTOGRAMMETRY

Photogrammetry offers an affordable and accessible means of creating 3D models. Several 2D

photographs of a static object are taken from different viewpoints allowing for measurements

between corresponding points to be taken, thus enabling a 3D reconstruction of the object to be

created. While large multi-camera systems allow for instantaneous image capture using hundreds

of photographs taken from different angles, such elaborate systems are not essential. In fact, a

major advantage of photogrammetry is that it can be a relatively low cost means of 3D capture

(Jastrow and Vollrath, 2003). While the quality of the camera equipment can affect the process

and resulting model, it is certainly possible to get very good results with low cost cameras and

even camera phones (a minimum resolution of 5 megapixels is a good starting point). Likewise,

5
there are numerous photogrammetry software applications available, ranging in price. Good

results can be achieved without spending too much however.

Photogrammetry is very sensitive to the resolution of the photographs used, with higher

resolution images resulting in better models. Where good quality, sharp photographs are used

however, the resulting texture map is often of a higher quality than that achieved with expensive

surface scanners.

Photogrammetry can be a highly accurate technique when carried out correctly. De Benedictis et

al (2018) used photogrammetry to support the 3D exploration and quantitative analysis of

cerebral white matter connectivity. The geometric resolution necessary to accurately reproduce

the fine details required was estimated to be higher than 0.1 mm. Close-up photogrammetry

acquisition was therefore undertaken to meet this specification.

6
 CHAPTER THREE

MATERIALS AND METHODS

3.1 MATERIALS
Hardware used: Nikon D 500 camera Laptop (Hpprobook, intel core i3, 8 gb ram, 5th generation);

Samsung 32 inch Plasma TV; mouse, external keyboard.

Software used: Daz 3d, Blender, Character creator; Photoshop 2d softwares;

Wondersharefilmora

3.2 PHOTOGRAPHIC TECHNIQUES

Human prosected specimens were used to evaluate photogrammetry’s creation of digital 3D

prosection models. The specimen was chosen for their wide range of sizes, textures, shapes, and

contours. These were primarily used to evaluate photogrammetry’s capture of small anatomical

structures. The goal of this section was to document sequential stages in cadaveric dissection and

examine whether photogrammetry could be used to create 3D dissection guides. The torso was

this study’s largest specimen and thus provided insight into possible size limitations of

anatomical photogrammetry. To optimize accuracy and resolution, an advanced

photogrammetric apparatus was developed by Anatomage, Inc. The proprietary setup featured

multiple digital cameras (Nikon D 500), aligned equidistant from one another on a rotatable arch.

Prosections were placed on a height-adjustable table. Four lights were placed at respective

corners of the table to eliminate shadows and darkened areas. Cameras were manually rotated in

a 210° arc, with each camera taking 1 photograph every 15°. Prosections were then flipped 180°

(revealing surfaces previously on the table), and the cameras were once more rotated in a 210°

arc, capturing images every 15°. This process gave 196 different images per prosection, requiring

approximately 15minutes per specimen.

7
PHOTOGRAMMETRIC TECHNIQUES

Following image capture, photographic data were transferred to a proprietary Daz 3d-rendering

software developed by Anatomage, Inc. Using this software, 2D images were manually rendered

into 3D models, by matching the surface points of a given prosection to different image locations

between individual photographs. Daz is delivers high quality animations and rendering without

worrying much about technicalities (modeling, sculpting face features, rigging and bone

structures). Daz Studio itself comes with a system of posing presets and smart parameters to

achieve professional shots in no time. The result is a realistic and visually compelling

image. Daz Studio has a very intuitive interface. Most likely you will get a notion of the

workspace as soon as you open it for the first time. This is highly recommendable for beginners

to have a first approach in the 3D world. In some way, you will be skipping the most annoying

stuff which is modeling, sculpting and rigging and will head straight to posing, animating and

rendering.

