Evaluating a Photogrammetry-Based Video for Undergraduate Anatomy Education.

Modern anatomy education has benefitted from the development of a wide range of digital 3D resources in the past decades, but the impact of the COVID-19 pandemic has sparked an additional demand for high-quality online learning resources. Photogrammetry provides a low-cost technique for departments to create their own photo-realistic 3D models of cadaveric specimens. However, to ensure accessibility, the design of the resulting learning resources should be carefully considered. We aimed to address this by creating a video based on a photogrammetry model of a cadaveric human lung. Students evaluated three different versions of this video in a Likert-type online survey. Most responding students found this type of video useful for their learning and helpful for the identification of anatomical structures in real cadaveric specimens. Respondents also showed a preference for specific design features such as a short video length, white text on black background, and the presence of captions. The positive student feedback is promising for the future development of photogrammetry-based videos for anatomy education and this study has provided pilot data to improve the accessibility of such videos.

Assessment of the mechanical role of cranial sutures in the mammalian skull: Computational biomechanical modelling of the rat skull.

Cranial sutures are fibrocellular joints between the skull bones that are progressively replaced with bone throughout ontogeny, facilitating growth and cranial shape change. This transition from soft tissue to bone is reflected in the biomechanical properties of the craniofacial complex. However, the mechanical significance of cranial sutures has only been explored at a few localised areas within the mammalian skull, and as such our understanding of suture function in overall skull biomechanics is still limited. Here, we sought to determine how the overall strain environment is affected by the complex network of cranial sutures in the mammal skull. We combined two computational biomechanical methods, multibody dynamics analysis and finite element analysis, to simulate biting in a rat skull and compared models with and without cranial sutures. Our results show that including complex sutures in the rat model does not substantially change overall strain gradients across the cranium, particularly strain magnitudes in the bones overlying the brain. However, local variations in strain magnitudes and patterns can be observed in areas close to the sutures. These results show that, during feeding, sutures may be more important in some regions than others. Sutures should therefore be included in models that require accurate local strain magnitudes and patterns of cranial strain, particularly if models are developed for analysis of specific regions, such as the temporomandibular joint or zygomatic arch. Our results suggest that, for mammalian skulls, cranial sutures might be more important for allowing brain expansion during growth than redistributing biting loads across the cranium in adults.

Computational biomechanical modelling of the rabbit cranium during mastication.

Although a functional relationship between bone structure and mastication has been shown in some regions of the rabbit skull, the biomechanics of the whole cranium during mastication have yet to be fully explored. In terms of cranial biomechanics, the rabbit is a particularly interesting species due to its uniquely fenestrated rostrum, the mechanical function of which is debated. In addition, the rabbit processes food through incisor and molar biting within a single bite cycle, and the potential influence of these bite modes on skull biomechanics remains unknown. This study combined the in silico methods of multi-body dynamics and finite element analysis to compute musculoskeletal forces associated with a range of incisor and molar biting, and to predict the associated strains. The results show that the majority of the cranium, including the fenestrated rostrum, transmits masticatory strains. The peak strains generated over all bites were found to be attributed to both incisor and molar biting. This could be a consequence of a skull shape adapted to promote an even strain distribution for a combination of infrequent incisor bites and cyclic molar bites. However, some regions, such as the supraorbital process, experienced low peak strain for all masticatory loads considered, suggesting such regions are not designed to resist masticatory forces.

Effect of marker position and size on the registration accuracy of HoloLens in a non-clinical setting with implications for high-precision surgical tasks.

