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Primal Pictures 3D Human Anatomy Medical Software


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Stellenbosch University

Double duty: Time-saving comprehensive human anatomy resources to serve both students and faculty

A postgraduate with lecturing and course tutorial preparation responsibilities, Jaydon Foiret of Stellenbosch University in South Africa needed a time-saving tool to suit his needs as both student and teacher. He found it in Primal Pictures.


I have not found any other product out there that helps me educate medical practitioners and patients the way Primal's images do.

Foiret, in his final year of a six-year master's program, has lectured on anatomy, histology, basic biology, and more for the past three years. He works closely with students, creating tutorials within the practical components of course modules and acting as a practical instructor as well.

I find [Primal Pictures' tools] such a blessing: really easy to use, really helpful.

As such, he was interested in identifying practical tools that give students and teachers the comprehensive anatomy resources they need – in a time-saving format that is also easy to use.

"Primal in my opinion is almost intuitive in its functioning and allows for easy use. And when a student is stressed out about an exam, the ease of use and easy, bite-size information is especially important," Foiret says. He notes that in other anatomy resources, relevant information is often buried within a video, forcing students to watch the entire thing to get to the tidbit they need.

Likewise, the level of detail on other resources is not as deep as that which he found in Primal. "The graphics on Primal I find are very clean and very easy to understand, and not as convoluted," he explains. "One of the functions I do like about Primal as well is that you can actually get all the information very easily off of Primal. And that's one of my biggest things for students as well, not only for myself."

As a student, he reports regularly seeing classmates using Primal Pictures to prep for practicals or study for exams in the university library; although, its usage is not mandated by the school.

Augmenting Learning with Detailed 3D Views

As an instructor, Foiret also relies on the accuracy of Primal Pictures' tools to augment the time his students get in the lab working with cadaver specimens. "As anatomists, in general, one of the biggest things we struggle with is 3D conceptualization of an actual area," he explains. "As much as we do with specimen cadavers in Stellenbosch University, it's not always as easy to understand things from that perspective because you're working from different modalities. So, you're working from a cadaveric specimen to a textbook. And it's very difficult, even when regarding anatomical variation, to actually marry the information between what you're working with on a wet specimen versus what you're seeing in a textbook. Of course, even worse is often you're actually just working with a textbook, which has no 3D depth, or you have no conceptualization of what's around in the area." To support his need, he uses Primal Pictures' 3D Atlas and 3D Real-time tools to fill in the gaps sometimes left by using wet specimens alone.

"Specifically, in the 3D Atlas, the layering function I find amazing: you can actually understand the depth of structures," says Foiret. "And then, my personal favorite thing about Primal Pictures is the 3D Real-time atlas. And I find that once you want to start testing your anatomy knowledge and real understanding in an area, you can go into that context [using 3D Real-time] and actually start [defining] what you know to be the human body. It's an absolutely amazing function, and very nice to build an understanding of the connections between systems and between structures, which in anatomy, and especially when you're looking into clinical anatomy, becomes highly important for the interplay between structures... and how that's going to affect physiology at the end of the day."

Students don't generally use something unless it's a prerequisite for their module or they find great value in it. So, I think it speaks volumes for Primal that as part of a non-prerequisite... they've actually gone and used it... It's something that the students really enjoy."


Primal helps the Electronic Library of Medicine (ELM) in Jordan to reach their goals to maximize budget while engaging students online, and reducing classroom size

The Electronic Library of Medicine — Jordan (ELM) is an online medical library that provides healthcare professionals and medical students in Jordan with free electronic evidence-based medical resources to improve patient care across the entire country. The ELM portal features a wide range of paid and open access e-Journals, clinical decision support tools and links to top evidence-based medical resources, which require high yearly subscriptions that are available at no cost to portal users.


We chose to introduce Primal on a national level because we believe everybody needs a solid anatomy platform.

ELM also works with other organizations within the healthcare system in Jordan, including the Jordan Medical Council and the Nursing Council, to provide continuous medical education and ongoing professional development.

As Education and Knowledge Manager for ELM, Ghaith Salemeh has many responsibilities. "Our main focus at ELM is on providing clinicians and practitioners at country's hospitals with clinical-decision support tools, because it is essential that those institutions can make informed, timely decisions at the point of care."

Many of Salemeh's other responsibilities focus on increasing both the usage and usability of the library's many medical databases, resources and tools, and not all users are clinicians. "We also work with other organizations within the healthcare system in Jordan. We make sure that all users understand portal features and how to locate the information they need, we provide specific training for those institutions, and I confer with key opinion leaders and decision makers to determine strategy for the library, each with its own set of priorities."

Maximizing Budget

As a non-profit organization, maximizing the budget is always a concern. Salemeh does fundraising because, although ELM has a budget from the Government, it is a private, not-for-profit company. "Because of our budget issues we wanted to focus on a resource related to clinicians but at the same time, would cover the entire healthcare sector, including academics, researchers, and the private sector. Our strategy was to provide students at the university with an anatomy platform that would acquaint them with the ELM, that they would continue to use throughout their studies and then through training, at the resident, fellow, and practitioner levels."

"We had heard about the Primal Pictures anatomy database and were excited to learn more. Other platforms we use focus primarily on serving clinicians. This is the first database or platform we have introduced to that covers the basic sciences, that will help students in their early years of study and will acquaint them with the ELM, since they will continue to use the online library throughout their careers."

When we saw the anatomy tool, everything just clicked. It has a reasonable pricing model that's within our budget and caters to our need.

University Faculty Puts Primal to the Test

First, the ELM committee, which consists of different parties and institutions, meets to discuss whether the platform meets a particular need, and to see whether the tool should be introduced to the library. If there's initial interest, they take a trial to see what the user experience is like. If there is still interest after that, they move ahead and ask for a quotation, which does to their procurement department for approvals and negotiation, as well as to company Board members, and to government representatives.

"When we saw the anatomy tool, everything just clicked. It has a reasonable pricing model that's within our budget and caters to our need. We worked with some faculty members in anatomy at the University of Jordan to evaluate Primal to determine whether it would serve the students in their early years. Through the trial period, we usually make sure to organize with the publisher or the company or whoever is providing the service, to do trainings, either online or on site, in order to make sure that the message is delivered."

ELM saw the distinct advantages that Primal Pictures offered that others did not. "First of all, our Primal rep was extremely responsive to our questions and our needs. Not only were we given a better price for Primal than for the competitive tool we were also trialing, our Primal rep offered flexible pricing options, taking into consideration our economic situation and budgetary issues. And, the platform has all the features that anybody needs."

Primal Makes Online Learning Easier When Classes are Full

"We know that many academics and anatomy faculty members are now looking for online eLearning platforms to work with. When we introduced Primal Pictures to them they were really enthusiastic. Some of Jordan's universities teach anatomy courses that are full, so educational institutions wanted an online tool that could help the students to use and navigate the platform without physically attending class, or they split students so that half of them attend the physical class while the other half attend online, then they switch. This worked smoothly using 3D Anatomy, so that was another thing that led us to make the decision to go with Primal."

Feedback was gathered and the trial deemed a success, and ELM has introduced Primal Anatomy at the national level, utilizing a single license to optimize funds. "We chose to introduce Primal on a national level because we believe everybody needs a solid anatomy platform. If you introduce a platform for just one institution, it's going to be a waste of resources and time. In Jordan, we have six medical universities, and our physicians, nurses, pharmacists, and other colleges can use the same Primal license as well, without each institution having to budget for it separately."

