THE ANATOMICAL RECORD (NEW ANAT.

) 49

FEATURE ARTICLE

The Visible Human Dataset: The Anatomical

Platform for Human Simulation
VICTOR M. SPITZER AND DAVID G. WHITLOCK

One goal of a medical school education is to teach the anatomy of the living human. With the exception of some
surface anatomy, the morphology education that goes on during a surgical procedure, and patient observation, live
human anatomy is most often taught by simulation. Medical anatomy courses utilize cadavers to approximate the live
human. Case-based curricula simulate a patient and present symptoms, signs, and history to mimic reality for the
future practitioner. Radiology has provided images of the morphology, function, and metabolism of living humans but
with images foreign to most novice observers. With the Visible Human database, computer simulation of the live
human body will provide revolutionary transformations in anatomical education. Anat. Rec. (New Anat.) 253:49-57,
1998. r 1998 Wiley-Liss, Inc.

KEY WORDS: Visible Human; anatomy; physiology; simulation; anatomical database

In the ideal, a laboratory for teaching
human anatomy would include a nor-
mal, living subject for surface inspec-
tion, radiological evaluation, and sur-
gical exploration. The subject would
be of either sex and of any desired age,
and its exact body composition would
be known for the past, present, and
future. Such an ideal subject would be
available to students for study before
and throughout their careers. Investi-
Dr. Spitzer is Director of the Center for
Human Simulation at University of Colo-
rado School of Medicine, in Denver. He
holds graduate degrees in Nuclear Engi-
neering and Physical Chemistry and has
worked in the field of medical (radiologi-
cal) imaging for over 20 years. He was
co-principal investigator on the Visible
Human Project and continues to work in
identifying new uses for that and similar
data. Dr. Whitlock is a professor emeri-
tus at the University of Colorado School
of Medicine in Denver and a member of
the Center for Human Simulation. He is
a past president of the Association of
Anatomy Chairmen and has served on
the National Board of Medical Examin-
ers and the Radiological Society of
North America’s task force for cross-
sectional anatomy. With Dr. Spitzer, he
was co-principal investigator for phase
one of the National Library of Medi-
cine’s Visible Human Project. Dr. Whit-
lock is a member of the American Asso-
ciation of Anatomists and the Cajal Club.
Grant sponsor: National Library of
Medicine; Grant number: N01-LM-1–
3543.
gation of these subjects would not
perturb their systems in any way.
This ideal could be approximated by
making available to the student a com-
puter database that appears, feels,
smells, and sounds like a living per-
son. If the teachings of the physiology
laboratory were integrated with the
anatomy of the simulated subject, the
database could be ‘‘reactive’’ like a
living person. As we extend the con-
cept, the database might be rendered
dynamic in time as well as space, so
the student could witness develop-
ment and aging. An anthropological
extension of the database could en-
velop all known human variations and
act as a repository for reporting new
ones.
The first need for constructing a
simulator for the living human body,
its structural basis, is already available
in the Visible Human Dataset. For con-
vincing simulations, visual images
must be provided that closely approxi-
mate real human anatomy. The Visible
Human Dataset is the first collection
of three-dimensional (volume) data
that can provide such reality for the
whole body. The data are photo-
graphic, and therefore their anatomi-
cal integrity (for that of a cadaver) is
unquestioned. The final goal, however,
is to simulate living human anatomy,
not cadaver anatomy.
The Visible Human Dataset had its
origin in 1986 when the National Li-
brary of Medicine (NLM) in its long-
range planning foresaw the need for
establishing libraries of digital images
that would complement its biographic
and factual services (NLM Long-Range
Plan, 1986). It surmised there would
be an increasing role for electronically
represented images in clinical medi-
cine and biomedical research. A plan-
ning panel convened by the NLM
Board of Regents to study the matter
in 1989 made the following recommen-
dation: ‘‘NLM should undertake a first
project building a digital image library
of volumetric data representing a com-
plete adult male and female. This Vis-
ible Human Project (VHP) will include
digitized photographic images from
cryosectioning, digital images from
computerized tomography (CT) and
magnetic resonance (MR) of cadav-
ers.’’1 The project was viewed as a
cornerstone for future collections of
related image datasets and digital-
image libraries.
In August 1991, the NLM contracted
with the authors at the University of
Colorado School of Medicine to carry
out phase one of the VHP. This first
step included the acquisition of trans-
verse CT and cryosection images
throughout the entire body of a repre-
sentative male and female cadaver.
50 THE ANATOMICAL RECORD (NEW ANAT.)
Figure 1. Coronal reconstructions of sections
from all the transverse slices (1,878 male and
5,189 female) of the Visible Human Dataset.
The white lines indicate block interfaces and
the location of backsaw kerf losses.
Transverse images were to be aligned
one to another and registered with the
CT scans. Axial MR images of the head
and neck and coronal images through
the rest of the body were obtained at
approximately 4 mm intervals.