PURPOSE: Emerging holographic headsets can be used to register patient-specific virtual models obtained from medical scans with the patient's body. Maximising accuracy of the virtual models' inclination angle and position (ideally, ≤ 2° and ≤ 2 mm, respectively, as in currently approved navigation systems) is vital for this application to be useful. This study investigated the accuracy with which a holographic headset registers virtual models with real-world features based on the position and size of image markers. METHODS: HoloLens® and the image-pattern-recognition tool Vuforia Engine™ were used to overlay a 5-cm-radius virtual hexagon on a monitor's surface in a predefined position. The headset's camera detection of an image marker (displayed on the monitor) triggered the rendering of the virtual hexagon on the headset's lenses. 4 × 4, 8 × 8 and 12 × 12 cm image markers displayed at nine different positions were used. In total, the position and dimensions of 114 virtual hexagons were measured on photographs captured by the headset's camera. RESULTS: Some image marker positions and the smallest image marker (4 × 4 cm) led to larger errors in the perceived dimensions of the virtual models than other image marker positions and larger markers (8 × 8 and 12 × 12 cm). ≤ 2° and ≤ 2 mm errors were found in 70.7% and 76% of cases, respectively. CONCLUSION: Errors obtained in a non-negligible percentage of cases are not acceptable for certain surgical tasks (e.g. the identification of correct trajectories of surgical instruments). Achieving sufficient accuracy with image marker sizes that meet surgical needs and regardless of image marker position remains a challenge.

Comparative cranial biomechanics in two lizard species: impact of variation in cranial design.

Cranial morphology in lepidosaurs is highly disparate and characterised by the frequent loss or reduction of bony elements. In varanids and geckos, the loss of the postorbital bar is associated with changes in skull shape, but the mechanical principles underlying this variation remain poorly understood. Here, we sought to determine how the overall cranial architecture and the presence of the postorbital bar relate to the loading and deformation of the cranial bones during biting in lepidosaurs. Using computer-based simulation techniques, we compared cranial biomechanics in the varanid Varanus niloticus and the teiid Salvator merianae, two large, active foragers. The overall strain magnitude and distribution across the cranium were similar in the two species, despite lower strain gradients in V. niloticus In S. merianae, the postorbital bar is important for resistance of the cranium to feeding loads. The postorbital ligament, which in varanids partially replaces the postorbital bar, does not affect bone strain. Our results suggest that the reduction of the postorbital bar impaired neither biting performance nor the structural resistance of the cranium to feeding loads in V. niloticus Differences in bone strain between the two species might reflect demands imposed by feeding and non-feeding functions on cranial shape. Beyond variation in cranial bone strain related to species-specific morphological differences, our results reveal that similar mechanical behaviour is shared by lizards with distinct cranial shapes. Contrary to the situation in mammals, the morphology of the circumorbital region, calvaria and palate appears to be important for withstanding high feeding loads in these lizards.

Image Overlay Surgery Based on Augmented Reality: A Systematic Review.

Augmented Reality (AR) applied to surgical guidance is gaining relevance in clinical practice. AR-based image overlay surgery (i.e. the accurate overlay of patient-specific virtual images onto the body surface) helps surgeons to transfer image data produced during the planning of the surgery (e.g. the correct resection margins of tissue flaps) to the operating room, thus increasing accuracy and reducing surgery times. We systematically reviewed 76 studies published between 2004 and August 2018 to explore which existing tracking and registration methods and technologies allow healthcare professionals and researchers to develop and implement these systems in-house. Most studies used non-invasive markers to automatically track a patient's position, as well as customised algorithms, tracking libraries or software development kits (SDKs) to compute the registration between patient-specific 3D models and the patient's body surface. Few studies combined the use of holographic headsets, SDKs and user-friendly game engines, and described portable and wearable systems that combine tracking, registration, hands-free navigation and direct visibility of the surgical site. Most accuracy tests included a low number of subjects and/or measurements and did not normally explore how these systems affect surgery times and success rates. We highlight the need for more procedure-specific experiments with a sufficient number of subjects and measurements and including data about surgical outcomes and patients' recovery. Validation of systems combining the use of holographic headsets, SDKs and game engines is especially interesting as this approach facilitates an easy development of mobile AR applications and thus the implementation of AR-based image overlay surgery in clinical practice.

Application of Photogrammetry in Biomedical Science.

