Multisensory medical illustrations of Buruli ulcer for improved disease detection, help seeking behaviour and adherence to treatment

Buruli ulcer (BU) is a skin infection caused by Mycobacterium ulcerans and a neglected tropical disease of the skin (skin NTD). Antibiotic treatments are available but, to be effective in the absence of surgery, BU must be detected at its earliest stages (an innocuous-looking lump under the skin) and adherence to prescribed drugs must be high. This study aimed to develop multisensory medical illustrations of BU to support communication with at-risk communities. We used a Think Aloud method to explore community health workers' (n = 6) experiences of BU with a focus on the role of their five senses, since these non-medical disease experts are familiar with the day-to-day challenges presented by BU. Thematic analysis of the transcripts identified three key themes relating to 'Detection,' 'Help Seeking,' and 'Adherence' with a transcending theme 'Senses as key facilitators of health care'. New medical illustrations, for which we coin the phrase "5D illustrations" (signifying the contribution of the five senses) were then developed to reflect these themes. The senses therefore facilitated an enriched narrative enabling the production of relevant and useful visuals for health communication. The medical artist community could utilise sensory experiences to create dynamic medical illustrations for use in practice.

Preference for realism in 3D anatomical scans

This study investigated individuals' preference for different levels of realism in anatomical 3D scans. Staff and students working with anatomical material at the University of Dundee were asked to look at three versions of a 3D scan of the upper limb as follows: high realism - i.e. minimally altered from the original scan; moderate realism - i.e. a more significantly processed scan; and lower realism - i.e. the most significantly processed scan. Twenty-two participants took part in the study, with the majority preferring the 'moderate realism' scan overall, suggesting however that the 'high realism' scan would be most preferable for use in relation to anatomy (i.e. cadaver) practical sessions.

Preparing anatomical scan data for sharing online

This paper gives an overview of working with anatomical scan data such as CT and surface scans. The various types of scans are discussed along with their pros and cons, before going on to provide a detailed guide as to how these can be further post-processed. A method for cleaning and enhancing scan data using the 3D modelling software ZBrush is outlined. Finally, a method for sharing the resulting scans online via Sketchfab is presented.

Representation in medical illustration: the impact of model bias in a dermatology pilot study

As greater attention is paid to representation and the 'decolonizing' of education and media, the field of medical illustration must stay current. Multiple previous studies have concluded that the majority of medical textbooks depict primarily 'default' young, white men. Many have expressed that this lack of representation resulted in feelings of alienation; others posited it is a contributing factor for the disparity of care for marginalised groups. This research took arguably the most identifiable feature, skin colour, to explore this disparity - the variation of dermatological symptom expression on melanin-dense skin for four conditions. To evaluate the impact of having a diverse range of models, a study was devised to demonstrate identification rates of melanin-dependent dermatological symptoms in a quantifiable, though non-statistically significant manner. Participants were split into two groups and asked to review four different skin conditions (Group-A receiving illustrations of homogeneous pale skin tones, and Group-B receiving illustrations depicting diverse skin tones) before identifying clinical photographs. While the group with a diverse reference pool performed marginally better overall, they performed better identifying specific conditions in which melanin levels impact the appearance of the condition. This pilot study serves as a strong base for a more developed future study.

The transparent minds: methods of creation of 3D digital models from patient specific data

This paper focuses on the method for creating 3-dimensional (3D) digital models extracted from patient- specific scans of the brain. The described approach consists of several cross-platform stages: raw data segmentation, data correction in 3D-modelling software, post-processing of the 3D digital models and their presentation on an interactive web-based platform. This method of data presentation offers a cost and time effective option to present medical data accurately. An important aspect of the process is using real patient data and enriching the traditional slice-based representation of the scans with 3D models that can provide better understanding of the organs' structures. The resulting 3D digital models also form the basis for further processing into different modalities, for example models in Virtual Reality or 3D physical model printouts. The option to make medical data less abstract and more understandable can extend their use beyond diagnosis and into a potential aid in anatomy and patient education. The methods presented in this paper were originally based on the master thesis 'Transparent Minds: Testing for Efficiency of Transparency in 3D Physical and 3D Digital Models', which focussed on creating and comparing the efficiency of transparent 3D physical and 3D digital models from real-patient data.

