Development of the Cardiovascular System: An Interactive Video Computer Program Arnold J. Smolen'2, George E. Zeiset' and Patricia Beaston-Wimmer'
'Interactive Multimedia Division, Office of Medical Education 2Department of Anatomy & Neurobiology The Medical College of Pennsylvania 3300 Henry Avenue Philadelphia, Pennsylvania system is of particular importance since it is the first system to become functional in the embryo. Additionally, congenital malformations of the heart are relatively common, accounting for approximately one-fourth of all congenital abnormalities.
ABSTRACT The major aim of this project is to provide interactive video computer based courseware that can be used by the medical student and others to supplementhis orherlearning ofthis very important aspectofbasic biomedical education. Embryology is a science that depends on the ability of the student to visualize dynamic changes in structure which occur in four dimensions - X, Y, Z, and time. Traditional didactic methods, including lectures employing photographic slides and laboratories employing histological sections, are limited to two dimensions - X and Y. The third spatial dimension and the dimension of time cannot be readily illustrated using these methods. Computer based learning, particularly when used in conjunction with interactive video, can be used effectively to illustrate developmental processes in all four dimensions. This methodology can also be used to foster the critical skills of independent learning and problem solving.
DESCRIPTION OF THE PROGRAM This program is designed to allow the student to learn, independently and at an individual pace, the essential aspects of the development of the cardiovascular system. The program is organized into nine lessons that follow the sequence of development of the various portions of the heart and major blood vessels, but the student may work through these lessons in any sequence. Computer generated text and graphics are presented, and the studentis able to interactively directthe subsequent development of the system using the touch screen. The program provides feedback to the student, and then displays graphically the next stage of development. Computer animation techniques are employed to illustrate these developmental processed.
INTRODUCTION A strong working knowledge of human embryology is critical for the physician working in a variety of specialties, including but not limited to pediatrics, obstetrics and gynecology and surgery. In addition, recent advances in ultrasound and other diagnostic imaging modalities have made it possible to observe embryonic and fetal development in situ, thus providing the ability to diagnose developmental malformations at a very early stage. The development of the cardiovascular 0195-4210/92/$5.00 0 1993 AMIA, Inc.
Lesson I: Angiogenic Cell Clusters This segment begins with the establishment ofthe mesodermal cell layer in the embryo, and the formation of angiogenic cell clusters within this layer. It follows the consolidation of these isolated angiogenic cell clusters into blood cells, blood vessels, and in the cardiogenic region, the heart tube.
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aortic arch, the pulmonary arteries, and other major arteries.
Lesson II: The Heart Tube In this segment, the establishment and change in position of the heart tube is followed in both transverse and sagittal views. At the end of this segment, the heart tube is located within the pericardial cavity, and has an arterial and a venous end.
Lesson VIII: Venous System The formation of the superior and inferior vena cava is illustrated, along with the establishment of the portal vein and ductus venosus.
Lesson IX: Circulatory Changes at Birth The final lesson illustrates the alterations in the circulation that occur following birth. Included are the closure of the ductus arteriosus and ductus venosus, and the closure of the foramen ovale. Several abnormalities associated with these events are also illustrated, including persistence of the ductus arteriosus and failure of closure of the foramen ovale.
Lesson III: The Heart Loop Once again, two views are presented, using computer animation of the elongation of the heart tube, and the formation of the S-shaped heart loop. At the conclusion of this segment, the heart has assumed its adult shape. Lesson IV: The Interatrial Septum Two views are employed to demonstrate the formation of the interatrial septum. The formation of the septum primum is shown with the establishment ofthe foramen primum. The foramen primum then closes, and the foramen secundum is established. Finally, the growth of the septum secundum is illustrated along with the formation ofthe foramen ovale. Several congenital anomalies associated with abnormal formation of the interatrial septum are available to the user, including the foramen secundum defect.
On-Line Atlas Images of complete series of histological sections of pig embryos at various ages and orientations are stored on the videodisk. At any stage in the program, the student can call up this atlas and examine the actual specimens which correspond to the computer animations. Thus, a laboratory-like experience is built into the program. The on-line atlas has several advantages over slide collections or printed atlases. One advantage is that any image in the library may be accessed rapidly. A second advantage is that the atlas can be used as motion video, where the student can view a series of adjacent sections in rapid sequence, providing the illusion of "walking through" the specimen. This method ofpresentation should assist the student in developing an appreciation for the three-dimensionality of the embryo at each age.
Lesson V: Aorticopulmonary Septum In this lesson, the division of the truncus arteriosus and conus cordis by the spiral aorticopulmonary septum into the ascending aorta and the pulmonary trunk is illustrated. Lesson VI: Interventricular Septum The normal formation of the interventricular septum is illustrated using computer animation. The contributions from the ventricular wall, endocardial cushions, and aorticopulmonary septum are shown. The establishment of the tetralogy of Fallot, a relatively common malformation of the interventricular septum, is also shown.
Congenital Anomalies This aspect of the program is designed to consolidate the student's understanding of the embryological material and to place it into its proper clinical context. This is accomplished by presenting the learner with a series of developmental anomalies. The student is asked to explain the embryological basis for the anomaly.