Photogrammetry is an upcoming technology in biomedical science as it provides a non-invasive and cost-effective alternative to established 3D imaging techniques such as computed tomography. This review introduces the photogrammetry approaches currently used for digital 3D reconstruction in biomedical science and discusses their suitability for different applications. It aims to offer the reader a better understanding of photogrammetry as a 3D reconstruction technique and to provide some guidance on how to choose the appropriate photogrammetry approach for their research area (including single- versus multi-camera setups, structure-from-motion versus conventional photogrammetry and macro- versus microphotogrammetry) as well as guidance on how to obtain high-quality data. This review highlights some key advantages of photogrammetry for a variety of applications in biomedical science, but it also discusses the limitations of this technique and the importance of taking steps to obtain high-quality images for accurate 3D reconstruction.

An assessment of the role of the falx cerebri and tentorium cerebelli in the cranium of the cat (Felis silvestris catus).

The falx cerebri and the tentorium cerebelli are two projections of the dura mater in the cranial cavity which ossify to varying degrees in some mammalian species. The idea that the ossification of these structures may be necessary to support the loads arising during feeding has been proposed and dismissed in the past, but never tested quantitatively. To address this, a biomechanical model of a domestic cat (Felis silvestris catus) skull was created and the material properties of the falx and tentorium were varied for a series of loading regimes incorporating the main masticatory and neck muscles during biting. Under these loading conditions, ossification of the falx cerebri does not have a significant impact on the stress in the cranial bones. In the case of the tentorium, however, a localized increase in stress was observed in the parietal and temporal bones, including the tympanic bulla, when a non-ossified tentorium was modelled. These effects were consistent across the different analyses, irrespective of loading regime. The results suggest that ossification of the tentorium cerebelli may play a minor role during feeding activities by decreasing the stress in the back of the skull.

Mechanical adaptation of trabecular bone morphology in the mammalian mandible.

Alveolar bone, together with the underlying trabecular bone, fulfils an important role in providing structural support against masticatory forces. Diseases such as osteoporosis or periodontitis cause alveolar bone resorption which weakens this structural support and is a major cause of tooth loss. However, the functional relationship between alveolar bone remodelling within the molar region and masticatory forces is not well understood. This study investigated this relationship by comparing mammalian species with different diets and functional loading (Felis catus, Cercocebus atys, Homo sapiens, Sus scrofa, Oryctolagus cuniculus, Ovis aries). We performed histomorphometric analyses of trabecular bone morphology (bone volume fraction, trabecular thickness and trabecular spacing) and quantified the variation of bone and tooth root volumes along the tooth row. A principal component analysis and non-parametric MANOVA showed statistically significant differences in trabecular bone morphology between species with contrasting functional loading, but these differences were not seen in sub-adult specimens. Our results support a strong, but complex link between masticatory function and trabecular bone morphology. Further understanding of a potential functional relationship could aid the diagnosis and treatment of mandibular diseases causing alveolar bone resorption, and guide the design and evaluation of dental implants.

Inclusion of periodontal ligament fibres in mandibular finite element models leads to an increase in alveolar bone strains.

Alveolar bone remodelling is vital for the success of dental implants and orthodontic treatments. However, the underlying biomechanical mechanisms, in particular the function of the periodontal ligament (PDL) in bone loading and remodelling, are not well understood. The PDL is a soft fibrous connective tissue that joins the tooth root to the alveolar bone and plays a critical role in the transmission of loads from the tooth to the surrounding bone. However, due to its complex structure, small size and location within the tooth socket it is difficult to study in vivo. Finite element analysis (FEA) is an ideal tool with which to investigate the role of the PDL, however inclusion of the PDL in FE models is complex and time consuming, therefore consideration must be given to how it is included. The aim of this study was to investigate the effects of including the PDL and its fibrous structure in mandibular finite element models. A high-resolution model of a human molar region was created from micro-computed tomography scans. This is the first time that the fibrous structure of the PDL has been included in a model with realistic tooth and bone geometry. The results show that omission of the PDL creates a more rigid model, reducing the strains observed in the mandibular corpus which are of interest when considering mandibular functional morphology. How the PDL is modelled also affects the strains. The inclusion of PDL fibres alters the strains in the mandibular bone, increasing the strains in the tooth socket compared to PDL modelled without fibres. As strains in the alveolar bone are thought to play a key role in bone remodelling during orthodontic tooth movement, future FE analyses aimed at improving our understanding and management of orthodontic treatment should include the fibrous structure of the PDL.

