Winter 2019
Embracing the future without tabling the past

synapse: University of Nevada, Reno School of Medicine

Doctors and Nurses at the Elko Hospital

Photo: Brin Reynolds

Anatomy, the language of medical practice, evolves in UNR Med’s high-tech and high-touch gross anatomy lab

By Tessa Bowen

The only thing that is constant is change." Greek philosopher Heraclitus could easily have been referring to the study of human anatomy, which has kept a steadily evolving pace.

While the University of Nevada, Reno School of Medicine prepares to celebrate 50 years as a community-based medical school in March, the UNR Med anatomy lab is already looking toward the future. As physician training transforms, UNR Med is preparing future doctors to understand and interpret human anatomy, all while evolving alongside it all.

Gross anatomy, more than meets the eye

UNR Med first-year medical students have the unique opportunity to take anatomy classes in a state-of-the art dissection laboratory, complemented by Nevada's largest and longest-serving anatomical donation program. Gross anatomy is the branch of anatomy that deals with structures visible to the naked eye.

Students share the state-of-the-art lab with 18 donors - people who gifted their bodies for the purpose of medical education, who will serve as teaching tools in three-dimensional, physical reality of the human body. Those donors, the cadavers, become a medical student's first patient and an essential part of medical education.

Anatomical teaching by way of cadaver dissection has been around for centuries. Generations of doctors have been initiated into the medical profession by this tradition which challenges medical students to understand the internal workings of humans via the hands-on method, cutting into actual flesh. A solid understanding of human anatomy will always be necessary for mastering physiology, pathology, medicine and surgery.

As UNR Med students advance onto years two, three and four, learning more about kidneys, lungs, hearts and systems, it is the time spent learning through the dissection of their cadavers that provides their baseline medical education training and gets them thinking about caring for their future patients.

Dissection goes digital

The evolving nature of knowledge and technological advances now allows for the digital dissection of the human body. As medical knowledge and technology expands, UNR Med's anatomy lab has expanded in tandem.

The School of Medicine's anatomy lab now offers both traditional cadaver and digital dissection. As of fall 2018, the lab includes an Anatomage life-sized digital dissection table. Not meant as a substitute for, but rather a supplement to human cadavers, digital, life-size cadavers are revolutionizing anatomy in three-dimensional, high definition, with a click of a button or touch of a screen on a table that resembles an oversized tablet device mounted on a wheeled stretcher.

The Anatomage Table allows medical students to examine a virtual human body layer-by-layer, perform digital dissections and identify anatomical features with ultra-high quality visualization that provides instant access to photorealistic human anatomy.

"We're constantly working to provide the best innovative and educational tools for our medical students," said Carl Sievert, Ph.D., professor, gross anatomy, embryology and neuroscience director, Advanced Surgical Training Lab (ASTL), Department of Physiology and Cell Biology. "Our new Anatomage Table is a powerful step forward in providing students with the most realistic anatomy visualization platform for medical education."

"The Anatomage Table and access to traditional cadavers offer a beneficial blend of instruction in my anatomy education," said first-year medical student Miguel Gonzalez, class of 2022. "Going beyond the practice of learning anatomy, the Anatomage Table offers extra features such as computerized tomography (CT) scans and quizzing modes that are great learning tools."

The three-dimensional Anatomage Table includes three full body cadavers that are completely annotated and fully dissectible. The table stores 1,400 images and offers microscopic histology scans for a variety of cell types. High-resolution regional anatomy allows for the viewing of small structures such as nerves or blood vessels that are difficult to see by any other means.

The digital anatomy available on the Anatomage Table's software is created from actual human cadavers. The imaging technology works to create accurate three-dimensional renderings by tracing anatomical structures throughout the entire body. All anatomical structures viewed on the table's software are life-sized and both soft and hard tissues are true to color so all anatomical landmarks, unique genetic variations, and clinical conditions can be viewed in vivid detail.

In the traditional cadaver course of dissection, whether removing a vein, artery or organ, only so much cutting can be done and internal or underside views can be hidden or blocked. By pausing the digital dissection, students are able to interact with the dissection, turn it around and look at in three-dimensions.

"The human body is still an excellent three-dimensional model for learning how to perform safe and successful practices for preparation of professional careers, but the table adds a new dimension that excels in cross sectional anatomy, which better prepares students for reading CT and magnetic resonance imaging (MRI) scans. All students learn differently, so the three-dimensional Anatomage Table adds another option and variant. Another real advantage of the Anatomage Table is the ability to download cases of both pathologies anatomical variance," said Sievert.

"I strongly believe there is no substitute for having actual cadavers, but the Anatomage Table offers supplemental instruction that cannot be achieved with a traditional cadaver," said Gonzalez. "The ability to view a perfect, digital cadaver allows me to see and learn everything I need to know to build a solid anatomy foundation for working on a more challenging, traditional cadaver."

Bodies of knowledge

Death can advance life, transforming the once living into life-giving teachers. Anatomical donors, people who donate their bodies to medical education and research after passing away, teach medical students about far more than gross anatomy. The process is strange and noble, clinical and deeply human. Cadavers posthumously teach medical students how to care, detach, work as a team and develop a sense of curiosity and discovery. And anatomical donors give a gift to medical students in how to navigate the emotions they'll face when delivering bad news and putting patients through difficult experiences in order to make them well again.

The anatomical donation program accepts donations from individuals across northern Nevada for anatomical research. The program has been in operation since 1987. The gift of body donation can be a way to make an impactful difference in the lives of others.

"People choose to become anatomical donors for a variety of reasons," said Joyce King, anatomical donation program administrator. "The most frequent reason I hear is how important it is to them that their remains benefit medical education and research. They express pleasure in knowing their donation may help a future doctor or researcher find a cure for diseases. Donors also appreciate that their advanced planning eliminates confusion at end of life and will make a lasting difference."

"If my body can teach students or ultimately even save someone, of course that's what I want - to help in some way, to do some good," said Margie Cooley, 78, a Reno local who decided to donate her remains for the good of medical education.

The anatomical donation process of gifting one's body to medical science is at no cost and offers cremation services. Both doctors and students at the School of Medicine understand the importance of the decision and ensure dignity and respect of donors and their families.

Each June, first-year medical students host a memorial service to honor those donors who gifted their bodies during the previous academic year. Through poetry and songs which they've written and perform, the students express deep gratitude to the donors' families and friends.

For further information on whole body donations, please contact Joyce King, UNR Med anatomical donation program administrator, at jaking@med.unr.edu or (775) 784-4569.