Thus far, Primal has helped ELM to achieve their goals to engage students online, maximize budget and reduce classroom size. "The main thing is we've laid the foundation and are evaluating feedback as to how exactly Primal is going to be used and exactly how it fits in with the overall objectives that are part of ELM's long-term plans. Our next objective is to promote awareness to make sure that everybody knows that we have an anatomy platform within ELM."

Fort Worth, Texas, USA

Primal Images Get Under the Skin at Integrated Manual Therapy Seminars

James Waslaski travels about 45 weekends a year – all over the world, by land, air, and sea – to teach Integrated Manual Therapy seminars to massage therapists, chiropractors, osteopaths, physical therapists, athletic trainers, and other professionals.


I have not found any other product out there that helps me educate medical practitioners and patients the way the use of Primal's images does.

And as a famous credit card advertising campaign once advised, Waslaski doesn't leave home without Primal Pictures' 3D anatomy software.

"A statement I use in all my seminars is we need to match the technique to the pathology of the condition based on ongoing assessment," says Waslaski, CEO of the Center for Pain Management in North Richland Hills, Texas, a suburb of Dallas-Fort Worth. "If you can't see what a condition looks like – whether it's thoracic outlet or carpal tunnel or Guyon's canal or cervical strain patterns – it will be difficult for most learners to be able to match the technique to the pathology of the condition based on the assessment.

"That's where I think Primal Pictures' 3D anatomy is one of the best tools on the market today. It enables you to see the pathology during both the assessment and the treatment phase of manual therapy," Waslaski adds.

To accomplish this goal, Waslaski – who was inducted into the Massage Therapy Hall of Fame in 2008 and earned the Florida State Massage Therapy Association's International Achievement Award in 1999 – shows Primal's images of the underlying anatomy on one screen during his presentations, while another screen shows a close-up of what his hands are doing as he demonstrates a manual therapy technique.

I can take my audience inside the human body to look at the cause of pain, and then teach them specific techniques to eliminate pain.

"So many learners are visual and kinesthetic learners. So, I can project Primal Pictures' images onto one screen as we perform specific techniques on a second screen. That allows participants to match each Manual Therapy Technique to the underlying pathology of each clinical condition. Too many educators are just teaching therapeutic techniques, without the students knowing what is happening inside the human body as that specific technique is applied."

The interactive function of Primal's 3D anatomy software allows Waslaski to "show antagonist relationships of muscle groups that cause pain when out of balance. It allows me to show functional movements. It allows me to show muscle layers, from superficial to deep. It allows me to show nerve pathways and innervations when I talk about nerve impingements."

From a Hobby to a Passion

Perhaps not surprising for a former serious runner who ran 2:39 at the Boston Marathon in the 1980s, Waslaski took the long road to massage therapy. After starting out in pre-med in college, he entered paramedic training in the mid-1970s and became a fulltime paramedic firefighter in 1980. He worked in a trauma center, emergency rooms, and performed high-level rescues.

"You get to see a little bit of everything," Waslaski says.

He also taught high-level rescue and paramedic and EMT courses at various junior colleges and hospitals over his two decades as a paramedic.

His initial interest in massage came as a patient. He tore ligaments in his back as a paramedic, and tore his meniscus and had back injuries as a result of his marathoning. "Massage was the one thing that would help me get back into running and training again," Waslaski says.

After seeing the difference massage therapy made in his own life, Waslaski began studying it in 1990. "I took massage as a hobby, and it turned into a passion," Waslaski says.

In 1992, while attending the Florida State Massage Therapy Association conference, Waslaski met Benny Vaughn, who would go on to be named one of the most influential massage therapists in the past 100 years by Massage Magazine. Waslaski began training with Vaughn, and discovered not just a new career, but a new calling.

"As I started to blend lots of manual therapy disciplines from osteopathic techniques to massage techniques, we were able to get people out of pain who normally would be in pain all their lives," he says.

Waslaski began teaching seminars in the early 1990s, and legally incorporated the Center for Pain Management in 1996. In addition to the seminars he teaches, Waslaski also has made a series of DVDs showing others how to use various techniques to relieve pain. In one of his most recent videos, he received permission to include a few Primal Pictures' images to show nerve pathologies.

"When I first started teaching seminars, I was using the old school, overhead projector," Waslaski recalls. He would mainly use black and white images that generally showed just a single muscle. Occasionally, he would find an image that showed muscle layering, but rarely if ever one that showed detailed pathology, such as the layering of nerves.

"Looking back, it seems like the dinosaur days," Waslaski says. "But that was back in the early '90s. I would show an overhead image, and then go around and work on that muscle."

So, when colleagues like Judith Delaney and Whitney Lowe began using Primal Pictures' images in their seminars, Waslaski contacted the company to request an image license and began incorporating Primal Pictures' images into his seminars.

"People were just so wowed by the ability to peel muscles off, put them on, look at the nerve patterns, look at movement patterns and antagonistic muscle patterns," he says.

Now, Waslaski can't imagine teaching his Integrated Manual Therapy seminars without Primal Pictures' images.

"I have not found any other product out there that helps me educate medical practitioners and patients the way the use of Primal's images does," he says.

New York, NY, USA

Anatomy.TV Passes the Exam at
New York College of Podiatric Medicine

When Eileen Chusid, PhD, looks at Primal Pictures' Anatomy.TV, she sees what may be the future of how general anatomy is taught.


From her vantage point on the Council of Faculties of Colleges of Podiatric Medicine, which includes clinical and pre-clinical deans from all of the nation's podiatry schools, Chusid helps set teaching objectives for podiatry courses – chairing the histology portion and sitting ex officio on pathology.

"I think the elephant in the room is, are we moving to – fast forward 10 years – total digital? My hunch is yes, at least in terms of a general anatomy course. I think it's going to be dictated by a cadaver shortage, and it's going to be dictated by the amount of genetics and immunology students must be taught. I think the other shift is going to be toward more self-directed learning because you can only teach so much during a limited lecture hour.

"Curriculum is an ever-evolving thing," she adds. "For right now, what we're talking about is a hybrid."

That means a combination of lecture, lab, and digital, such as the 3D Anatomy.TV.

Chusid, dean for pre-clinical sciences, associate professor for pre-clinical sciences, and director of histology/cell biology at the New York College of Podiatric Medicine (NYCPM), is the first professor at her school to incorporate Anatomy.TV into her teaching.

The school invested in the product at the start of the 2017-18 academic year on the recommendation of Joy Reidenberg, who teaches gross anatomy and clinical anatomy at NYCPM and is familiar with Anatomy.TV from her involvement in the American Association of Anatomists.

"We are constantly looking for additional information which would help our students," Chusid says. "Not everybody learns the same way, so there would be additional ancillary help outside the classroom the student could access himself or herself that would be sort of a programmed learning experience for them."

Chusid used the program in her histology course in fall 2017, and Reidenberg will incorporate it into her anatomy course starting in January 2018.

"I find that when students come into medical school from college, they're very much on the binge and purge program: study from test to test," Chusid says.

Chusid found that students had grown overly dependent on the PowerPoint presentations used in lectures, so she tried a different motivational approach to get them to study on their own. She assigned selected modules for students to study in Anatomy.TV.

And she told them she would include, almost word for word, the self-assessment questions from those modules on exams. The information would not be covered in class.

I knew they were studying something besides trying to memorize my PowerPoint.

