The electronic body uncovered

The ADAM (Animated Dissection of Anatomy for Medicine) stable of anatomical software has now launched ADAM Interactive Anatomy (AIA), aimed at medical students, others in allied health studies at undergraduate level and people in health care with patient education responsibilities. It costs approximately Pounds 850 if purchased in the United States, rather more in the United Kingdom. There are versions for both PCs and Macintoshes. In the promotional literature, William H. Hightower of Southside Virginia Community College says the new package's only limitation is "your imagination".

We have to admit our first limitation was getting started: it is not easy to instal and this must be done correctly if problems are to be avoided. This is an observation rather that a criticism, for one can always get help with this sort of thing, as we did. We used a PC and ran the program at 800 x 600 screen resolution in 16 bit colour, using a Pentium 133 and Windows 95.

There are four components: Dissectable Anatomy, Atlas Anatomy, Slide Show and 3-D Anatomy. The software enables a skilled operator to work simultaneously with multiple windows, shuffling different images of the chosen organ or region on the screen, viewing it from different perspectives. As relative beginners, we chose to explore the components one at a time and to have only one picture on the screen at once. Although navigation appears to be straightforward, using familiar icons and menus, we are uncertain we have fully explored all its nooks and crannies, simply because there are so many of them. Not for the first time we noted that reviewing computer software is many times more time consuming than reviewing a new version of a textbook.

When we first dipped into the Dissectable Anatomy component it was strangely reminiscent of small booklets produced in the 1940s and 1950s whose transparent pages could be turned to reveal successive layers. ADAM is of course infinitely more sophisticated. One can have either sex, concentrate on a particular region such as the head or the pelvis, call up parts, check the names of structures, or creep through the body layer by minute layer. A one-layer-at-a-time journey through the abdomen from front to back means wading through more than 150 images.

In a traditional atlas one can usually view structures only from the front, and possibly also from the back. Dissectable Anatomy can also "dissect" from the left or the right, in which case the midline is available as a starting point. A helpful little picture in the corner shows just where the current slice comes from. This is particularly useful when viewing cross sections, the ADAM equivalent of a CT or MRI scan. But, unlike diagnostic scans, the software allows viewing from the superior as well as the inferior aspect.

Although the sheer number of "dissected" images is impressive, their appearance is often disappointing. The colours are harsh and there is a coarseness to the line effect around the edges of structures. The elegence of flat-drawn artwork is always degraded when it is pixellated and used with this form of technology. It becomes tiresome to see the same images again and again.

We feel that this type of package deserves a style and quality of images that matches the technology to which it is attached. The present drawings, while accurate, are now out of date: adequate but uninspired. They compare poorly with those of Peter Cull or Frank Netter. These observations are made in the light of so much fine imagery seen in many modern publications where variations in style and fashion reflect the changes that make an image new and exciting. We suspect the authors of AIA are aware of these shortcomings since they have included a number of photographs from the Bassett collection. They seem out of place here and do not adequately solve the problem.

Atlas Anatomy is basically what one might expect. There are more than 400 pictures including a number of photographs. The illustrations are "pinned": structures are identified by short leader lines with white discs on their ends. Clicking the disc changes its colour and the name of the structure appears elsewhere on the screen. This system produces pictures that are uncluttered by labels and useful for self assessment.

Slide Show is a program that enables anatomy teachers to assemble lectures or computer assisted learning packages for their students. We expect it will appeal to many teachers in view of the vast library of images upon which they may draw.

It is in 3-D Anatomy that we find something new and up to date. It all becomes dynamic and uses current technology to the full. Unfortunately, one can call up only three topics in the current version but we expect more will be available in the next year or so. The present three topics are the skull, the heart and the lungs. Each can be rotated - one step at a time or in a continuous and rather dizzy pirouette - around four axes: vertical, transverse and two obliques. The rotatable heart can even be rendered translucent so that its four valves can be seen as the organ spins. Alternatively a component structure, such as a coronary artery or cardiac valve, can be selected from a menu, thereupon the specimen tumbles to a suitable angle and the selected feature is highlighted. This may involve the creation of a window to gain access to the interior. We liked the heart and the lungs (the latter includes the main bronchi, trachea and larynx) but found the skull disappointing. A student would find this of value only if he or she had no access at all to a real skull or a plastic model. 3-D Anatomy is based on the Visible Human Project in which 1mm thick sections of a cadaver have been digitised so that the anatomy can be cleverly reassembled to produce all manner of 3-D rotatable pictures. Those who have been privileged to see the full potential of this type of imagery will appreciate that there is very little that will be able to compete with it once it all becomes available, and that is just a matter of time.

This new software is a very comprehensive anatomical resource and while it is of limited value in the context of surgical and pathological anatomy, should be a great asset to those medical students who are not privileged to experience traditional dissection.

Richard Neave is artist in medicine and life sciences and John Humpherson is senior lecturer in anatomy at the University of Manchester.