Evaluation of the willingness for cadaveric donation in Greece: a population-based study

Three-dimensional replica of the temporal bone in the teaching of human anatomy

PURPOSE

The current study proposes the comparison of the visualization and identification of anatomical details between natural human temporal bone, its respective copy from three-dimensional printing, and the virtual model obtained from CBCT.

METHODS

The sample consisted of undergraduate students in Dentistry (Group UE, n = 22), Postgraduate students in Radiology and Imaging (Group P-RI, n = 20), and Postgraduate students in Forensic Odontology (Group P-FO, n = 24). All participants attended a theoretical class on specialized anatomy of the temporal bone and subsequently performed the markings of 10 determined structures.

RESULTS

The number of correct identifications was similar in natural bone and printed three-dimensional models in all groups (p > 0.05). The virtual model showed a significantly lower number of correct structures (p < 0.05) in the 3 groups. In general, there were significantly higher percentages of accurate answers among postgraduate students compared to undergraduate students. Most graduate students believed that the printed three-dimensional model could be used to teach anatomy in place of natural bone, while undergraduate students disagreed or were unsure (p < 0.05). Regarding the virtual tomographic image, in all groups, students disagreed or were not sure that its use would be beneficial in replacing natural bone.

CONCLUSION

Three-dimensional and virtual models can be used as auxiliary tools in teaching anatomy, complementing practical learning with natural bones.

Giving a voice to our silent teachers: Whole body donation from the donor perspective at one donation program in the United States

Human body donors play a crucial role in anatomical education, research, and clinical skills training, and those interested in anatomical donation may bequeath their bodies to body donation programs (BDPs). The purpose of this study was to evaluate the perspective of body donors on the donation process in order to make recommendations for improvement that align with donor values. A survey was administered via email to 2145 individuals that had enrolled in The Ohio State University's BDP and yielded a 40% response rate. Results showed that a majority of registered donors do not place high importance on detailed consent options during the enrollment process, but do value BDP oversight, such as through the use of an oversight committee to supervise the program. Only 9.1% of donors felt that their loved ones should be permitted to make changes to their consent forms after they have passed. Although 96.2% of participants would allow photos/videos to be taken of their donated bodies, females were significantly less likely to consent to this than males (p = 0.001), as well as less likely to allow their donations to be utilized for anatomy outreach (p = 0.023). Racial minorities were significantly less trusting of the university to treat their donation with dignity and respect compared to White registrants (p = 0.034). Suggestions for improving BDP protocols include the implementation of an annual newsletter for registrants, improving methods to spread awareness about donation, increasing transparency during the consent process, and creating resources for donors' families.

A cross-sectional survey on university students' knowledge, attitudes, and behaviors regarding organ, tissue, and body donation

PURPOSE

Body donors continue to have an important role in anatomy education in medical schools. Furthermore, the demand for organ transplantation is increasing as life expectancy increases. In Turkey, there are efforts to enable both donations to be made through a single system. These issues were addressed together, and it was aimed to evaluate the level of knowledge and attitudes of medical and law students regarding tissue-organ and body donation.

METHODS

A questionnaire consisting of 29 questions was administered to 693 individuals to measure these aspects. Data were analyzed using a one-way analysis of variance with Bonferroni correction. Categorical data collected during the study were summarized in terms of frequency and percentage.

RESULTS

When asked about their willingness to donate their bodies, 39.4% answered no, 29.5% responded yes, and 31.1% were undecided. Regarding organ donation, 61.8% of the participants expressed willingness, 22.8% were undecided, and 15.4% declined. Notably, there was a significant difference between those who had prior knowledge of organ tissue and body donation and those who did not (p < 0.001).

CONCLUSION

The findings of our research indicate that knowledge about organ tissue and body donation, as well as the inclination to donate, increased as medical education progressed into clinical practice. Additionally, the level of knowledge among university students on this subject was found to be correlated with whether they had received prior training on the topic. It was observed that there is a need to provide more education for students to understand the importance of organ and body donation.

Whole body donation for teaching in Ghana: The perspectives of medical doctors

Historically, both donated bodies and unclaimed bodies have been the sources of human bodies for anatomy dissection globally with the latter discouraged for ethical reasons. Ghana lacks well-established body-donation programs, thus relying heavily on unclaimed bodies. Medical doctors benefit foremost from human bodies in their training and therefore should have a better disposition toward body bequeathal. This study assessed the perception, knowledge, and attitude of medical doctors in a Ghanaian institution toward body donation. As the first Ghanaian study on the subject, it provides the foundation for systematic study of the subject in Ghana. An internet-based questionnaire was administered to volunteering medical doctors requesting information on their perception of, knowledge of, and attitude toward whole-body donation. Data were summarized as frequencies. The 200 respondents comprised 1 consultant, 4 specialists, 14 residents, 63 medical officers, and 118 house officers. About 194 (97.0%) were familiar with body donation while 6 (3.0%) were not. Also, 39 (19.5%) were willing to donate their bodies, 98 (49.0%) were unwilling, and 63 (31.5%) undecided. Religion, culture, mishandling of bodies, and lack of awareness were barriers to body donation. Finally, 178 (89.0%) viewed human body dissection as relevant and should remain as part of medical curriculum. Doctors were aware of body donation though only few were willing to donate. Cultural and religious factors were major hindrances to body donation for anatomy education and research, though they were willing to persuade others to participate. Deliberate public education on the subject is required to grow body donation in Ghana.