The digital dataset for the Visible
Human male (VHM) was completed
and delivered to the NLM in the spring
of 1994 and made available over the
Internet in November of that year. The
dataset for the Visible Human female
(VHF) was finished in December 1995
and is also obtainable over the Inter-
net from the NLM (Fig. 1).
CREATING THE VISIBLE HUMAN
DATASET
Undertaking the Visible Human
Project was a daunting challenge. Un-
like past research we had pursued,
there were no guidelines, protocols, or
equipment available, and there were
many questions about how to proceed.
Where and how would we obtain in-
tact adult human cadavers, free of
infectious or invasive disease, from
which the digital database could be
constructed? How could we prepare
serial CT images at 1 mm intervals
throughout the specimen that would
be congruent with the anatomical
Figure 2. The anatomical specimen co-
cooned in hardened foam to maintain the
configuration of the specimen. Containment
box is fixed to the CT table in the same orien-
tation as the backsaw to follow. The laser
positioning light, shown in red, was used to
record the optimum block interface location,
as determined from the CT survey image, on
the skin surface.
cross-sections? Indeed, how could we
section and capture images of cross-
sections through an entire adult hu-
man cadaver from head to toes and
maintain the same plane for all cut
surfaces?
The search for suitable cadavers
proved to be the most time-consuming
part of phase one; it took approxi-
mately 2.5 years to identify the male
and female. Human bodies for pur-
poses of medical research and teach-
ing are obtained in most states through
donations by their citizens to the State
Anatomical Board (SAB). These boards
have been established to consummate
arrangements for donations and to
oversee the handling and appropriate
distribution of such material. The
search for cadavers as normal as pos-
sible was pursued by a consortium of
SABs in Colorado, Texas, and Mary-
land, through whose combined re-
sources approximately 3,000 gifts a
year were received. The final choices
for the VHP were made from sample
sets of three cadavers of each sex after
reviewing their medical records and
analyzing survey radiographs, CT
REVIEW
scans, and MR images of each candi-
date.
Processing of potential specimens
commenced immediately upon their
arrival at the University of Colorado
Health Sciences Center (UCHSC),
since it had been determined that opti-
mum CT and MR images could best be
obtained from unfrozen material. In
order to obtain a fixed position for the
unfrozen cadaver that could be main-
tained throughout the entire process,
each candidate was positioned, after
MRI, for CT imaging in a specially
constructed box that was fastened to
the CT patient table. The cadaver was
positioned in the box and cocooned in
a foam that rapidly hardened to stabi-
lize it. Survey CT images were cap-
tured to ascertain that it was correctly
situated. After the CT images were
captured, this entire mass, positioned
cadaver and all, was frozen and stored
(Fig. 2).
In order to cut the cadaver at inter-
vals of 1 mm or less, we needed a
special cryomacrotome. It had been
determined that a motorized system
that did not require its blade to be
repeatedly removed for sharpening
during the process would work best.
The cutting blade consisted of a spe-
cially constructed 14 inch diameter
disk mounting teeth around its periph-
ery that could be spun at 300 rpm. A
large cryomacrotome was constructed
with a extended range of motion that
allowed us to section a block as large as
14 inches wide 3 20 inches long 3 22
inches deep.
To use this cryomacrotome, we seg-
mented the frozen cocooned cadaver
into blocks no larger in depth than 22
inches in which the plane for the cross-
sections from one block to another
could be maintained. For that pur-
pose, a backsaw was constructed
mounting a very thin blade at high
tension. The entire specimen mass was
frozen to the temperature of dry ice
and segmented with the saw into four
blocks of approximately equal size
(Fig. 3). The precise location for the
three sawcuts was established by CT.
After a block was isolated, the hard-
ened foam surrounding it was par-
tially removed, and the unit was pre-
pared for embedding in a 3% gelatin
solution. An Aluminum-walled mold
of sufficient size to accommodate indi-
vidual blocks was used as an embed-
REVIEW
ding receptacle. Adjustable pedestals
situated in the floor of the chamber
allowed the block to be mounted
within the cavity so the block’s surface
was parallel to the cryomacrotome’s
cutting plane. After this alignment was
achieved, the mold was filled with the
gelatin solution and frozen to 2707C.
Slicing of the frozen gelatin-embed-
ded specimen commenced by fixing
the mold’s base plate to the table of the
cryomacrotome. The aluminum side-
walls of the mold were removed, and a
larger chamber of plywood and Styro-
foam was constructed into which
pieces of dry ice could be placed
around the specimen block to main-
tain its frozen state during the cutting
process. The top surface of the block
was planed by the desired interval (1
mm for the VHM, 0.33 mm for the
VHF) and continued to an adjacent
chamber for photography. After image
capture, the table and block were
moved back to their initial position
and raised by the desired interval in
the z axis preparatory to the next cut.
This entire process was initiated and
remotely controlled by a cryomacro-
tome operator.
In the photographic chamber, each
