Emerging Imaging Techniques in Anatomy: For Teaching, Research and Clinical Practice.

Visualisation plays a key role in anatomy, where the depiction of gross anatomical structures is essential in understanding and conceptualising content during research and medical teaching. Technology has allowed us to utilise imaging techniques for the visualisation of anatomical features, pathology and correlating physiological functions in a non-invasive manner which is atypical to traditional forms of anatomical investigation. These imaging methods develop integration between anatomy and clinically oriented medical study as well as biomechanics. The progressive research in anatomy can benefit from the vast field of biomechanics which allows for precise and conclusive results regarding the biomechanical integrity of anatomical structures and allows for intricate planning of procedures. 3D imaging techniques have enhanced the modelling of internal structures which are especially essential when implemented as diagnostic tools. An integration of these modalities into medical training accommodates for a more clinically orientated and immediate visualisation as produced when utilising ultrasound imaging which has the added advantage of 3D modelling and manipulation. Immersive technology has revolutionised teaching and learning particularly during the new age of hybrid education. Visualisation in anatomy has many clinical and educational applications which can optimise research, create interactive learning experiences and aid medical practise.

Sulci 3D mapping from human cranial endocasts: A powerful tool to study hominin brain evolution.

Key questions in paleoneurology concern the timing and emergence of derived cerebral features within the human lineage. Endocasts are replicas of the internal table of the bony braincase that are widely used in paleoneurology as a proxy for reconstructing a timeline for hominin brain evolution in the fossil record. The accurate identification of cerebral sulci imprints in endocasts is critical for assessing the topographic extension and structural organisation of cortical regions in fossil hominins. High-resolution imaging techniques combined with established methods based on population-specific brain atlases offer new opportunities for tracking detailed endocranial characteristics. This study provides the first documentation of sulcal pattern imprints from the superolateral surface of the cerebrum using a population-based atlas technique on extant human endocasts. Human crania from the Pretoria Bone Collection (South Africa) were scanned using micro-CT. Endocasts were virtually extracted, and sulci were automatically detected and manually labelled. A density map method was applied to project all the labels onto an averaged endocast to visualise the mean distribution of each identified sulcal imprint. This method allowed for the visualisation of inter-individual variation of sulcal imprints, for example, frontal lobe sulci, correlating with previous brain-MRI studies and for the first time the extensive overlapping of imprints in historically debated areas of the endocast (e.g. occipital lobe). In providing an innovative, non-invasive, observer-independent method to investigate human endocranial structural organisation, our analytical protocol introduces a promising perspective for future research in paleoneurology and for discussing critical hypotheses on the evolution of cognitive abilities among hominins.

Exploring the relationship between soft and hard tissues: The example of vertebral arteries and transverse foramina.

Understanding how the brain is provided with glucose and oxygen is of particular interest in human evolutionary studies. In addition to the internal carotid arteries, vertebral arteries contribute significantly to the cerebral and cerebellar blood flow. The size of the transverse foramina has been suggested to represent a reliable proxy for assessing the size of the vertebral arteries in fossil specimens. To test this assumption, here, we statistically explore spatial relationships between the transverse foramina and the vertebral arteries in extant humans. Contrast computed tomography (CT) scans of the cervical regions of 16 living humans were collected. Cross-sectional areas of the right and left transverse foramina and the corresponding vertebral arteries were measured on each cervical vertebra from C1 to C6 within the same individuals. The cross-sectional areas of the foramina and corresponding arteries range between 13.40 and 71.25 mm2 and between 4.53 and 29.40 mm2 , respectively. The two variables are significantly correlated except in C1. Using regression analyses, we generate equations that can be subsequently used to estimate the size of the vertebral arteries in fossil specimens. By providing additional evidence of intra- and inter-individual size variation of the arteries and corresponding foramina in extant humans, our study introduces an essential database for a better understanding of the evolutionary story of soft tissues in the fossil record.

Are endocasts reliable proxies for brains? A 3D quantitative comparison of the extant human brain and endocast.

