|
 
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| REVIEW ARTICLE |
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| Year : 2022 | Volume
: 8
| Issue : 1 | Page : 16 |
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Digital anatomical study based on Chinese Visible Human data sets
Na Chen, Jingjing Liu, Shaoxiang Zhang, Yi Wu
Department of Digital Medicine, College of Biomedical Engineering and Medical Imaging, Third Military Medical University (Army Medical University), Chongqing, People's Republic of China
| Date of Submission | 25-Nov-2021 |
| Date of Decision | 05-Mar-2022 |
| Date of Acceptance | 19-Mar-2022 |
| Date of Web Publication | 07-Jul-2022 |
Correspondence Address:
Yi Wu
Institute of Digital Medicine, Biomedical Engineering College, Third Military Medical University (Army Medical University), Gaotanyan Street, Chongqing 400038
People's Republic of China
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/digm.digm_45_21
Chinese Visible Human (CVH) data sets have been widely used in anatomical teaching and scientific research. Based on true-color, thin-thickness, and high-resolution images which are much more superior than computed tomography, magnetic resonance imaging, and ultrasound, human organs have been segmented and three-dimensional (3D) reconstructed, and the organs have higher accuracy and more detailed information, which makes complex anatomical structures simplified, and makes abstract anatomical structure visualization. Through CVH and their 3D models, researchers got much more anatomical new finding and understanding about human anatomy, which can update anatomical reference books and atlas, and can provide more human morphological information for medical students, surgeons, and anatomists. Here, we will provide a brief summary of the CVH data sets and its applications in teaching and research in recent years.
Keywords: Anatomical research, Chinese Visible Human, Digital anatomy, Sectional anatomy, Three-dimensional reconstruction
How to cite this article:
Chen N, Liu J, Zhang S, Wu Y. Digital anatomical study based on Chinese Visible Human data sets. Digit Med 2022;8:16 |
| Introduction | |  |
In 1986, the Visible Human Project (VHP) was proposed by the National Library of Medicine of the United States. Spitzer et al. completed and created the male and female whole body's sectional anatomical image data sets in 1994 and 1996.[1],[2] The VHP data sets have been widely used in teaching, medical, manufacturing, aerospace, and other fields. Based on this data set, interactive three-dimensional (3D) anatomical atlas, virtual anatomy teaching system, and virtual surgical platform, Voxel-Man and Primal Pictures were developed.[3],[4],[5],[6],[7],[8] Voxel-Man and Primal Pictures virtual anatomy system includes two parts: virtual anatomy teaching system and virtual surgery system, which can be widely used in medical teaching and surgical education and training.[3],[4],[5],[6],[7],[8],[9],[10] Chung et al. created the sectional anatomical images of the male whole body in 2001, which was called the Visible Korean Human (VKH). They developed an interactive virtual anatomy system which has the entire human body's 3D model based on the VKP data set.[11],[12],[13] The Chinese Visible Human (CVH) data sets including young male and female whole body have been separately created by Zhang et al. from the Third Military Medical University (Army Medical University) in 2002 and 2003.[14],[15] Up to now, they have acquired five CVH data sets.[16] The sectional thickness, resolution, and pixel size of the CVH images are superior to those of the VHP and the VKP.[16],[17],[18]
Like the VHP and the VKH images, the CVH data sets have great significance and tremendous applications,[19],[20] which have been widely used in many fields, including anatomy teaching,[21],[22] assistant in diagnosis and treatment of clinical diseases, medical virtual simulation, human body display, and especially anatomical research. Then, we will provide a brief summary of The CVH data sets and its application in recent years in the following [Table 1].
| The Chinese Visible Human Image's Character and Superiority | | |
To prevent loss of small structures such as teeth, nasal conchae, and articular cartilage from the milling surface, the CVH project was created in a low-temperature laboratory (−25°C).[16],[19],[20] Hence, the CVH images have thin-sectional, high-resolution, and better-registration. [Figure 1].[16],[17],[18] The CVH data sets had the following characters: (1) The data sets presented the whole body and had no sectional data loss. (2) Digital images had higher resolution which was much better than that of CT and magnetic resonance imaging (MRI) images. (3) Vascular perfusion with a colored gelatin solution was better performed and the vessel was easy to be identified. (4) The CVH subjects represented young age, middle-sized, and height so as to be more representative of the Chinese population [Table 2].[18] Based on the Chinese Visual Human data set, the Third Military Medical University 3D reconstructed almost all human systems, organs, and regions [Figure 2].[16],[18] | Figure 1: Transverse sections of Chinese Visible Human. (a) Section image of head; (b) Section image of neck; (c) Section image of lung; (d) Section image of liver; (e) Section image of pelvis; (f) Section image of thigh; (g) Section image of knee; (h) Section image of shank.