freshly cut surface of the block was
flushed with compressed air and exam-
ined for defects. Uncut fragments of
tendons, fascia, etc., were removed
and exposed cavities (e.g. sinuses, tra-
chea, and colon) filled with latex and
uncut fragments of tendons, fascia,
etc., were trimmed and removed.
When the surface was judged to be
suitable for photography, it was
sprayed with absolute alcohol and sur-
rounded with a black mask, slice num-
ber, and a calibrated grey scale (Fig. 4).
Digital and photographic images of
the prepared surfaces were captured
under computer control. The sequence
that was used first recorded a digital
image of the surface with a Leaf cam-
era using Leaf software. This image
was examined on the image acquisi-
tion computer’s screen to make sure
the surface was suitable for film cap-
ture. If judged satisfactory, it was com-
pressed to a 24 bit image (eight each
for red, green, and blue) and cropped
to anteroposterior dimensions of the
anatomy (2,048 to 1,216 pixels). These
digital images later were aligned with
the aid of vertically situated fiduciary
rods that were embedded with the
THE ANATOMICAL RECORD (NEW ANAT.) 51
cadaver specimens. Film images were
taken with 35 mm and 70 mm Rollie-
flex cameras that were successively
positioned by computer over the
masked block surface. Polarized
Strobe lights were used to illuminate
the block’s surface during the imaging
process. After the three-camera se-
quence was completed, the block sur-
face received a 30–60 s contact expo-
sure to an aluminum tray containing
dry ice to assure its frozen state prior
to the next cycle.
Acquisition of the 1,878 anatomical
cross-sectional images at 1 mm inter-
vals for the Visible Human Male took 9
months. The dataset delivered to the
NLM included in addition CT, MR,
and radiographic images. Axial MR
images of the head and neck and coro-
nal sections through the rest of the
body were obtained at 4 mm intervals
and in matricies of 256 pixels by 256
pixels. Each pixel has 12 bits of grey
tone. CT data consisted of axial scans
through the entire body at 1 mm inter-
vals. CT images are 512 pixels by 512
pixels, where each 12 bit pixel value is
related to electron density of the speci-
men at that point. The CT axial images
have been aligned with the anatomical
cross-sections.
The Visible Human Female dataset
has the same characteristics as the
male with one exception: the axial
anatomical images were obtained at
0.33 mm intervals instead of 1 mm
intervals. It took 12 months to obtain
the 5,189 anatomical cross-sectional
photographs that comprise the female
dataset.
APPLICATION FOR EDUCATION
The Visible Human Dataset of over
13,000 images (including both male
and female) is available on the Inter-
net from the NLM (www.nlm.nih.gov/
research/visible/visible_human.html).
Recently three mirror sites have been
established in Glasgow (vhp.gla.ac.uk
(FTP ATM connection; vhpe.gla.ac.uk
[FTP Ethernet connectioon]), Milan
(vhd-mms.cilea.it [FTP connection])
and Singapore (http://vhp.nus.sg). Ac-
cess to the data requires a license from
the NLM (it is also available via the
Internet). To date, over 800 licenses
have been granted to individuals, com-
panies, and schools in over 30 coun-
tries for use or development of the
images. As a result, the Visible Human
Dataset is now the most widely circu-
lated compilation of digital human
anatomy in the world. The image data-
base for the two cadavers occupies 64
gigabytes of pixel-based information,
making it the largest collection of ana-
tomical images ever assembled.
Many resources that incorporate the
data are now available.2 The first gen-
eration of products presented the im-
ages with navigation interfaces (some
examples include the Female Visible
Human CD (1997) from Research Sys-
tems Inc.; Complete Visible Human
Male laserdisc and CDs (1995) from
Gold Standard Media Inc.; Digital Hu-
mans (1996) from Multimedia Medi-
cal Systems; Visible Human Explorer
CD (1997) and Coronal Man: The Vis-
ible Human Male Navigator (1995)
from Anatomical Visualization Inc.).
The next generation of educational
resources incorporated labels: Atlas of
the Visible Human Male: Reverse Engi-
neering of the Human Body (1998)
from Jones and Bartlett, and Cross-
Sectional Anatomy Tutor CD (1996)
from Jones and Bartlett. The latest
generation includes fully segmented
and classified data (Segmented Visible
Human (1997) and Virtual Human
(1997) from Gold Standard Media
Inc.). Future generations of the image
database will include the logic, pro-
gression, and supporting material to
give the images dynamic properties
and convert the image dataset into a
learner-centered course for living hu-
man anatomy.
Among the results achieved at the
University of Colorado Center for Hu-
man Simulation (http://www.uch-
sc.edu/sm/chs) has been the segmenta-
tion and classification of the entire
VHM Dataset that was completed in
1997. Each of the 1,878 images in the
VHM Dataset was filtered to enhance
the contrast of selected tissue inter-
faces. Edge-detection isolated the high-
contrast edges of selected tissue inter-
faces. The edge images were then
edited to eliminate computer-gener-
ated edges that were anatomically ir-
relevent or missing for each tissue
type. The result of this process was a
mask image, 16 bits deep, for each of
the 1,878 slices. Eleven bits of the 16
bit mask image were utilized to assign
each of the over 1,200 anatomical ob-
jects a unique number. A master data-
base of these unique mask numbers
52 THE ANATOMICAL RECORD (NEW ANAT.) REVIEW

