Global Vision

Human anatomy has always been a challenging subject for aspiring doctors.

It's taught in the first year of medical school when students find themselves trying to absorb a fusillade of new information under trying circumstances. To make matters worse, educators have few realistic learning aids to offer besides cadavers that are stiff and discolored from the embalming process.

A remarkable series of videotapes may, however, hold the key to presenting students and practicing doctors with the most realistic overview of human anatomy ever created.

"Acland's Video Atlas of Human Anatomy," produced by UofL surgery professor Robert Acland, M.D., is a series of five 2 1/2-hour VHS cassettes detailing virtually every aspect of the human body. (A sixth and final tape is scheduled for release in the spring of 2002, and DVD versions with interactive menus should be available a few months later.)

The tapes, which have sold more than 85,000 copies worldwide since their introduction in 1995, are not meant to replace traditional methods of instruction, Acland says. But they do offer a unique view of the human body using unenbalmed tissue that retains its natural color and full mobility.

The highly acclaimed series also has one major advantage over textbooks: Anatomical subject matter is presented in three dimensions using a unique camera technique that rotates the image around both the horizontal and vertical axes, as though specimens are spinning in air.

"The Video Atlas is intended to reduce the time required to understand human anatomy in three dimensions -- and 'three dimensions' is the point of emphasis," says Acland, director of the Fresh Tissue Dissection Laboratory at UofL's School of Medicine.

"It's not too hard to understand anatomy in terms of chalkboard diagrams and two-dimensional images with lists of memorized structures.

"But to actually understand what's where in three dimensions is an immense learning task. Few people can create a mental picture that's three-dimensional by looking at pictures in books.

"Our camera technique presents a rotating image to the human brain, which can synthesize a three-dimensional concept out of that, allowing a student to better comprehend anatomical structures.

"Object rotation is what we do naturally when we're curious about an object," Acland adds. "If the object is small, we pick it up and turn it around. If it's big, we walk around it.

"Either way, we give our brain a succession of images that it synthesizes to create a three-dimensional object. Once we gain that image, we know the object in a way we never could by looking at two-dimensional pictures of it."

Acland's rotating-image technique owes its genesis to a fortunate bit of happenstance back in 1984. The clinical anatomist and plastic surgeon, who earlier in his career had produced a popular series of videotapes on microsurgical techniques, was in the habit of using video gear to aid classroom instruction.

On this particular day, Acland was videotaping an anatomical specimen when the camera mount -- an old and somewhat unstable surgical light fixture -- began to drift along an arc. The resulting imagery was, Acland says, remarkable.

"We went back to the start of the tape and saw that we had accidentally created the image of something very nice. The amazing thing was that the specimen was located precisely in the axis of rotation, so as the camera went around, the background was whirling past but the object stayed centered as it rotated in space. It looked perfectly three-dimensional."

This fortuitous incident sparked Acland's imagination: Here was a technique perfectly suited to teaching human anatomy. Unfortunately, video technology was still relatively crude in 1984. Acland's equipment was useful in a limited sense to supplement classroom instruction, but he would need prohibitively expensive broadcast-quality gear to produce an adequate overview of human anatomy.

Acland put the idea on hold until the fall of 1993, when a second occurrence spurred him to re-evaluate the concept. He had just finished delivering an anatomy lecture to first-year UofL medical students when one of those students approached him and struck up a conversation.

Acland's lecture had featured several photographs of anatomical structures, and the student suggested that a video presentation of the same material would be extraordinarily helpful.

"One of our senior professors, who was standing by and overheard the conversation, said, 'Bob, you've had that in your mind for 10 years. You should do that because you're the one who could,'" Acland recalls.

Indeed, Acland had the knowledge and the experience. And now, with the cost of professional video equipment having dropped enough to make the project feasible, the Video Atlas of Human Anatomy was an idea whose time had come. Technological advances had even made cameras small enough to move easily through space, allowing the three-dimensional effect Acland would help pioneer.

Backed by UofL surgery department chairman Hiram Polk Jr., M.D., and armed with $360,000 in funding from Jewish Hospital Foundation, Norton Heathcare and the United States Surgical Corp., Acland set about building a professional TV studio featuring Betacam SP video gear and a sophisticated camera mount he personally designed.