Endocasts (i.e., replicas of the inner surface of the bony braincase) constitute a critical proxy for qualifying and quantifying variations in brain shape and organization in extinct taxa. In the absence of brain tissues preserved in the fossil record, endocasts provide the only direct evidence of brain evolution. However, debates on whether or not information inferred from the study of endocasts reflects brain shape and organization have polarized discussions in paleoneurology since the earliest descriptions of cerebral imprints in fossil hominin crania. By means of imaging techniques (i.e., MRIs and CT scans) and 3D modelling methods (i.e., surface-based comparisons), we collected consistent morphological (i.e., shape) and structural (i.e., sulci) information on the variation patterns between the brain and the endocast based on a sample of extant human individuals (N = 5) from the 3D clinical image database of the Steve Biko Academic Hospital in Pretoria (South Africa) and the Hôpitaux Universitaires Pitié Salpêtrière in Paris (France). Surfaces of the brain and endocast of the same individual were segmented from the 3D MRIs and CT images, respectively. Sulcal imprints were automatically detected. We performed a deformation-based shape analysis to compare both the shape and the sulcal pattern of the brain and the endocast. We demonstrated that there is close correspondence in terms of morphology and organization between the brain and the corresponding endocast with the exception of the superior region. By comparatively quantifying the shape and organization of the brain and endocast, this work represents an important reference for paleoneurological studies.

Sulcal pattern variation in extant human endocasts.

Our knowledge of human brain evolution primarily relies on the interpretation of palaeoneurological evidence. In this context, an endocast or replica of the inside of the bony braincase can be used to reconstruct a timeline of cerebral changes that occurred during human evolution, including changes in topographic extension and structural organisation of cortical areas. These changes can be tracked by identifying cerebral imprints, particularly cortical sulci. The description of these crucial landmarks in fossil endocasts is, however, challenging. High-resolution imaging techniques in palaeoneurology offer new opportunities for tracking detailed endocranial neural characteristics. In this study, we use high-resolution imaging techniques to document the variation in extant human endocranial sulcal patterns for subsequent use as a platform for comparison with the fossil record. We selected 20 extant human crania from the Pretoria Bone Collection (University of Pretoria, South Africa), which were detailed using X-ray microtomography at a spatial resolution ranging from 94 to 123 µm (isometric). We used Endex to extract, and Matlab to analyse the cortical imprints on the endocasts. We consistently identified superior, middle and inferior sulci on the frontal lobe; and superior and inferior sulci on the temporal lobe. We were able to label sulci bordering critical functional areas such as Broca's cap. Mapping the sulcal patterns on extant endocasts is a prerequisite for constructing an atlas which can be used for automatic sulci recognition.

The endocast of StW 573 ("Little Foot") and hominin brain evolution.

One of the most crucial debates in human paleoneurology concerns the timing and mode of the emergence of the derived cerebral features in the hominin fossil record. Given its exceptional degree of preservation and geological age (i.e., 3.67 Ma), StW 573 ('Little Foot') has the potential to shed new light on hominin brain evolution. Here we present the first detailed comparative description of the external neuroanatomy of StW 573. The endocast was virtually reconstructed and compared to ten southern African hominin specimens from Makapansgat, Malapa, Sterkfontein and Swartkrans attributed to Australopithecus and Paranthropus. We apply an automatic method for the detection of sulcal and vascular imprints. The endocranial surface of StW 573 is crushed and plastically deformed in a number of locations. The uncorrected and therefore minimum cranial capacity estimate is 408 cm3 and plots at the lower end of Australopithecus variation. The endocast of StW 573 approximates the rostrocaudally elongated and dorsoventrally flattened endocranial shape seen in Australopithecus and displays a distinct left occipital petalia. StW 573 and the comparative early hominin specimens share a similar sulcal pattern in the inferior region of the frontal lobes that also resembles the pattern observed in extant chimpanzees. The presumed lunate sulcus in StW 573 is located above the sigmoid sinus, as in extant chimpanzees, while it is more caudally positioned in SK 1585 and StW 505. The middle branch of the middle meningeal vessels derives from the anterior branch, as in MH 1, MLD 37/38, StW 578. Overall, the cortical anatomy of StW 573 displays a less derived condition compared to the late Pliocene/early Pleistocene southern African hominins (e.g., StW 505, SK 1585).

Broca's area, variation and taxic diversity in early Homo from Koobi Fora (Kenya).