The devil is in the details: developing a modern methodology for detailed medical illustrations

The Pernkopf Atlas has posed an ethical dilemma for the past 30 years. Although its illustrations are of an indisputably high quality, its unethical origins yield questions with its use. This study aimed to identify successful methods for creating equal if not higher quality anatomical visualisations through an analysis and comparison of past and present medical illustrator's techniques. Pernkopf's illustrations were not used as an anatomical reference to ensure the new visuals were ethical; instead other existing visuals and written sources were compiled and reviewed to create an original 3D model of the posterior cervical triangle using ZBrush 2020. Some visualisation techniques used by Pernkopf were used as a part of this project (i.e. rendering in partial colour) this technique is not unique to Pernkopf and was also used by Henry Carter, the illustrator of Grey's anatomy. The survey was distributed to 78 participants with a strong anatomical or medical/biological art background. The reception to the new resource was positive; participants favoured it in terms of quality and ease of understanding. However, participants noted that the images in the survey were not the same resolution which may have skewed the results in favour of the new image. When rated for detail compared to the Pernkopf Atlas, the number of structures in the resource need to be increased before it can be ranked equally to the Pernkopf Atlas for detail. Participants did note that they may have selected differently depending on what was inferred by quality and detail in the survey.

Cystic Fibrosis: A Pocket Guide

In 2010, an iPad app titled 'A Patient's Guide to Cystic Fibrosis' was developed for use by Cystic Fibrosis (CF) clinical nurse specialists during a patient's annual review. Feedback from pseudo-CF patients and NHS staff including CF clinical nurse specialists and respiratory consultants about the appearance, usability and content of the app and iPad interface, and the appropriateness of the app for CF patients was positive. The visual images, animations and interactive elements of the app were sufficient in providing an engaging experience for the user. The app was deemed suitable for patients and set a foundation for the development of comprehensive and interactive CF patient information learning tools. Since 2010, the prevalence and popularity of iPad apps in healthcare have soared and apps now have the capability to include more interactive touch-based experiences with digital content such as 3D models. The original iPad app was re-developed as an Apple iBook and an Android app titled 'Cystic Fibrosis: A Pocket Guide'. This paper describes the design, development and feedback on the original iPad app and its subsequent variants, and concludes with reflections from the specialist CF nurses, who have continued to use pocket guide over 10 years.

Exploration of temporal bone anatomy using mixed reality (HoloLens): development of a mixed reality anatomy teaching resource prototype

Mixed reality (MR), a technology which supplements the real world with virtual objects, is increasingly becoming available as a teaching tool in medical education. The Microsoft HoloLens device allows operators to experience MR using a head-mounted device without interfering with their physical reality, stimulating a realistic learning experience using virtual objects. This project aimed to develop a MR anatomy teaching application with HoloLens for exploring the anatomy of the temporal bone. The educational application was developed from a multidisciplinary collaboration between undergraduate and postgraduate students across several academic disciplines with Medtronic, a medical technology company. 3D anatomical models were built using ZBrush and Blender, while the HoloLens1 application was developed using Windows 10, Visual Studio 2017, Unity and Mixed Reality Toolkit (MRTK). Modules developed within the application included a basic HoloLens tutorial, a virtual temporal bone with surgical anatomy landmarks and free drilling of the temporal bone. The basic tutorial allows the operator to adapt to the MR environment prior to exploring the anatomical landmarks of the 3D temporal bone. The free drilling of the temporal bone using vertex displacement and texture stretching replicates a real-time bone drilling experience and allows the operator to explore the anatomical relationship between different otological structures.

Interactive 3D Digital Models for Anatomy and Medical Education

This chapter explores the creation and use of interactive, three-dimensional (3D), digital models for anatomy and medical education. Firstly, it looks back over the history and development of virtual 3D anatomy resources before outlining some of the current means of their creation; including photogrammetry, CT and surface scanning, and digital modelling, outlining advantages and disadvantages for each. Various means of distribution are explored, including; virtual learning environments, websites, interactive PDF's, virtual and augmented reality, bespoke applications, and 3D printing, with a particular focus on the level of interactivity each method offers. Finally, and perhaps most importantly, the use of such models for education is discussed. Questions addressed include; How can such models best be used to enhance student learning? How can they be used in the classroom? How can they be used for self-directed study? As well as exploring if they could one day replace human specimens, and how they complement the rise of online and e-learning.