can then be three-dimensionally ren-

Figure 3. The backsaw in the diagram was used to segment the cadaver into blocks. The
blade of the saw was positioned to the surface mark previously identified by CT. The frozen
state of the cocooned cadaver was maintained by dry ice.
and associated anatomical objects also
associates each structure with a sys-
tem and region of the body. For the
classification scheme, anatomical
names generally conform to standard
texts such as Gray’s Anatomy.3 These
masks can now be utilized as identifi-
ers for each voxel, or 3D image ele-
ment, in the anatomical images; one
use for these identifiers is for selection
of the voxels to render in a three-
dimensional representation of any de-
sired body part, region, or system
(Fig. 5).
We have also utilized Lorensen’s
marching cubes algorithms4 to reduce
the outermost voxels that define each
anatomical entity to polygon represen-
tations of the surfaces of those struc-
tures. These polygon representations
dered, very quickly, on specialized
graphical engines. We have pushed the
envelope of utility for these polygons
by texture-mapping the color intensi-
ties from the most closely associated
voxels to these polygons. Utilizing this
technique preserves the visual reality
of the tissues in the original cut slices,
including the appearance of any struc-
tures that are deep to the surface (e.g.,
superficial veins). All this reality would
be lost with the typical mapping of a
fabricated clay-like texture to the sur-
faces or even the mapping of a realis-
tic texture taken from a different sub-
ject or specimen.
For some regions of the body (e.g.,
the posterior abdomen and the knee),
we have begun the process of assign-
ing mechanical properties to the iden-
tified tissues. With each voxel (or poly-
gon) now having its mechanical
properties defined, we can not only
visualize these three-dimensional enti-
ties but can also begin to interact with
them. We have utilized a haptic feed-
back interface to feel the tissues (vox-
els or polygons) of the Visible Hu-
man.5,6 In the case of a scalpel, the
feeling of cutting through the tissues
of the Visible Human is provided by
reactive forces applied to the scalpel
as it encounters different tissues (vox-

