In recent decades, teaching of human anatomy has been reduced inmedical curricula globally and replaced with clinical education; resultingin a potential decrease of human anatomical knowledge in newlygraduateddoctors.1-3 Historically large anatomy departments havecommonly been converted into small entities of medical education groupsor incorporated into surgical departments.4 However, most medicalinstitutions still utilise traditional teaching styles in anatomy and physiologyteaching, such as cadaveric dissection where the main learning is traditionallyguided by an educator.5 In courses where dissection is not implemented, orcommonly utilised, the human anatomy teaching and how it links to thesubsequent physiology is pivotal to the curriculum for prospectiveclinicians.6 In many medical schools nowadays, a mix of postgraduate andundergraduate students study in the same class, with traditional methodsoften not meeting the additional support required for undergraduate studentsnew to university study.7 Learning in human anatomy has been centredaround dissection of cadavers for many decades, during which time thestyle of teaching gradually progressed with the implementation ofprosected specimens, plastinated specimens, computer-based and web-basedlearning, multimedia learning and virtual anatomy software.8-11
Focusing on the addition of technology in anatomical courses,Ramsey-Stewart G, et al.,12 conducted a study on senior medical studentsin Sydney and concluded that dissections should remain an integralcomponent of medical education. In addition, Azer and Eizenberg13 concluded that utilising multimedia did not change studentperceptions regarding usefulness of cadaveric dissections.Most learners also found that the cadaver dissection methodincreased their perception of learning additional anatomythrough technology. Virgil Mathiowetz et al.,14 comparedanatomy laboratory teaching versus online anatomy softwareand observed that the students who attended anatomylaboratories scored higher than students who solely engagedwith their online learning program. This was consistent withthe observation of Custer and Michael,15 that a virtual dissectiontable was a beneficial learning tool in the education of imagingscience students. Winkelmann16 reviewed fourteen studiescomparing different teaching approaches including dissection,prosection and online computer- based teaching aids, findingthat there was a lack of sufficient evidence to demonstrate onemethod’s superiority over others in anatomical education.
The way both anatomy and physiology have been taughthas been greatly modified over recent years, leaving a degreeof uncertainty concerning the overall goals of modern anatomyteaching.4,17 One new technology that can assist with the learningexperience in these subjects is the virtual dissection table. Thisarticle aims to provide a description of the functionality,modules and potential of virtual dissection tables, and toprovide insights for schools seeking to adopt this technologywithin their anatomy curricula. The authors make norecommendations on whether any particular virtual dissectiontable itself, such as the Anatomage Table, is a suitable tool.Instead, this article focuses on informing educators on possibleuse-cases for the devices, to assist with their considerationstowards which new technologies may be useful withinmedical and health science programs.
One commonly utilised virtual dissection table inmedical or health education departments is the AnatomageTable. This device depicts segmented human 3D anatomy asinteractive life-size displays of 3D models. It rendersvisualizations of 3D anatomy and interactive perceptions withdisplayed visualizations of anatomy, as they would appear onan embalmed cadaver. It conveys anatomical details forvirtual cadaver-based dissections and provides simulationsthat can be programmed when required. A life-sized perceptionof the full human body also provides learners with an abilityto simulate surgical operations. The learner can stand besidethe Anatomage Table and interact with the model, such as byrotating the virtual patient horizontally, or into a position thatassists their desired learning objective. Finger gestures or astylus can be used to interact with the table. The physical tableis movable or can be locked into a fixed position. The Tablehas been developed based on the Invivo5 imaging softwaretechnology, allowing volume rendering, photographic renderingand 3D mesh rendering.14,15 For more specific use of theAnatomage Table, 3D digital anatomy libraries with scans ofpathology, clinical cases and routine medical examinations are accessible. Anatomage has medical imaging software approvedby the FDA, which maintain compatibility with all CT or MRIdata. Within these modules, identical to the anatomicalsimulations, the learner can zoom, rotate and cut the imageusing finger gestures.14,15 Models can be edited, and imagelabels from anatomical structures imported, with theadditional potential of users uploading patient scans into thesystem for examination. With finger gestures it can turn images,move the models, or alter viewpoints. Individual structurescan be reconstituted in high-detailed 3D, culminating inanatomical imagery that can be explored by the student, ordemonstrated to a small group of learners by the educator.