The biomechanical role of the chondrocranium and sutures in a lizard cranium.

The role of soft tissues in skull biomechanics remains poorly understood. Not least, the chondrocranium, the portion of the braincase which persists as cartilage with varying degrees of mineralization. It also remains commonplace to overlook the biomechanical role of sutures despite evidence that they alter strain distribution. Here, we examine the role of both the sutures and the chondrocranium in the South American tegu lizard Salvator merianae We use multi-body dynamics analysis (MDA) to provide realistic loading conditions for anterior and posterior unilateral biting and a detailed finite element model to examine strain magnitude and distribution. We find that strains within the chondrocranium are greatest during anterior biting and are primarily tensile; also that strain within the cranium is not greatly reduced by the presence of the chondrocranium unless it is given the same material properties as bone. This result contradicts previous suggestions that the anterior portion (the nasal septum) acts as a supporting structure. Inclusion of sutures to the cranium model not only increases overall strain magnitudes but also leads to a more complex distribution of tension and compression rather than that of a beam under sagittal bending.

Masticatory biomechanics in the rabbit: a multi-body dynamics analysis.

Multi-body dynamics is a powerful engineering tool which is becoming increasingly popular for the simulation and analysis of skull biomechanics. This paper presents the first application of multi-body dynamics to analyse the biomechanics of the rabbit skull. A model has been constructed through the combination of manual dissection and three-dimensional imaging techniques (magnetic resonance imaging and micro-computed tomography). Individual muscles are represented with multiple layers, thus more accurately modelling muscle fibres with complex lines of action. Model validity was sought through comparing experimentally measured maximum incisor bite forces with those predicted by the model. Simulations of molar biting highlighted the ability of the masticatory system to alter recruitment of two muscle groups, in order to generate shearing or crushing movements. Molar shearing is capable of processing a food bolus in all three orthogonal directions, whereas molar crushing and incisor biting are predominately directed vertically. Simulations also show that the masticatory system is adapted to process foods through several cycles with low muscle activations, presumably in order to prevent rapidly fatiguing fast fibres during repeated chewing cycles. Our study demonstrates the usefulness of a validated multi-body dynamics model for investigating feeding biomechanics in the rabbit, and shows the potential for complementing and eventually reducing in vivo experiments.

The biomechanical function of periodontal ligament fibres in orthodontic tooth movement.

Orthodontic tooth movement occurs as a result of resorption and formation of the alveolar bone due to an applied load, but the stimulus responsible for triggering orthodontic tooth movement remains the subject of debate. It has been suggested that the periodontal ligament (PDL) plays a key role. However, the mechanical function of the PDL in orthodontic tooth movement is not well understood as most mechanical models of the PDL to date have ignored the fibrous structure of the PDL. In this study we use finite element (FE) analysis to investigate the strains in the alveolar bone due to occlusal and orthodontic loads when PDL is modelled as a fibrous structure as compared to modelling PDL as a layer of solid material. The results show that the tension-only nature of the fibres essentially suspends the tooth in the tooth socket and their inclusion in FE models makes a significant difference to both the magnitude and distribution of strains produced in the surrounding bone. The results indicate that the PDL fibres have a very important role in load transfer between the teeth and alveolar bone and should be considered in FE studies investigating the biomechanics of orthodontic tooth movement.

The importance of accurate muscle modelling for biomechanical analyses: a case study with a lizard skull.

