A network of blood vessels coursing through a human head is clearly visible, layers of skin tissue and the bones of the skull having been pulled away to reveal a deadly glioblastoma tumor straddling both sides of the brain.
The dissection is very real here in the sub-level laboratory at UT Health San Antonio, based on actual patient scans created for teaching anatomy to first- and second-year medical students.
But the tissues and systems are a digital image projected onto screens and manipulated via game controllers and BodyViz software and hardware the school installed four years ago.
BodyViz renders data from magnetic resonance imaging and CT scans into interactive 3D visualizations. In the school’s digital lab, widescreen monitors are positioned throughout the room, and 84 workstations with laptops, controllers, and sets of 3D glasses add gaming elements to the head dissection to promote learning.
“We’re actually the only medical school in the country that has this software on this scale,” said Omid Rahimi, associate professor and director of the human anatomy program in the Joe R. and Teresa Lozano Long School of Medicine at UT Health San Antonio. “It’s a different level of enhancement. We really wanted something that the students can collaborate and share and kind of work together.”
But when it comes to how the dead teach the living, technology is no replacement for what the real thing – a preserved human body – can accomplish.
Dissection of human cadavers for learning anatomy goes as far back as the 3rd century B.C. in ancient Greece. For a time, religious and cultural views forced it out of favor but the practice was then revived in 1231 when a Roman emperor issued a decree mandating dissection for anatomical studies, according to a historical account published by the National Institutes of Health.
In the gross anatomy lab at UT Health San Antonio, which is located behind locked double doors labeled “no admittance” in a separate building from the digital lab at Floyd Curl Drive in the South Texas Medical Center, three large rooms are lined with stainless steel cadaver tanks. When not in use, the hinged tanks are closed and the labs are noiseless and orderly. The faint odor of embalming chemicals hangs in the air.
It is here that future doctors, other health professions students, and area surgeons work in teams – sometimes standing on their feet for hours at a time – to dissect the human body for the study of anatomy and surgical technique.
The bodies, as many as 200 a year, are donated by individuals through the Body Donation Program and kept for dissections before they are cremated and then interred during an annual memorial service conducted by the students.
Working with students in the cadaver lab is the best part of his job, Rahimi said. “To see as the students are learning how detailed the body is, how the muscles of the hands function – every part of the body is amazing.”
Second best, he added, is conveying the responsibility and sensitivity of working with family members of a donated body.
“I feel I’m in the position that I’m not only teaching basic science to the students but also altruism, professionalism, and kind of facilitating that,” Rahimi said. “We have the students write a thank-you to their body donor. And it’s really amazing what they’ve captured. They come in as undergrads, but now they’re on their way to becoming a professional health [provider].”
Day One for students in the anatomy lab begins with the reading of a poem by a former student, taking the cadaver’s hand in theirs, and giving thought to what the person may have done for a living and who they were.
“We talked to them about the importance of caring for this body donor, making sure that the body is always shrouded, doing things with respect,” he said. “You know, working in that lab is a grueling thing, so there’s a fine line to walk in being able to think about the care of the cadaver” while at the same time using scalpels and saws to dissect the body and examining the organs.
Rahimi approached his own first experience in the anatomy lab years ago with his head down, focused on learning the required material and not recognizing the humanity in his cadaver until halfway through the course. “Then I got to dissecting the hand and I stopped and thought, ‘This is a real person,’” he said.
Interacting with a cadaver is seen as one of the first steps in teaching health professionals compassion and the art of medicine, Rahimi said. It’s a skill that can’t be taught with video and a game controller.
So while some prominent medical schools across the country were shutting down their anatomy labs 10 years ago as virtual cadaver technology came into use, most have reinstated the use of real cadavers and combine the two in their curriculum.
Rahimi said he is “biased” in his preference for teaching anatomy with the gross anatomy lab but appreciates the digital lab for independent learning and how it allows students to learn about imaging and making sense of the complex systems within the body.
In addition to the cadaver labs, UT Health San Antonio also houses an extensive collection of plastination models – preserved body parts in which organic tissue is replaced with silicone to create specimens that can be touched and held and that do not decay. UT Health had the first plastination lab in the country, Rahimi said, and now has every organ and joint in the human body.
In the School of Health Professions at UT Health, where future physicians assistants, physical therapists, nurses, and others attend classes, the study of anatomy is augmented with virtual cadavers using seven life-size anatomy visualization systems the school purchased three years ago. The 7-foot-long touch-screen tables developed by Anatomage are three-dimensional representations of a human specimen.
“Students can go in there and, if they want to peel away a layer of skin or remove a nerve or muscle and look at a bone, they can do that on one of these cadavers,” said Tony Skaggs, an assistant professor and associate program director. “The greatest benefit for students is that it’s all touch-screen-based … and when you look at the cadavers, it’s almost like looking at them in a [cadaver] tank.”
Anatomy has been taught in a consistent way for years, Skaggs said. “That’s not going to change. But technology is on this up-ramp,” he said, going from clunky digital technology starting in the 1990s to augmented reality development happening today.
“Maybe we’re not there yet, but I think maybe the future of teaching anatomy is the use of tools like this over using cadavers in certain courses.”