I'm Vic Spitzer, and I created a virtual cadaver—AMA

My medical school uses a virtual cadaver to teach anatomy, but I find a virtual model (complete anatomy app) to be much more clear and informative. It’s also much cheaper. What benefits would you say the virtual cadaver has over a model?

I think cadavers still have a lot to offer - over the virtual world - although much of the offering is different. The virtual world will eventually be better than real cadavers - as virtual humans become more like living humans. Our goal is NOT to teach the anatomy of the dead - it is to teach the anatomy of the living. Photographic anatomy captures the REALITY of the cadaver and models based on photorealistic anatomy will someday be more life-like -- muscles will contract to move the skeleton - then students will understand FUNCTION as well as structure. There are functional models of anatomy today but they are as cartoon like as much of the anatomy - and I think this is counterproductive to advancing the VR world of learning. Aircraft simulations now have video REALISTIC airports and surroundings - our healthcare providers deserve the same.

Another advantage of virtual - is the position of anatomical structures - they are MUCH closer to the living than a typical student dissection - where structure are intentionally moved from their functional position in order to improve their visibility - but we are try to teach anatomical spatial relationships in the living.

Does this mean that my plan to donate my body to the University of Tennessee Body Farm in 40-odd years is in jeopardy? Am I being replaced by a robot?

I don't think so - the body farm provides information that we aren't even close to simulating. When we do achieve a great simulation of a body burned in a car trunk - or left in a field for a month - THEN there will be other forensic activities we haven't even thought of - that need to be understood. I AM SURE they will still want and NEED you donation when you are ready.

Robots are taking our jobs even when we are dead.

They are threatening by cadavers still hold the upper hand. Robots are GREAT - the ones that can do things (that need to be done) better than us - They free us up to advance to higher order thinking and efforts. Medicine DEPENDS on a knowledge of anatomy - but now SO MUCH MORE. We have to learn the anatomy faster - or just in time - in order to accommodate all the other knowledge in genetics, biochemistry, immunology etc. that didn't burden our healthcare providers of 100 years ago. WE NEED the cadaver donations that many people so voluntarily give - they provide a great experience - no matter how much I push the virtual world - IT IS DIFFERENT.

Hi Professor Spitzer, I just watched the video about this on YouTube the other day! My question is, what was the hardest part emotionally of the process of slicing the cadaver. You mention in the video that you grew a personal connection with Ms.Potter when she was alive, did that make the project harder at any point?

I don't feel like there was any EXTRA emotional cost - with Susan - because I was expecting her death (for over ten years) and was fulfilling her wishes. Doesn't mean there was NO emotional cost with someone I knew well - but I wasn't grieving like a friend - when I was working like an anatomist. I have major emotional trouble with cadavers of people that aren't expected to die (children, young people etc.). THANKS for your interest.

It was also a little unclear in the video when you expect this project to be finished, is there a set date this will be released for med students?

Like the original Visible Human (1993 - 95) this work has no end. The first major milestone will be to identify ALL the visible anatomy in the body - THEN - to model it and present it like the real world - is stereo 3D or in virtual reality - THEN the models of this non responding cadaver need to become dynamic - to show their function and then become dynamic to demonstrate (SIMULATE) pathology. Don't forget development and evolution - We age facial features fairly well today - but we haven't worked very hard on simulating the aging (positive or negative) process over the span of an adult life (and then an entire life) - and evolution - to SIMULATE evolutionary changes from Susan Potter back to "Lucy". I won't see MOST of this - but I am sure this is where its going. A more practical answer - I think we might have enough segmentation done in the next year - to put the image and some 3D representations in student's hands. My next major goal is to get the world working on the segmentation - of Susan Potter and many other specimens - through crowd-sourcing. I need to develop the infrastructure to MANAGE segmented and identified data in all the terabytes of pixels - that effort relates to $ - (as do most other aspects of this and other work).

What was the biggest challenge you faced in creating the virtual cadaver?