"Let's say the student clicks and opens epithelium, and reads through," she says. "At the end of that module, there are several questions that they click on. If you go over to the left-hand side, it will say self-assessment and there will be three or four questions that they should be able to answer if they've read what came before."

Students have access to Anatomy.TV at any time through the library portal, although the school did notice "an uptick in use before the exam. Everybody expects that."

Chusid's motivational ploy worked, as students have done well so far on the Anatomy.TV questions she has included on exams.

"At least I knew they were studying something besides trying to memorize my PowerPoint, that they had to read through the program," she says.


For Queensland University of Technology,
Anatomy.TV Adds 'Wow' to Library Resources

When Sarah Howard, a librarian with Queensland University of Technology in Australia (QUT), introduces new students and faculty to the kinds of resources the school has, she always showcases Primal Pictures' Anatomy.TV to get their attention.


Primal Pictures is our 'wow' tool.

Howard, who has been a librarian for a decade, is currently a liaison librarian and project officer working with the school's nursing and optometry faculty in Brisbane. A liaison librarian is the main contact in specific subject areas for any library research queries for teaching, learning, or research.

"I learned from one of my bosses a few years ago that you don't necessarily need to have the content knowledge as long as you know the tools to use to find the content," Howard says.

Working as a health liaison, Anatomy.TV is "a big part of our tool set, our resources to show our academics and students," she says.

Howard was first introduced to the Primal Pictures product when she was a reference librarian at Australian Catholic University about eight years ago.

"It was way ahead of its time," she recalls. "There was nothing like it that we had access to."

At the time, Howard was asked to help with a series of classes to provide an overview of what the library had to offer to new international students studying a wide variety of subjects.

"I knew that Primal Pictures would get their attention quite quickly," she says. After getting their attention, she would share other programs and resources to find books and journal articles.

"I used it for more of a promotional way to get people in the library," Howard adds.

A lot of students say the e-books aren't giving them what they need. They need tools like Anatomy.TV that help them visualize and really immerse themselves in the content.

In addition to the wow factor, what impressed Howard the most about Anatomy.TV was the way it meets the university's blended learning policy addressing the needs of students with different learning styles.

"Some couldn't learn anatomy through a book, and we didn't have e-books accessible back then," she says. "Even now, a lot of students say the e-books aren't giving them what they need. They need tools like Anatomy.TV that help them visualize and really immerse themselves in the content."

The 3D imaging and video help students better understand the material than a simple 2D image. And the ability to control the anatomical models, clicking through different layers and information, "is just unique and helps the learner to understand the contents on that deeper level for learning," Howard says.

Anatomy.TV also works seamlessly with the university's Blackboard learning management system, where faculty post information, video, resources, and other materials for students in their classes.

"Our faculty are always looking for resources," Howard says.

The Primal Pictures product allows faculty to embed "this interactive content with animated images and videos into their units so students can use it to learn at a deeper level and access it how they need to," she adds.

"There are so many different capabilities Anatomy.TV provides that allow us to use it how we need it."

The QUT library staff evaluates resources annually, looking at usage statistics, feedback from students, and comments from faculty. "That's how we make the decision to progress with a subscription or a tool," Howard says.

That process enabled the library staff to successfully make the case for the university to increase its Anatomy.TV license to an unlimited number of users this year. "We unfortunately only had 10 user licenses up to last year, so we would show it to faculty, but they would be put off a little bit because they knew they'd only have certain user access," Howard says. "We don't have that barrier any more. It's just fantastic."

Now that students and faculty have unlimited access to the Primal Pictures product, the library staff have come up with some creative ways to promote it. One is to print out color images from Anatomy.TV and place them on bookends on the library bookshelves in the section that houses anatomy books.

"Students who are actually in our physical collection will see a little note popping up with a picture and a QR code that will take them to Anatomy.TV," Howard says. "So we're referring students from our collection to our online resources."

The library also added large TV screens throughout the facility and plans to feature big images from Anatomy.TV on them "so it's really in people's faces when they come into the library," she says.

Primal Pictures also donated some "cool 3D glasses" that Howard gave away as prizes during an introductory library session to students who answered questions correctly about Anatomy.TV.

All of those efforts are guaranteed to make a lot more people say, "Wow."

Barnsley, England, UK

Anatomy.TV Solves Problem for Doctoral Thesis

Anthony McWilliams first became familiar with Primal Pictures' Anatomy.TV during the long and arduous academic and clinical journey that culminated in his current position as a trauma and orthopedic consultant, or senior surgeon, specializing in hip and knee replacements in Great Britain.


"I used Anatomy.TV to look at the anatomy for surgical approaches — how do you get to the forearm from the front and what nerves do you need to make sure you avoid or what muscles do you need to preserve and shuffle out of the way if you're going to fix a forearm fracture? That sort of thing," says McWilliams, who is based at Barnsley Hospital, part of the National Health Service (NHS) Foundation Trust, in the city of Barnsley.

But it was while working on a required research paper that eventually turned into a doctoral thesis that McWilliams gained a deeper appreciation for what Anatomy.TV could do. As McWilliams began his six years of training as a registrar — a training period for doctors similar to a resident in the U.S. — a new rule was handed down requiring orthopedic registrars to publish a peer-reviewed paper on original research before completing the program.

McWilliams worked with Martin Stone, a research-oriented orthopedic surgeon in Leeds, to study leg length inequality following total hip replacements. As McWilliams dug deeper into the research, the paper he began working on to fulfill a requirement to become a consultant evolved dramatically – first, to a master's of engineering thesis, due to the amount of engineering involved in hip and knee replacements, and finally to a doctoral thesis for an MD(Res) degree in the UK completed in 2017.

As he wrote his thesis, McWilliams recalls, "I was looking at how to describe the ways that the pelvis can tilt. Now, the bony pelvis is quite a complicated structure. Like everything, it can move in six degrees of freedom. It can move up and down, side to side, and front and back. But it can also rotate on those axes. So in the first part of my thesis, in the glossary, I needed digital images of the pelvis I could put arrows on to describe what's pelvic tilt, what's pelvic obliquity, what's pelvic rotation."

Having been impressed with the quality of images he had seen in Anatomy.TV, McWilliams asked Primal Pictures for permission to include some of the product's digital images of the pelvis in his doctoral thesis. The request was granted, since it was for a non-commercial use.

It solved a major problem that I had in terms of getting good, quality images to describe the movements of the pelvis.

"I'm very grateful to Anatomy.TV for letting me use their images in the thesis," McWilliams says. "It solved a major problem that I had in terms of getting good, quality images to describe the movements of the pelvis."

In fact, he says, when he included the images following initial review, "they were complimented upon, actually."

McWilliams, who had access to Anatomy.TV through the NHS during his years of training to become a consultant and now has access through the Royal College of Surgeons, says he continues to find the 3D product useful.

"It was the functionality of it that I found most appealing," he says. That includes being able to click through the different layers, spin the anatomy around, get clinical images and MRI scans, and review details of topics such as the course any given nerve takes through the body.

"I've used Anatomy.TV throughout my training to remind myself of the anatomy to go through in a surgical approach I haven't done for a while," McWilliams says. "I still use it, actually. If I'm doing an operation I haven't done for a while on a broken bone, I just have a quick flick-through on the anatomy to make sure I understand it beforehand. It's quite reassuring."

Like most doctors in the NHS, McWilliams does some teaching. And he has found Anatomy.TV to be a helpful tool there as well.