8
1. Content Tab: In this area you will view your purchases and content available for your

figure, such as poses, wearables (clothing, hair, accessories), environments, shaders, etc.

2. 3D Viewport: Your content will be displayed here

3. Toolbar and shortcuts: Icons that give access to common features from Daz Studio such

as: Render Settings, Add New Camera, Add a New Light Source, Import/Export a File,

Save/Load a File, Undo/Redo and many more.

4. Scene Tab: This tab displays all the objects included in our scene (figure model, clothing,

hair, props, etc.). We can choose which objects we want to edit and also hide/show with one

click. 

5. Parameters Area: Here you will find presets and parameters from a specific object. You

will also be able to easily change its position, scale, rotate, and apply different materials and

shaders. One quick example, you can change the color of the hair of your character.

6. Animation Timeline: You can see the transition, duration and movement of the object in

a specific time.

7. Tutorial Dropdown box: You can access interactive tutorials to learn more about Daz

functions. 

As we can see, the workspace from Daz is pretty much it. Although there are many more

sections and tabs, in general, it does not go further from those boxes. 

9
 CHAPTER FOUR

RESULTS

Figure 4.1a: represents the visceral surface of the spleen which shows the anterior extremity,

colic, gastric and renal impression, superior and inferior border

Figure 4.1b: shows 3D model of prosected specimen

Figure 4.2a: Represents the diaphragmatic surface of the spleen which shows the anterior

extremity, posterior extremity, superior border and inferior border

Figure 4.2b: shows 3D model of prosected specimen

10
 FIGURE 4.1b: shows 3D model of
1. Anterior extremity prosected specimen
2. Colic impression
3. Hilum of spleen
4. Gastric impression
5. Renal impression
6. Posterior extremity
7. Superior border
8. Inferior boreder

FIGURE 4.1a: represents the visceral

surface of the spleen which shows the
anterior extremity, colic, gastric and
renal impression, superior and inferior
border

11
 1. Anterior extremity
FIGURE 4.2b: shows 3D model of
2. Posterior extremity prosected specimen
3. Superior border
4. Inferior border

FIGURE 4.2a: Represents the

diaphragmatic surface of the spleen which
shows the anterior extremity, posterior
extremity, superior border and inferior
border

12
 FIGURE 4.4: shows inferior view of the
FIGURE 4.3: shows superior view of the
3D model of the spleen
3D model of the spleen

13
 CHAPTER FIVE

DISCUSSION

Digital 3D anatomical models can applied in many ways in a medical or dental curriculum.

Online materials, lecture presentations, instructor notes, and assessment can include 3D models

of organs or tissues that are interactive (interactive PDFs) and enhanced in attention to specific

structures. Characteristics of the models, such as resolution, color, scale, opacity, interactivity,

time, and the inclusion of adjunct images or text, can be manipulated to enhance specific

learning objectives or to target specific student populations. As described above, these models

can be used as individual learning assets or as part of a larger learning object. Printed

Anatomical Models The simplest implementation of printed 3D anatomical models into medical

and dental curricula is as current anatomical models are used. The value of 3D printing lies in the

choice of anatomical perspective, resolution, and scale. Instructors can now create models from

specific perspectives, such as disarticulated skull bones, expanded models of the temporal bone,

and pulmonary or vascular structures. A limitation to the application of 3D printed models is the

depiction of fascia. Anatomical education is incomplete without the student understanding fascia,

fascial compartments, and connective tissue . Physical anatomical models, either commercial,

plastinized, or 3D printed, cannot depict fine fascial elements and connective tissue

compartmentalization of organs and vessels. In curricula that do not engage in cadaver dissection

or prosection, the students are at a disadvantage and must learn these concepts in postgraduate

education. Costs of printed 3D models have been cited as impediments to their implementation

into the medical curriculum.