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 | Figure 2: Examples of three-dimensional reconstructed organs or structures based on the Chinese Visible Human data set.
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| Digital Anatomical Teaching Based on the CVH Images | | |
The CVH sectional anatomical images, the virtual anatomy teaching system, and the interactive 3D model based on the CVH data set have been widely applied in the medical and teaching fields, which created anatomical new finding, new anatomical atlas, and medical or teaching productions.
Virtual anatomical system
Based on the CVH data set (one male and one female), the Third Military Medical University created a virtual anatomical system [Figure 3]. This system has nine anatomical systems such as alimentary system, respiratory system, et al and includes nearly all anatomical structures. Medical students can learn anatomical knowledge of the coronal, sagittal, transverse sections through this system on a personal computer in the local network, and a 3D-reconstructed realistic model can help students easier to master the anatomical structures. This virtual anatomy system is operated only through mouse, keyboard, and touch screen, rather than scalpel, scissor, and forceps.[21] | Figure 3: Virtual anatomical system and virtual simulation system. (a) Interface for the systematic anatomy module in the virtual anatomy system; (b) interface for the augmented reality; (c) interface for the virtual reality.
Click here to view |
On the basis of the virtual anatomical system, the Third Military Medical University repurchased augmented reality, virtual reality (VR), 3D gait tracker, 3D projector, and other equipment to build a virtual simulation teaching platform of human morphology [Figure 3]. Relying on the virtual anatomical system and virtual simulation teaching platform, they have successfully carried out in undergraduate and graduate programs in the digitized virtual simulation theory and practical lesson. Students have good learning effect and high interest in learning.
Virtual reality Dextrobeam system
Based on the CVH data sets and VR technology, the Third Military Medical University also built a VR Dextrobeam system. Dextrobeam stereoscopic is a highly interactive operating console, with external 3D stereoscopic display. The console has two 6-dOF motion-tracking devices, which can realize hand interaction. The operator and observer wear 3D eyes, and can see the 3D structure of multimodal images from anatomical images, volunteers, and patients, so that students can understand and master the 3D shape and adjacent relationship of human anatomical structure more deeply. This system can display an arbitrary section of the anatomical structural model and provide a virtual dissection function. Liu et al. used this system and created a digital laryngeal anatomy model, and the 3D model can be read remotely, displayed locally, and manipulated interactively.[22]
| The Application of Chinese Visible Human Data Sets in Digital Anatomy | | |
Digital anatomy in head
Li et al. used CVH1 and CVH2 head images to segment and 3D reconstruct the main cerebral structures, and visualized them.[23] Li et al. also created digital human brain atlas based on CVH1 and CVH2, which included gray matter, white matter, deep nucleus, hippocampus, and lateral ventricle via surface rendering and volume rendering. This atlas structure can be arbitrarily rotated, translated, zoom, and cut in 3D space. Medical students and junior doctors can visit the brain atlas through the Internet.[23]
Chen et al. used the CVH images and computed tomography (CT) images to observe basal cistern. The CT images include acute craniocerebral trauma patients and volunteers. By comparing the CT images and CVH images, the morphology of quadrigeminal and ambient cisterns was similar, but the suprasellar cistern changed substantially.[24] On the basis of the advantages of sectional anatomy of CVH images, the accuracy of diagnosis of acute craniocerebral traumas based on CT image was improved.