"I use it just to go over the anatomy," he says. "For instance, there's quite a complicated way of classifying fractures around the ankle called Lauge-Hansen that requires you to understand what position the foot was in and then what ligaments were tight at the time. Once you understand it, it makes an awful lot of sense. But to understand it, you have to understand the anatomy."

More recently, McWilliams found it helpful to use Anatomy.TV to review the anatomy around the hip as he learned about a new surgical approach to the hip called the SPAIRE technique.

"As a hip surgeon, there are essentially two or three generally accepted ways to get into the hip. I routinely use the posterior approach. If you feel the bony part of your hip, there are some surgeons that go in just in front of that bony part of the hip. Some surgeons go around the back for the posterior approach, and I'm one of those. There's a smaller group that goes in at the front. That may be emerging, but it's still yet to generally bed in.

"I've just been to some training for what's called the SPAIRE approach where you can go in through the back of the hip, but without damaging very many muscles. That approach requires a fairly detailed understanding of the anatomy, which I have. But it's useful to picture it."

Mechanicsburg, Pennsylvania, USA

Anatomy.TV Creates 'a Path to Learning'
for Undergraduate Anatomy students

Scott Kieffer, EdD, FACSM, professor of exercise physiology at Messiah College in Dillsburg, Pennsylvania, only has one problem with Primal Pictures' Anatomy.TV. Once he starts working with it, he has a hard time pulling himself away.


"There are literally millions of things and combinations you can put together on here," says Kieffer, who uses the product extensively in the Human Anatomy course he teaches. "Going through and learning every semester has been fabulous for me. Sometimes, I spend too much time in Primal Pictures looking and re–educating myself, thinking how I'm going to teach this stuff. "It keeps me excited. I learn every time I get in there."

And most important, Kieffer has noticed the same reaction among his students.

His Human Anatomy course includes two, four-hour labs a week that include dissecting human cadavers. But since Messiah is primarily an undergraduate school, it only has access to two cadavers. So Kieffer splits his class in half, with each getting one full lab period each week to actually perform dissection. On the days students don't have access to the human cadavers, they simulate dissection and work on their applied science and anatomy structure on Anatomy.TV, following detailed study guides created by Kieffer.

"I got six, 55-inch TVs in the lab," he says. "I have students bring their computers and I hook them up to the TVs with HDMI cables. So when they're doing the Primal Pictures aspect of lab, they're actually showing Anatomy.TV on a 55-inch screen. The image is life-size. When they're looking at the knee and they're looking at the structures, it's not just that little thing on a 13-inch laptop. They can actually see it."

I have complete access to it anywhere on campus and so do my students. They can be in the residence hall, in the lab, in the classroom, or we can be at the coffee shop going over different things.

He recalls a session in fall 2017 when "the four hours ended and the cadavers went away and I still had two groups sitting there on Primal Pictures. They were just going through, quizzing each other. The way it's set up, at least for me, helps facilitate a lot of independent learning as well."

When Kieffer started teaching 32 years ago, he would take images from textbooks and photocopy them onto transparencies. In the 1990s, he moved on to PowerPoint and eventually to the software program A.D.A.M., which is what Messiah was using before discovering Primal Pictures.

By 2014, the college's anatomy software "was many, many versions old, and we were just having a lot of troubles with it." While attending the annual Experimental Biology conference that year, Kieffer roamed the exhibition space to see if he could find something that would better engage his students and allow them to dig deeper into the subject.

"I was going around to all the different booths and I was getting a lot of information, checking out the products, and I just kept coming back around to Primal Pictures," he recalls. "There was just something about the utility and the way we were able to work with it that I liked. The functionality really hit me."

Specifically, Kieffer says the way the anatomy images and information are integrated so students can view the structure of a muscle and see the origin and insertion, then click through layer-by-layer for more detail or access other sections for more information provides them with "a path to learning".

"For my students, I thought to be able to see it, to be able to click, to be able to work with each other and have that information automatically appear was fantastic," he says. "It was pretty fluid for me as far as the way that I like to teach. If they were missing something, they could click on that link and then go explore a little bit more. I can engage the students to go deeper – pun intended."

Another title Kieffer loves is the 3D Real-time, which he uses to make his own models to use in teaching.

"I put one muscle on, I'll go in and put the neural innervation with it, I'll do the blood supply, put the arteries and the veins that are by there, and I've got my self-contained muscle. It's been really fun for me," Kieffer says. "Then I link it in my worksheets or my study guides and my students can go directly to the saved file that I have. And they can actually look at it from 360 degrees, so they can take their mouse and go over the image to look at it from the top, from the bottom, from the right, from the left."

Since most of his students are planning to go into physical therapy, occupational therapy, or become a physician's assistant, allowing them to explore movement and view a muscle or other structure from different angles is extremely helpful, he says.

Another huge benefit is that students don't have to be in the classroom to access Anatomy.TV.

"We have the perpetual license and we have it on our server," Kieffer says. "I have complete access to it anywhere on campus and so do my students. They can be in the residence hall, in the lab, in the classroom, or we can be at the coffee shop going over different things."

"The other nice thing about it is that Primal Pictures works fabulously with our library," he adds.

Even if students are home for the weekend or off campus for other reasons, they can sign into the library through the college website, and use a proxy system to access Anatomy TV.

The only thing students can't do, Kieffer jokes, is tell him they didn't complete their assignment because, "I didn't have access at night."

Hattiesburg, Mississippi, USA

Primal Pictures Helps Students
Continue to Learn After Devastating Tornadoes

The tornadoes that roared through the campus of William Carey University in Hattiesburg, Mississippi, in the early morning hours of January 21, 2017, left devastation in their wake. Vehicles were strewn about like toy cars and buildings suffered significant damage, including a gaping hole in the wall of Green Science Hall, the roof of historic Tatum Hall almost completely ripped off, and the school's anatomy laboratory reduced to rubble.


Rebuilding began almost immediately, and neighboring schools generously offered to help. The University of Southern Mississippi (Southern Miss), also located in Hattiesburg, offered to let William Carey University faculty and students use a small anatomy lab in its School of Kinesiology to finish the spring semester.

The Anatomy.TV substitute experience (for cadaver labs) worked well in allowing students, via 3D manipulation, to gain some of the same insights and provided a good foundation for very good examination performance.

"They were very generous by allowing us to use it," says Kenneth "Cal" Hisley, PhD, associate professor of preclinical sciences and senior anatomist at William Carey's College of Osteopathic Medicine.

But the lab space at Southern Miss was only the size of two or three faculty offices, and three cadavers maximum could fit in the room, Hisley says.

Hisley, Kamal Abouzaid, MD, PhD and Jennifer Hotzman, PhD comprise the William Carey University College of Osteopathic Medicine anatomy faculty teaching the first-year medical school anatomy courses for fall and spring, which totals about four hours of lecture and four hours of lab per week. On top of that, they also teach full dissective anatomy to a combined Master of Biomedical Science and Doctor of Physical Therapy graduate program that requires another four hours of lecture and four hours of lab per week.

"So it's about eight hours of lecture and eight hours of lab per week spread across four days," Hisley says.

With 108 William Carey students to accommodate in the small anatomy lab available at Southern Miss, he adds, "we just couldn't figure out the logistics to get everybody through there on a reproducible basis.

"We compensated by using Anatomy.TV," says Hisley, who was familiar with the Primal Pictures 3D anatomical software from his previous position as an associate professor at Touro University-California.