14
 REFERENCES

Abid B, Hentati N, Chevallier J-M, Ghorbel A, Delmas V, Douard R.(2010) Traditional versus

three-dimensional teaching of peritoneal embryogenesis: a comparative

prospective study. Surg Radiol Anat. 2010;32:647–652.

Arráez-Aybar L-A, Casado-Morales MI, Castaño-Collado G. (2004) Anxiety and dissection of

the human cadaver: an unsolvable relationship? Anat Rec B New Anat.;279B:16–

23.

Boeckers A, Brinkmann A, Jerg-Bretzke L, Lamp C, Traue HC, Boeckers TM.(2010) How can

we deal with mental distress in the dissection room? an evaluation of the need for

psychological support. Ann Anat.; 192:366–372.

Chen S, Pan Z, Wu Y (2017) The role of three-dimensional printed models of skull in anatomy

education: a randomized controlled trail. Sci Rep. ;7:575.

Dirven R, Hilgers FJM, Plooij JM, (2008) 3D stereophotogrammetry for the assessment of

tracheostoma anatomy. Acta Otolaryngol;128:1248–1254.

Donnelly L, Patten D, White P, Finn G. (2009) Virtual human dissector as a learning tool for

studying cross-sectional anatomy. Med Teach.;31:553–555.

Estevez ME, Lindgren KA, (2010) Bergethon PR. A novel three-dimensional tool for teaching

human neuroanatomy. Anat Sci Educ.;3:309–317.

Garg AX, Norman GR, Eva KW, Spero L, Sharan S. (2002) Is there any real virtue of virtual

reality?: the minor role of multiple orientations in learning anatomy from

computers. Acad Med.;77:S97–S99.

15
Lewis TL, Burnett B, Tunstall RG, Abrahams PH. (2014) Complementing anatomy education

using three-dimensional anatomy mobile software applications on tablet

computers. Clin Anat.; 27:313–320.

Müller-Stich BP, Löb N, Wald D, et al. Regular three-dimensional presentations improve in the

identification of surgical liver anatomy—a randomized study. BMC Med Educ.

2013;13:131. doi:10.1186/1472-6920-13-131.

Nicholson DT, Chalk C, Funnell WRJ, Daniel SJ. (2006) Can virtual reality improve anatomy

education? a randomised controlled study of a computer-generated three-

dimensional anatomical ear model. Med Educ.;40:1081–1087.

Nocerino E, Menna F, Remondino F, (2017) Application of photogrammetry to brain anatomy.

Paper presented at: 2nd International ISPRS Workshop on 10 Journal of Medical

Education and Curricular Development PSBB: The International Archives of the

Photogrammetry, Remote Sensing and Spatial Information Sciences; May 15-17, ;

Moscow, Vol XLII-2/W4:213– 219.

Paul F, Connor L, McCabe M, Ziniel S. (2006) The development and content validity testing of

the Quick-EBP-VIK: a survey instrument measuring nurses’ values, knowledge

and implementation of evidence-based practice. J Nurs Educ Pract.;6:118–126.

Preece D, Williams SB, Lam R, Weller R. (2013) “Let’s get physical”: advantages of a physical

model over 3D computer models and textbooks in learning imaging anatomy.

Anat Sci Educ.;6:216–224. doi:10.1002/ase.1345.

Pujol S, Baldwin M, Nassiri J, Kikinis R, Shaffer K. (2016) Using 3D modeling techniques to

enhance teaching of difficult anatomical concepts. Acad Radiol. ;23:507–516.

16
Ruisoto P, Juanes JA, Contador I, Mayoral P, Prats-Galino A.(2012) Experimental evidence for

improved neuroimaging interpretation using three-dimensional graphic models.

Anat Sci Educ. ;5:132–137.

Schenk T. (2005) Introduction to photogrammetry. Department of Civil and Environmental

Engineering and Geodetic Science, The Ohio State University;:79–95.

Tunali S. (2008) Digital photogrammetry in neuroanatomy. Neuroanatomy. 2008;7:47–48.

17