Use of the Anatomage Table as a virtual dissection device inteaching sessions
Cadavers represent the gold standard of teaching toolswithin the anatomical laboratory. However, due to supervisory,ethical, accessibility and financial constraints, student use ofthese models can become limited. As a supplement tostructured anatomical laboratories, virtual dissection tablesmay suit some medical and health science schools wishing toextend their teaching to allow further individual student study,or additional interactivity. The Anatomage Table has both fullbody female and male anatomy, depicted from head to toeproviding detail such as minute nerves and blood vessels athigh resolutions. The regional anatomy includes the head andneck, upper and lower extremities, thorax, abdomen, pelvisand related structures (Figure 1). The images illustrate theanatomy of a cadaver by maintaining consistent colour andshape, and can be sectioned at various regions to exposinganatomical structures that allows learners to visualize softtissues, skeletal tissues, muscles and organs. These tissues canbe customised by virtually slicing, segmenting and layering,although it does lack the haptic feedback from doing this activitywith cadaveric models. With the help of annotation icons thatcan be saved and viewed later, each learner can develop newmethods for individualised study, and the educator can guideexploration through innovative programs, quizzes, and tests,as well as data from still photographs, or CT and MRI Scanners.
A virtual dissection table with imaging data may analternative for student learning when the traditional cadavericdissections are not available. Learners can incise the skin,remove soft tissue, section the body and isolate any organ withfinger gestures. The learners repeat the dissection and can undotheir action at any time, with cutting and sectioning allowedacross most directions. One benefit often presented to supportusing virtual dissections in this way is that if a structure isaccidently cut, it does not devaluate the experience in any way.However, it needs to be noted that although cadavers can oftenbe sutured or repaired, and there are educational benefits forstudents making ‘mistakes’, which can be a great enhancementto genuine and authentic learning. In virtual dissections, allcuts can be removed or the body immediately reconstruct ifrequired. For immediate comparisons, many virtual dissectiontables allow the learner a simple method to compare two clinical presentations or cases side by side, and users canreview pre- and post-surgery cases, measure tumour growthsand correlate chest volumes between inhalation and exhalation.This is all without the requirement for chemicals, additionalventilation, freezers or other facilities, with no leakage,disposal needs, or embalming equipment required. As cadaversusually provide solely one case for each student, there is a fargreater ability for variation in student experiences throughvirtual models. There are also no recurring acquisition costssince all content is reusable. Image data within a virtualenvironment can be modified and reused unlike a cadaverdissection. This allows a greater potential for each learner togain a similar understanding of the anatomical relations,identification of difficult structures and will be able toassimilate various biological systems in the human bodythrough virtualisations compared to cadaveric preparations(Figure 2).
Figure 1: The Anatomage Table (upper left image) and representations of the virtual humancadaveric modules, detailing the skeletal and muscular system.
Figure 2: Examples of dissections performed with the Anatomage Table. Note the potential toannotate names of each feature, organ or body part of interest on top of the model provided.
In small group learning activities limited to around 12 students, an instructor should be able to comfortably stand onone side to direct a lesson viewing images, resolving clinicaldiagnoses, or relating features and structures to physiology. Inmedical education, a virtual dissection table could be used tosimulate a patient on a table, as the size and appearance maybe appropriate in some lesson styles. The device could also beincorporated into assignments and assessment activities, wherelearners may wish to analyse anatomy concepts, createannotations, export images and provide written comments ona 3D visualised model. In this way, the table offers a potentialsupplement to traditional cadaver dissections with real life patientcolours and shapes. Each system of the body or anatomicalstructure can be isolated and viewed separately with itssegmentation features. An institution can also upload data froma CT scan to the virtual dissection table and allow students toThe use of virtual dissection tables in clinics or hospitalsVirtual dissection tables may be useful as a part ofsurgical case reviews, consultations, radiology or researchthrough the input of magnetic resonance image (MRI) orcomputed tomography (CT) scans. In the hospital setting thiscould provide new options for clinicians when conductingconsultations or educating patients (Figure 4). For example, itis possible to capture an image of a patient with an exposedrevise this alongside a virtual 3D rendered model at the sametime.
The virtual dissection tables are large, heavy and bulkyand may be difficult to move between anatomy teaching roomsand lecture theatres. However, if accessible, the device couldbe integrated into lectures and provide live demonstrations.Most virtual dissection tables can now connect to projectors,so can be used directly during lectures with previously preparedsets of lessons. Educators can create and demonstrateexperiments or provide experiential-based sessions in adifferent or unique way. Video clips and screenshots can besaved and shared with students and integrated into lesson plans,and images extracted from using the Anatomage Table aredepicted in Figure 3.