Hisley had been impressed by Anatomy.TV at Touro, which had a limited license for the product at the time, and his interest grew when he and some of his William Carey colleagues saw it demonstrated at conferences of the American Association of Clinical Anatomists and the American Association of Anatomists.

Primal Pictures gave William Carey free access for a month to Anatomy.TV for all students in the wake of the tornadoes. The university purchased an unlimited license, allowing students continued access to the Primal Pictures product.

The students already were about a month into the head and neck anatomy course before the tornado hit. "So fortunately, they did have some dissection experience," Hisley says. "The last half of the course was digital."

Asked how things worked out given the inability to have students do actual dissection for much of the semester, Hisley replies: "...although anatomical dissection has 3D spatial and haptic components to it that aid in developing an intuitive sense of how human morphological regions and sub-regions are organized, the Anatomy.TV substitute experience worked well in allowing students, via 3D manipulation, to gain some of the same insights and provided a good foundation for very good examination performance."

Additionally, Anatomy.TV allows students to "get a sense of 3D spatial configurations from any viewpoint — something difficult to accomplish with a cadaver laying in a specific position," Hisley says. "That's one of the great saving graces of applications like Anatomy.TV. You can't rotate the cadaver, but you can rotate Anatomy.TV into an orientation that kind of approximates how you're working on the cadaver – but you have more flexibility."

When medical students returned in August 2017 for the fall semester, a gleaming new and enlarged anatomy lab awaited them.

"It was very impressive," Hisley says. "This was a product of a very good administration pushing hard."

And with the anatomy lab rebuilt bigger and better than ever, Anatomy.TV continues to be used to enhance student learning. For example, Holtzman, assistant professor of preclinical sciences, incorporates images from Anatomy.TV in her gross anatomy lectures. "And I encourage them to go find the image on their own in Anatomy.TV so it's an interactive image instead of the still image that I show them," Holtzman says.

Adds Hisley: "We encourage students to use it. In fact, we encourage anyone to use it in the undergraduate or graduate curriculum if we come upon them."

And Hisley sees plenty of possibilities to expand how William Carey faculty and students use the Primal Pictures product.

"Anatomy.TV, in my opinion, presents remarkable opportunities to understand how students learn anatomy, based on the classes of structures and annotations they use in the course of applying the application. Is it detailed structure, or is it group structure? Is it orientation? Is it the ability to ghost things, or solidify things, or hide things as you're moving through a certain space?

"For instance, as you're moving through the mediastinum of the thorax, you ghost the heart, and you're looking at the posterior mediastinum. Then you hide the heart completely. You get a sense that the heart was there, but now you understand why you couldn't see something – and sometimes why you can't see something when you're looking down at the actual cadaver."

The William Carey anatomy faculty are already developing a research project with Primal Pictures "to meld augmented reality with the Primal images data sets," using some of Anatomy.TV's polymesh structures of the lower extremities, Hisley says.

"We are consistently going to extend our involvement with Anatomy.TV, in terms of its integration with lectures and labs," he adds. "We're going to keep pushing it. This is the kind of knowledge that can assist students for all four years of medical school."

University of the West of England

Innovative Sport Rehabilitation program relies on Primal resources to enhance teaching and learning outcomes

Vincent Singh has used Primal Pictures solutions in his teaching for the past 10 years in a number of Academic institutions. He is currently program leader for the BSc (Hons) Sport rehabilitation at the University of the West of England, Bristol; an institution at the forefront of using technology to enhance students' learning. Vincent tells us why this resource is a valued addition to the university's provision, and gives us some insight into how this resource supports his teaching and enhances his student's learning.


Anatomy has really been brought to life...

Students have access to this immensely comprehensive, exceptionally vivid and anatomically precise online learning resource ( Anatomy has really been brought to life in the 3D Sports, Therapy and Rehabilitation Package that is unparalleled and provides a fantastic opportunity for students with various learning styles to explore the functional human body.

...enable[s] students to visually explain the musculoskeletal injuries patients present with to the clinic.

The Sport Rehabilitation Clinic at the university uses computer tablets which have the Primal Pictures software to enable students to visually explain the musculoskeletal injuries patients present with to the clinic.

I have used Primal Pictures for the past 10 years in my teaching and am confident that it provides medically accurate and detailed information.

The functional anatomy series has enabled a rich graphic learning experience about how the muscles in our body work during movement. Furthermore, this is also apparent when teaching about muscle activity during resistance type exercises.

The range of opportunities for the use of this resource is being explored in other aspects of teaching and learning. Already many students engage with this resource for their own learning of anatomy and physiology and we have found that it is useful for the more visual learners.

There are also varying levels of difficulty that can be set for the online quizzes which are able to provide the students with immediate feedback on their answers. We are planning to use the quizzes in class to provide students with a regular evaluation of their understanding about the anatomical region being taught.

There is also a host of biomechanical and clinical orthopaedic assessment video clips that I use in my teaching which provides the specific detail necessary when teaching about injuries that occur in the dynamic sports environment.

The additional content such as x-rays, MRI scans and surgical description is exceptionally useful to introduce students to as they progress through their degree.

Overall, this resource supports my teaching and enhances student learning. It offers the student another way for them to engage with learning more about the human body.

G Miller Hand Surgery and Claremont Private Hospital, England, UK

A Primal approach to educating patients
about anatomy and surgery

To explain why he considers Primal Pictures' 3D Anatomy products so invaluable, hand surgeon Gavin Miller turns to an old, familiar expression...


I do think a picture is worth a thousand words, especially when it comes to getting over complex ideas and concepts to non-medics.

"And of course", Miller continues, "medicine's full of those, isn't it? It's often difficult enough for clinicians to fully grasp what's going on, and to get ideas across and the complexity of the situation just in word form is very challenging."

For the past decade, Mr Miller, a plastic surgeon who specializes in hand surgery in Sheffield, UK, has used Primal Pictures anatomy images to help explain to patients the surgery they face, as well as in presentations to a variety of audiences, ranging from doctors and medical students to lawyers and members of the public.

"I use it quite extensively" Mr Miller says. "If you're giving a talk or trying to explain an operation or a condition, then anatomy forms a very important part of that."

The Primal Pictures anatomical images are especially important in patient and student education, says Mr Miller, who worked in a university teaching hospital in Sheffield for 17 years before going into independent practice, performing surgery at Claremont Private Hospital in Sheffield.

"Patients are interested in the problem they have and what you can do to help," he says. "They want to know in a lot of detail as this helps them understand their condition and proposed treatment options and make important decisions about their health."

Mr Miller, who first bought a Primal Pictures CD-ROM that detailed the anatomy of the hand, eventually moved up to the DVD version with all of the anatomy modules and now has a subscription to the online Anatomy.TV through the Royal College of Surgeons of England

"It's one of the most useful resources that I have to show patients relevant anatomy, especially if I'm going to operate, so they understand what structures might be at risk," he says. "It takes a little bit of extra time to do, but you get the message across much better if you do it that way because patients can really understand."

Mr Miller also includes images in reports he files as a medicolegal expert in personal injury and clinical negligence claims involving hand and plastic surgery cases.

As a medical student, he remembers, words were the main way complex anatomy concepts were conveyed. "All we had were pretty dry textbooks with the occasional image or diagram to help you try to put these three-dimensional concepts in your mind, and the dissection lab where, in those days, the anatomy was distorted by preservation techniques," he recalls.