Figure 4. a: An air dusting of the newly exposed block surface is done just prior to alcohol and black mask application. b: The fifty-first surface of
the third block (3,051) is shown after surface preparation with the black mask and attached grey scale applied. Note the surrounding blue
gelatin matrix and the blue latex which was poured into exposed cavities.
REVIEW
els or polygons) in its path.7,8 Users
feel the drag of the scalpel just as
though they were cutting through real
tissue. Of course, the tissue of the
Visible Human must now react as
though it were cut by the scalpel, so
there are new surfaces where the scal-
pel cut was made. These techniques
are the beginnings of the generalized
surgical simulator to be available in
the anatomy teaching laboratory of
the future.9
At the Center for Human Simula-
tion (CHS), we have built prototype
simulators for medical procedures that
utilize this type of serial section data
for dynamic, user-controllable, 3D pre-
sentation and also allow the user to
feel the anatomy through the instru-
ments utilized in clinical practice.
Each of these procedures was chosen
because of its dependence on a thor-
ough understanding of complex 3D
anatomy or because feeling is a major
source of feedback to the expert doing
the procedure. Our prototype simula-
tors are based on realtime visualiza-
tion and haptic feedback and to date
include the following.
● Surgical cutting. The student, hold-
ing a scalpel handle, can feel each
tissue interface as a cut is made
through the thigh of the Visible Hu-
man male (Fig. 6).
● Anesthetic block. The student, per-
forming a celiac plexus block and
holding the injection needle, can
feel each tissue interface the needle
encounters in its path from the skin
surface of the T12-L1 area all the
way to the neighborhood of the ab-
dominal aorta. As a simulator, the
goal of the procedure is well de-
fined, but the simulator does not
restrict the user from directing the
needle into a position far from the
desired target. In the event of a
misdirect, the student can be
brought back to the proper path or
allowed to error along a path that,
for example, might be more appro-
priate for a renal biopsy. This simu-
lator also incorporates clinically
available cues such as fluoroscopy
to confirm the position or misposi-
tion of the needle (Fig. 7).
● Arthrocentesis. The student prepar-
ing for a knee arthrocentesis would
choose a syringe and appropriate
needle and then be required to cor-
rectly navigate the knee joint space
THE ANATOMICAL RECORD (NEW ANAT.) 53
of the VHM. The primary feedback
in this situation is from an initial
inspection and possible palpation of
the surface anatomy followed by the
feel of the needle as it penetrates the
joint space. Unlike the clinical world
with real first-time patients, the in-
ternal anatomy of the joint space
can be revealed as an aid for the
student having problems with the
injection.
Users feel the drag of the
scalpel just as though
they were cutting
through real tissue.
● Radial keratotomy. The student is
looking through binocular optics,
closely matching the ophthalmologi-
cal microscope, at a three-dimen-
sional cornea. During this realistic
display of the anatomy of the eye
(this time not from the Visible Hu-
man), the student utilizes the scal-
pel to cut along predetermined ra-
dial lines inked on the cornea to
produce the desired visual correc-
tion. The procedure allows the stu-
dent to practice the hand-eye coordi-
nation required for this procedure
with all the visual and haptic cues
provided in the clinical setting.
These simulators of living human
anatomy will be coupled with others
to provide a complete operating room
environment for team-teaching all the
players involved in a given OR proce-
dure. The future of these theaters will
closely mimic the reality of the cockpit
used for flight instruction in modern
flight-training schools.
TOWARD PERFECTING THE
HUMAN SIMULATION
The use of the Visible Human Dataset
to create a simulator for the human
body requires that each voxel be iden-
tified and assigned the properties that
characterize that particular tissue. This
massive task has been started with the
identification of every voxel in the
male database; in some regions, me-
chanical properties have also been de-
fined. For one to appreciate the com-
plexity of creating a simulator from
the segmented and classified database
that duplicates the living human sub-
ject, a review of methods of teaching
human anatomy and the ways technol-
ogy is changing them is valuable to
consider, since one long-term goal is
for these simulators to meet or exceed
the advantages of these current meth-
ods.
Surface Anatomy
Anatomical instruction utilizing sur-
face anatomy, stagnant for many years,
has tremendous potential for change
based on recent advances in remote
sensing and computer graphics. Study
of external body surface is possibly the
oldest method of human anatomy edu-
cation. Many misconceptions about
the human body were based on obser-
vations of external anatomy. Recent
technological innovations in remote
sensing (miniature videocameras and
fiber optics), however, provide new
frontiers for the visualization of body
surfaces, many of them deep within
the body of live humans. Topographi-
cally, new surfaces of the body that
now can be visualized include those of
the vascular, gastrointestinal, gastro-
urinary, and respiratory systems. With
bronchoscopes, laryngoscopes, colono-
scopes, and sigmoidoscopes, we are
now able to remotely view external
body surfaces such as the stomach
lining, the carina, or the cardiac
sphincter in the living patient. With
minimal invasion, endoscopes and ar-
throscopes open up another expanse
of internal surface anatomy. Interpret-
ing and archiving the views of these
surfaces inside the body can provide
insight for the anatomy student and
challenges to the ‘‘-oscopist.’’
Cadaver Dissection
The educational contribution of infor-
mation gained through cadaver dissec-
tion, where technology seems to play a
nominal role, may be determined by
how well a human simulator can dupli-
cate, compete with, or enhance its
considerable advantages. Teaching by
cadaver dissection has changed very
little during this century. In general,
student teams still participate in dis-
section or observe prosected cadavers.
Access to cadaver dissection has be-
come more restricted due to compet-
ing curriculum demands and increased
environmental protection costs, even
54 THE ANATOMICAL RECORD (NEW ANAT.) REVIEW