There were many - but I often credit my ignorance and inexperience for much of the success. My background was in physics, engineering and medical imaging - NOT anatomy. I never had tissue to manage or work with - and therefore, unlike most anatomists, I was happy to work with picture rather than tissues - allowed us to grind off smaller sections than we could slice off. I also had no career devotion to any particular part of the body - but rather the entire body and the process. So my experience in other areas didn't burden me classical anatomy methods. Maybe more to the point - our major challenge now is the distortion caused by freezing the body - water expands on freezing and human bodies expand (different amounts for different tissues) - This becomes much more important as we increase resolution and see more of the freezing artifacts. All image analysis depends on spatial resolution which is increasing as cameras improve - but also contrast resolution - how tissues that are nearly the same color can be distinguished - we work in this area - by looking beyond the visible light spectrum and by attempting to "stain" SPECIFIC tissues. We have also been challenged to make keep a deceased human in the same configuration as the living - the changes are small but gravity, loss of muscle tone, loss of blood pressure, loss of respiration and bowel gas - all need to be managed in the dead - to make them appear more life-like. We were not able to do a lot of that with Susan - and continue to work on methods for future specimens.

What's your favorite Muscle, Ligament, Bone and overall Structure and why?

The "foramen ovale" - because I think it sounds like a great name for a large ranch in Colorado, Wyoming or Montana. Great muscles include the Sartorius - because it is so long its function(s) so apparent when attached (in isolation) to the skeleton. What is not easy is the synergy and antagonism that neighboring muscles play when they are all sued together. This is why we need to push this kind of work to REALISTIC dynamic modeling. Great ligaments have to include the ACL - because it is one structure we have "brought to life" - so that you can see and FEEL it move in a virtual environment knee arthroscopy simulator (ArthroSim). The Liver might be my organ of choice - mostly because I was in the Nuclear Medicine department at the University of Colorado - processing the images of liver transplant donors and patients of Dr Tom Starzel. At that time - all the patients died in very short order

What would you most like to tell us that no one asks about?

I don't often enough thank the hundreds of people that have contributed directly to my work on the Visible Human here at CU and ToLTech - and the many others that have contributed to the NIH-NLM Visible Human throughout the world - THANKS. But I also want to stress more - the need for crowd sourcing the identification and modeling of Susan Potter and future data - as we are now able to produce images more rapidly but the identification process is NOT automated. I also feel like there are a lot of people around the world that would LOVE to contribute to more knowledge and understanding - of VERY specific parts of the body. - We need to create the infrastructure to support this kind of activity - and that requires $ - to create and to curate.

Could there be an argument that the images look too good? It's a hard one to properly describe, but I'll try.

To me, the images look brilliant as a learning tool, but in reality there is going to be a lot messier for a surgeon or a real cadaver is usually not that fresh or dissected that well.

Good argument - if you want surgical simulation. I see no reason to EVER make them look more like a cadaver (unless we are trying to teach forensics). I always want them to look more like a living human. If we are talking surgery simulation then we need to make 3D images appear more moist and have the field of view obliterated with blood (if that is appropriate). It would also be great to move tissue as it would move in surgery. Again, we want to simulate the living and embalmed cadavers don't do that very well. Texture and color of cadavers are NOT like that of the living. The other problem with "too good" is that there is an overwhelming amount of information - and "segmentation" and classification - draws attention to an area of focus.

I'm late to this and that makes me sad.

I'm a pulmonary epidemiologist and I spend way to much time thinking about the fiber structure of the lungs. Have you done any work on simulating the architectural micro/macro-structure that drives breathing? I'm consistently amazed at what we can derive from a chest CT in terms of the failure state of lungs in diseases such as COPD but all of that is driven by fractal lung development and the eventual tensegrity structure which we can observe as it fails but that we can only measure after death. So from a simulation perspective; does a virtual lung fiber network exist? Can you breath a virtual lung? Can you damage a virtual lung and see the results?

Thanks for any comment you care to make! Also I'm in 500 which is odd to me since I could probably just find your office and knock on your door in order to ask this question right?

Never too late - and I ma still here - after I hang up. I have worked with radiologists from National Jewish Hospital on this issue - but that was back in Nuclear Medicine days. I think we are now getting to the point where we might be able to photograph the macro and down into the micro levels. I think we would need some major effort in tissue preparation - and then the ideal specimen. With the enormity of the problem it sounds like fascinating area to work on. I presume there may be pharmaceutical support to support a greater understanding.

Hello professor Spritzer,

I was wondering if there are plans to release the scan files (be them STLs or Point Clouds) to the public as a resource for other research?

No plans but it has to happen some day. There are no STLs or point clouds till the segmentation and identification steps are completed. We are working on that now. The imaging was the major step in the early 90's - now the major bottleneck is the modeling. I hope to keep information flowing on the links below.

Hi Professor Vic, how are you doing?

Great! Christmas is upon me and still a ton of work to do.