The legal and ethical framework governing body donation in Europe - 2nd update on current practice

BACKGROUND

In 2008, members of the TEPARG provided first insights into the legal and ethical framework governing body donation in Europe. In 2012, a first update followed. This paper is now the second update on this topic and tries to extend the available information to many more European countries.

METHODS

For this second update, we have asked authors from all European countries to contribute their national perspectives. By this enquiry, we got many contributions compiled in this paper. When we did not get a personal contribution, one of us (EB) searched the internet for relevant information.

RESULTS

Perspectives on the legal and ethical framework governing body donation in Europe.

CONCLUSIONS

We still see that a clear and rigorous legal framework is still unavailable in several countries. We found national regulations in 18 out of 39 countries; two others have at least federal laws. Several countries accept not only donated bodies but also utilise unclaimed bodies. These findings can guide policymakers in reviewing and updating existing laws and regulations related to body donation and anatomical studies.

Motivational factors, attitudes, and knowledge about the cadaveric body donation program among body donors in Myanmar

To achieve the simple goal of cadaveric body donation (CBD) program-gaining deceased donors-numerous scientific studies have been conducted, including the current study. This cross-sectional descriptive study used questionnaires to assess the motivational factors, attitudes, and knowledge of registered body donor participants toward CBD. Among 372 respondents, most (80.6%) were motivated by specific reasons such as "to save lives through medical education," "to contribute to medical research," and "to help medical students." Most respondents had good attitudes (61.7%) but poor knowledge (55.9%) about the CBD program, and there was no association among them (p = 0.08). However, the good knowledge and good attitude level were found 1.7 times (p = 0.02) and 2.4 times (p = 0.005) more, respectively, in basic-educated respondents than in highly educated respondents, implying the influence of peer conversation and message diffusion instead of knowledge or attitudes acquired through education. Additionally, 75% of respondents had co-registration within their family, peers were chosen by 66.7% of respondents as a source of information, and married respondents had 1.8 times better knowledge than unmarried respondents (p = 0.01), indicating the possibility of peer influence and growing peer communication. This study explored the poor knowledge status of registered donors, who are the cornerstone of knowledge propagation in the general population. Hence, after implementing this study, a knowledge-raising campaign for registered donors was conducted by distributing pamphlets about the CBD program, explaining keystone information, and supplementing a follow-up study. Moreover, this study will help us plan further strategies for program enhancement.

Knowledge levels and attitudes of medical faculty students related to whole body donation in Türkiye

BACKGROUND

Cadaver is a very important educational material for medical faculty students, students of health sciences, residents of any specialty in medicine and specialists. In developed countries, cadavers are mainly obtained by individual donations. However, like in other developing or underdeveloped countries, whole-body donations for cadaveric use in Türkiye are extremely scarce. This study sought to investigate the knowledge and awareness levels of medical faculty students about body donation and the factors that might influence their attitudes to body donation. The aim of the study is, with the results of the questionnaire, to raise public awareness for whole-body donation by creating public spots and by giving place in the official website of the Ministry of Health and make medical faculties to put lectures about body donation and its importance into their anatomy curriculum.

METHODS

A 31-item questionnaire with close-ended statements was administered to 291 students at Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty.

RESULTS

Only two of the participants (0.7%) stated that they had already donated their bodies to be used as a cadaver. Of note, those who reported considering whole body donation had higher maternal education levels (p = 0.002). The presence or absence of religious belief and the degree of religiosity were also significant factors, for significantly higher rates of non-believers and those who defined themselves as having a low degree of religiosity were in favor of body donation (p < 0.0001).

CONCLUSIONS

According to the religion of Islam, we should inform the relevant media that there is no harm in donating a body. In addition, considering the effect of mother's education level on the decisions of young people on this issue, we can state that we see once again how important women's education is in order to make progress in every field.

Development of a Pedicle Screw Fixation Simulation Model for Surgical Training Using a 3-Dimensional Printer

OBJECTIVE

Training surgeons in pedicle screw fixation (PSF) techniques during actual surgery is limited because of patient safety, complications, and surgical efficiency issues. Recent technical developments are leading the world to an era of personalized three-dimensional (3D) printing. This study aimed to evaluate the educational effect of using a 3D-printed spine model to train beginners in PSF techniques to improve screw accuracy and procedure time.

METHODS

Computed tomography (CT) scan data were used in a 3D printer to produce a life-size lumbar spine replica of L1-3 vertebrae. Four residents performed PSF thrice. Each resident performed 18 screw fixations on both sides (6 screws per trial). The time to complete the procedure and pedicle violation was recorded.

RESULTS

The average time for the 3 procedures was 42.1±2.9 minutes, 38.8±3.3 minutes, and 32.1±2.5 minutes, respectively. Furthermore, the average pedicle screw score for the 3 procedures was 13.0±0.8, 14.5±0.6, and 16.0±0.8, respectively. As the trial was repeated, the procedure time decreased and the accuracy of screw fixation tended to be more accurate.