Creating the images would, however, prove more difficult. It was painstaking work.

"Each minute of the finished product absorbs 12 hours of my time," Acland says. "It takes me five hours alone to write the script for one minute's worth of tape because I have to sit and think for the longest time to dream up the sequence of words and images that would best explain the anatomy in the most succinct manner possible. And then I have to go back and relearn the anatomy myself by doing a number of learning dissections on specimens before I start taping."

Once Acland completes his carefully choreographed videography, often with the help of skilled dissecting assistants and physicians like Ramon DeJesus, Tuncay Üstüner, Ivan Ljubic and Heidi Bas, he takes the raw footage to UofL's Television Services division.

There, Ken High, Randy Cissel and Ron Harrison edit the tape into a polished product complete with graphics, music and Acland's own voice-overs.

First-time viewers might think they've mistakenly selected a PBS program to watch -- Alistair Cooke's Masterpiece Theatre, perhaps -- instead of an educational video on human anatomy. Each tape begins with a lilting passage of orchestral string music, gracefully spinning video images and Acland's erudite British accent expressing thanks to the series' sponsors.

Acland's narration is, in fact, one of the series' most compelling features. He uses precise enunciation and the simplest possible language -- "front" rather than "anterior," for example -- to aid the learning process and increase accessibility.

This straightforward presentation, which includes the use of on-screen titles for anatomical structures, has earned the series a place in many high school anatomy courses despite the college-level material.

Another important feature is the manner in which anatomical structures are revealed, Acland says. The Video Atlas begins with the foundation -- in most cases, the bones -- and builds outward to the nervous system.

"This is the reverse of the order seen in dissection, where the foundation is not understood until the end," Acland notes.

Each segment of the series concludes with a review, and an accompanying booklet provides additional information, including a time index for locating any section on the tape.

By all accounts, "Acland's Video Atlas of Human Anatomy" works brilliantly. The surgeon has received dozens of letters from medical students and practicing doctors around the globe, all of whom have found it to be a phenomenal learning tool.

One grateful medical student from Nigeria writes that the first four volumes "created an unforgettable knowledge of human anatomy in my life," and he seeks help in ordering the rest of the tapes as quickly as possible.

Another correspondent describes how useful the tapes have been in the instruction of his anatomy courses at the University of the West Indies.

"The Video Atlas of Human Anatomy has had a tremendous impact on the system of medical education," writes the instructor, a physician who trained in the former Soviet Union and has taught in Ethiopia and Trinidad.

"It not only facilitates the teaching and learning of human anatomy, but it also significantly improves the quality of acquired knowledge and increases students' performances. It is obviously a great contribution to the medical sciences."

Arthur Dalley, Ph.D., agrees.

The director of medical gross anatomy at Vanderbilt University's School of Medicine, Dalley uses segments from Acland's tapes to complement his anatomy lectures, and he calls the series a "powerful supplement to the learning of human anatomy through first-hand dissection of the cadaver."

"Dr. Acland's dissections are beyond doubt the finest being performed on fresh tissue today," Dalley says. "He has developed unique methodologies which, combined with his meticulous photography, result in a masterful demonstration of functional anatomy.

"Further, he is truly gifted in his ability to identify concepts that are most challenging to students and then is able to explain and demonstrate them in a way that allows them to be clearly understood -- almost appearing simple."

For Acland, who notes that the project would not be possible without the support of the Department of Anatomical Sciences and its Body Bequeathal Program, such praise is the ultimate reward.

"I get a kick out of practically every part of this project," he says. "When I'm in my cabin in the woods and just choosing the words and dreaming up the images, that's satisfying. And when I'm figuring out some little simple gadget that will make the next difficult shot possible, that's satisfying.

"And then at the end of the day in the lab -- after many hours of hard work, and I've got two minutes of real good video in the can -- that's satisfying.

"But I think the biggest satisfaction of all is hearing from an end user who says this has made a difference. That's the best reward of all."

"Acland's Video Atlas of Human Anatomy" is distributed by Lippincott Williams & Wilkins. For product information, visit www.lww.com/promos/acland. Video clips and additional background are available at http://videoatlas.louisville.edu/.