That's why that first Primal Pictures CD-ROM was "revolutionary," Mr Miller says. And with the technological evolution to DVD and online, he calls today's sophisticated anatomy images "a revelation."

"If you're actually looking at the body in real time, with something like Primal Pictures, for visual learners like me the brain understands it considerably quicker because it can relate in three dimensions the anatomy you want to look at," Mr Miller says.

Mr Miller is so convinced that more of his colleagues should be incorporating images and videos in patient education that he wrote a blog post that included Primal Pictures images titled, of course: A Picture Is Worth a Thousand Words. In addition to explaining why he thinks using images to explain complex medical conditions and procedures is important, he offers some practical tips to help his colleagues do it effectively, such as: If using a fixed monitor, and patients cannot see the screen easily from the other side of the desk or office, get up and invite the patient to sit in your chair so they can get close to the screen.

As a surgeon, Mr Miller appreciates that Primal Pictures representatives have solicited his feedback on Anatomy.TV as part of their continuing efforts to make it better and more useful for professionals.

"I think it's a wonderful resource," he says. "I have seen few products that compare to it, really. I've seen similar products on the internet, but I don't think they can compare to the Primal products in terms of the depth and the ingenuity, and the amount of research involved, to be honest. It's an extremely well thought-out package. A helluva lot of work has gone into it."

AECC University College, Bournemouth, Dorset, UK

Chiropractic students literally see the big picture

When Philip A G Dewhurst, Doctor of Chiropractic, was a student at AECC University College in 2001, a lecturer introduced his cohort to Primal Pictures' Interactive Spine: Chiropractic Edition CD-ROM, and it quite literally changed the way he viewed anatomy.


The pictures are 3D, real-time, and you can literally see the big picture and then go into the details.

"For a student at the time, it was revolutionary," Dewhurst recalls. "Suddenly, you had something that was three dimensional and you could flip the image around and still get the information you would get in a textbook. It was a real game-changer in order to understand where things are in the body."

Today, Dewhurst is a lecturer in chiropractic sciences at the college, specializing in teaching anatomy, and he is using the latest evolution of Primal's game-changing anatomy series – the 3D Atlas of Human Anatomy and 3D Real-time Human Anatomy, delivered online through subscription via Anatomy.TV – to change the way his students view the subject.

Dewhurst worked in private chiropractic practice for three years before accepting a full-time lecturer's position in 2008 at AECC University College, located in Bournemouth on the south coast of England. He says when students have difficulty understanding or conceptualizing human anatomy, "the majority of them are just trying to memorize information and they're not really applying it. And they're not seeing the big picture, as it were."

That's where Primal Pictures comes in. "The pictures are 3D, real-time, and you can literally see the big picture and then go into the details," Dewhurst says.

The Anatomy.TV products are featured in some of the students' pre-reading assignments for classes, as well as in the recommended resources for the unit. Dewhurst also incorporates pictures taken from Anatomy.TV in lectures, as well as some of the videos, and includes hyperlinks so that students can go to the pages he is demonstrating.

One of the courses Dewhurst teaches is neuro-anatomy, and one of the biggest struggles students have with the topic, he says, "is trying to visualize it in three dimensions." Understanding how muscles function is less challenging because the students can observe muscles on themselves and on cadavers.

"But they really struggle to understand and put together the brain and the spinal cord in three dimensions and understand that there are pathways that run through it," Dewhurst says.

When he started teaching the course, he says, he recommended that students use the 3D Atlas of Human Anatomy (the subscription allows students to use it any time by logging in to the college's library services) when they study to help them "build up a three-dimensional image of how the nervous system works."

For the muscular-skeletal anatomy courses he teaches, Dewhurst strongly recommends that students use it when they study as an interactive alternative to relying solely on a textbook. "You can actually click on something, rotate the image, zoom in and zoom out, and get the textbook information at the same time," he says.

In addition to using Primal Pictures anatomy products as a student and a teacher, Dewhurst also was involved in the 2011 update of the Anatomy for Chiropractic program along with two colleagues from the college.

"We reviewed the product (now part of the 3D Atlas), and identified where the gaps were, where evidence was out of date, where there was new thinking going on, and put together a revised template for how to update the program," Dewhurst says.

The process took about 18 months, during which he had the opportunity to visit Primal Pictures offices in London and see first-hand how many people and how much expertise and work goes into developing the anatomy series. "Knowing what goes into that, I have 100 percent more confidence in that than anything else I have seen on the market," he says.

And Dewhurst fully expects that Primal Pictures anatomy products will play an important role in the institution's future as it prepares to make the transition from an independent college to a publicly funded university next year. As a university, the institution plans to increase the number of health-related courses it offers, which will increase the demands on the anatomy lab.

"So within the anatomy team, we've been discussing the physical constraints we have within our anatomy lab and how we can improve that and how we can improve the student experience as the lab is being used more and as more students come through the door. One of the ways we've talked about it is to increase the technology we have in there."

One proposal under consideration involves setting up cameras with televisions in the lab and having iPads available there for students so that instead of having them gather around the tutor, the tutor can demonstrate on one table and the students can watch it on TV. If the tutor is rotating an arm, for example, the students would simultaneously be able to perform the same rotation on their iPads on 3D Real-time Human Anatomy, which Dewhurst says would be "almost like the real thing in their hands." The product also allows users to take an image and add their own labels and annotations.

Dewhurst says that would turn the Primal Pictures product into "a tool they're actually using alongside their teacher and the cadavers so they can really get an appreciation of what it is. It's more active than having a textbook next to them. And they can change the view on Anatomy.TV to reflect what they're doing in the lab. That, for me, is where I would like to see it evolve to."

Cochise College, Arizona, USA

Bringing anatomy to life in a remote, rural college setting

Layer by layer, the image of the human brain unfolds in vivid, colorful 3-D on the computer screen, revealing what looks like a vintage Mohawk hairdo from the punk era.


You want to talk about a visual understanding of what you're trying to teach, this personifies Primal Pictures' software in a heartbeat.

"I'm a neuro-geek, so I love this one," exclaims Dr Shaun P McGuire, a licensed chiropractic practitioner and biology instructor at Cochise College in southern Arizona. The "Mohawk," he explains, is actually the corpus collosum, which is Latin for "tough body" – the swath of myelinated fibers that connects the two hemispheres of the brain.

The detail is astounding. "You want to talk about a visual understanding of what you're trying to teach, this personifies Primal Pictures' software in a heartbeat," Dr McGuire says.

He then switches to a different image that ostensibly shows the same portion of the brain, a traditional, 2-dimensional textbook illustration from another online site.

It appears flat, offering "a poor understanding of what you're looking at," he says.

"The tools that Primal Pictures created for me to do what I do are much better," Dr McGuire says.

He has been a fan of Primal Pictures since his graduate school days, almost 20 years ago, when he took an elective course to learn a soft tissue technique known as the Active Release Technique. The instructor used Primal images to show how the technique worked, and it made a lasting impression on Dr McGuire.

"At the time, I'd never seen anything like it," he says. "They were just mind-blowing."

After graduation, Dr McGuire went into private practice as a chiropractor for a decade. Seven years ago, he started teaching biology part-time at night at Cochise College, a two-year public community college. When a fulltime faculty position opened in 2012 at the college's center in Benson, he applied and was hired. Cochise has two campuses, in Douglas and Sierra Vista, and centers in Benson, Nogales and Willcox.

Dr McGuire's lecture class is viewed simultaneously online by students at the Willcox center.