CONCLUSIONS

It was possible to decrease the procedure time and increase accuracy through repeated training using the 3D-printed spine model. By implementing a 3Dprinted spine model based on the patient's actual CT data, surgeons can perform simulation surgery before the actual surgery. Therefore, this technology can be useful in educating residents to improve their surgical skills.

Understanding beliefs, preferences and actions amongst potential body donors

Body donation is a prosocial act providing a unique learning experience to students, ultimately impacting on patient care and science. With an increasing number of training professionals, there is an increasing need for body donors, yet little is understood about donors' beliefs and preferences. A four-center study aimed to understand donors' perceptions, 843 responses highlighted a significant relationship between completing a body donor consent form and being both an organ donor and having ever donated blood (p < 0.01). In exploring donor intentions, 69% had been considering donation for fewer than five years, 40% knew another body donor, and 27% had a family member or friend currently registered. Of those who had requested donor information packs, 97% had completed body donation consent forms. Of these, 92% had not selected any time restriction for their donation and 96% had consented to images being taken. Almost all (98%) were aware that their donation might not be accepted. Donors' motives highlighted a wish to: improve education, improve health care, advance science, and contribute to the greater good. A bimodal response was observed with body donation being used to save relatives money and inconvenience. Donors felt comfortable with their bodies being used by medical, dental, and allied health professionals; however, donors were less comfortable with their bodies being used by other groups. Only 57% were comfortable with artists, beauticians and yoga teachers using their remains. Understanding donors' motivations and decision-making process is vital to ensure resources for future and to meet any changing requirements of both donors and those studying them.

Human body donation and surgical training: a narrative review with global perspectives

Utilization of human material in surgical simulation training has been well-established as an effective teaching method. Despite the value of donor-based surgical simulation training, its application may be hampered by difficulties regarding access to donated bodies. Therefore, the aim of this review is to assess body donation and body acquisition practices with regard to surgical simulation training programs around the world. The results of this review highlight discrepancies regarding body donation practices and surgical simulation programs among continents and countries. The utilization of donor bodies in surgical simulation appears to mirror body donation practices. In countries that rely mostly or exclusively upon unclaimed bodies or executed criminals, there are scant reports of donor-based surgical simulation programs. In countries where willed-body donation is the principal source of human material, there tend to be many surgical simulation programs that incorporate human material as part of surgical training. This review suggests that, in anatomical and surgical education, the utilization of active willed-body donation programs, as opposed to the utilization of unclaimed human bodies, positively corresponds with the development of beneficial donor-based surgical simulation programs. Likewise, donor-based surgical simulation training programs may have an influence on the perpetualization of willed-body donations.

Musculoskeletal anatomy: evaluation and comparison of common teaching and learning modalities

Anatomy teaching has traditionally been based on dissection. However, alternative teaching modalities constantly emerge, the use of which along with a decrease in teaching hours has brought the anatomy knowledge of students and young doctors into question. In this way, the goal of the present study is to a. compare the efficacy of the most common teaching modalities and b. investigate students' perceptions on each modality. In total, 313 medical students were taught gross anatomy of the upper limb, using four different learning modalities: dissection (n = 80), prosections (n = 77), plastic models (n = 84) and 3D anatomy software (n = 72). Students' knowledge was examined by 100 multiple-choice and tag questions followed by an evaluation questionnaire. Regarding performance, the dissection and the 3D group outperformed the prosection and the plastic models group in total and multiple-choice questions. The performance of the 3D group in tag questions was also statistically significantly higher compared to the other three groups. In the evaluation questionnaire, dissection outperformed the rest three modalities in questions assessing students' satisfaction, but also fear or stress before the laboratory. Moreover, dissection and 3D software were considered more useful when preparing for clinical activities. In conclusion, dissection remains first in students' preferences and achieves higher knowledge acquisition. Contemporary, 3D anatomy software are considered equally important when preparing for clinical activities and mainly favor spatial knowledge acquisition. Prosections could be a valuable alternative when dissection is unavailable due to limited time or shortage of cadavers. Plastic models are less effective in knowledge acquisition but could be valuable when preparing for cadaveric laboratories. In conclusion, the targeted use of each learning modality is essential for a modern medical curriculum.

Mississippi's whole body donors: Analysis of donor pool demographics and their rationale for donation

BACKGROUND

Whole body donation (WBD) is fundamental to anatomical education and research because human dissection provides an educational tool for training healthcare professionals. Investigation into the demographics and rationale of whole body donors can provide insight on who donates their bodies to science. Literature reports a typical donor who is a 60 to 70-year-old, white, married, educated man with the reason for donating to be altruism. Because there are no studies in the United States (US) about the rationale of WBD in correlation with the donor characteristics, this study seeks to accomplish two aims: (1) analyze the demographics of the University of Mississippi Medical Center's (UMMC) current donor registrants and (2) analyze their reasons for donation.

METHODS

Data from authorization forms from living preregistered donors were analyzed. A survey was sent to registrants who filled out these forms between 2017 and 2019 about their reasons for body donation.