Computer-based simulation techniques such as multi-body dynamics analysis are becoming increasingly popular in the field of skull mechanics. Multi-body models can be used for studying the relationships between skull architecture, muscle morphology and feeding performance. However, to be confident in the modelling results, models need to be validated against experimental data, and the effects of uncertainties or inaccuracies in the chosen model attributes need to be assessed with sensitivity analyses. Here, we compare the bite forces predicted by a multi-body model of a lizard (Tupinambis merianae) with in vivo measurements, using anatomical data collected from the same specimen. This subject-specific model predicts bite forces that are very close to the in vivo measurements and also shows a consistent increase in bite force as the bite position is moved posteriorly on the jaw. However, the model is very sensitive to changes in muscle attributes such as fibre length, intrinsic muscle strength and force orientation, with bite force predictions varying considerably when these three variables are altered. We conclude that accurate muscle measurements are crucial to building realistic multi-body models and that subject-specific data should be used whenever possible.

Comparing the distribution of strains with the distribution of bone tissue in a human mandible: a finite element study.

Comparative anatomy and experimental studies suggest that the mass and distribution of tissue within a bone is adapted to the strains the bone experiences during function. Finite element analysis is a powerful tool that can be used to investigate this since it allows the creation of hypothetical models with unadapted morphology. Here we use FE models of a human mandible with modified internal morphology to study the relationships between the gross distribution of bone tissue (i.e., the presence or absence of bone in a certain area), the variation of cortical bone thickness within the mandible and the distribution of strain magnitudes. We created one model in which all internal cavities were filled with cortical bone material and a second, hollow model with constant cortical bone thickness. In both the models, several load cases representing bites at different positions along the tooth row were applied and peak strain magnitudes across these load cases were calculated. The peak strain distributions in both models show striking similarities with the gross distribution of bone tissue and the variation of cortical thickness in the real mandible, but the correlation coefficients are rather low. These low coefficients could be explained by confounding factors and by the limited spectrum of load cases that were simulated. However, the correspondences we find between strain magnitude and bone tissue distribution suggest that models with altered internal geometry are useful in studying the mechanical adaptation of bone, especially in the absence of any in vivo strain data.

Modeling the human mandible under masticatory loads: which input variables are important?

Finite element analyses (FEA) that have simulated masticatory loadings of the human mandible differ significantly with regard to their basic input variables such as material properties, constraints, and applied forces. With sensitivity analyses it is possible to assess how the choice of different input values and the degree of model simplification affect FEA results. However, published FEA studies are rarely accompanied by sensitivity analyses so that the robusticity of their results is impossible to assess. Here, we conduct a sensitivity analysis with an FE model of a human mandible to quantify the relative importance of several modeling decisions: (1) the material properties assigned to the cancellous bone tissue; (2) the inclusion or not of the periodontal ligament; (3) the constraints at the joints and bite point; and (4) the orientation of applied muscle forces. We study the effects of varying these properties by analysing the strain magnitudes and directions across the model surface. In addition, we perform a geometric morphometric analysis of the deformation resulting from the loading of each model. The results show that the effects of altering the different model properties can be significant and that most effects are potentially large enough to cause problems for the biological interpretation of FEA results. We therefore recommend that researchers conduct more sensitivity analyses than at present to assess the robusticity of their FEA results and their biological conclusions.

The earliest evidence for anatomically modern humans in northwestern Europe.

The earliest anatomically modern humans in Europe are thought to have appeared around 43,000-42,000 calendar years before present (43-42 kyr cal BP), by association with Aurignacian sites and lithic assemblages assumed to have been made by modern humans rather than by Neanderthals. However, the actual physical evidence for modern humans is extremely rare, and direct dates reach no farther back than about 41-39 kyr cal BP, leaving a gap. Here we show, using stratigraphic, chronological and archaeological data, that a fragment of human maxilla from the Kent's Cavern site, UK, dates to the earlier period. The maxilla (KC4), which was excavated in 1927, was initially diagnosed as Upper Palaeolithic modern human. In 1989, it was directly radiocarbon dated by accelerator mass spectrometry to 36.4-34.7 kyr cal BP. Using a Bayesian analysis of new ultrafiltered bone collagen dates in an ordered stratigraphic sequence at the site, we show that this date is a considerable underestimate. Instead, KC4 dates to 44.2-41.5 kyr cal BP. This makes it older than any other equivalently dated modern human specimen and directly contemporary with the latest European Neanderthals, thus making its taxonomic attribution crucial. We also show that in 13 dental traits KC4 possesses modern human rather than Neanderthal characteristics; three other traits show Neanderthal affinities and a further seven are ambiguous. KC4 therefore represents the oldest known anatomically modern human fossil in northwestern Europe, fills a key gap between the earliest dated Aurignacian remains and the earliest human skeletal remains, and demonstrates the wide and rapid dispersal of early modern humans across Europe more than 40 kyr ago.

