Augmented Reality in Anatomy Education and Training

By Dr. Priyom Bose, Ph.D.Reviewed by Danielle Ellis, B.Sc.

Traditional Vs. modern- medical education and training strategy
Why are AR programs beneficial for students and educators?
AR-based programs for anatomical studies
Future perspectives
References
Further reading

Augmented reality (AR) is a fairly new technology that has gained significant attention in medical education and training. This technology is based on the integration of digitally generated three-dimensional (3D) representations with real environmental stimuli.¹ By offering more realistic experiences and remote learning opportunities, AR has gained considerable popularity among medical students.

This article focuses on how AR use has helped in medical education and training. AR has been defined as “an interactive virtual layer on top of reality’.¹ The advancements in smartphone technology and tablet devices have expanded the utility and accessibility of AR-based programs.

Traditional Vs. modern- medical education and training strategy

Learning about human anatomy is an important part of medical training. Traditionally, human anatomy was taught using preserved specimens, anatomical models, lectures, cadaveric dissections, 2-dimensional (2D) image representations (e.g., tomographic scans and textbook illustrations), and live patients.² 

The recent advent of computational technologies, such as virtual reality (VR) technology and AR, have replaced several traditional teaching methods.³ In the 1990s, basic computer-assisted anatomy programs were developed and implemented in education institutes. The continual advancements in software and hardware and the advent of computer-based stereoscopy paved the ground for the future development of virtual reality (VR) and AR.⁴

In the field of medicine, several AR-based programs have been designed and categorized into two sub-groups, namely, treatment programs and training programs. The treatment programs help patients and practitioners within a clinical or hospital setting, such as surgical procedures, therapies, and rehabilitation. The training program is specially designed for medical education and training in academic settings. To run an AR application, tablets or smartphones, as well as AR glasses, are required.⁵

Why are AR programs beneficial for students and educators?

AR programs are increasingly used in medical education and training because of their flexibility in integrating physical and virtual environments. The enhancement in reality in education is achieved through auditory, haptic (touch), and even olfactory information and feedback.⁶ Importantly, a partial augmentation of the real environment allows controlling the level of exposure, which helps shape the learning experience.¹

Instead of the traditional use of silicone or physical models, educators encourage students to download AR applications on their smartphones/tablets or use websites to study human anatomy.⁷ In addition to the educational institutes’ in-house AR programs, many free AR applications are also available online, such as visiblebody.com.⁸

Using this technology, a student can visualize several anatomical structures online. While the educator describes the model and features, students can point the camera marker to a specific spot to magnify the image and better understand the anatomical structures described in the lecture. A dissect button is also available to remove layers and view underlying anatomical features. The undo command allows the student to revert changes and further explore the topic.

Using AR-based medical applications, a medical student can be subjected to actual stressful conditions without the risk of improper patient handling.¹ Other benefits of using AR simulators are low cost per use, absence of ethical issues, and safe learning practice compared to training on live patients. AR platforms enhance the skill of users in handling diverse, complex situations.⁹ They offer telementoring of laparoscopic surgical training. The supervisor can train a student by indicating proper surgical moves, paths, and handling via the AR screens.¹⁰ 

AR-based programs for anatomical studies

The massive availability of online databases of human images obtained through computed tomography and magnetic resonance imaging (CT/MRI) scanning techniques has immensely boosted the development of AI programs to study human anatomy.¹¹ The Visible Human Project was developed by the University of Colorado in 1991, and it could act as the foundation of AR programs.

The Visible Human Project offered more than 7000 digital anatomical images that could be accessed free of cost.¹² Other databases that offer digital images of human bodies are Visible Korean Human, The Virtual Human Embryo, The Virtual Body, and The Visible Human Server.

Smartphone/tablet-based AR applications provide extensive information about human anatomy along with visual 3D structures. Many times, these images are linked to traditional pages of anatomy textbooks. Recent hardware advancements, such as Microsoft's development of Hololens glasses, have enhanced the application of these programs.¹³ AR-based applications allow 3D exploration of the human brain with interactive opportunities. These applications are developed based on MRI data.

