2015, 1–5, Early Online

TWELVE TIPS

Twelve tips for enhancing anatomy teaching

and learning using radiology
FIONA R. CASWELL, ASHA VENKATESH & ALAN R. DENISON
University of Aberdeen, UK

Abstract
Anatomy is a keystone of many healthcare curricula and its understanding fundamental to patient care. The close relationship
between clinical radiology and anatomy is well recognised and expanding. Imaging resources can be effectively integrated
alongside traditional methods for learning anatomy in a resource efficient manner in order to enhance anatomy teaching. The
following 12 tips have been divided into imaging tips, clinical tips and educational tips and offer practical advice and suggestions
for designing and integrating radiological resources across the curriculum.
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Introduction contemporary anatomists (Pathiraja et al. 2014).

An understanding of human anatomy in a clinical context is
fundamental to progression and success in healthcare educa-
tion. Anatomy provides the building blocks that underpin the
foundations for understanding many pathological processes
and their management. The constant reform of medical
For personal use only.
Contemporary imaging modalities can now provide not only
high quality structural anatomical images but can also provide
physiological information. McLachlan and Patten (2006) sug-
gest that in order to prepare students for their future practice,
the teaching of radiological anatomy should rise to half of the

total curricular time for anatomy.

curricula has not left anatomy untouched. A reduction in the
number of hours dedicated to anatomy teaching has been
driven in part by the emergence and expansion of other
curricular themes. Anatomists have responded by exploring
and identifying time efficient techniques for ensuring that the
subject remains relevant, rigorous and (particularly for medical
students) mindful of the changing patterns of healthcare
systems.
New doctors typically encounter anatomy in their day-
to-day practice either as surface anatomy (during clinical
examination) or as radiological images (McHanwell et al.
2007). McHanwell et al. (2007) proposed a core syllabus for
anatomy, which details the minimum level of anatomical
knowledge expected of a recently qualified UK medical
graduate. The syllabus states the topographical knowledge
outcomes for each anatomical region, including surface
anatomy, interpretation of routine clinical images as well as
the value of such knowledge in the understanding of common
pathologies. Such guidance can help curriculum planners
when designing courses and help them to consider where
integration of radiology into the curriculum might be most
appropriate to help to equip students for future safe medical
practice.
Whilst cadaveric based teaching resources are still widely
used (Heylings 2002), their value can be enhanced by
integration with modern techniques (Ashraf Aziz et al. 2002;
Gunderman & Wilson 2005; Brenton et al. 2007). The close
relationship between clinical radiology and anatomy is
well recognised and radiologists can be considered as
Incorporating radiology into curricula at an early stage is
not only a valuable resource for teaching anatomy, but also
helps students to understand the role of imaging within the
patient pathway and introduce them to the language they will
encounter when requesting and interpreting clinical reports.
Practical suggestions for integrating radiology are outlined
within the following Twelve Tips, which have been divided
into three main categories and are summarised in Table 1.
Imaging tips
Tip 1
Develop and curate a bank of anonymised
images
Although internet search engines will reveal many examples of
images, their provenance may be uncertain and educational
value unclear. Creating an electronic bank of institutional
resources where the images are quality assured can allow both
faculty and students access to high quality images, which can
be used in different educational settings and encourage
integration across the curriculum. The images could be
stored in a shared drive to allow easy access.
Permission to use clinical images for educational purposes
may not need to be sought from patients provided they are not
identifiable. For more complicated datasets, anonymisation
software may need to be employed to remove all hidden or

Correspondence: Dr Fiona R. Caswell, Division of Medical and Dental Education, University of Aberdeen, Room 2:049, Polwarth Building,
Foresterhill, Aberdeen AB25 2ZD, UK. Tel: +44 (0)1224 437881; Fax: 01224 437971; E-mail: fiona.caswell@abdn.ac.uk
ISSN 0142-159X print/ISSN 1466-187X online/15/000001–5 ß 2015 Informa UK Ltd. 1
DOI: 10.3109/0142159X.2015.1029896
 F. R. Caswell et al.

Table 1. Summary of Twelve Tips.