When he started teaching, he struggled with how to convey the abstract complexities of anatomy to students without a cadaver in the lab and without quality images.

He found the answer when he saw the Primal Pictures booth at the Human Anatomy and Physiology Society annual conference in Las Vegas in the summer of 2013, which attracts some 2,500 educators from around the globe and dozens of exhibitors.

As he checked out how Primal Pictures' 3-D anatomy offerings had evolved since his graduate school days, Dr McGuire says, "I saw exactly how that would work in my classroom.

"I can deliver your textbook on any smartphone, tablet, or device anywhere in the world," he says. "That's cool as hell. And the images are untouchable. For me, the Primal Pictures software was exactly what I was looking for. Exactly."

Asked what sets Primal Pictures apart, Dr McGuire replies: "The quality of their images, hands down. It's images, images, images, and – one more time – images. And with that, video."

When he was in college and grad school, Dr McGuire says, textbooks were the main tool for students to learn. Today's students have far different expectations. That's why the compelling videos and interactive imaging incorporated into Anatomy.TV are critical to helping students understand the subject matter – especially those taking courses online.

"I'm a rural, community college professor, and I'm away from the biggest campuses," Dr McGuire says. "We've got 12,000 students, and 10,000 are at one location. I'm not there. I reach into two centers even more remote. The Primal Pictures program helps me do what I do better."

Los Angeles, CA, USA

Student project shows how holograms can elevate anatomy learning, with a little help from Primal

Nicole Hanratty has always loved telling stories. She has also always loved holograms. While earning a master's degree in communications from the S.I. Newhouse School of Public Communications at Syracuse University, Hanratty found a way to combine both two passions. With a little help from Primal Pictures...


It is so much easier than you can imagine... within 20 minutes, you could bring your science class alive for your students.

Hanratty, who completed her graduate degree in communications with an emphasis in journalism innovation in 2017, was challenged in her Emerging Media Platforms class to come up with a project that found a new way to tell a story.

"It was really fun because there were no boundaries," Hanratty recalls. "At the same time, it was really stressful because there were no boundaries."

Facing an eight-week deadline to conceive and complete the project, Hanratty decided to explore how to incorporate a hologram in what she did. That led her to a product called Spectre Projector, which can project a hologram from a 4 face hologram video on your smartphone.

"I wanted to show that you can tell a really cool story in a hologram," Hanratty says. "It evolved from there. I have to be honest, I was really struggling to find the deeper meaning to what I wanted to present. I had a celebrity attorney do a hologram for me, and I enlisted my daughter to be a part of my project. I was going back and forth with my classmates about what would bring meaning to it, make it more than just fun.

"I realized this is more than just videotaping a celebrity and turning them into a hologram on your iPhone, or videotaping my daughter and turning her into Princess Leia. This was something that could really revolutionize the way we learn."

Hanratty, who got her master's through the Newhouse School's online program from her home in California, contacted the university library across the country, searching for something with 3D video that she could convert to a hologram that would be of instructional value in a classroom setting. The helpful folks at the library suggested Primal Pictures' Anatomy.TV products, which students have access to through the university's licensing agreement.

"I was like a kid in a candy store, with all that video," Hanratty says.

While researching options with the library staff, Hanratty says she looked at other anatomical imaging products, but "they were not nearly as helpful. There was almost no comparison. The choice was very easy for me."

She requested, and received, permission from Primal Pictures to use some of the company's content in her project, titled "Emerging Hologram Media and Technology at Your Fingertips." She created two, 4 face hologram videos from Anatomy.TV, one called "Podiatric," the other "Thorax Abdomen."

"With proper voiceover and explanation, this is an enlightening and engaging way to teach anatomy," Hanratty wrote of her hologram project.

The project not only earned Hanratty an "A" in the course, but a rave review from leading technology expert Bill Frischling, who at the time was vice president and entrepreneur-in-residence at U.S. News & World Report and was a surprise virtual visitor during the class presentations.

Hanratty, who describes herself as a competitive person, was happy to get an "A" from her hologram project. But she was more pleased that "it opened eyes to how we can marry technology to elevate the conversation and elevate the learning."

Hanratty, who was hired as vice president of communications at the Brand Wagon Agency in Calabasas, Cal., in January 2017, hopes other teachers, "from grade school on up," will explore how to use new technology to use innovative products such as Anatomy.TV in new ways.

"It is so much easier than you can imagine," she says. "If I could figure it out, they can. And within 20 minutes, you could bring your science class alive for your students. I promise it was that easy."

Chingford Osteopathy Clinic

Teaching osteopathy in 3D

Osteopath, Daryl Herbert has been using Primal Pictures software since the first interactive skeleton was launched some years ago. When the first edition of the Interactive Anatomy Series was brought out, he quickly adopted it.


The material has been produced in such a way that it is easy to export images into presentations and I use this facility extensively when I am teaching.

"When I first saw the Interactive Anatomy software I was extremely impressed," comments Daryl. "I had already been using the interactive skeleton for a couple of years but this new series was more realistic; giving me an almost living view of the joints, arteries, veins, muscles and ligaments, as well as the spine. It also included x-rays and MRI scans, pictures, slides and video clips demonstrating the bio-mechanics of movement.

"In fact this computerised, digital model of the spine that allowed me to view in 3D and rotate the images through 360 degrees, gave me a brand new way of teaching anatomy," he explains. "Previously, anatomy had been taught to osteopathic students predominantly through two-dimensional images in text books – particularly if you didn't have access to cadavers.

"Anatomy is one of the most important things that osteopaths have to learn. Although the actual information remains constant, there is a vast amount of knowledge that has to be acquired over a relatively short period of time. We have to know and understand all the internal, skeletal, vascular and neurological structures of the body and even if students are able to watch a dissection once a week, having the software enables us to supplement their learning and reinforce what they have seen in the cadaver lab.

"In some ways, students see more through looking at the software than they do by dissecting a cadaver. The software shows tissue in its 'true' state – ie. as it should be when they treat a patient — and provides dissection views so that they can see how the tissue is different in a cadaver and relate the two to put structures into the correct context.

"When I teach first year students basic osteopathic techniques, the software allows me to show them the bones, muscles and joints so that they can form an image in their heads of what I am explaining. I project images onto a large screen so that whilst I lecture, I can demonstrate the points I am making and relate them directly to the parts of the body in question. This gives them a much better feel for what they are supposed to be doing and many of them then access the software through the online resource to study and revise.

"At a postgraduate level, I am able to use the spine to show diagnosis and pathology and then relate it to manipulation techniques. The material has been produced in such a way that it is easy to export images into presentations and I use this facility extensively when I am teaching. I know a lot of lecturers who use the software now in their teaching and we all find it immensely helpful. Once seen, Primal Pictures is the sort of product that people will adopt and use for themselves," he comments.

Daryl also finds the software extremely useful for patient education: "I often use the software when a patient doesn't understand where their problem is and what is wrong," he explains. "The images really help them to visualize what I am explaining. So, if their joints are not moving correctly, I can show them the position and orientation and explain what has happened and how I am going to treat it. This relaxes them, instills trust and confidence and aids greatly with patient compliance."

See Daryl Herbert Osteopath

WellBeing Clinics

Picture speaks a thousand words viewing in 3D:
improving patient understanding and compliance

When we set up WellBeing Clinics, my colleague Richard Nelson and I wanted to create a practice that patients really valued. Whether we like it or not, we are in a service industry and people do want to know that they are getting value for their money. We are always looking for ways to improve the 'patient experience' – because people do expect more – and we believe that if we exceed their expectations, they will want to come back.