Figure 3: Depictions of images within the Anatomage Table software which may have a potential use in lectures,such as detailing cells, animal models, or developmental anatomy, such as illustrating the development of a foetus.
Virtual dissection tables may be useful as a part ofsurgical case reviews, consultations, radiology or researchthrough the input of magnetic resonance image (MRI) orcomputed tomography (CT) scans. In the hospital setting thiscould provide new options for clinicians when conductingconsultations or educating patients (Figure 4). For example, itis possible to capture an image of a patient with an exposedrevise this alongside a virtual 3D rendered model at the sametime.Use of virtual dissection tables in lecturesThe virtual dissection tables are large, heavy and bulkyand may be difficult to move between anatomy teaching roomsand lecture theatres. However, if accessible, the device couldbe integrated into lectures and provide live demonstrations.Most virtual dissection tables can now connect to projectors,so can be used directly during lectures with previously preparedsets of lessons. Educators can create and demonstrateexperiments or provide experiential-based sessions in adifferent or unique way. Video clips and screenshots can besaved and shared with students and integrated into lesson plans,and images extracted from using the Anatomage Table aredepicted in Figure 3.abdominal cavity and display this on the table within theclinic. Patients can view their personal anatomy in 3D colourand navigate the imagery on the screen. As a pathological andprocedural training tool, it has a digital library that incorporatespathological examples to for students or junior doctorsstudying pathology. Many virtual dissection tables can alsooverlay 3D models onto images of a patient, thus allowing alife-size simulation. This, and other uses of 3D renderedmodels used in the place of 2D scan presentations is becoming commonplace,7 and as the applications of these 3D anatomicalmodels increases, a virtual dissection table is well-suited forassisting with life-sized spatial understanding of the humanbody. In the field of forensic and archaeological sciences, theAnatomage Table had a role in the investigation of PharaohTutankhamun’s cause of death in August 2012 and wassubsequently documented by Fuji TV, PBS and in a ScientificAmerican article on virtual autopsies in 2013.18 The anatomyof different animals can be compared for research in veterinaryscience and the user can upload veterinary scans for teachinganimal anatomy, such incorporating full-body cat and dog images. For example, the latest Anatomage Table software hasalso added 4D scans to visualize heart beats and respiration,which may be useful in a range of teaching practices orvirtual autopsies.19 Additionally, models of different ages canbe presented to the learners, whereas cadaveric dissection mostcommonly involves examinations of elderly people. Thisallows students using virtual dissection tables the ability toinvestigate models of different ages, which is useful forlearners wishing to identify variations in the skeletal systemduring ageing or development.20
Figure 4: Depictions of scans side-by-side with virtual imagery of the structures, taken from the Anatomage Table.
Researchers relating to teaching methods, case reviews,patient education, or hospital teamwork may find use inintegrating virtual dissection tables within their investigations.Different researchers can interact with images, presentationsand data simultaneously. Research on hollow organs, such asthe gastrointestinal tract or the urinary bladder,21-23 maybenefit from using the 3D models or objects as training toolsfor new students. The ability to import files from patient MRIor CT scans gives early-career researchers, in particular, theability to inspect research data or patient information throughthe life-sized rendering. The finger-gesture interactivity mayassist in identifying comparisons between scans, or uniqueanatomical variations and features when compared to using amouse-and-keyboard approach. Other research has beenconducted on student perceptions of learning anatomy, suchas within a Doctor of Chiropractic program, where studentsusing the Anatomage table for musculoskeletal anatomyperformed higher on examinations than students using plasticmodels or cadavers. This study identified other variablesbetween the cohorts, and as such, research is required toconfirm the conclusions, although this presents an interestingarea for future studies.24
There is limited data to suggest that virtual dissectiontables are a suitable complete replacement for cadavericstudies. In programs such as medicine, which rely on cadavericstudies to teach students human anatomy, real and genuinecadavers are a primary and important tool for medicine. Cadaversallow a unique view into anatomical variation, provide hands-onkinaesthetic and tactile feedback, and expose students to areal-world experience. The uses outlined in this article provideoptions for methods solely to supplement cadaveric work,rather than act as replacement. However, the opportunity ofusing a virtual dissection table in combination with cadavericdissections may present an opportunity for educators wishingto supplement learning in anatomy and physiology. Anadditional limitation is that the technical acumen of individuallearners may be different. A student who is used to studyinganatomy through a tablet device or digital form of learning,may be more experienced in the gestures, insights and contentutilised within the virtual dissection table software. Thistherefore results in the potential for different students to havevaried degrees of success in learning from this device.Additionally, the tables themselves are relatively large andbulky, and its usage and storage may require a dedicated space.
