The dead man lay on the table, naked except for a small white towel draped over his genitals.
David Wilkenfeld walked up to the table in the middle of the room and with the sweep of his right finger, sliced the man in half in what amounted to a dissection.
The body was not there in the flesh, however. It was a digitized image of an actual man who was once alive. The cadaver was called up on the Anatomage, a 6-foot long flat computer screen that resembles an operating table and is housed in the Flicker Virtual Cadaver Lab at Moravian College’s Sally Breidegam Miksiewicz Center for Health Sciences.
The computer technology allows instructors and students to peel away lifelike 3D images of the complex architecture of skin, muscles, tendons, ligaments and bones of actual human cadavers.
As virtual reality improves and costs decline, Moravian and other schools in the Greater Lehigh Valley are among a growing number of schools using computer-generated simulations to teach and train students in health care.
Although not cheap – the Anatomage Table cost $70,000 and was the gift of an alumni in 2017– proponents say virtual reality can be a safer, less expensive and more practical pedagogical tool that in some cases can lead to better diagnostic outcomes.
Moravian has been using the virtual cadaver since 2017 to teach anatomy and physiology to undergraduate and graduate students in its athletic training, rehabilitation sciences and nursing programs.
“It’s a really unique learning tool for the students,” said Wilkenfeld, an assistant professor of athletic training at Moravian.
“The anatomy is all there. It’s just like in a real life cadaver,” he said. “Unlike a regular cadaver lab, if you make a mistake you can hit the undo button.”
Wilkenfeld said the virtual cadaver program is more cost effective than a traditional human cadaver program, which entails a major investment and would require procuring bodies, storing and managing them.
Cedar Crest College has invested more than $90,000 in several virtual-reality devices in recent years that simulate a lung, eye, ear, nose and throat.
“It’s the front edge of how we need to educate our practitioners,” said Eileen Fruchtl, an instructor and manager of the Nurse Learning Resource Center at Cedar Crest College.
“Virtual health care is all about simulation and about making a situation appear real so that we can practice in it,” Fruchtl said.
“We can’t put a scope down someone’s lungs or look in someone’s eye with a bright light for 15 minutes just to practice,” she said. “The students don’t want to hurt anyone. They want to do it right. By using the technology, we allow them the opportunity to practice over and over until they get it right,” Fruchtl said.
Wendy Robb, dean of the School of Nursing at Cedar Crest, said schools need to have this technology in order to stay competitive.
“We are in the hotbed of health care here in the Lehigh Valley and we need to prepare our students, many of whom will stay and work here,” Robb said.
Last fall, Cedar Crest started using a bronchoscopy simulator, called the BronchExpress, in its nurse anesthetist program. The device is a simulated scope, an instrument with a long, flexible lighted wire with a camera on the end used to examine a patient’s lungs. The simulated scope is inserted inside a box and, using computer technology, projects photographic images of the airway.
Likewise, the school’s OtoSim and OpthoSim, are virtual-reality tools that resemble scopes used to examine ears and eyes.
The devices, which cost about $30,000 each, are essential for teaching students about normal and abnormal anatomy, diseases and pathologies they may never see during their training.
With the touch of a button, the instructor can call up any of hundreds of images of actual conditions, such as a burst eardrum or an insect or blue crayon wedged deep inside an ear.
“They need to be able to see it, then they can practice how to fix it,” Fruchtl said.
In a randomized trial conducted by the inventors of the OtoSim, a simulated otoscope, an instrument used to exam and diagnose conditions in the ear, students had a 78 percent diagnostic accuracy rate compared to 54 percent by a control group.
As Wilkenfeld continued to manipulate the cadaver, he zoomed in and out and rotated cross-sectional views and pointed out features. Using the technology, he could isolate and highlight structures, whether they were musculoskeletal or the nervous or cardiovascular systems. With his finger, he virtually circled a structure in red and dropped a virtual pin on another structure to highlight it.
“If you’re talking about a particular artery, the table will actually show you the blood flow route it takes to get to that point, which is quite neat,” he said.
“I would say it’s as close you’re going to get without having the actual human cadaver. The one limitation of the table is you can’t manipulate tissues. If I were to grab a muscle and pull on it with a real cadaver, you would see how that muscle does. With the table, you can’t manipulate that,” he said.
The table’s strong visuals is useful for teaching students about pathologies in a more direct way.
With appendicitis, for example, the professor may describe clinical symptoms, and show where the practitioner needs to palpate, or gently push, on the area where the patient describes feeling tenderness
“With the table we can walk through the process and show the landmarks of the palpation points. Why if you push on this place, you are pushing right over where the appendix would be,” Wilkenfeld said.
“It adds to the learning experience. It’s not just a professor standing up and saying this is where you need to palpate the patient who may or may not have appendicitis. You can actually see the anatomy and follow the guidelines where you should be palpating,” he said.
About 10 students can stand comfortably around the Anatomage and the image can also be displayed on screens at the front of the classroom for those seated at desks.
The table has the capability for instructors to take an actual 2D clinical image from an MRI or CT scan, load it into the table and render it into a 3D model that can be manipulated on the table. The table also be used by students to take self-assessment quizzes.
“It’s truly something that we’re just scratching the surface of,” Wilkenfeld said.