Imaging tips Clinical tips Educational tips

Develop and curate a bank of
anonymised images
Invest in suitable resources
Carefully select and optimise
images
Integrate radiologists and other diagnostic specialists
in teaching anatomy
Add clinical context
Familiarise students with the most appropriate
investigations for different anatomical structures
Highlight differences in anatomical and clinical
terminology
Promote three-dimensional visualisation and thinking
Fully integrate radiology into teaching resources,
curricular outcomes and assessments
Engage students by involving them in creating imaging
resources
Embrace modern technology and innovative teaching
methods
Understand that radiology resources will not always be
appropriate

encrypted patient information. Where a patient’s identity could increases the potential for distance learning. It may be
be directly revealed or deduced (e.g. surface shaded rendering tempting to downsize images when designing online resources
of a CT head scan or exceptionally rare diagnoses), manipu- in order to reduce downloading time; however, caution is
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lation of the dataset to blur identifiable features or explicit
permission from the patient would normally be required. In
the UK, discussion and agreement with a Caldicott Guardian is
recommended to ensure information governance standards are
satisfied, where patient data has been used.
Tip 2
Invest in suitable resources
For personal use only.
advised as this may compromise quality which can lead to
frustration for both teacher and learner.
Tip 3
Carefully select and optimise images
Radiological images can be used to complement rather than
replace more traditional anatomy resources. Some structures
such as blood vessels lend themselves more to the radiological

Advances in radiological technology mean that in clinical
practice, images are typically displayed electronically.
Teaching resources should be similarly displayed by electronic
means and investment in display infrastructure, such as Picture
Archiving and Communication Systems (PACS) can help
students become familiar with systems they will use following
graduation.
Consideration should be given to the likely demands of
your teaching department prior to investment. Displaying a
stack of large sized high quality images will require a computer
with a large enough hard drive to store images (or rapid access
to a network drive), a graphics card that can cope with high
resolution images and a monitor of high enough resolution to
display images in suitable quality. A compromise may need to
be sought between image quality and resource limitations.
Whilst images do not need to be of diagnostic quality, it is
advised that the highest possible quality is achieved so that
images maintain their resolution when projected in large size
without becoming pixilated. If images are being saved from
PACS, this is normally achieved by saving images in their
original resolution, rather than at the resolution displayed on
the screen. Prior downloading of large data sets onto the hard
drive in advance of teaching sessions may ensure smoother
running of sessions.
Close collaboration with academic and hospital IT depart-
ments should ensure that systems will be appropriate and
anticipatory and that optimal image quality is achieved.
One of the key advantages of radiological resources is that
they can be made available to students outside of sessions to
promote consolidation of learning and revision by either
uploading images onto virtual learning environments or
creating accompanying e-learning modules. The latter also
2
illustration than others and these should be targeted for use in
anatomy sessions. Co-operation between anatomists and
radiologists in selecting the most appropriate structures will
maximise learning potential. It is powerful to show students a
CT slice of solid organs at the same level as a prosection slice
as this will allow them to compare and contrast the different
resources. Later on, in their training when looking at CT
images this will help them to relate their anatomical know-
ledge directly to the clinically relevant images.
Multiplanar reconstruction of images is a powerful way of
demonstrating complex anatomy. For example, whilst demon-
strating the pathway of branches of the abdominal aorta, the
coronal and sagittal planes demonstrate the superior mesen-
teric artery in a more accessible manner than the axial plane
showing the length of the vessel and its anatomical relations.
Windowing and slice thickness should be manipulated to
optimise visualisation. The most appropriate imaging modality
should be selected; MRI is best for showing soft tissue detail,
whereas CT is better for fine bony detail. Different phases of
contrast can also be used to highlight different structures, such
as highlighting arteries, veins or ureters.
Clinical tips
Tip 4
Integrate radiologists and other diagnostic
specialists in teaching anatomy
Radiologists are a valuable resource for teaching anatomy
because of their relevant anatomical knowledge and clinical

