A visible human online reference for medical education & reseach
the detailed, free of charge www-atlas of human cross sections
of the Workshop Anatomy for the Internet

Dr. H. Jastrow
Department of Anatomy, Histology, Johannes Gutenberg-University, Mainz, Germany

(this presentation was shown at the 3rd Visible Human Conference on 5.10.2000)
(For viewing larger images, click on the minaturized ones, please!)

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Ladies and gentlemen,
in the present ‘information society’ with high-speed computers and increasing network connections throughout the whole world, medical education and particularly anatomy cannot do without the new media. In this context the internet seems to be the best place to offer easily accessible, interactive teaching modules for acquisition of a three-dimensional functional picture of the human body.
The atlas is based on digitised sections of the Visible Human male and female as, at present, the most important international source for free high quality images of human gross anatomy including CT and MRI. In regions of special clinical interest like the head and with many small details more sections were selected than in others with less evident changes between the slices (Fig.3). Further, corresponding axial radiological images were included.
Image data were obtained from the NLM or its mirror sites. Decompression and conversion into JPG files were necessary to put the images at disposal in the internet. Thereby the original resolution was maintained. 12-Bit greyscale CT- and MR images were reduced to 8-Bits of grey. The JPG compression resulted in a strong reduction of the file size without naked-eye detectable loss of colour contrast (Fig.4).
Fig.5 (link to labelled image atlas page)
The converted pictures were oriented according to radiological standard, trimmed and prepared to appear on a black background (Fig.5). For labelling black margins were added in order not to cover the pictures by the letters. Labelling was performed mostly by instructed students attending the workshop according to the present international terminology, Terminologia Anatomica, by using different anatomical atlases and books. After thorough checks, revision, correction and trimming, internet pages were composed.

In Fig.6 you see such a web page. As many structures as possible and reasonable were labelled on the pages with marked sections. When a structure was not labelled, it was either not clearly visible or there was not sufficient space available. In that case, the structure was labelled on the neighbouring sections. There is no strict uniformity in the layout, thus all labelled images reflect the individuality of the involved student whose name is given below the image.

Fig.6 (link to labelled image atlas page)
Fig.7 (link to atlas page)
As you can see in Fig.7 images are presented in full original pixel resolution in all pages of original sectionsin the head, neck and lower limb regions. Prepared sections, available corresponding CT and MR-images, and in some cases icons of details enlarged on linked pages were arranged with further links using the Netscape Composer™.

The images of pages with sections of the thoracic, abdominal and pelvic regions were reduced to half size with a link to the full-sized picture in order not to push the CT scans out of the screen (Fig.8).

Fig.8 (link to atlas page)
Fig.9 (link to atlas page)
CT-Scans are shown below the original sections for optimal space management in web pages with sections of the lower limb (Fig.9).

The motion pictures of the web atlas were created from stacks of trimmed, aligned, cleaned and equally sized images of all the anatomical or radiological sections mainly of the VH-male provided by the NLM (Fig.10). They were produced using Ulead Media Studio™ or MainActor™ software in either AVI™ or Quicktime™ format, both in Cinepack Radius™ compression. Only some of the motion pictures of the original sections are reduced in size due to the enormous amount of data involved. One motion picture even runs through the scaled down total of the complete sections of the VH-male.

Fig.10 (link to atlas motion picture [17 MB!])
Fig.11 (link to atlas page)
In Fig.11 you see three of five pages providing a total of over 120 motion pictures ready for download that were mainly produced from the VH-male data set.

The atlas of visible human sections is one of some anatomy web-teaching modules of the Workshop Anatomy for the Internet of the Johannes Gutenberg University of Mainz, Germany. These modules are linked to each other as shown in Fig.12.

Fig.13 (link to atlas homepage)
Fig.13 shows the English homepage of the Workshop. Apart from the extensive electron microscopic atlas and the other teaching modules it leads to the atlas of visible human sections in the internet which is presented here. When choosing “List of sections”, the index page of this atlas (Fig.14) is loaded.

This index page provides miniaturised transverse overview sections for each region of the body, linked to pages with browsed overviews of the chosen sections. Further one section is labelled with terms of orientation providing a link to an appropriate page of a vocabulary. Additional icons provide links to this vocabulary of gross anatomy, motion pictures, language selection and conditions of use. If you click on the head 1 icon you will reach the first region overview of the head.