LapMentor is used to teach basic laparoscopic skills with advanced laparoscopic operations. This application is equipped with an assessment system that provides metrics to the user. In addition to basic laparoscopic kills, LapMentor is also used to train students for laparoscopic cholecystectomy, gastric bypass, ventral hernia, and gynecology cases.¹⁴ 

LapSim is another AR simulator used for anastomosis, suture, and laparoscopic cholecystectomy scenarios. This simulator can transfer functions between instructors and institutions. AR simulators are popularly used in neurosurgery training as well. These simulators are affordable, extremely realistic, and represent detailed neurosurgery structures.¹⁵

ImmersiveTouch is used for multiple discipline training, including neurosurgery, ophthalmology, spine surgery, and ENT surgery. NeuroTouch Cranio is another AR simulator for brain tumor resection. Anatomical Simulator for Pediatric Neurosurgery, RoboSim, and ANGIO Mentor are commonly used AR simulators in medical training.

Future perspectives

It is imperative to validate the credibility of AR simulators using diverse and large-size cohorts. To date, no standard design is available for all simulators. More studies must be conducted to manage the affordability of the simulators so that they can be implemented in more medical training facilities.

Future improvements must focus on integrating olfactory stimuli within the existing platforms. Odors can be used as diagnostic tools or to create stressful conditions to recreate the operation room with greater reality. There is a need to improve the resolution and processing power of the existing programs. Also, a better design of clinical scenarios with greater realism is required. More advanced haptic devices are also essential for training purposes.

Greater compatibility of AR programs is required between devices to expand their usage. It has been observed that the image resolution of the same AR program in different devices is different. A decrease in the cost of hardware and software would improve AR affordability, which will increase its utility at different educational levels.

References

1. Dhar P, Rocks T, Samarasinghe RM, Stephenson G, Smith C. Augmented reality in medical education: students' experiences and learning outcomes. Med Educ Online. 2021;26(1):1953953.
2. Chen S. et al. Can virtual reality improve traditional anatomy education programmes? A mixed-methods study on the use of a 3D skull model. BMC Med Educ. 2020; 20, 395.
3. Al-Ansi AM. et al. Analyzing augmented reality (AR) and virtual reality (VR) recent development in education. Social Sciences & Humanities Open. 2022; 8(1), 100532.
4. Khot Z, Quinlan K, Norman GR, Wainman B. The relative effectiveness of computer-based and traditional resources for education in anatomy. Anat Sci Educ. 2013;6(4):211-215.
5. Wang PH, Wang YJ, Chen YW, Hsu PT, Yang YY. An Augmented Reality (AR) App Enhances the Pulmonary Function and Potency/Feasibility of Perioperative Rehabilitation in Patients Undergoing Orthopedic Surgery. Int J Environ Res Public Health. 2022;20(1):648.
6. Barsom, E.Z., Graafland, M. & Schijven, M.P. Systematic review on the effectiveness of augmented reality applications in medical training. Surg Endosc. 2016; 30, 4174–4183.
7. Bölek KA, De Jong G, Henssen D. The effectiveness of the use of augmented reality in anatomy education: a systematic review and meta-analysis. Sci Rep. 2021;11(1):15292.
8. Aland RC. et al. A plethora of choices: an anatomists’ practical perspectives for the selection of digital anatomy resources. Smart Learn. Environ.2023; 10, 66.
9. Gasteiger N, van der Veer SN, Wilson P, Dowding D. How, for Whom, and in Which Contexts or Conditions Augmented and Virtual Reality Training Works in Upskilling Health Care Workers: Realist Synthesis. JMIR Serious Games. 2022;10(1):e31644.
10. Vera AM, Russo M, Mohsin A, Tsuda S. Augmented reality telementoring (ART) platform: a randomized controlled trial to assess the efficacy of a new surgical education technology. Surg Endosc. 2014;28(12):3467-3472.
11. Zhang Y, Feng H, Zhao Y, Zhang S. Exploring the Application of the Artificial-Intelligence-Integrated Platform 3D Slicer in Medical Imaging Education. Diagnostics (Basel). 2024;14(2):146.
12. Ackerman MJ. The Visible Human Project. Inf Serv Use. 2022;42(1):129-136. Published 2022 May 10.
13. Palumbo A. Microsoft HoloLens 2 in Medical and Healthcare Context: State of the Art and Future Prospects. Sensors (Basel). 2022;22(20):7709.
14. Andreatta PB, Woodrum DT, Birkmeyer JD, et al. Laparoscopic skills are improved with LapMentor training: results of a randomized, double-blinded study. Ann Surg. 2006;243(6):854-863.
15. Kantamaneni K, Jalla K, Renzu M, et al. Virtual Reality as an Affirmative Spin-Off to Laparoscopic Training: An Updated Review. Cureus. 2021;13(8):e17239.

Further Reading

• All Anatomy Content
• Anatomy of the Kidney