Because brain tissues rarely fossilize, pinpointing when and how modern human cerebral traits emerged in the hominin lineage is particularly challenging. The fragmentary nature of the fossil material, coupled with the difficulty of characterizing such a complex organ, has been the source of long-standing debates. Prominent among them are the uncertainties around the derived or primitive state of the brain organization in the earliest representatives of the genus Homo, more particularly in key regions such as the Broca's area. By revisiting a particularly well-preserved fossil endocast from the Turkana basin (Kenya), here we confirm that early Homo in Africa had a primitive organization of the Broca's area ca. 1.9 million years ago. Additionally, our description of KNM-ER 3732 adds further information about the variation pattern of the inferior frontal gyrus in fossil hominins, with implications for early Homo taxic diversity (i.e. one or two Homo species at Koobi Fora) and the nature of the mechanisms involved in the emergence of derived cerebral traits.

Adapted full-face snorkel masks as an alternative for COVID-19 personal protection during aerosol generating procedures in South Africa: A multi-centre, non-blinded in-situ simulation study.

INTRODUCTION: SARS-CoV-2 has resulted in increased worldwide demand for personal protective equipment (PPE). With pressure from ongoing epidemic and endemic episodes, we assessed an adapted snorkel mask that provides full-face protection for healthcare workers (HCWs), particularly during aerosol-generating procedures. These masks have a custom-made adaptor which allows the fitment of standard medical respiratory filters. The aim of this study was to evaluate the fit, seal and clinical usability of these masks. METHODS: This multicentre, non-blinded in-situ simulation study recruited fifty-two HCWs to don and doff the adapted snorkel mask. Negative pressure seal checks and a qualitative fit test were performed. The HCWs completed intubation and extubation of a manikin in a university skills training laboratory, followed by a web-based questionnaire on the clinical usability of the masks. RESULTS: Whilst fit and usability data were generally satisfactory, two of the 52 participants (3.8%) felt that the mask did not span the correct distance from the nose to the chin, and 3 of 34 participants (8.8%) who underwent qualitative testing with a Bitrex test failed. The majority of users reported no fogging, humidity or irritation. It was reportedly easy to speak while wearing the mask, although some participants perceived that they were not always understood. Twenty-one participants (40%) experienced a subjective physiological effect from wearing the mask; most commonly a sensation of shortness of breath. DISCUSSION: A fit-tested modified full-face snorkel mask may offer benefit as a substitute for N95 respirators and face shields. It is, however, important to properly select the correct mask based on size, fit testing, quality of the three-dimensional (3D) printed parts and respiratory filter to be used. Additionally, HCWs should be trained in the use of the mask, and each mask should be used by a single HCW and not shared.

Visualization Within the Ventricles of the Brain: A Micro-Focus X-Ray Study.

Conceptualization of the ventricular system of the brain by macroscopic studies is complicated by the lack of physical structure of these interconnected cavities. Dissection procedures designed to display the structures in the walls of the ventricles are destructive and not conducive for the appreciation of the ventricular system in its entirety. The application of Micro-focus X-ray tomography affords the possibility to appreciate hidden structures in a nondestructive manner. The aim of this study was to explore the possibility of using micro-focus X-ray tomography in the three-dimensional (3D) visualization of the ventricular system as well as the various neuroanatomical structures within its walls for educational purposes. Randomly selected embalmed human cadaver brains were scanned at Necsa (South African Nuclear Energy Corporation) housing the MIXRAD laboratory consisting of a Nikon XTH 225 ST micro-focus X-ray tomography facility. A 3D flythrough video of the ventricular system was reconstructed from these scans using software to view the inner surface of the ventricles. Micro-focus X-ray tomography provides feasible means of delivering high-resolution images in a nondestructive way to design a representation of the ventricular system. In addition, structures in the walls of the ventricular system could be appreciated in a novel way. It is envisaged that this 3D-fly-through video of the ventricular system will be valuable when integrated with standard prosections and atlas pictures in the educational setting. Further studies evaluating the use of this integrative visualization of the ventricular system of the brain for its applicability in the educational setting should be performed. Anat Rec, 301:1138-1147, 2018. © 2017 Wiley Periodicals, Inc.