RESULTS

UMMC has an average donor registrant population consisting of 69-year-old white (95.2%), females (56.5%) who acquired a college degree (24.9%) and are in good health at the time of donation (50.8%). Males and females differed in their marital status (p = 0.001), with more married males (67.2%) than females (46.2%) donating their bodies to science. Seven hundred eighty-one registrants completed the survey (56.3% response rate, n = 1,387). Their primary and secondary reasons for donation were furthering medical education/research (57.4%) and giving their body purpose after life (49.2%), respectively. In addition, thematic analysis of 62 donor rationale statements revealed that the majority of registrants wanted to donate their bodies for the purpose of being useful.

CONCLUSIONS

These results indicate that UMMC's current registrant demographic data deviates from what is presented in the literature. The study also found that the main reason for donation for this registrant population was altruism with the purpose of being useful. Information from this study adds current US data to the published literature on WBD.

A graphical guide for constructing a finite element model of the cervical spine with digital orthopedic software

Three-dimensional (3D) reconstruction and finite element analysis (FEA) have been extensively used to simulate cervical biomechanics. However, instructive articles providing full descriptions for operating Mimics software, Geomagic software, and FEA are rare in the literature. This omission has hindered research and development related to cervical spine biomechanics. Herein, we expound a detailed and easily understandable protocol for performing a digital biomechanics study which may facilitate a better understanding of the internal anatomy mechanics and the investigation of novel screw fixation techniques. We describe step-by-step instructions for use of Mimics and Geomagic software in FEA, along with a concise literature review. The key procedures of digital FEA stepwise instruction are presented, accompanied by a brief but complete report on the computed tomography (CT) imaging data for establishing the final finite element model. Previous publications regarding the commonly used software are also reviewed and discussed. Each piece of software performs a specific function for digital FEA establishment and each has its inherent shortcomings, making it is necessary to combine the software to leverage the advantages of each in order to best serve finite element research. For reasons of brevity, this study only provides an illustrative report on a small key part of finite element research in the cervical spine. These stepwise instructions can guide orthopedic researchers in conducting FEA studies in digital cervical biomechanics.

Human anatomy education and management of anatomic specimens during and after COVID-19 pandemic: Ethical, legal and biosafety aspects

COVID-19 is an infection caused by the SARS-CoV-2 virus, initially identified in the city of Wuhan, China, in December 2019. Since then, the virus has spread to the continents, causing a major pandemic. The impacts of this pandemic on the education of human anatomy interfere in at least two aspects: (1) receiving and managing anatomical specimens in anatomy laboratories and (2) adaptations for classes on remote virtual teaching. Therefore, this study reviewed and discussed the legal and bioethical aspects, considering the scenario of a South American Country, aiming to stimulate the debate on these two relevant themes in the international community. Because of the COVID-19 pandemic and the impossibility of mass testing, anatomists and other workers in the field must deal with the risk of receiving bodies infected with SARS-CoV-2. In this situation, additional care measures in biosafety practices are essential to protect the staff. Such measures are: the bodies must be preserved by the perfusion of formaldehyde or other fixative solutions; embalming must be performed in ventilated rooms with a good air exhaust system; to avoid excessive manipulation of bodies and procedures such as pulmonary insufflation or craniotomy; and proper use of personal protective equipment, including lab coat, gloves and masks. As for exposure of body images in online classes, this review showed that there are no legal impediments to this end. However, anatomists must adopt measures aimed at protecting the memory of the deceased, such as using secure digital platforms with restricted access; family authorization/consent and student awareness.

Anatomy Learning from Prosected Cadaveric Specimens Versus Plastic Models: A Comparative Study of Upper Limb Anatomy

Human cadaveric prosections are a traditional, effective, and highly appreciated modality of anatomy learning. Plastic models are an alternative teaching modality, though few studies examine their effectiveness in learning of upper limb musculoskeletal anatomy. The purpose of this study is to investigate which modality is associated with a better outcome, as assessed by students' performance on examinations. Overall, 60 undergraduate medical students without previous knowledge of anatomy participated in the study. Students were assigned into two groups. Group 1 attended lectures and studied from cadaveric prosections (n = 30) and Group 2 attended lectures and used plastic models in the laboratory (n = 30). A knowledge assessment, including examination with tag questions (spot test) and written multiple-choice questions, was held after the end of the study. Students' perceptions were also investigated via an anonymous questionnaire. No significant difference in students' performance was observed between the group using prosections and the group using plastic models (32.2 ± 14.7 vs 35.0 ± 14.8, respectively; P = 0.477). Similarly, no statistically significant difference was found regarding students' satisfaction from using each learning modality (P = 0.441). Plastic models may be a valuable supplementary modality in learning upper limb musculoskeletal anatomy, despite their limitations. Easy to use and with no need for maintaining facilities, they are highly appreciated by students and can be useful when preparing for the use of cadaveric specimens.