Hi professor,

This might be an odd question but, after slicing/sanding the blocks, how did you handle the 'residue' ? a.i. Did she get a proper burial/ cremation?

A cremation - just like all other cadavers donated to State Anatomical Board of Colorado. Her remains were just a little different because they also included a lot of blue PVA - but it all burns away. We work hard to capture ALL the tissue as it is removed.

What are people's reaction to your project when you tell them what you've been working on?

From the early 90's people are always fascinated - adults have some problems with the idea of cutting up a body - children seem to have no problem with it (and also do not generally trivialize it). Most everyone does not have a problem with it - after they actually see a REAL cross-section (in my freezer) or a picture. I have had reactions of wooziness and lightheadedness - from a vegetarian. Given enough time for explanation - MOST people are ok with it. From the most recent work with Susan Potter I have yet to see a negative remark. I do expect some. I myself, feel differently about being cut up with a machine vs with a scalpel - at the hand of a medical student - don't know why - I just do.. I wish I understood why - its NOT logical to me.

Hi Professor! Saw your video on NatGeo the other day. Did you face any ethical issues/ opposition when you went about this project?

SURE - was Susan of sound mind in her donation. I put that concern to rest after I explained everything to her - and then took her into the freezer where we dog the imaging. She understood, she never waivered in her desire to give (in this way). We generally work hard to assure anonymity. It was clear with Susan that we could not - and she was ok with that. I would like to see more donors SHARE their life with the students that will learn from their body. SOME DO - write a letter to the medical student - describing their life and their desire. I would also encourage them to include their clinical images and medical history - its a lot to ask - but donors are already giving so much. Opposition - yes from some that knew here and cautioned me that I was asking for trouble. - She liked to threaten "law suit" when things didn't go her way. I don't think she ever sued anyone - but a few people THAT I HIGHLY RESPECT - cautioned me repeatedly.

Hi Dr. Spitzer,

I use images from the visible human project pretty much every week to study anatomy, and they are integral to our school's anatomy curriculum.

My question arises from a debate that has been occurring amongst the medical students in my school. Is there still value in students dissecting cadavers, when there are such readily available resources like the visible human project available online to teach the anatomy?

I think there is - for those open minded and wanting to learn from the cadaver. I don't think we should force it on everyone. I think we need to examine our evaluation - to make sure they are competent. My experience is that about 20-30% of medical students LOVED their cadaver experience - a similar amount hated it - and others - in not hard and fast relationship. We need to evaluate healthcare providers knowledge and ability - how they acquire their knowledge seems irrelevant to me. --- If someone can pass all the exams related to gross anatomy - prior to their matriculation they should be allowed but not forced to go through a formal education. If anyone thinks that shouldn't happen - then I think their evaluation process isn't good enough. THANKS for using the Visible Human images - I hope they help accelerate or extend your understanding of anatomy. Would love to know where you study.

I think there is - for those open minded and wanting to learn from the cadaver. I don't think we should force it on everyone. I think we need to examine our evaluation - to make sure they are competent. My experience is that about 20-30% of medical students LOVED their cadaver experience - a similar amount hated it - and others - in not hard and fast relationship. We need to evaluate healthcare providers knowledge and ability - how they acquire their knowledge seems irrelevant to me. --- If someone can pass all the exams related to gross anatomy - prior to their matriculation they should be allowed but not forced to go through a formal education. If anyone thinks that shouldn't happen - then I think their evaluation process isn't good enough. THANKS for using the Visible Human images - I hope they help accelerate or extend your understanding of anatomy. Would love to know where you study.

Hi Professor! My mom was just showing me the Susan Potter story the other night. It’s absolutely fascinating.

Mom just got back from a trip to a lab in Colorado where she got to dissect a cadaver. She’s a personal trainer so she’s very interested in how the human body works, and she always wants to learn more.

How will the virtual cadaver change the way we understand the body? Will it, or is it intended to just make it easier to learn? Will there be any public form of the virtual cadaver, where anyone can go on and look at it and interact with it?

I think it will change in a way that you will be able to learn more - at home. There are fantastic resources for learning anatomy on the web and available today - but those that involve a real human (as opposed to art) inspire my confidence and have the greatest emotional impact. There is a lot to learn from YOUR body - by feeling structures on the inside (while you are looking at images of those structure). Structures you can't feel limit you to understanding with vision only. So get the best of the visual experience through 3D. That is what VR promises. Today you can also "feel" structures in virtual reality - but that is available (in high fidelity) to those that can afford their own "in home" theater. It is intended to make it easier to learn - that frees up time - to learn more. A picture is worth a thousand words. A 3D picture is worth a lot more. And feeling - "Doubting Thomas" taught its what that is worth.