Figure 5. Simulation of a surgical incision in the reconstructed thigh of the Visible Human Male
displays. in real time, the internal anatomy as it is exposed. The virtual scalpel in the image is
haptically interfaced to a real scalpel handle to provide the user with the feel of the cut. Figure 7. In this simulation of a celiac plexus
block, the physician ‘‘feels’’ each tissue as he
inserts the needle toward the target area.
Fluoroscopic localization of the needle can
be seen on the monitor. On successful pen-
etration, he will also feel the pulsation of the
aorta.

of human anatomy is dramatized by

Figure 6. This ray-traced rendering of the segmented and classified structures of the Visible
Human Male knee isolates skeletal, muscular, and vascular elements.
though better and less toxic embalm-
ing methods have been introduced.
Cadaver dissection often is an intense
and very humanizing experience for
students; however, cadaver anatomy
has little resemblance in either color
or feel to the living body. The use of a
human simulator with haptic feed-
back may overcome these deficiencies
and greatly enhance the experience
obtained from dissection. Computer
simulation, made possible by the intro-
duction of virtual reality computer
technology coupled with a computer-
ized anatomical database such as that
of the Visible Human, affords opportu-
nities for developing a human simula-
tor that may transform anatomical
education as dramatically as flight
simulation has transformed pilot train-
ing.
Clinical Radiology
Clinical radiology, which rapidly fol-
lows and sometimes pioneers techno-
logical change, records the anatomy of
the living human. Its utility is dimin-
ished only by its use of potentially
harmful energies and their interac-
tions with tissues. The role of radiologi-
cal applications for the understanding
the fact that in February 1896, just 3
months after Konrad Roentgen an-
nounced the discovery of X-rays, the
first American clinical X-ray image
was produced in a physics laboratory
at Hanover, New Hampshire.10 This
rapid clinical application of his discov-
ery for the visualization of internal
human anatomy by a noninvasive
method foreshadowed the massive
amount of information on internal
structures that was to come. With the
appearance of the CT in the early
1970s and MRI in the 1980s, anatomi-
cal structures in any part of the body
were being revealed in astonishing
detail. The latter instrument also could
display cross-sectional anatomy in any
plane through the body. The massive
accumulation of information on hu-
man morphology that has resulted
from the use of these powerful clinical
imaging modalities has led to the pos-
sibility of rendering the entire human
body in three dimensions.
Changes occurring in some clinical
radiology subspecialties often used in
teaching human anatomy include the
following.
REVIEW THE ANATOMICAL RECORD (NEW ANAT.) 55