Temporal bone anatomy is a complicated anatomical structure and very difficult to understand. Qiu et al. used CVH data sets to three-dimensional reconstruction of ear models and 3D printing them. Through virtual endoscopy, high-precise 3D ear models, and 3D printing models based on CVH images, surgeons could enable to conduct preoperative drills and surgical path planning to improve the accuracy of treatment.[25]
Digital anatomy in parapharyngeal space
Li et al. used CVH male and female image to segment and 3D reconstruct the parapharyngeal space's anatomical structures. Digital 3D models displayed perfectly the anatomic relationships of the parapharyngeal space, vessels, muscles, parotid, and mandible. The digitized model of the parapharyngeal space provides morphologic data for imaging diagnosis and surgery of the pharyngeal disease.[26]
Digital anatomy in thoracic structures
The anatomical structure of chest, such as heart, lung, and mediastinum, is very complex. The three-dimensional shape of chest and their spatial relationship is abstract, which makes it difficult for medical students to master. Wu et al. used CVH1 data set and created the 3D model of human thoracic structures, and the model can be displayed together clearly and accurately. This 3D model has 25 anatomical structures, including chest organs, nerves, blood vessels, muscles, and bone tissue.[27] The 3D models provide a better way for medical students and junior surgeons to learn interpreting human thoracic anatomy and virtual thoracic and cardiovascular surgery.
Based on CT images and CVH images, Wu et al. 3D reconstructed and visualized the superior mediastinum. Due to CVH images have thin-sectional, high-resolution, and better-registration, small soft-tissue structures such as superior mediastinum can be 3D reconstructed and visualized. This will can help less experienced thoracic surgeons to familiarize the anatomy of the superior mediastinal structures and thus to interpret CT images of patients.[28]
Digital anatomy in shoulder joint
Frozen shoulder is a common type of periarthritis of shoulder, mostly in middle-aged and old people. The exact anatomical and pathological cause is unknown. Rotator interval (RI) is considered to be the key area for treating frozen shoulder. Clinicians are used to identify the anatomy and lesions of RI region based on experience, which may lead to misdiagnosis or missed diagnosis. Li et al. used CVH data set and 3D reconstructed and visualized the RI structure and its adjacent structures. The CVH has been shown to be the imaging modality of choice for identifying the borders of the RI and its adjacency.[29] Li et al. found that the boundary shape of RI region was similar to a long tongue rather than a traditional triangle, so the RI area measured by previous methods could be insufficiently reflected RI pathology.[30] Through the 3D anatomical study of RI, it is helpful for doctors to improve the accuracy of frozen shoulder's diagnosis.[29],[30],[31]
Digital anatomy in left extraperitoneal space
In traditional gross anatomy and CT imaging, it is hard to identify and observe the 3D shape and spatial relationship of the left extraperitoneal space (LES). Based on the CVH data sets, Xu et al. 3D reconstructed and visualized the LES and its adjacent structures.[32]
Xu et al. found that the LES consists of the left subdiaphragmatic fat space and gastric bare area. Moreover, the LES is adjacent to the lesser omentum in the anterointernal and the hepatic bare area in the right rear direction. Three-dimensional reconstruction can facilitate to understand the anatomy of the abdominal spaces and its adjacent structures, which help to understand the abdominal diseases and its treatment.[32]
Digital anatomy in heart
Guo et al. used a series of the CVH images to study the heart. Comparison of CVH images with those echocardiography images such as the pulmonary trunk and aortic valve indicated that CVH images and echocardiography images had good correspondence. The interval between layers of CVH data sets is smaller than that of clinical continuous tomography. CVH images have richer anatomical details, especially in the mitral valve and tricuspid valve of the heart.[33]
Based on CVH1, a high-precision visual anatomical model of the heart is established by Guo et al., which can directly reflect the spatial relationship of the adjacent anatomical structure of the heart.[34] The advantage of the CVH data set is that not only can the cardiac fiber skeleton be clearly observed, but also the original spatial relationship of the anatomical structure is maintained. Meanwhile, inexperienced ultrasonographers can perform multiplane, multi-oblique sections and thin-layer dissection on the reconstructed 3D model of the heart, laying an important foundation for virtual surgery and cardiac interventional operations.[34]