Dr Spitzer,

What does the wider community think about what you have achieved?

Most, but not all, anatomists approve. Some feel it threatens traditional cadaver er dissection - and it does - but it should only replace it IF it is better. Some day it may be. Today, they are apples and oranges. Some criticism is based on the small numbers - and I agree. We NEED a bookshelf of human bodies that encompass a variation in age, gender, race, body build - and then variation and pathology. We don't want JUST the Visible Human (male and female) and Susan Potter. There are also Visible Human Korea and China Projects that were patterned after ours.

Some people are overwhelmed by the information available in cross-sections - but Richard Scarry had no problem with it - and incorporated it into many of his children's books. It does require focus to learn from cross-sections - but cross-sections turn into 3D photorealistic models once the anatomy is identified.

I just finished watching the documentary earlier this morning coincidentally!

I love the technology being used. Spektrum, I believe it was. Is this a technology being developed with you guys or is it already in place in other hospitals? How do I donate my body for this sort of purpose and what sort of criteria do you look for?

EDIT: Bonus question. While using the technology - was there anything new or surprising you discovered?

we display our images in a Sectra anatomy visualization table - and in software called the VH Dissector - This may be where Susan will first show up. It is difficult to donate for a SPECIFIC purpose. It is to donate for education and research - There are State Anatomical Boards in 46 of our 50 United States - to receive body donations. In the other states (and even in some states with SABs - you can donate directly to a medical school. Find the exact way to donate and the rules of the state or school can probably best be done by contacting the medical school nearest you. Donating to a specific project - like this - requires a program to have the funding to complete the project.

Bonus - I am AMAZED at the condition of Susan Potter's body - her collapsed vertebrae, calcified vessels tortuous paths of her neurovasculature. Some of this was specific to her - but a lot of it is just aging. -- I don't appreciate this in a cadaver dissection (even though it is generally on an older person) because we clean structures off and isolate them from their surroundings in order to see things better. When looking at all the anomy intact - It gives a ME a very different perspective. She always said she was in pain - I can see it now. But she always wore a smile when out in public.

I just read through the natgeo article and was captivated. Susan Potter seems to have been made of the sternest stuff. After this article was published and it made news, did either of her daughters reach out to you about her?

I have not discussed it with either BUT am VERY interested in talking to them. I am very concerned and hope they are pleased with the outcome. They didn't always agree with her decisions.

How large is your team and what are the backgrounds of the people you have working on this?

In the NIH funded days of the Visible Human (1991-2001) the team was 10-12 full time people. Over that same time there were over 100 students and interns involved in the segmentation process. Today the computer work is supported by my Company (Touch of Life Technologies) and the cutting and imaging is supported by the University of Colorado School of Medicine with laboratory and office space. We now offer a Master's Degree in Modern Human Anatomy (about 25 students per year) and their involvement also makes this possible today (there were a few medical students involved in the early 90's). I am always looking for money to further the goals of this effort.

Can you virtually replicate the smell?

Of the living human - I hope - someday. Not of formaldehyde. Researchers have worked on simulating smell. More importantly - SOME pathologies have a distinctive smell - this would be important to simulate - if we could also simulate the visual manifestation of those pathologies. (Not my area of expertise - but fascinating).

What made you want to create a virtual cadaver?

My partner, Dr Whitlock, believed that cross-sections are a great way to teach the anatomy of the human body. The Chair of Anatomy in the early 90's wanted to hire people in his Department to present anatomy - similar to radiology CT scans - including 3D. He hired me, bought me a PIXAR computer and gave me a year off to study anatomy. What kind of person with a PIXAR computer has time to study anatomy. I worked with Dr Whitlock to cut thinner and thinner sections (with a band saw). It became obvious that we could cut much thinner if we DIDN'T save the slices - just the images. The whole goal of imaging the cross-sections was to re-stack them into a complete human, identify everything in the body, and then take the body apart - our present it any way a learner wants to see it -- from the skin, in cross-section - in ANY cross-section - not just the one of the original images - OR in 3D. We can now "feel" the body with haptic devices.

I am inspired by the human body - but also the process. learning about an animal, plant, human (or anything we don't have the original design for) is fascinating AND enabling for others to learn from.

What specific field do you think will benefit most from your work?