Regular servicing, updates and maintenance are also required,and during this time the table cannot be used by educators orstudents. As such, it is highly recommended that prior toadopting new technologies or devices to supplement learning,curriculum leads and educators consider the uses, benefits andlimitation of each resource carefully.
According to Drake et al.,5,25 dissection helps in theidentification of structures along with tactile information ontissue texture, and the reduction of applied hours of clinicalanatomy within medical curricula over recent decades is ofconcern. Anatomical dissection provides kinaesthetic aspectsof learning through the 3D visualization of structures. Onceany structure is cut or damaged during dissection, it cannot bereconstructed hence, dissection is irreversible in nature.Through these features, virtual dissection tables are becomingversatile teaching tools within many university medical andhealth science curricula. Although virtual models, such asthose used within virtual and augmented reality9,10 or cadavericdissections are highly useful teaching tools, in a classroomenvironment, the virtual dissecting tables allows students theability to undergo both teacher-directed learning, individualexploration or self-directed learning.26 The virtual dissectiontables allows students to isolate different structures in 3D form,dissect, reconstruct, zoom in and out, transecting them toacknowledge the anatomical knowledge. Rosenzweig et al.,27reported that pausing, rewinding and revisiting differentstructure and systems by creating pre-settings in the virtualdissection table is a unique feature that helps to provide furtherpersonalization to the learners.
Quentin-Baxter and Dewhurst28 suggested that thesimulation based on computer or software programs offers abulk of sustaining and emphasizing information to learners,and they can work with them at their own speed. Additionally,Downie and Meadows29 reported that students who areprovided with a substitute to dissection, such as throughutilising artificial models, charts and pictures, exhibited nosignificant differences in their performance on the writtenexaminations compared to those students who studied solelythrough dissections. Custer and Michael15 conducted a studyon medical imaging students in regards to utilization of theAnatomage Table observed that the students appreciatedstudying using the device and suggested that it would be ahelpful and efficient technology to incorporate into healthprofessions. In this study, 94% of students agreed with the factthat they felt benefit from the use of Anatomage virtualdissection Table when studying anatomy. Almost 88% ofstudents further described that they found a positive influenceof the Anatomage virtual dissection Table on the overallclassroom experience.
Chan et al.,30 studied the efficacy in learning humananatomy and medical imaging with the Anatomage Table andcompared with prosections. The results indicated thatdifferences between the total scores for the Anatomage Tableand the prosection group were not statistically significant.Similarly, between the two groups the differences in the totaldiagnostic medical imaging scores were also not statisticallysignificant. Although instruction based on the AnatomageTable scored higher on identifying relative anatomical locationsand imaging planes, these differences were not statisticallysignificant. Anand and Singel8 conducted a comparative studyof learning with the Anatomage Table and traditional dissectionin neuroanatomy and reported that 90% of the students feltthat the Anatomage virtual dissection Table helped them tovisualize relations of different parts better. The majority ofthese students (79%) agreed that the Anatomage virtualdissection Table enhanced their learning experience and 75%agreed that the use of the Table required less time to understandstructures. Almost 84% of students were in favour of includingthe Anatomage virtual dissection Table in the regular curriculum.
Virtual dissection tables are a novel technologyenhancedlearning and teaching tool that facilitates 3Dvisualization of structures and their relations. Learningoutcomes with these tables was thought to be comparable totraditional dissections in neuroanatomy, and learning was alsoaugmented by allowing students independent and extendedtimes with the models. It could be included in medicalundergraduate curriculum as a teaching tool to facilitate learningand better spatial understanding of anatomy. However, furtherresearch is required to explore the synergistic learning effectsof virtual dissection tables, prosection and other learningmethods and materials as this could be of great benefit.
Images of software and anatomical visualisations authorisedfor use by Anatomage Inc, San Jose, CA.
The authors declare no conflict of interest. The authorsreceive no payments, financial support or funding fromAnatomage, its affiliated companies or any manufacturer ofvirtual dissection tables. Neither author receives any benefitfrom the publication of this article. Neither author is affiliatedin any way with any maker of virtual dissection tables or theirembedded software, and there is no financial interest orpersonal relationship with any third party whose interests couldbe influenced by the article’s content.