Lesson VII: Aortic Arches The formation of the six pairs of aortic arches is illustrated, demonstrating the establishment of the 848
'Interactive Multimedia Division, Office of Medical Education 2Department of Anatomy & Neurobiology The Medical College of Pennsylvania 3300 Henry Avenue Philadelphia, Pennsylvania system is of particular importance since it is the first system to become functional in the embryo. Additionally, congenital malformations of the heart are relatively common, accounting for approximately one-fourth of all congenital abnormalities.
ABSTRACT The major aim of this project is to provide interactive video computer based courseware that can be used by the medical student and others to supplementhis orherlearning ofthis very important aspectofbasic biomedical education. Embryology is a science that depends on the ability of the student to visualize dynamic changes in structure which occur in four dimensions - X, Y, Z, and time. Traditional didactic methods, including lectures employing photographic slides and laboratories employing histological sections, are limited to two dimensions - X and Y. The third spatial dimension and the dimension of time cannot be readily illustrated using these methods. Computer based learning, particularly when used in conjunction with interactive video, can be used effectively to illustrate developmental processes in all four dimensions. This methodology can also be used to foster the critical skills of independent learning and problem solving.
DESCRIPTION OF THE PROGRAM This program is designed to allow the student to learn, independently and at an individual pace, the essential aspects of the development of the cardiovascular system. The program is organized into nine lessons that follow the sequence of development of the various portions of the heart and major blood vessels, but the student may work through these lessons in any sequence. Computer generated text and graphics are presented, and the studentis able to interactively directthe subsequent development of the system using the touch screen. The program provides feedback to the student, and then displays graphically the next stage of development. Computer animation techniques are employed to illustrate these developmental processed.
INTRODUCTION A strong working knowledge of human embryology is critical for the physician working in a variety of specialties, including but not limited to pediatrics, obstetrics and gynecology and surgery. In addition, recent advances in ultrasound and other diagnostic imaging modalities have made it possible to observe embryonic and fetal development in situ, thus providing the ability to diagnose developmental malformations at a very early stage. The development of the cardiovascular 0195-4210/92/$5.00 0 1993 AMIA, Inc.
Lesson I: Angiogenic Cell Clusters This segment begins with the establishment ofthe mesodermal cell layer in the embryo, and the formation of angiogenic cell clusters within this layer. It follows the consolidation of these isolated angiogenic cell clusters into blood cells, blood vessels, and in the cardiogenic region, the heart tube.
847
aortic arch, the pulmonary arteries, and other major arteries.
Lesson II: The Heart Tube In this segment, the establishment and change in position of the heart tube is followed in both transverse and sagittal views. At the end of this segment, the heart tube is located within the pericardial cavity, and has an arterial and a venous end.
Lesson VIII: Venous System The formation of the superior and inferior vena cava is illustrated, along with the establishment of the portal vein and ductus venosus.
Lesson IX: Circulatory Changes at Birth The final lesson illustrates the alterations in the circulation that occur following birth. Included are the closure of the ductus arteriosus and ductus venosus, and the closure of the foramen ovale. Several abnormalities associated with these events are also illustrated, including persistence of the ductus arteriosus and failure of closure of the foramen ovale.
Lesson III: The Heart Loop Once again, two views are presented, using computer animation of the elongation of the heart tube, and the formation of the S-shaped heart loop. At the conclusion of this segment, the heart has assumed its adult shape. Lesson IV: The Interatrial Septum Two views are employed to demonstrate the formation of the interatrial septum. The formation of the septum primum is shown with the establishment ofthe foramen primum. The foramen primum then closes, and the foramen secundum is established. Finally, the growth of the septum secundum is illustrated along with the formation ofthe foramen ovale. Several congenital anomalies associated with abnormal formation of the interatrial septum are available to the user, including the foramen secundum defect.
On-Line Atlas Images of complete series of histological sections of pig embryos at various ages and orientations are stored on the videodisk. At any stage in the program, the student can call up this atlas and examine the actual specimens which correspond to the computer animations. Thus, a laboratory-like experience is built into the program. The on-line atlas has several advantages over slide collections or printed atlases. One advantage is that any image in the library may be accessed rapidly. A second advantage is that the atlas can be used as motion video, where the student can view a series of adjacent sections in rapid sequence, providing the illusion of "walking through" the specimen. This method ofpresentation should assist the student in developing an appreciation for the three-dimensionality of the embryo at each age.
Lesson V: Aorticopulmonary Septum In this lesson, the division of the truncus arteriosus and conus cordis by the spiral aorticopulmonary septum into the ascending aorta and the pulmonary trunk is illustrated. Lesson VI: Interventricular Septum The normal formation of the interventricular septum is illustrated using computer animation. The contributions from the ventricular wall, endocardial cushions, and aorticopulmonary septum are shown. The establishment of the tetralogy of Fallot, a relatively common malformation of the interventricular septum, is also shown.
Congenital Anomalies This aspect of the program is designed to consolidate the student's understanding of the embryological material and to place it into its proper clinical context. This is accomplished by presenting the learner with a series of developmental anomalies. The student is asked to explain the embryological basis for the anomaly.
Lesson VII: Aortic Arches The formation of the six pairs of aortic arches is illustrated, demonstrating the establishment of the 848