Guo et al. also used CVH1 data set and created 3D models of the coronary arteries (CAs). They combined 2D ultrasound and 3D CAs models, which help to diagnose coronary heart disease. It shows that the accuracy of diagnosis combined with the three-dimensional model was greatly improved. These techniques help clinicians to identify the CA segments more accurately.[34]
Digital anatomy in liver
Li et al. used CVH and individual clinical CT images to establish a digital three-dimensional anatomical model of the liver; the model can clearly and intuitively display the information of the hepatic duct system, lesions, and liver segments from any angle. Various parameters of liver, liver segment, and vascular system can be accurately measured. It can assist doctors to accurately analyze the distribution of the pipeline system, the relationship between the lesion and the liver segment, and the relationship with the supply of blood vessels, and make surgical planning and surgical plan, so as to improve the therapeutic effect of surgery and reduce surgical complications.[35]
Digital anatomy in pelvic floor
Based on CVH data set, Wu et al. 3D reconstructed almost all the pelvic floor structures of different ages, including late pregnant embryos, children, young people, and elderly women and men [Figure 4]. Wu's research shows that the levator ani muscle is composed of four parts. The quartering method updated the three-part method of traditional anatomical teaching materials and atlas. Wu et al. 3D reconstruct and re-defined the “hammock” structures in the female anterior pelvic cavity, which complements DeLancey's hammock theory and updates its anatomical theory. It supports the proximal urethra and neck of the bladder when abdominal pressure increases, maintaining pelvic floor stability and preventing urinary incontinence. In the middle of the pelvic, periuterine supporting ligaments play an important role in the stability of the uterus and provide an important morphological basis for gynecological surgery, imaging diagnosis, and surgical anatomy. In the back of the pelvic, the external anal sphincter, together with the levator ani muscle, controls the discharge of stool.[36] | Figure 4: Reconstructions of pelvic floor based on the Chinese Visible Human data set. (a and b) Anterior view of female and male pelvic floor support structures; (c and d) inferior view of pelvic floor supporting structure in female and male; (e and f) superior view of pelvic floor supporting structure in female and male; (g and h) transverse image of pelvic floor.
Click here to view |
Wu et al. used 4 CVH young female and 1 VHP old female's 3D reconstruction of pelvic floor to investigate age-related changes. They found that the major difference between the young adult and postmenopausal pelvic floor was the expansion and accumulation of fat in the components of the pelvic floor. They hypothesized that accumulation of pelvic fat leads to pelvic-floor cohesion and fat is an excellent lubricant.[37]
Wu et al. reinvestigated the area in three males including the VHP and CVH male and two 26-week-old male fetuses, and compared the pelvic floor anatomy with CVH females. They found that the volume of the levator ani muscle in male was approximately two folds smaller than that in female, and its funnel shape of the levator ani muscle was steeper in males than in females. In males, muscles occupy the urogenital triangle, but additional tightening of the locally fibrous adipose tissue by the superficial transverse perineal muscle appears necessary to generate a little functional support in women. According to the CVH images, Wu et al. also created an interactive 3D-PDF with these anatomical details; this file should allow more accurate interpretation of ultrasound, CT, and MRI.[38]
Digital anatomy in knee joint
Song et al. used a series of CVH data sets to segment and 3D reconstruct knee joint [Figure 5], including posterolateral complex (PLC), fibular collateral ligament (FCL), popliteofibular ligament (PFL), arcuate popliteal ligament, popliteus tendon (PT), fabellofibular ligament, and biceps femoris tendon (BT).[39] Song et al. observed and studied the tendon junctions of PLC. They found that the FCL and PT had constant attachment to the femur, and the FCL, BT, and PFL had constant attachment to the fibula. They proposed a new surgical procedure for Chinese patients with PLC reconstruction, named single-tunnel reconstruction of femur. This gave joint surgeons a new way to design and select PLC surgical tunneling schemes.[40] | Figure 5: Three dimensional reconstructed of knee joint based on the Chinese Visible Human data set. (a) Anterior view of the knee-joint; (b) lateral-posterior view showing the knee-joint capsule; (c and d) sectional images of the knee joint in which the posterolateral complex structures can be identified.
