Review of the main surgical and angiographic-oriented classifications of the course of the internal carotid artery through a novel interactive 3D model.

The course of the internal carotid artery (ICA) and its segment classifications were reviewed by means of a new and freely available 3D interactive model of the artery and the skull base, based on human neuroimages, that can be freely downloaded at the Public Repository of the University of Barcelona (http://diposit.ub.edu/dspace/handle/2445/112442) and runs under Acrobat Reader in Mac and Windows computers and Windows 10 tablets. The 3D-PDF allows zoom, rotation, selective visualization of structures, and a predefined sequence view. Illustrative images of the different classifications were obtained. Fischer (Zentralbl Neurochir 3:300-313, 1938) described five segments in the opposite direction to the blood flow. Gibo-Rothon (J Neurosurg 55:560-574, 1981) follow the blood flow, incorporated the cervical and petrous portions, and divided the subarachnoid course-supraclinoid-in ophthalmic, communicating, and choroidal segments, enhancing transcranial microscopic approaches. Bouthillier (Neurosurgery 38:425-433, 1996) divided the petrous portion describing the lacerum segment (exposed in transfacial procedures and exploration of Meckel's cave) and added the clinoid segment between the proximal and distal dural rings, of interest in cavernous sinus surgery. The Kassam's group (2014), with an endoscopic endonasal perspective, introduces the "paraclival segment," including the "lacerum segment" and part of the intracavernous ICA, and details surgical landmarks to minimize the risk of injury. Other classifications are also analyzed. This review through an interactive 3D tool provides virtual views of the ICA and becomes an innovative perspective to the segment classifications and neuroanatomy of the ICA and surrounding structures.

Applications of Virtual and Augmented Reality in Biomedical Imaging.

Virtual and Augmented Reality has experienced a steady growth in medicine in recent years. At the same time, the radiological images play a central role in the diagnosis and planification of surgical approaches. The aim of this study is to present the first attempt to enhanced radiological image visualization using virtual and augmented reality for better planification and monitorization of surgeries. This application allows to move beyond traditional two-dimensional images towards three-dimensional models that can be visualized and manipulated with both Augmented Reality and Virtual Reality. We propose possible approaches to automate the segmentation of radiological images, using computer vision techniques and Artificial Intelligence.

Results of the Use of a Simulator for Training in Anesthesia and Regional Analgesia Guided by Ultrasound.

Show the learning results obtained by a simulation tool used by students of an online course on anesthesia techniques and regional analgesia guided by ultrasound. A satisfaction survey generated with a form of Google Forms was carried out in September 2018 with 14 questions related to the quality, ease and capacity of the learning obtained after the use of the nerve blocks Simulator, which was firstly published on the first edition of the course for 34 students. An average of 7.3 attempts of resolution have been made per practice and per student in the simulator. The students are, in their immense majority, habitual users of the ICTs and 73% of them consider that their experience with the simulator has been satisfactory and that their learning has been favored by this fact. The authors have verified that the ultrasound simulator contributes to the learning of skills for the practice of nerve blocks and, furthermore, it helps to ensure that theoretical knowledge is carried out in a more productive and efficient way.

A Novel and Freely Available Interactive 3d Model of the Internal Carotid Artery.

We describe a new and freely available 3D interactive model of the intracranial internal carotid artery (ICA) and the skull base that also allows to display and compare its main segment classifications. High-resolution 3D human angiography (isometric voxel's size 0.36 mm) and Computed Tomography angiography images were exported to Virtual Reality Modeling Language (VRML) format for processing in a 3D software platform and embedding in a 3D Portable Document Format (PDF) document that can be freely downloaded at http://diposit.ub.edu/dspace/handle/2445/112442 and runs under Acrobat Reader on Mac and Windows computers and Windows 10 tablets. The 3D-PDF allows for visualisation and interaction through JavaScript-based functions (including zoom, rotation, selective visualization and transparentation of structures or a predefined sequence view of the main segment classifications if desired). The ICA and its main branches and loops, the Gasserian ganglion, the petrolingual ligament and the proximal and distal dural rings within the skull base environment (anterior and posterior clinoid processes, silla turcica, ethmoid and sphenoid bones, orbital fossae) may be visualized from different perspectives. This interactive 3D-PDF provides virtual views of the ICA and becomes an innovative tool to improve the understanding of the neuroanatomy of the ICA and surrounding structures.

Advances in the Study of the Middle Cranial Fossa through Cutting Edge Neuroimaging Techniques.

The objective of this paper is to present a morphometric study of the middle cranial fossa from the study of 87 patients using cutting edge multislice computed tomography scans (32 detectors) and Magnetic Resonance Imaging. The study presents a detailed anatomical-radiological and morphometric analysis of the middle cranial fossa as well as its neurovascular elements in normal conditions. The implications of this investigation in training and clinical contexts are discussed.

New Generation of Three-Dimensional Tools to Learn Anatomy.

We present a new generation tool based of interactive 3D models. This models are based on the radiological two-dimensional images by computed tomography imaging. Our article focuses on the anatomical region of the skull base. These new three-dimensional models offer a wide field of application in the learning, as they offer multiple visualization tools (rotation, scrolling, zoom…). In this way, understanding of the anatomical region is facilitated. A feature to be dismissed is that a professional workstation is not required to work with three-dimensional models, since a personal computer can be viewed and interacted with the models. Educational and clinical applications are also discussed.