I think we are all about education - but that includes ALL healthcare providers - at all levels of their careers MANY patients at the time of their specific need The GENERAL PUBLIC has an appetite for knowledge about the human body

I don't think I can answer the question - without knowing what benefit means. If benefit is money and entertainment - it might be Hollywood - as they are constantly trying to mimic human behavior.

The field of ergonomic engineering will be grateful recipients when we are able to produce real motion - and put the simulated human in simulated positions (maybe a better airplane seat).

Wasn't there also a 'Visible Human' project in the early 90s where they used a prisoner who was sentenced to death? Whatever became of that project? I'd have to imagine it was a bit different given (a) possible moral issues and (b) the cadaver would have been from a relatively young healthy individual who was killed by lethal injection and therefore (apart from having been killed) was undamaged and relatively unaged.

That Project was completed in my lab - and is utilized today - around the world. (See www.toltech.net) or just search Visible Human for over a million hits. It is what inspired Susan Potter (a newspaper article about the Visible Human) to want the same thing. we have improved resolution, added her life story and medical history - but out is all done in the same vein (npi). The relatively healthy aspect was a requirement of the Visible Human Project - a very difficult donation to acquire.

What is your thought on simulation training in the medical field? Are companies like CAE and Simulaids well regarded or do you think their product has been lagging in terms of innovation and fidelity?

Simulation is KING. The companies you mention are well regarded - but the entire industry is embryonic. You want to say how good you are - and they are - they are just LOUSY compared to what they will be in the future. The first Lear airplane simulator was an amusement park ride - but persistence brought it to the level of producing a "Sully" and a 9/11 - that proves simulators are EFFECTIVE. But for some reason - its OK to spend $13M on one aircraft simulator - but a medical simulator should run a PC and never involve expensive hardware.

The military is responsible for most aircraft simulation advances and they gave medical simulators a grand kick-off - but that funding effort is still required and I feel will only come from the commercial environment.

To answer your question - Lagging in fidelity ---- YES

Do you think there might be any moral incentive to using an artificial body rather than a former person?

I think is is an honor to learn from "former people". I don't want to deny them the ability to give what they can - to further humanity. The morality only enters in if we are bad custodians and don't use their donation properly.

how did he died?

If you mean the Visible Human Male - He was executed by lethal injection.

I just read an article about Susan Potter. Based on her expectations of involvement prior to her death, do you think that you will ever accept a donor again, prior to their death?

I am always interested in the possibilities. but there are very few cases that would actually happen. I didn't really expect Susan Potter to end up in my freezer. We generally don't die when or how we want. My answer - yes. There are a lot of very generous people out there and most of them know they are going to die.

Is Vic short for VirCad?

It wasn't - but maybe it will be - if you will let me use it. Short for Victor.

Hi,

have you considered creating a truly open data set that is available to anyone in a "libre", public domain sense? The current data sets are only available on an approval basis requiring a signed agreement. While I understand why this is done, I also believe there is a case to be made that when data is liberated it will often be used in new and surprising ways that nobody could have foreseen. I suppose if such a data set were to be made, the person donating the body would have to agree to the data set being released in such a way.

Thanks for reading.

I haven't considered it much. The NLM was directed by Donald Lindberg at the time of the Visible Human and he pioneered the open access model - but they still wanted an agreement - just to know what people are doing with it. I believe money is required to accelerate innovation. Raising money is a major and difficult sales job. If anyone has a surprising way to use any data - there is no reason they should not be able to sell their idea - to make such data free to them. As far as the person donating - this was an issue I discussed with Susan Potter. She stated her data could not be used in any commercial way. I let her know that was the end of our relationship. At the time she donated I was working with commercial pharmaceutical money. I am proud of that work and the distribution of our data that it provided. It is why I could tell her that I would accept her donation and would complete her project. After some discussion she agreed. She refused to die and I had to find other money to live up to my end of the bargain. That money was mostly from my company.

Dogs or cats?

Sure They also deserve the best healthcare we can provide - and that is what we think we are doing - improving healthcare through education.

What makes your product stick out when compared to similiar applications, like Surgeon Simulator?

Surgical simulators should be as realistic as aircraft simulators - that, TODAY, all use photorealistic backgrounds (they started with cartoons). Our anatomy is photorealistic - surgical simulators should be based on the most realistic technology available. Our ArthroSim is - and that is the reason the American Academy of Orthopedic Surgeons chose to partner with us to develop an arthroscopy simulator. BUT - we need more image data, variation, pathology and motion to mover the industry forward.