experience. Clinicians from other specialties can also contrib-
ute to anatomy undergraduate teaching by highlighting the
clinical application of anatomy
Postgraduate curricula and assessments in various sub-
specialties including radiology include anatomy knowledge
and teaching skills (Royal College of Radiologists 2013). Since
learning can be enhanced by the act of teaching others with an
improvement in both immediate and delayed comprehension
performance (Fiorella & Mayer 2013), involving trainees in
teaching undergraduate anatomy may help to facilitate success
for trainees. Such interdisciplinary interactions can also nurture
mutually beneficial relationships between academic and health
service training structures (Chowdury et al. 2008).
Trainees with an interest in medical education can under-
take posts, such as Clinical teaching fellowships (Wilson et al.
2008) where they can become involved in projects to develop
radiological resources and be actively involved in teaching.
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Tip 5
Add clinical context
As radiological images come from real patients, there is rich
potential for introducing clinical context to demonstrate the
application of anatomical concepts to clinical scenarios.
Kulasegaram et al. (2013) performed a literature review
examining how medical educators have integrated basic and
For personal use only.
clinical science within the curriculum. They found evidence
suggesting that successful integration can be achieved if
interventions attempt to link basic and clinical science in a
causal relationship. Designing authentic clinical vignettes
which link anatomy and physiology with clinical presentations,
explaining cause-and-effect relationships may therefore
increase understanding among learners and improve diagnos-
tic ability. By developing clinical vignettes using authentic
images but fictitious clinical information, confidentiality can
still be maintained. Plastinated models also have similar
potential for enhanced clinical context and can be used
alongside radiological resources and prosections.
Tip 6
Familiarise students with the most
appropriate investigations for different
anatomical structures
Clinicians’ lack of knowledge about accurate use of radiology
has been identified as a contributing factor in the increasing
unnecessary use of radiological investigations (Lysdahl &
Hofmann 2009). Radiological resources may be used to
implicitly introduce students to the most appropriate investi-
gations for different clinical conditions at an early stage.
Although not a core learning outcome within the early
undergraduate curricula, the careful planning of the display
of radiological imaging in an anatomy class can help to nurture
future good clinical practice. Providing positive role models to
introduce students to appropriate investigations, particularly
when anatomy is discussed in a clinical context, with case-
based discussion can help to lay the foundations for future
Enhancing anatomy teaching and learning
good clinical reasoning and ultimately encourage judicious use
of radiological resources.
Tip 7
Highlight differences in anatomical and clinical
terminology
When interpreting results of investigations as future clinicians,
students must be familiar with the clinical terminology and
language that is used. Introducing radiology to students at an
early stage can help to facilitate this. Anatomical language is
defined within the Terminologia Anatomica (TA) (Whitmore
1999). Although the terminology used within the clinical
setting is generally similar to that from the TA, sometimes slight
variation can occur, which can lead to confusion for learners.
An example is the femoral artery, which is the anatomical or
TA nomenclature, often referred to by clinicians as the
superficial femoral artery (Benninger 2014). These differences
are especially pertinent in vertically integrated curricula, where
students are often exposed to clinical practice almost simul-
taneously as their study of anatomy. In such situations, it is
important to make students aware of these differences in order
to prevent confusion.
Educational tips
Tip 8
Promote three-dimensional visualisation and
thinking
Spatial ability describes a student’s aptitude for understanding
three-dimensional structure and positions of objects when they
are manipulated and is an important predictor of success in
learning anatomy (Garg et al. 2001). These skills are vital for
many clinical practical skills, such as inserting central venous
catheters and intercostal chest drains where internal structures
are not directly visible and medical professionals must rely on
knowledge of surface anatomy and their mental spatial
representations of anatomical structures (Hegarty et al. 2007).
Learners in the early years, in particular, can struggle to
achieve this, especially if trying to learn structures from two-
dimensional diagrams. Whilst prosections can help, the
addition of radiological resources can also help to strengthen
learners’ spatial ability since spatial cognition is central to
interpreting and fully understanding radiological images
(Hegarty et al. 2007).
Cross-sectional imaging, such as CT and MRI is usually
displayed as slices through structures and can be manipulated
in any plane. Inviting learners to consider in which plane
cross-sectional images have been taken to display the struc-
tures that are visible can encourage development of an appre-