Breaking down apoptosis: animating programmed cell death in 3D for a pathology curriculum

Contemporary medical education is expected to keep up with the rapidly expanding corpus of medical scientific knowledge to train informed doctors. Swift communication and assimilation of complex concepts are required, yet traditional teaching methods are often suboptimal means to this end. This paper details the making of a concise 3D animation on the apoptotic pathways, designed to improve first-year undergraduate medical students' grasp of cell signalling. A simplified visual language was adopted to increase the effectiveness and expedite the production of beginner molecular biology animations. Favourable student feedback suggests that the chosen design approach could yield further positive results.

Histology in 3D: development of an online interactive student resource on epithelium

Epithelium is an important and highly specialised tissue type that makes up the lining of inner and outer surfaces of the human body. It is proposed that a self-study tool adds to efficient learning and lecturing on this complicated topic in medical curricula. This paper describes the development and evaluation of an online interactive 3D resource on epithelium for undergraduate medical students. A first evaluation was carried out by means of an online survey (n = 37). The resource was evaluated positively on the website in general, its visual contents and its value and potential for the medical curriculum.

The cell cycle: development of an eLearning animation

The use of eLearning resources is becoming increasingly widespread in medical education because of its numerous advantages. They awaken interest in students can be reused without loss of quality and give students added control over their own education by allowing them to review content in their own time. This article describes the development and evaluation of an innovative eLearning animation for the curriculum of the pathology class at the University of Dundee School of Medicine.

Does Virtual Haptic Dissection Improve Student Learning? A Multi-Year Comparative Study

This study investigated the haptic 'dissection' of a digital model of the hand and wrist in anatomy education at both undergraduate (UG) and postgraduate (PG) levels. The study ran over five successive years and was split into three discreet phases. Phase one compared the results of PG students across control, non-haptic and haptic groups. Phase two compared the results of UG students between control and haptic groups. Phase three compared the results of UG students across control, non-haptic and haptic groups. Results for all phases indicate that use of the model, both through haptic and non-haptic interfaces produced some significantly improved test results. The non-haptic group performing the strongest overall indicating that the addition of haptic feedback may not be beneficial to student learning.

Laparoscopic nephrectomy for adult polycystic kidney disease: safety, feasibility, and early outcomes

BACKGROUND AND PURPOSE

Indications for laparoscopic renal surgery are increasing; however, benefits in adult polycystic kidney disease (APKD) remain uncertain. Our objective was to systematically synthesize the reported literature on safety, feasibility, complications, and early outcomes of laparoscopic nephrectomy in APKD to determine clinical benefits for surgical practice.

METHODS

We conducted a meta-analysis of the published literature reporting on laparoscopic nephrectomy in APKD between 1991 and 2013. The criteria from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) study were used to assess the quality of reported literature.

RESULTS

One prospective and 15 retrospective studies of low to modest quality (according to the STROBE checklist) were identified, reporting on 293 patients who underwent laparoscopic nephrectomy for APKD. None of the studies was a randomized clinical trial (RCT). The transperitoneal approach was the most commonly used technique. Body mass index ranged from 16 to 57 (mean 26.2 kg/m(2); 53% of patients were dialysis dependent, and 31% had a previous or simultaneous transplant. Kidney length ranged from 8 to 50 cm (mean 34.5cm), and the mean mass of affected kidneys was 1647 g (range 132 g-7200 g). Duration of hospital stay ranged from 2.6 to 11 days (mean 4.9 days). Operative time ranged from 90 to 568 minutes, with 16.2% of patients needing blood transfusion. There were 24 intraoperative complications and 68 postoperative complications, a rate of 8% and 24%, respectively. A total of 16 (5%) cases were converted to an open technique. No mortality was reported in any of the included studies.

CONCLUSION

The quality of the included studies is poor, and it is difficult to argue for or against change in clinical practice because the evidence included is of level 3 and 4 only. Higher quality studies are needed to demonstrate that the technique is generalizable across all populations.

Preference for detail in medical illustrations amongst professionals and laypersons

This study investigated the preferences of medical professionals and laypersons with respect to the level of detail shown in medical illustrations (i.e. graphic art shown in patient education materials) and the complexity of the subject being depicted (i.e. a visually simple versus a visually complex subject). Additionally, respondent's age, gender, and art background were recorded to yield further insight. The results showed that generally there was preference for high-detail (complex) illustrations between the two groups, though the professionals group was somewhat more diverse in their choices. The other variables had no impact on illustration preference.