1. Roentgenographs or classical X-ray 3. CT images are easier to interpret

images are difficult for the novice
to interpret but have been utilized
in gross anatomy teaching for many
years. A major technological ad-
vance in this area that may benefit
anatomy teaching is the introduc-
tion of the digital radiograph. All
clinical procedures in radiology can
now be collected in a digital for-
mat. Therefore, digital picture ar-
chive and communication systems
(PACS) are being developed for the
management, reading, and distribu-
tion of clinical radiological images.
The advantage this holds for ana-
tomical teaching is that, as systems
become more sophisticated and ca-
pable of handling confidentiality is-
sues, then all radiological images
should become accessible for medi-
cal education. Much of the power
of such a resource lies in the possi-
bility, for example, of coupling
medical and surgical follow-up re-
ports into a teaching program. The
anatomical education community
needs only image management ca-
pability, a sort of national registry
of interesting anatomy, to utilize
such a vast resource for case-based
teaching.
2. Ultrasound generates cross-sec-
tional images that are also difficult
to interpret and are based on a
tissue property (acoustic imped-
ance) most students are unfamiliar
with. Images are generated from
nonionizing radiation and there-
fore can be used in vulnerable popu-
lations such as pregnant women,
fetuses, and children. The modality
is enjoying increased use in remote-
(than radiographs) but require a
knowledge of cross-sectional
anatomy. They reveal the same tis-
sue properties and utilize the same
radiation as radiographs. There-
fore, reconstructions derived from
multiple CT slices can provide views
in different planes. Three-dimen-
sional renderings from multiple CT
serial sections provide views more
familiar to the 3D viewing public.
Recent technological advances in
CT such as fast scanning and auto-
segmentation provide highly de-
tailed demonstrations of living
human anatomy (skeletal in par-
ticular) that can be utilized in ana-
tomical education. The Visible Hu-
man Dataset includes CT images at
1 mm intervals through both speci-
mens.
4. MRI is the most rapidly changing
modality in radiology. Advances in
detection and localization of small
radio wave frequency shifts which
constitute the image are tied to
antennae design, pulse sequence op-
timization, and computer recon-
structions. The modality provides
excellent soft tissue definition and
now provides true volumetric data
acquisition, as opposed to the serial
sections of CT that each contribute
to a volume. Images are relatively
easy for the novice versed in cross-
sectional anatomy to interpret but
are still based on physical prin-
ciples unfamiliar to the general
medical public. With segmentation Figure 8. A coronal plane is through a 24
and graphical rendering, these data week gestation fetus. This image is one of 600
can take on familiar 3D surface sections from the volumetric set of 250 micron
representations of anatomical enti- sequential serial sections.