ciation of the human body in three dimensions. Ultrasound in
particular requires excellent spatial ability. Whilst not a core
undergraduate skill in the UK, ultrasound is increasingly used
by a variety of postgraduate specialties to support procedures,
such as ultrasound guided joint aspirations and insertion of
3
 F. R. Caswell et al.
central venous catheters. Developing spatial ability at an early
stage in the context of learning surface and structural anatomy
will provide a grounding to develop these skills at a later date.
Tip 9
Fully integrate radiology into teaching
resources, curricular outcomes and
assessments
As use of radiological investigation increasingly becomes
mainstream in clinical practice, it behoves medical educators
to introduce its study in the undergraduate medical curriculum.
Arriving at a consensus of core radiology curriculum
(Misradraee et al. 2012) could pave the way for these core
radiology learning outcomes to easily be integrated into the
anatomy curriculum. This would ensure that radiological
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anatomy resources become a core component of a session
rather than being viewed as an optional ancillary.
Material in anatomy classes should include radiology
stations. Resources such as practical anatomy workbooks
should include questions about radiological stations. Similarly,
by assimilating radiology into anatomy assessment blueprints,
this will ensure that there is appropriate coverage within
formative and summative assessments.
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Tip 10
Engage students by involving them in
creating imaging resources
The contribution that students can make within a variety of
domains including resource development has been previously
demonstrated (Furmedge et al. 2014). As such, there is great
potential for involving students in developing radiological
resources including e-learning packages. This might include
students completing summer projects, student selected com-
ponents or as part of an intercalated BSc. Such work may lead
to publications for participating students and may stimulate an
interest in future involvement in medical education, as well as
providing resources that can be embedded into the curricula.
Tip 11
Embrace modern technology and innovative
teaching methods
With rapidly enhancing technology there is increasing scope
for introducing ever more sophisticated technology to teach
anatomy. Although physical resources are costly, staffing costs
are invariably much higher and new technologies bring the
potential to support an enhanced learning experience at
modest cost.
3D stereoscopic anatomy resources are popular and
some have reported positive feedback from students with a
perceived improved understanding of anatomy and pathology
(Brown et al. 2012). CT and MRI scans can be used to create
3D models which can be manipulated and labelled. Other
technologies that have been introduced with good effect
4
include ultrasound (Swamy & Searle 2012) and surgical
simulators (Solyar et al. 2008).
Tip 12
Understand that radiology resources will not
always be appropriate
Whilst radiological resources can be valuable while teaching
anatomy in many situations, it is vital that its limitations are
respected so that the resources are not used inappropriately.
Close collaborative working between radiologists and anat-
omists can help ensure that the optimum instructional method
is used for a given structure. Many structures are optimally
demonstrated using non-imaging methods. For example, the
anatomy of the inguinal canal is extremely important for
clinical practice but is difficult to demonstrate using imaging.
Similarly, the skull base is often best appreciated by
handling a dried or synthetic skull rather than a radiological
model. It may be useful in this instance for students to review
skull base imaging, but only after they have developed the
required knowledge and understanding from looking at skulls.
Recognising that fundamentally anatomy is the scaffold for
learning radiology is key and so consideration is therefore
needed when planning the timing of radiological resources.
Conclusion
Radiological resources can be integrated effectively to com-
plement and enhance traditional resources in order to enhance
anatomy learning. A collaborative approach between diagnos-
tic specialists and anatomists is key in addition to careful image
preparation, anticipatory resource investment and consider-
ation of future clinical applications.
Notes on contributors
FIONA R. CASWELL, BMSc, MBChB, FRCR, is a radiology registrar currently
undertaking a clinical teaching fellowship with the University of Aberdeen.
She has worked on developing radiological resources including 3D
stereoscopic resources.
ASHA VENKATESH, MBBS, DO, PGCert (Medical Education), is a teaching
fellow in anatomy and leads anatomy teaching for year 2 MBChB. She
teaches anatomy to all levels of medical students and facilitates the
integration of radiology resources within the anatomy curriculum.
ALAN R. DENISON, FRCR, FRCP, MRad, FAcadMEd, is Deputy Head,
Division of Medical and Dental Education, University of Aberdeen, and
Honorary Consultant Radiologist, NHS Grampian.
Declaration of interest: The authors report no conflicts of
interest. The authors alone are responsible for the content and
writing of the article.
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