To a certain extent, little things can make a difference. We have ensured that parking is easy, the clinic looks nice, there is a selection of up-to-date magazines in the waiting room (rather than the 1923 edition of Punch that they used to have in my dentist's surgery) and that patients have access to tea or coffee when they arrive.

The saying goes that a picture speaks a thousand words and visual explanation really does improve understanding enormously.

However, we believe the major difference comes from the way we actually talk to and treat our patients. Our philosophy is to help our patients to understand what is wrong with them and how we intend to treat it. We have found that by being clear, confident and knowledgeable, patients are more likely to accept their treatment and comply with our recommendations.

It's easy to forget that our training has given us a very detailed knowledge of how the body operates. Many of our patients don't realise that there is more than one vertebra – they think the spinal column is just one bone – so when it stops working properly, they have little comprehension of what has happened. Although a simple explanation can help, a visual demonstration can increase understanding significantly.

This ability to educate our patients with a powerful visual tool is invaluable. It's a major factor in improving our service to our patients and has a tremendous effect on patient compliance and satisfaction.

We use a variety of visual tools within the practice to educate our patients including posters, anatomical models and 3D anatomy software from Primal Pictures. A model allows us to demonstrate movement and allows us to explain why they are experiencing pain when they move. But a model only shows them the bones and so we use the software to bring the body to life.

The software allows us to show our patients where their problem is – relating the actual pain or discomfort identified through physical examination, to the same point on the 3D image – and we can then rotate the image and add or remove layers to show them how their problem is affecting the muscles, nerves or ligaments. It's a bit like leading the patient by the hand; the images clarify their understanding, they are able to relate the images to that point on their own body and can therefore make more sense of what is happening to them.

We also try to get the patients to reinforce their understanding through discussion and by encouraging them to ask questions. Visual demonstration provides more opportunity for them to ask questions and ensures both a better understanding and a higher retention. Whilst this initial education process is key to successful treatment, it is important to continue to explain what is happening at subsequent treatments; although a detailed visual demonstration is only necessary if a new problem arises.

I came across a piece of research a few years ago about transmission effectiveness. The results showed that if you explain something verbally there is an 11% chance that the listener will understand it, but if you explain visually, there is an 83% chance that they will understand it because they are able to picture it. Combining a verbal and a visual explanation therefore gives you a 94% chance of getting your message across effectively.

The saying goes that a picture speaks a thousand words and visual explanation really does improve understanding enormously. This ability to educate our patients with a powerful visual tool is invaluable. It's a major factor in improving our service to our patients and has a tremendous effect on patient compliance and satisfaction.

About Ian Reed
Ian Reed trained at AECC and qualified in 1992. He set up WellBeing Clinics in Derby with his colleague, Richard Nelson in March 2000. For more information on WellBeing Clinics, please visit

Bristol University, UK

Creating an e-tutorial on musculoskeletal
anatomy using Primal Pictures

Helen Taylor is a fourth year medical student at the University of Bristol. At the end of her third year she was required to spend a month completing a self-led project in a medicine-related subject of her choice. She used cutting-edge, 3D imagery from Primal Pictures to design an online revision tutorial for medical students based on musculoskeletal anatomy.


Primal Pictures has really helped me to design and build a high standard e-tutorial.

"I was on a placement in Gloucester at the time and was keen to do a project based on musculoskeletal anatomy as I was really enjoying orthopaedics," explains Helen. "One of the orthopaedic consultants agreed to supervise my project and recommended Primal Pictures. I subsequently discovered that we had a University subscription to Primal which made the project much easier to complete."

At the University of Bristol all the anatomy teaching for medical students takes place in the first two years of their training. During this time, most of the learning takes place in the dissection room using cadavers and this is supplemented with small group sessions run by anatomy demonstrators and with lectures. Primal Pictures is now playing a role in this important training process.

"In the last year, computer-based learning has been added into anatomy teaching at Bristol," comments Helen. "All of the teaching in the dissection room is still done in small groups with anatomy demonstrators and there are supplementary lectures to complement this learning. However, whereas we used to do one three-hour session each week; students now spend half the time in the dissection room working through computer tutorials and half the time with the demonstrators, enabling work to take place in even smaller groups. Students are also encouraged to use Primal Pictures during this computer tutorial time as well as for private study."

Since there is no formal anatomy teaching after the second year, Helen was keen to provide an easy resource for third year students who wish to brush up on relevant practical information.

"When I came to do my clinical musculoskeletal medicine placement at the end of my third year, I was feeling very rusty on my anatomy," continues Helen. "Until I sat down and did some revision I felt a bit clueless when surgeons fired questions at me in theatre. So I decided to design an e-tutorial for third year students that would be an easy and convenient means of revising relevant anatomy prior to commencing musculoskeletal medicine."

The University has an online learning environment called 'Blackboard' where students are able to access tutorials, most of which are designed using software called Course Genie. Helen attended teaching sessions to learn how to use this package as a platform on which to construct her e-tutorial. Since the Anatomy Department subscribes to Primal Pictures, she already had access to this software through a University login provided to her at the start of the course.

"Having completed a lot of e-tutorials in the past, I had an idea of the types that keep your attention and those that send you to sleep," she comments. "Tutorials with blocks of text and few images are very hard to concentrate on, so wherever possible I decided to substitute images for text. As anatomy is a very visual subject, a lot of the points I wanted to make were much more easily conveyed using pictures. I also wanted to use the images to introduce interactivity to the tutorial which I hoped would further enhance its ability to hold attention and help make the information more memorable."

Helen enjoyed the versatility of the Primal Pictures software and by incorporating the images into her project in a number of ways she was able to achieve her goals of interactivity and innovation. "Some of the images are simply used as illustrations to complement the text and some actually substitute text so the students have less reading to do. I have also integrated the images into exercises to aid learning, for example, matching a picture to the name of a bone.

"I also subscribed to another piece of software called Dragster which allowed me to create, drag and drop labels for some of the images," continues Helen. "I have created one drag and drop image per section of the tutorial and I was pleased at how this worked out, adding a further element of interactivity.

"Primal Pictures has really helped me to design and build a high standard e-tutorial, to improve my computing skills and to broaden my knowledge and understanding of anatomy. It has also helped me to gain recognition from my peers and medical professionals as the tutorial looks impressive."

In fact, Helen's work has recently been nominated for a University award for innovative e-learning and she has found the software helpful in other aspects of her studies: "I've found Primal a really useful learning and revision tool, not only for the anatomy related to this project but also for other aspects of my clinical training. It's much easier to grasp what's going on, especially during surgical placements, if you have an understanding of the underlying anatomy. The interactive 3D design of the software helps apply it to real life.

"I liked being able to rotate images to the desired viewpoint; building up images in layers makes the anatomy easy to understand. The accompanying text is also very useful, particularly the clinical sections. I also liked the fact that you could access an image of almost anything you wanted – the image bank is huge and I haven't seen any other resources with this volume available!

"There is no question in my mind that the end result of my e-tutorial wouldn't have been anywhere near as good without the use of Primal Pictures. It made my tutorial stand out from the others and I feel it makes it much more educational."

Helen achieved a 93% mark for her e-tutorial and also won the University's Aungshuk Ghosh prize for innovative e-learning.


Ian Reed

Chiropractor, WellBeing Clinics,
Derby, United Kingdom