Strain accommodation in the zygomatic arch of the pig: a validation study using digital speckle pattern interferometry and finite element analysis.

It has been repeatedly suggested that mammalian cranial sutures act not only to allow growth but also to reduce the levels of strain experienced by the skull during feeding. However, because of the added complexity they introduce, sutures are rarely included in finite element (FE) models, despite their potential to influence strain results. Because sutures present different morphologies and with differing degrees of internal fusion, many different methods of modeling may be necessary to accurately measure strain environments. Alternatively, these variables may exert very little influence on the scale of a whole-skull model. To validate suture modeling methods, four alternative ways of including a suture in 3D FE models of the pig zygomatic arch were considered and compared with ex vivo experimental data from digital speckle pattern interferometry (DSPI). The use of DSPI rather than traditional strain gauge techniques allows strain gradients around the suture as well as the motions of the two bones to be observed. Results show that the introduction of 3D elements assigned more compliant material properties than the surrounding bone, is the most effective way of modeling both morphologies of suture, both in tension and compression. However, models containing no suture are almost indistinguishable from these compliant suture models, beyond the high strain gradient immediately adjacent to the suture. Conversely, modeling the suture as an open break in the mesh, or with spring elements assigned suture properties, fails to reproduce the experiment. Thus, although a solid but flexible model of sutures is preferred, the similarity between these models and those without sutures tentatively suggests that such extra detail may be unnecessary in pigs if the behavior of the whole skull is of interest.

Why do humans have chins? Testing the mechanical significance of modern human symphyseal morphology with finite element analysis.

The modern human mandibular symphysis differs from those of all other primates in being vertically orientated and possessing a chin, but the functional significance of this unique morphology is not well understood. Some hypotheses propose that it is an adaptation to specific loads occurring during masticatory function. This study uses finite element analysis to examine these symphyseal loads in a model of a modern human mandible. By modifying the symphyseal cross-sectional form, the mechanical significance of the presence of the chin and symphyseal orientation is tested, and modern human and Neanderthal symphyseal cross-sections are compared with regard to their ability to withstand different loads. The results show that changes in symphyseal form have profound effects on the strains. The presence of a chin leads to lower symphyseal strains overall, whereas a vertical orientation of the symphysis results in higher strains under wishboning, but not under vertical bending in the coronal plane and dorsoventral shear. Compared to Neanderthals, the modern human symphysis shows higher strains during dorsoventral shear and wishboning, but is as effective as the Neanderthal symphysis in resisting vertical bending in the coronal plane and the loads resulting from simulated incision and unilateral molar biting. In general, the results of this study corroborate prior hypotheses about the mechanical effects of the human chin and vertical symphyseal orientation and support the idea that the relative importance of wishboning and vertical bending in the coronal plane might have played a role in the evolution of modern human symphyseal morphology.

Combining geometric morphometrics and functional simulation: an emerging toolkit for virtual functional analyses.

The development of virtual methods for anatomical reconstruction and functional simulation of skeletal structures offers great promise in evolutionary and ontogenetic investigations of form-function relationships. Key developments reviewed here include geometric morphometric methods for the analysis and visualization of variations in form (size and shape), finite element methods for the prediction of mechanical performance of skeletal structures under load and multibody dynamics methods for the simulation and prediction of musculoskeletal function. These techniques are all used in studies of form and function in biology, but only recently have they been combined in novel ways to facilitate biomechanical modelling that takes account of variations in form, can statistically compare performance, and relate performance to form and its covariates. Here we provide several examples that illustrate how these approaches can be combined and we highlight areas that require further investigation and development before we can claim a mature theory and toolkit for a statistical biomechanical framework that unites these methods.