Click here to view |
Digital anatomy models in radiation absorption calculation
Digital human models are generally supine, but in some applications, a standing position is required. Wu et al. reconstructed a standing anatomical model based on CVH images which was obtained from a supine postured cadaver. More comprehensive data were obtained by using supine and standing models to assess the radiation dose to the human body from electromagnetic field exposure and different incident directions.[41]
Digital anatomy in clinical application
If the doctor identify the complicated and abstract anatomical structures in the CT, MRI, and ultrasonography images difficultly, the high-resolution true-color CVH images and its 3D digital model can be used as an important method which help the doctor to identify unrecognizable anatomical structures in grey-scale CT, MRI, and solography, which can help to improve the clinician's diagnostic and treatment suggestion efficiency.[42],[43]
The surgeons can use the CVH images and its digital model as a tool to design surgical approach and optimize the surgical protocol, and then, the surgeons can choose the best surgical approach.[44],[45]
| Summary and Prospect | | |
With the development of digital medicine, the CVH images and digital anatomy which represents Chinese body can be used more widely in medical and teaching fields, such as in digital anatomy or digital medicine course creation. This image can create digital physical and physiology human model which can be used in medical image diagnosis and surgery simulation, and can create digital flexible physical body which can be used in costume designing and working simulation in the hazardous environment. Some of these advances have made their way into clinical practice, such as virtual endoscopy and surgery, surgical navigation, frameless stereotactic brain surgery, virtual environment for acupuncture learning, and practice of traditional Chinese medicine. The CVH data sets can be carried out in future research with the following major objectives.
In the field of simulation and simulation computing
In the field of engineering, scientists in both computer science and informatics can use the CVH data set to construct geometric model, physical model, and physiological model, and realize multimodal fusion among various models, and then carry out various surgical simulation and simulation calculation research.
In clinical application, the local and whole-body models based on CVH data set are combined with interactive technology to realize preoperative digital surgical simulation. At present, 3D printing physical models used in clinical surgery assisted by 3D printing are relatively single and isolated models constructed based on CT and MRI. However, combined with CVH images, a composite model with higher precision and reduction degree can improve the accuracy of preoperative rehearsal and the accuracy of surgical approach.
In the military field, CVH data set can be used to carry out ergonomics research. For example, to avoid training injuries, it is necessary to carry out mechanical analysis of human body combined with simulation parameters, and then carry out human function analysis. On the basis of simulation, the maximum load of human body is obtained, so as to protect human body, avoid load damage, and improve training efficiency.
In the field of exact anatomy
In the aspect of anatomy learning, gross anatomy in medical colleges and universities mainly relies on human eyes to recognize and distinguish specimen structures, and it is easy to ignore some subtle structures or tiny structures, thus neglecting their functions. For example, the muscular dural bridge was neglected in the previous anatomy. Through exact anatomical study, it was found that the muscular dural bridge may be related to the transmission of head proprioception, prevention of dural discounting, chronic headache, and influence of cerebrospinal fluid circulation. Therefore, in subsequent anatomical studies based on CVH data set, more attention should be paid to some fine structures to explore unknown functions.
To reduce unnecessary injuries caused by minimally invasive surgery, exact vascular and nerve structures should be constructed based on CVH data set in further. By simulating the pathway along which a catheter will be traversed, surgeons will become well informed of the corresponding anatomical structures and foresee possible problems in surgery.
These data sets can also be useful for radiotherapy localization and treatment of tumors. 3D structural model based on the CVH data set can be used to simulate proper placement of the radiation. By accessing biological irradiation doses for specific tumors, optimal irradiation treatment positions and doses can be determined for correct delivery.
Acknowledgments
Na Chen contributed to study design, data and literature collection, data analysis, drafting of the manuscript. JingJing Liu and Shaoxiang Zhang contributed to study design of the manuscript. Yi Wu contributed to study design of the manuscript and revise the manuscript. All authors provided consent to publish this study to the Digital Medicine journal. All authors read and approved the final version of the manuscript.
Financial support and sponsorship
This work was supported by the National Natural Science Foundation of China (No. 31771324), Chongqing Science and Technology Talent Project (CQYC201905037), and Graduate Education Teaching Reform Research Project in Army Medical University (No. 2018yjgA009).
Conflicts of interest
Shaoxiang Zhang is an Founding Editor-in-Chief of the journal. The article was subject to the journal's standard procedures, with peer review handled independently of this editor and his research groups.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
[Table 1], [Table 2]
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