sensing applications much the same ties. MRI presents a phenomenal

as the video-oscopies mentioned in
surface imaging. In these applica-
tions, the ultrasound transducer is
threaded into vessels and cavities in
order to place it closer to the area of
interest. Unlike the standard cross-
sections (transverse, coronal, and
sagittal) produced by MRI and CT,
cross-sectional views from ultra-
sound are normally without a stan-
dard reference axis, so specialized
anatomical visualization expertise
is required. Because the Visible Hu-
man Dataset comprises a volume, it
can be reformatted in any plane to
display anatomical cross-sections
to correlate to such images.
resource for learning and teaching
anatomy and constantly places new
anatomical knowledge demands on
radiologists who are seeing struc-
tures invisible in previous genera-
tions of the technology. T1-, T2-, and
proton density-weighted MR im-
ages, which are not congruent with
the anatomical cross-sections, com-
prise a part of the Visible Human
Dataset.
5. Positron emission tomography
(PET) provides resolution similar
to scintigraphic images, but, be-
cause it employs nuclei of low
atomic number, e.g., oxygen, nitro-
gen and carbon it does provide a
mechanism for imaging metaboli-
cally important chemistry. Techno-
logical advances in radiochemistry
make the major contributions to
the modality for imaging human
metabolism and function.
The Human Simulator
All of these anatomical teaching or
imaging methods will be incorporated
into a human simulator. We should
someday be able to view the surface
anatomy of a selected human, image
the selected virtual subject with any of
the radiological modalities, and dis-
sect any part of the body either as a
56 THE ANATOMICAL RECORD (NEW ANAT.)
cadaver or as a living patient (a user
option). Furthermore, all of the tech-
niques we used or images we saw or
tissues we felt could be recorded and
analyzed for constructive criticism or
examination. The important point here
is that the instructor can see or experi-
ence exactly what the student saw or
experienced in his or her self-directed
laboratory.
Computer simulation when based
on visible light photographic images
such as those of the Visible Human
couple, can duplicate not only surface
anatomy but also internal anatomy
revealed only by radiology or dissec-
tion in the real world. Most impor-
tantly, it does not inconvenience or
compromise patient care. Many ad-
vances required for these simulators
are anticipated to come from other
fields. For example, computer technol-
ogy utilized in Hollywood for special
effects (morphing, 3D rendering, ani-
mation, movie colorization) and dy-
namic feature isolation (rotoscoping)
all contribute to the many tools re-
quired for simulating the scientifically
correct human body. The mathemat-
ics and computational speed required
for morphing a man into a car may
someday provide the ability to atrophy
a muscle or inflame a pancreas. Ren-
dering tools provide the ability for the
student to visualize objects in three
dimensions from their own perspec-
tive. Animation tools may provide
physiological and kinematic exten-
sions of this database, and coloriza-
tion and technology has already con-
tributed to the process of feature
extraction from photographic ana-
tomical images. Theme park entertain-
ment and video arcades will most likely
drive the haptic interface industry to
make devices that give realistic feeling
at a substantially reduced cost. Of
course, the aircraft industry can con-
tribute the maturity of a well-devel-
oped, well-studied, and well-received
utilization of computer simulations
for the training of highly skilled profes-
sionals.
Some major demonstrations of the
concepts already available for com-
puter simulation of medical proce-
dures have convinced us that the hu-
man body can be duplicated well
enough to capture the student imagina-
tion in situations that simulate human
anatomy and limited physiology. The
fabrication is close enough to the clini-
cal situation that the student can prac-
tice and learn effectively with such a
simulator.
Our steps for the creation of a hu-
man simulator involve the following.
1. Record visible light reflection of
human cadaver tissues from serial
sections like the Visible Human
Dataset to enable visualization of
the anatomy of a human cadaver by
any means (cross-sections, 3D ren-
derings, physical model reconstruc-
tion, etc.)
2. Modify visible light reflections re-
corded in step 1 to simulate the
appearance of live (but inanimate)
tissue to enable visualization of the
anatomy of a live human.
3. Add mechanical properties to each
tissue visualized in step 1 to enable
haptic interaction with the data.
The student can now ‘‘feel’’ any
tissues visualized in step 1 of the
human cadaver.
4. Add physiological properties to each
tissue visualized in step 1 to enable
visualization and haptic interac-
tion with the data as tissues from a
selected live human (i.e., enable
visualization of the beating heart,
musculoskeletal motion, GI motil-
ity, and respiration either in isola-
tion or as the student (or teacher)
perturbs the system).
5. Relate visible light reflection, me-
chanical, and physiological proper-
ties of each tissue to age, race,
development, disease, and environ-
ment to enable visualization and
haptic interaction with any simu-
lated living human, enabling the
student to investigate, appreciate,
and understand human diversity.
The first step in this list has begun
with the Visible Human Project: an
adult human male and a female speci-
men have been imaged. The extension
of the concept to other bodies, includ-
ing young female, fetal, and pediatric
specimens, is ongoing at the CU Cen-
ter for Human Simulation (Fig. 8). We
are now able to ‘‘feel’’ these tissues
through the instruments normally used
to interact with such tissues—scalpels,
needles, and probes. These procedure
simulators have provided responses
judged realistic by experts in their
fields of use. Formal evaluation of
these simulators is in progress.
REVIEW
With the maturation of computer
technologies, including 3D visualiza-
tion and haptic, audio, and olfactory
interfaces, combined with volumetri-
cally defined anatomy such as the Vis-
ible Humans, we are now able to learn
in immersive environments simulat-
ing the reality of the living human
body. Computer simulations will sup-
port dynamic systems and are rapidly
growing in sophistication and abili-
ties. The photographic cadaver im-
ages, such as those comprising the
Visible Human anatomical volume,
will become more sophisticated and
more lifelike as the image data is
personified with characteristics and
properties that will bring it ‘‘to life’’ in
a virtual reality laboratory. This vir-
tual lab will afford the student an
opportunity to study and interact with
what seems to be the living tissues of a
human being—all without the hin-
drance of inconveniencing or jeopar-
dizing living patients or volunteers.
CONCLUSIONS
The Visible Human Dataset has served
as a demonstration that a whole body
can be prepared in such a way that it
can be volumetrically reconstructed
by computer. The data are being uti-
lized all over the world as a resource
for human anatomy applications in
education, modeling, simulation, train-
ing, morphometrics, and entertain-
ment. Some of these applications dem-
onstrate the use of the dataset in the
construction of human simulators. At
the CU Center for Human Simulation,
segmentation and classification of the
Virtual Human Male has been com-
pleted, and prototype simulators for
clinical procedures have been con-
structed. The implications of com-
puter simulation of the human body
and technological advances impacting
the teaching of human anatomy are
anticipated.
ACKNOWLEDGMENTS
The authors thank Dr. Donald A.B.
Lindberg, Director of the NLM, and
Dr. Michael J. Ackerman, Visible Hu-
man Project Officer, for their support.
We also thank our team of young
investigators that made this project
successful. We especially acknowledge
those citizens who donate their re-
REVIEW
mains to medical research and teach-
ing.
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