Virtual Reality Educational Tool for Human Anatomy.

Virtual Reality is becoming widespread in our society within very different areas, from industry to entertainment. It has many advantages in education as well, since it allows visualizing almost any object or going anywhere in a unique way. We will be focusing on medical education, and more specifically anatomy, where its use is especially interesting because it allows studying any structure of the human body by placing the user inside each one. By allowing virtual immersion in a body structure such as the interior of the cranium, stereoscopic vision goggles make these innovative teaching technologies a powerful tool for training in all areas of health sciences. The aim of this study is to illustrate the teaching potential of applying Virtual Reality in the field of human anatomy, where it can be used as a tool for education in medicine. A Virtual Reality Software was developed as an educational tool. This technological procedure is based entirely on software which will run in stereoscopic goggles to give users the sensation of being in a virtual environment, clearly showing the different bones and foramina which make up the cranium, and accompanied by audio explanations. Throughout the results the structure of the cranium is described in detailed from both inside and out. Importance of an exhaustive morphological knowledge of cranial fossae is further discussed. Application for the design of microsurgery is also commented.

Avances tecnológicos en la formación médica: presente y futuro / Technological advances in medical training: present and future

Presentamos una revisión del estado actual de las tecnologías aplicadas a la formación médica y las perspectivas que estos sistemas tecnológicos traerán en los nuevos métodos y formas de enseñanza en medicina y ciencias afines. Mostramos ejemplos prácticos de procedimientos tecnológicos concretos desarrollados por nuestro grupo de investigación reconocido sobre sistemas de visualización médica avanzada (VisualMed Systems) de la Universidad de Salamanca. Destacamos aplicaciones tecnológicas desarrolladas por nuestro grupo para dispositivos portables (smartphones y tablets), sistemas de visión estereoscópica con gafas de realidad virtual, entornos tecnológicos de simulación clínica, como la exploración ecográfica virtual o los sistemas de auscultación cardíaca mediante sensores de movimiento empotrados en fonendo, y abordajes laparoscópicos virtuales, mediante el empleo de dispositivos tecnológicos de captación de movimientos manuales. La incorporación de tecnologías en la formación médica permitirá transformar radicalmente las condiciones tradicionales de la docencia, gracias al empleo de nuevas formas de enseñar y de aprender, mediante la utilización de entornos tecnológicos virtuales clínicos, a través del uso de sistemas de visión artificial, y la utilización de dispositivos portables y gafas de visión estereoscópicas. Este tipo de recursos tecnológicos formativos permiten ventajas educativas, ya que brindan una seguridad ante los errores en entrenamientos de técnicas y exploraciones clínicas específicas, ofrecen un coste más reducido y menos peligroso que trabajar con la realidad y, además, pueden ayudar a la comprensión de procedimientos concretos

We present a review of the current state of the technology applied to medical training and prospects that these technological systems bring into new methods and forms of education in medicine and health sciences. We show practical examples of specific technological procedures developed by our recognized research group named "advanced medical visualization systems" (VisualMed Systems) at the University of Salamanca. We highlight technological applications developed by our group for portable devices (smartphones and tablets); stereoscopic vision systems with virtual reality goggles; Clinical simulation technology environments as virtual ultrasound examination, or cardiac auscultation systems using sensors embedded in phonendoscope movement; and virtual laparoscopic approaches, by employing technological devices to capture hand movements. The incorporation of digital technology in medical training, allow radically transform traditional teaching conditions thanks to the use of new forms of teaching and learning; such as using clinical virtual IT environments, through the use of machine vision systems, and the use of portable devices and stereoscopic vision goggles. These types of training technological resources enable educational benefits because they offer security to errors in training techniques and specific clinical examinations, offer a smaller and less dangerous to work with reality cost and also may help to comprehension of procedures concrete

3D interactive model of lumbar spinal structures of anesthetic interest.

A 3D model of lumbar structures of anesthetic interest was reconstructed from human magnetic resonance (MR) images and embedded in a Portable Document Format (PDF) file, which can be opened by freely available software and used offline. The MR images were analyzed using a specific 3D software platform for biomedical data. Models generated from manually delimited volumes of interest and selected MR images were exported to Virtual Reality Modeling Language format and were presented in a PDF document containing JavaScript-based functions. The 3D file and the corresponding instructions and license files can be downloaded freely at http://diposit.ub.edu/dspace/handle/2445/44844?locale=en. The 3D PDF interactive file includes reconstructions of the L3-L5 vertebrae, intervertebral disks, ligaments, epidural and foraminal fat, dural sac and nerve root cuffs, sensory and motor nerve roots of the cauda equina, and anesthetic approaches (epidural medial, spinal paramedial, and selective nerve root paths); it also includes a predefined sequential educational presentation. Zoom, 360° rotation, selective visualization, and transparency graduation of each structure and clipping functions are available. Familiarization requires no specialized informatics knowledge. The ease with which the document can be used could make it valuable for anatomical and anesthetic teaching and demonstration of patient information.