Fig.14 (link to atlas index page)
Fig.15 (link to atlas page)
The first region overview of the head providing small icons of all sections chosen here (Fig.15). When you click an icon the page with the full sized section and its corresponding radiological images, in the head region MR and bone CT come up. A tick on the section number below opens the page with this section labelled. Further down you see the beginning of the list of the most important structures of the sections.

The linked vocabulary of gross anatomy (Fig. 16) provides over 850 Latin anatomical terms and their corresponding expressions in English and German. The terms are arranged according to subject as well as alphabetically. Thus unclear labelling can be looked up easily.

Fig.16 (link to atlas page)
By the points listed in Fig.17 the atlas intends to be a useful online reference for medical education and research. It enables a visual journey through the whole body showing all relevant structures of gross anatomy and in so far contributes to a three-dimensional understanding of topographic relationships. All important structures of gross anatomy are labelled using the official terminology to make the atlas ideal for use throughout the world. By giving representative views of all relevant structures of all body regions next to corresponding radiological images a valuable reference for correlation of radiological and anatomical structures has been created.

In Fig.18 you see why the present atlas is published the internet as the most important medium of today and future times to retrieve and present knowledge. Namely, the web offers possibilities that partly even CDs cannot provide and that are of great advantage in comparison to printed media. Since it is the aim to offer entirely correct labelling, the users of the atlas are requested to inform the author of imperfections via E-mail, as, in contrast to a book, publication in the internet offers the possibility of quick and easy correction.

Many people can benefit from the internet atlas since the offered material can be used for teaching as well as learning gross anatomy in general (Fig.19). The spectrum reaches from university, health care related schools and colleges to lay people interested in the construction of the human body.

The students who help to create teaching material for others by labelling the images in the workshop benefit in many ways (Fig.20) and acquire a special qualification useful for their later work as medical doctors and when seeking positions.

The offered material is suitable for study and instruction of anatomy in general. In Figs.21 & 22 you see some examples what it can be used for. The broad spectrum of usability spans from university instruction of specialists and reference for scientific purposes over education of medical students, doctors and staff, teachings of clinical anatomy to biology lessons in college and high school. Either direct internet access or printouts of the images are applicable. For non-professionals the vocabulary is a valuable key to understanding the international terminology. The sequence of sections and motion pictures facilitate acquisition of a 3D-understanding of anatomy and topographical relationships. In the training of medical students and doctors it is essential to correlate anatomical structures of the human body with radiological images. For this reason sections are presented next to corresponding radiological images that also can serve radiologists as a reference. In brief the atlas is a source for many uses. Fig.22
A page with the conditions of use informs about legal aspects and explains how to obtain printouts of the images. High quality anatomy software is often not affordable for students. In contrast, the present offer, even though no freeware, allows everybody to benefit from the excellent material offered by the NLM. In so far it contributes to the realisation of the goals of the Visible Human Project (Ackerman 1998) by being easily accessible in the Internet and at no charge for personal use (Fig.23).

It is apparent that the present atlas is the most comprehensive one in the internet offering most detailed labelling of sections in the web. Otherwise, comparable detailed labelling, usually in English, is only present in few commercial CDs and books. For the reasons listed in Fig.24, the present contribution surveys other web-anatomy atlas projects and commercially available software. With its further anatomy teaching offers the Workshop Anatomy for the Internet represents a unique concept of presenting anatomy to specialists as well as to the general public.

The present atlas is constantly extended by including further original and labelled sections aiming at a maximal intersection distance of 5 millimetres in all regions (Fig.25). Due to considerable download time, especially for the motion pictures, it is planned to offer them on a student affordable CD-ROM with as many sections as possible. Apart from the extension of the vocabulary it is planned to offer computed coronal and sagittal sections, 3D reconstructions and self assessment tools. With these goals it is intended to contribute to world-wide improvement of 3D-understanding of anatomy in pre-clinical and clinical medicine.

With the summary of Fig.26 I want to invite you to explore the internet pages of the Workshop Anatomy for the Internet. Further, I acknowledge those who supported this project.

Ackerman-MJ (1998): The visible human project. Proceedings of the IEEE 86 (3): 504-511.

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