Effects of Commemorations and Postdonation Services on Public Willingness to Donate Bodies in China

Multiple body donation programs have been established throughout China over the last 20 years, but these programs remain challenged by an insufficient supply of cadavers for medical education. The commemoration of body donors is a feature of many successful programs, and adopting this practice throughout the country could be an important element of raising public awareness and encouraging body donation among the public. The present study aimed to investigate public views on the commemoration of whole-body donors and postdonation services in China by analyzing the factors that influence participants' willingness to donate. A survey was conducted using convenience sampling with a non-probability sampling method, and data were analyzed using chi-square and post hoc multiple comparisons tests. A total of 1,800 questionnaires were distributed, 1,717 were returned, and 1,605 were considered valid. Of the respondents, 20.87% were willing to donate, and 64.80% thought that it is necessary to commemorate donors. The results of multiple comparisons demonstrated that the elderly and those with a higher educational level were more willing to donate than participants in other groups. Education was also found to influence views on donation memorial activities, and the chi-square test revealed that conducting commemorations and improving postdonation services can promote the establishment of successful donor programs in China and improve the social acceptance of body donation.

Perceptions and Attitudes toward Brain Donation among the Chinese People

Postmortem human brain donation is crucial to both anatomy education and research. The China Human Brain Banking Consortium was established recently to foster brain donation in China. The purpose of this study was to gain information about the public perception of and attitudes toward brain donation and to identify factors that may impact the willingness to participate in brain donation among the Chinese people. A specifically designed questionnaire was delivered to community residents in Changsha (the capital city of Hunan province) with a total of 1,249 completed forms returned and statistically analyzed. The majority of the participants considered that brain donation would help medical research and education, and 32.0% of respondents agreed that the brain donation would help change the traditional Chinese funeral belief in keeping the body intact after death. However, participants aged over 60 years old were less supportive of this concept. Among all participants, 63.7% stated that they were not knowledgeable about brain donation, while 26.4% explicitly expressed a willingness to participate in brain donation. Age, gender, monthly household income, and knowledge about brain donation significantly affected the willingness. Compared with other age groups, a higher proportion of participants aged over 60 years old preferred to be informed by a medical college. To promote brain donation in China, especially among the elderly, better communication of its medical benefits and a reinterpretation of the Confucius view of the human body should be provided. Efforts are also needed to provide appropriate forums and sources of brain donation information to targeted communities and society in general.

A descriptive study of community-based profile and attitudes of body donors of an urban conglomeration in Western India

Background

Body donation is considered an altruistic act done by people for advancement of science. There has been a significant depreciation in the availability of cadavers for teaching and research all over the world. Unlike India, many countries have studied the profile and attitudes of potential body donors to improve body donation. With a huge health sector, this Indian study studied the profile and attitudes of body donors and their role in aiding science through body donation.

Methods

Four hundred thirty-one survey forms with informed consent were sent to registered body donors. The questionnaire focused on demographic parameters and their perception on body donation. The data were collated, compared and interpreted with similar studies done worldwide.

Results

The study shows an interesting pattern among the Indian donors in comparison to the West. An Indian donor is a male individual in 70s, highly educated and religious with good social background. Despite many similarities, there are important distinguishing features unique to our country and many myths surrounding body donation.

Conclusion

The Indian donor is highly educated male and charitable with strong belief in God. He believes in aiding medical science through body donation.

Attitudes of Turkish university employees and their relatives towards whole body and organ donation

BACKGROUND

Dissection of human anatomic specimens still keeps its importance in medical curriculum. Experiences of medical students in the anatomy laboratory and the time they spent there makes them feel as doctors at the beginning of their education and helps them to get used to the notion of death. Unfortunately, the number of human body donors available for medical research and education as well as organ transplantation is limited. Obtaining human anatomic specimens continues being a great problem especially in middle-east countries. Religious factors, socioeconomic status, education, marital status or age are probably the main factors those effect body donations. The aim of the present study is to evaluate the attitudes of Turkish university employees and their relatives towards whole body donation and organ donation.

METHODS

A total of 780 questionnaires taken from the participants were evaluated. All the participants were academic and administrative staff from four different universities based in Ankara, Eskişehir, İstanbul and Adana and their relatives. Participants were between the ages of 18-85. All the subjects were provided a questionnaire composed of 38 questions.

FINDINGS

26.2% of the individuals declared that they could donate their body for medical education while 73.8% of them did not. In contrast, 69.1% of the participants were willing for being organ donors. Of the ones who had accepted to donate their organs, 64.5% refused to donate their bodies.

CONCLUSION

The results of this study indicate that not only whole body donation, but also organ donation continue being a problem in Turkey.

The addition of 3D printed models to enhance the teaching and learning of bone spatial anatomy and fractures for undergraduate students: a randomized controlled study

Background

Whether or not the addition of 3D (three-dimension) printed models can enhance the teaching and learning environment for undergraduate students in regard to bone spatial anatomy is still unknown. In this study, we investigated the use of 3D printed models versus radiographic images as a technique for the education of medical students about bone spatial anatomy and fractures.

Methods

The computed tomography (CT) data from four patients, each with a different fracture type (one spinal fracture, one pelvic fracture, one upper limb fracture, and one lower limb fracture), were obtained, and 3D models of the fractures were printed. A total of 90 medical students were enrolled in the study and randomly divided into two groups as follows: a traditional radiographic image group (presented by PowerPoint) and a 3D printed model group (combined PowerPoint and 3D models). Each student answered 5 questions about one type of fracture and completed a visual analog scale of satisfaction (0-10 points).

