Inside and Out

Diagnostic imaging gives medical

students another view in gross anatomy lab

"Unless they become surgeons, this is the last time they are going to see their patients that way," said Kenneth Ruit, Ph.D., associate professor and vice chairman of anatomy and cell biology at the UND School of Medicine and Health Sciences, about the gross anatomy lab medical students are required to take. 

Cadaver dissection is essential to medical students' knowledge of basic human anatomy, but instructors have found it difficult to apply that knowledge to what the students will experience in their practices.  But now, thanks to the medical school's new radiology chair, Edward ("Ted") Fogarty, M.D. (Transitional Residency '98), first-year medical students are starting to see anatomy lessons inside and out. 

High-tech photo album

Fogarty provides anatomy instructors like Ruit with a library of electronic diagnostic images of the abnormalities and pathologies the students are seeing in the cadavers.  These images can be from x-rays, Computed Tomography (CT), angiography,

OsiriX, a free, downloadable Apple platform-based program, can be used to perform "virtual" dissections on diagnostic images.  In this image, the sternum and portions the overlying muscles and ribs are removed revealing the heart chambers.

mammography, Magnetic Resonance Imaging (MRI) or ultrasound.  Faculty members display the related images on a large screen, located in the gross anatomy lab, and explain how to see the abnormality or pathology in the image.      

"This lets them translate what they learn with the cadaver to diagnostic imaging right in the gross anatomy lab," said Ruit.  "We are combining the traditional dissection-based learning of anatomy with state-of-the-art digital technology for navigating and interpreting clinical imaging of patients."

The faculty members are using a free, downloadable Apple platform-based program called OsiriX to manipulate and display the images for the students.  The program allows faculty and students to create multidimensional images and combine different types of images.  The program also can separate out only parts of the image so, as an example, an image can be changed to reveal only blood vessels.   

The goal of the addition of radiology to gross anatomy lab is twofold:  It will improve radiology teaching among first- and second-year students who have often found interpreting diagnostic images difficult when they entered their clinical years and it will connect cadaver dissection (which is not an option when diagnosing a patient) to the reality of diagnostic imaging (which is).  

Something old, something new

The idea of connecting basic science learning to real life is not a new one at UND.  Since 1998, medical students have been taught using a curriculum that places the patient at the center of learning.  From the first day of medical school, students are introduced to patients, in "paper cases," each week and learn the basic sciences necessary to arrive at the correct diagnosis for the condition presented. 

When Fogarty, a radiologist based in Bismarck, came on board as chair of the medical school's radiology department in July, he was determined to expose medical students to radiology from the beginning of their education. 

"When I was in medical school, I had some great anatomy teachers, but I never fully grasped some of the relevance," said Fogarty.  "When I was learning to read diagnostic images later in medical school I remember thinking 'this would have been nice to have in the gross anatomy lab.'" 

"I hope this will create a bridge of knowledge from clinical imaging anatomy to what is initially learned in the first year," he continued.  "This is a way for the students to look at the whole picture." 

Although cadaver dissection is one of the oldest forms of medical education, in the lab at UND it is being combined with modern-day technology to ensure that medical students can fully understand the anatomy of the human body and the diseases that affect it. 

-Amanda Scurry

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