Government's Investment in Visible Human Project Begins to Pay Dividends in Oncology

BETHESDA, Md—The Visible Human Project has become a virtual reality beyond the expectations of many. Already, researchers are experimenting with the computerized anatomies of a man and woman, seeking ways to use them to the benefit of medical education, diagnostics, and surgery.

Using specialized software, physicians can reconstruct enormous amounts of digital information into three-dimensional images, which they can rotate, examine, take apart, and reassemble.

"This is an entirely new, exciting medical tool, based on computer science, that will allow us to study human anatomy," said Steven Phillips, MD, of the Iowa Heart Center, Des Moines, who chairs the Board of Regents of the National Library of Medicine (NLM). "Physicians and scientists are already using this tool to substitute for cadavers, to plan surgery, and to do colonoscopies."

Dr. Phillips spoke during a demonstration of some of the medical advances evolving from the Visible Human Project at a 2-day meeting sponsored by the NLM. "Applications of this tool are really unlimited," he said.

At the Mayo Clinic, physicians are using the visible man to rehearse prostate cancer operations in order to reduce complications and time in surgery. Richard A. Robb, PhD, and his colleagues have coupled datasets from the Visible Human Project with a patient's own scans and a computer program that rapidly renders high-resolution 3D images (see Figures 1, 2, 3, 4, and 5).

Such renderings are useful for studying spatial dimensions and relationships, he said, and allow surgeons to visually plan and rehearse an operation in advance. In addition, the models can be updated in real time for more realistic surgical simulations.

"It should be possible to scan the patient in the morning, process the data, show it to the surgeon in the afternoon, and help him or her go through the rehearsal and understand the anatomy preparatory to the surgery the next morning," Dr. Robb said. "Ultimately, with the advances in computer technology, we'll be able to have these kinds of capabilities on line in the operating room."

Mark Wax, MD, and his coworkers at the State University of New York at Stony Brook envision a virtual colonoscopy simulator that would replace costly and uncomfortable colon cancer screening procedures with a noninvasive scan.

Software developed by computer scientist Ari Kaufman, PhD, converts CT scans of a patient into a 3D image of a colon through which the researchers can "fly" via the computer, looking for signs of polyps or cancer.

"We envision this as an easier way for patients to go through an initial screening," Dr. Wax said. "We are still working on differentiating actual masses from retained stool, but if we are able to use this technique to screen a large number of patients and then select a small group for routine colonoscopy, we can cut costs, screen more patients, and catch polyps at a premalignant size."

A Bargain at $1.4 Million

The federal investment in developing the dataset derived from slicing and scanning the two cadavers totals $1.4 million. "So it is really very small, when you consider what all research costs," Dr. Phillips said.

Currently, 650 licensees in 26 countries are turning the data into usable software and other products, added Michael Ackerman, PhD, the NLM's Visual Human Project manager. "It's evolved to the place where we hope that the visible humans will do for surgery and medicine what the flight simulator has done for aviation," Dr. Ackerman said.

One licensee, Engineering Animation, Inc. (EAI) of Ames, Iowa, has spent more than $5 million in technology development, says Michael S. Sellberg, a senior project manager at EAI.

One example is the company's Dissectable Human CD-ROM ($49.95), a series of interactive, 3D-rendered anatomical atlases. It includes the male skeletal, muscular, cardiovascular, nervous, digestive, respiratory, endocrine, urinary, reproductive, and lymphatic systems.

Published by Mosby-Year Book, Inc., the atlas is intended as an educational tool for college and medical students, and for use by medical professionals.

Researchers at the meeting expressed confidence that the training, diagnostic, and surgical improvements emerging from the Visible Human Project will help physicians better manage costs as well as patients. "This is a brand new technology," Dr. Phillips said. "These tools will absolutely cut the costs of future medicine and future care."

Dr. Robb suggested that this will happen through the use of high-resolution images to help train physicians to understand human anatomy at a lower cost, and the use of patient-specific anatomy.

More detailed information is available from the Visible Human Project, National Library of Medicine, 8600 Rockville Pike, Bethesda, MD 20894; Fax: 301-402-4080; email: vhp@nlm.nih.gov.