Results

No significant differences were found in the upper limb or lower limb test scores between the 3D printed model group and the traditional radiographic image group; however, the scores on the pelvis and spine test for the traditional radiographic image group were significantly lower than the scores for the 3D printed model group (P=0.000). No significant differences were found in the test-taking times for the upper limb or lower limb (P=0.603 and P=0.746, respectively) between the two groups; however, the test-taking times for the pelvis and spine in the traditional radiographic image group were significantly longer than those of the 3D printed model group (P=0.000 and P=0.002, respectively).

Conclusions

The 3D printed model may improve medical students' understanding of bone spatial anatomy and fractures in some anatomically complex sites.

Bodies for Anatomy Education in Medical Schools: An Overview of the Sources of Cadavers Worldwide

The International Federation of Associations of Anatomists (IFAA) recommended in 2012 that only donated bodies be used for anatomy teaching and research. However, in many countries around the world, anatomists still depend on bodies that do not stem from voluntary donations by the deceased but, rather, are "unclaimed." A broad search of the literature was conducted to produce a baseline overview of the sources of cadavers used for anatomy teaching in undergraduate medical curricula on a global scale. Information from the literature search was supplemented with data from a 2016-2017 survey of selected senior local anatomists. Of 165 countries with medical schools, information was gathered for 71. In 22 (32%) of the 68 countries that use cadavers for anatomy teaching, body donation is the exclusive source of bodies. However, in most other countries, unclaimed bodies remain the main (n = 18; 26%) or exclusive (n = 21; 31%) source. Some countries import cadavers from abroad, mainly from the United States or India. In one country, bodies of executed persons are given to anatomy departments. The heterogeneous geographical distribution of body sources cannot easily be accounted for, but religion, culture, and folk beliefs about what should happen to bodies after death seem to play a role. Implementation of the IFAA recommendations still has a long way to go, but it is encouraging that functioning body donation programs exist on all continents and that there are examples of recent rises in donations and of anatomists initiating new donation programs.

Use of a life-size three-dimensional-printed spine model for pedicle screw instrumentation training

Background

Training beginners of the pedicle screw instrumentation technique in the operating room is limited because of issues related to patient safety and surgical efficiency. Three-dimensional (3D) printing enables training or simulation surgery on a real-size replica of deformed spine, which is difficult to perform in the usual cadaver or surrogate plastic models. The purpose of this study was to evaluate the educational effect of using a real-size 3D-printed spine model for training beginners of the free-hand pedicle screw instrumentation technique. We asked whether the use of a 3D spine model can improve (1) screw instrumentation accuracy and (2) length of procedure.

Methods

Twenty life-size 3D-printed lumbar spine models were made from 10 volunteers (two models for each volunteer). Two novice surgeons who had no experience of free-hand pedicle screw instrumentation technique were instructed by an experienced surgeon, and each surgeon inserted 10 pedicle screws for each lumbar spine model. Computed tomography scans of the spine models were obtained to evaluate screw instrumentation accuracy. The length of time in completing the procedure was recorded. The results of the latter 10 spine models were compared with those of the former 10 models to evaluate learning effect.

Results

A total of 37/200 screws (18.5%) perforated the pedicle cortex with a mean of 1.7 mm (range, 1.2–3.3 mm). However, the latter half of the models had significantly less violation than the former half (10/100 vs. 27/100, p < 0.001). The mean length of time to complete 10 pedicle screw instrumentations in a spine model was 42.8 ± 5.3 min for the former 10 spine models and 35.6 ± 2.9 min for the latter 10 spine models. The latter 10 spine models had significantly less time than the former 10 models (p < 0.001).

Conclusion

A life-size 3D-printed spine model can be an excellent tool for training beginners of the free-hand pedicle screw instrumentation.

Current status of cadaver sources in Turkey and a wake-up call for Turkish anatomists

Persisting difficulties in body procurement in Turkey led to the acquisition of donated, unclaimed, autopsied, and imported bodies regulated under current legislature. Yet, no study had investigated the extent of the on-going cadaver problem. This study was aimed to outline cadaver sources in anatomy departments and their effectiveness by means of an online survey. Additionally, official websites of each department were investigated regarding any information on body donation. Unclaimed cadavers (84.8%) were the major source for anatomy departments, followed by donated (50%) and imported cadavers (39.1%). Foundation-based medical faculties were more likely to import cadavers (P = 0.008). There was a moderate increase (r_s  = 0.567; P = 0.018) in donation registrations to our department after 2000. The departments in cities with significantly higher City-Based Gross Domestic Product measures (US$9,900 vs. US$16,772, P = 0.041), frequencies for mid- or high-school graduates (30.4% vs. 31.3%, P = 0.041), and frequencies for under- or post-graduates (13.1% vs. 15.8%, P = 0.24) had managed to use donated cadavers. Anatomy departments' major reasons for using unclaimed cadavers were education (45.9%), unclaimed cadavers being the only source (24.3%), and receiving inadequate donations (21.6%). Nine out of seventy-four departments (12.2%) provided information regarding body donation on their websites. Body procurement remains as a serious problem in Turkey and it is apparent that current legislature does not provide a sufficient cadaver inflow. Similarly, anatomy departments' effectiveness in public awareness of body donation and support in the National Body Donation Campaign seems questionable. Anat Sci Educ 11: 155-165. © 2017 American Association of Anatomists.

Three-dimensional reconstructions in spine and screw trajectory simulation on 3D digital images: a step by step approach by using Mimics software

There is a rapidly increasing amount of literature outlining the use of three-dimensional (3D) reconstruction and printing technologies in recent years. However, precise instructive articles which describe step-by-step methods of reconstructing 3D images from computed tomography (CT) or magnetic resonance imaging (MRI) remain limited. To address these issues, this article describes a detailed protocol which will allow the reader to easily perform the 3D reconstruction in their future research, to allow investigation of the appropriate surgical anatomy and allow innovative designs of novel screw fixation techniques or pre-operative surgical planning.

Improving the trajectory of transpedicular transdiscal lumbar screw fixation with a computer-assisted 3D-printed custom drill guide

Transpedicular transdiscal screw fixation is an alternative technique used in lumbar spine fixation; however, it requires an accurate screw trajectory. The aim of this study is to design a novel 3D-printed custom drill guide and investigate its accuracy to guide the trajectory of transpedicular transdiscal (TPTD) lumbar screw fixation. Dicom images of thirty lumbar functional segment units (FSU, two segments) of L1-L4 were acquired from the PACS system in our hospital (patients who underwent a CT scan for other abdomen diseases and had normal spine anatomy) and imported into reverse design software for three-dimensional reconstructions. Images were used to print the 3D lumbar models and were imported into CAD software to design an optimal TPTD screw trajectory and a matched custom drill guide. After both the 3D printed FSU models and 3D-printed custom drill guide were prepared, the TPTD screws will be guided with a 3D-printed custom drill guide and introduced into the 3D printed FSU models. No significant statistical difference in screw trajectory angles was observed between the digital model and the 3D-printed model (P > 0.05). Our present study found that, with the help of CAD software, it is feasible to design a TPTD screw custom drill guide that could guide the accurate TPTD screw trajectory on 3D-printed lumbar models.

Cultural acceptability and personal willingness of Iranian students toward cadaveric donation

Cadaver dissection stands as a crucial component in medical curricula around the world, although computer-based multimedia programs have been introduced in order to replace the need for cadaver donations. Due to a decrease in the number of unclaimed bodies and rather few donations, there is an insufficient number of cadavers for anatomical studies in Iran. This study was carried out to evaluate medical students' awareness and willingness regarding body donation in Kashan University of Medical Sciences, Iran. In this study, a questionnaire was designed to focus on the cultural acceptability and personal willingness to donate one's body after death. Students from the university's anatomy classes (n = 331) participated in this study. Seventy-seven percent of the students expressed their agreement toward the idea of utilizing body donation services, though only 25.4% of participants were willing to donate their own bodies. None of the demographic factors were associated with cultural acceptability or personal willingness towards body donation. These findings indicated that besides "payment", other factors were associated with students' willingness to become donors. All factors of awareness except "previous awareness of organization" were associated with cultural acceptability. In this study, students suggested that encouraging people to register for body donation using mass media (25.6%) and teaching students to respect cadavers in the dissection environment (24.8%) were the best solutions for addressing the lack of cadavers. These findings indicated that a lack of awareness about body donation might be the main factor responsible for unwillingness towards body donation; therefore, improving the public's awareness and addressing the willingness of students regarding body donation may help overcome the current lack of donated cadavers. Anat Sci Educ 10: 120-126. © 2016 American Association of Anatomists.

Human cadaveric dissection: a historical account from ancient Greece to the modern era

The review article attempts to focus on the practice of human cadaveric dissection during its inception in ancient Greece in 3rd century BC, revival in medieval Italy at the beginning of 14th century and subsequent evolution in Europe and the United States of America over the centuries. The article highlights on the gradual change in attitude of religious authorities towards human dissection, the shift in the practice of human dissection being performed by barber surgeons to the anatomist himself dissecting the human body and the enactment of prominent legislations which proved to be crucial milestones during the course of the history of human cadaveric dissection. It particularly emphasizes on the different means of procuring human bodies which changed over the centuries in accordance with the increasing demand due to the rise in popularity of human dissection as a tool for teaching anatomy. Finally, it documents the rise of body donation programs as the source of human cadavers for anatomical dissection from the second half of the 20th century. Presently innovative measures are being introduced within the body donation programs by medical schools across the world to sensitize medical students such that they maintain a respectful, compassionate and empathetic attitude towards the human cadaver while dissecting the same. Human dissection is indispensable for a sound knowledge in anatomy which can ensure safe as well as efficient clinical practice and the human dissection lab could possibly be the ideal place to cultivate humanistic qualities among future physicians in the 21st century.

The accuracy of a method for printing three-dimensional spinal models

Background

To study the morphology of the human spine and new spinal fixation methods, scientists require cadaveric specimens, which are dependent on donation. However, in most countries, the number of people willing to donate their body is low. A 3D printed model could be an alternative method for morphology research, but the accuracy of the morphology of a 3D printed model has not been determined.

Methods

Forty-five computed tomography (CT) scans of cervical, thoracic and lumbar spines were obtained, and 44 parameters of the cervical spine, 120 parameters of the thoracic spine, and 50 parameters of the lumbar spine were measured. The CT scan data in DICOM format were imported into Mimics software v10.01 for 3D reconstruction, and the data were saved in .STL format and imported to Cura software. After a 3D digital model was formed, it was saved in Gcode format and exported to a 3D printer for printing. After the 3D printed models were obtained, the above-referenced parameters were measured again.

Results

Paired t-tests were used to determine the significance, set to P<0.05, of all parameter data from the radiographic images and 3D printed models. Furthermore, 88.6% of all parameters of the cervical spine, 90% of all parameters of the thoracic spine, and 94% of all parameters of the lumbar spine had Intraclass Correlation Coefficient (ICC) values >0.800. The other ICC values were <0.800 and >0.600; none were <0.600.

Conclusion

In this study, we provide a protocol for printing accurate 3D spinal models for surgeons and researchers. The resulting 3D printed model is inexpensive and easily obtained for spinal fixation research.

Predicting People's Intention to Donate Their Body to Medical Science and Research

Predictors of people's intention to register with a body bequest program for donating their deceased body to medical science and research were examined using standard theory of planned behavior (TPB) predictors (attitude, subjective norm, perceived behavioral control) and adding moral norm, altruism, and knowledge. Australian students (N = 221) at a university with a recently established body bequest program completed measures of the TPB's underlying beliefs (behavioral, normative, and control beliefs) and standard and extended TPB predictors, with a sub-sample reporting their registration-related behavior 2 months later. The standard TPB accounted for 43.6%, and the extended predictors an additional 15.1% of variance in intention. The significant predictors were attitude, subjective norm, and moral norm, partially supporting an extended TPB in understanding people's body donation intentions. Further, important underlying beliefs can inform strategies to target prospective donors.

An overview of the roles and responsibilities of Chinese medical colleges in body donation programs

The use of human tissue is critical for gross anatomy education in the health professions. Chinese medical colleges have faced a shortage of anatomical specimens over the past decade. While body donation plays an important role in overcoming this gap, this practice has only recently been introduced in China, and the donation rate is relatively low and fraught with a number of difficulties. In the past, traditional Chinese culture focused on preserving the human body intact, which often limited body donation. In recent years, the public has become more open toward body donation. At Nanjing Medical University, only 20 bodies were donated in 2001. After the university became involved in an organized body donation program, this number increased to 70 donated bodies per year (2007 to 2012). This article describes and reviews Chinese medical colleges as a special case study among body donation programs, particularly in terms of the multiple responsibilities and roles that such institutions must assume in the course of adopting these programs. Medical colleges in China must serve as advocates, coordinators, builders, managers, educators, and beneficiaries in undertaking body donation programs. It is important for medical colleges to recognize these pluripotent roles and educate the public in order to promote body donation programs. This case study may also effectively guide and encourage Chinese medical colleges in refining their own body donation programs in the future.

Attitudes of Australian chiropractic students toward whole body donation: a cross-sectional study

Cadavers play an important role in anatomy education. In Australia, bodies for anatomy education are acquired only through donations. To gain insight into educational dynamics in an anatomy laboratory as well as to facilitate body donation programs and thanksgiving ceremonies, it is important to understand students' attitudes toward body donation. In this cross-sectional study, the attitudes of Macquarie University's first, second, and fifth year chiropractic students toward body donation were investigated. Macquarie University chiropractic students have a four semester long anatomy program, which includes cadaver-based instruction on prosected specimens. A questionnaire was used to record respondents' demographics and attitudes toward body donation: personal, by a relative, and by a stranger. It was found that ethnicity and religion affect attitudes toward body donation, with Australian students being more willing to donate a stranger's body and atheists and agnostics being more willing to donate in general. Furthermore, willingness to donate one's own or a family member's body decreases as year of study increases, suggesting a possible negative impact of exposure to cadavers in the anatomy laboratory. This was only true, however, after controlling for age. Thus, the impact of viewing and handling prosected specimens, which is the norm in anatomy classes in Australia, may not be as strong as dissecting cadavers. It is suggested that anatomists and educators prepare students for cadaver-based instruction as well as exhibit sensitivity to cultural differences in how students approach working with cadavers, when informing different communities about body donation programs and in devising thanksgiving ceremonies.

The dissection room experience: A factor in the choice of organ and whole body donation--a Nigerian survey

The psychosocial impact of human dissection on the lives of medical and health science students has been noted. To assess the impact of the dissection room experience on one's willingness to become a whole body and organ donor, the attitudes of 1,350 students and professionals from the medical, health, and non-health related disciplines to body and organ donation were studied. The participants were broken into categories according to degree of exposure to human dissection. Participants who were never exposed to the dissection experience showed more willingness to donate their bodies than those who were exposed. With the exception of the physiotherapy department, the students and professionals from the health science departments who were exposed to the dissection room but never engaged in dissection showed the most unwillingness to donate their bodies (P < 0.001). An unwillingness to donate oneself was noted as one of the negative impacts associated with exposure to the dissection room. Willingness to donate an organ correlated positively with the level of exposure to the dissection room (P < 0.001). Most of the reasons for unwillingness were traceable to negative perceptions of the dissection room as a result of poor and disrespectful management of the human cadavers.