Clinical Anatomy 00:000–000 (2013)

ORIGINAL COMMUNICATION

Complementing Anatomy Education Using

Three-Dimensional Anatomy Mobile Software
Applications on Tablet Computers
T. L. LEWIS,1* B. BURNETT,2 R. G. TUNSTALL,2 AND P. H. ABRAHAMS2
1
Warwick Medical School, University of Warwick, Coventry, CV4 7AL, United Kingdom
2
West Midlands Surgical Training Center, University Hospital Coventry and Warwickshire NHS Trust,
Coventry, CV2 2DX, United Kingdom

Anatomy has traditionally been a cornerstone of medical education, which has

been taught via dissection and didactic lectures. The rising prevalence of
mobile tablet technology means medical software applications (“apps”) play an
increasingly important role in medical education. The applications highlighted
in this article will aid anatomical educators to identify which are the most useful
in clinical, academic, and educational environments. These have been system-
atically identified by downloading all applications with keywords related to
anatomy and then carrying out qualitative assessment. Novel anatomy applica-
tions from developers such as Visible Body, 3D4Medical, and Pocket Anatomy
allow students to visualize and manipulate complex anatomical structures
using detailed 3D models. They often contain additional content including clini-
cal correlations and a range of media from instructional videos to interactive
quiz functions. The strength of tablet technology lies in its ability to consolidate
and present anatomical information to the user in the most appropriate manner
for their learning style. The only question mark remains over the level of detail
and accuracy of these applications. Innovative medical educators who embrace
tablet technology will find that anatomy applications serve as a useful learning
tool when used in conjunction with existing teaching setups. Clin. Anat.
00:000–000, 2013. V 2013 Wiley Periodicals, Inc.
C

Key words: anatomy education; mobile tablet; 3D model gross anatomy educa-
tion; medical education; anatomy laboratory; mobile learning;
cadaver dissection; educational technology; contextual learning;
iPad

INTRODUCTION anatomical community that the standard of anatomy

It is widely recognized that the ideal method for
students to learn and understand anatomy is through
hands on experience with human cadavers in the dis-
secting room and didactic lectures (Winkelmann,
2007). However, over the past number of years, med-
ical schools have come under increasing curriculum
pressures to reduce the amount of time and resources
available to students with cadaveric specimens
(Turney, 2007). Furthermore, some medical schools
no longer carry out dissection and instead rely on pro-
sections or plastinated specimens (Heylings, 2002).
As a result, there is some concern within the
knowledge amongst medical graduates when they
leave medical school is poor and often below the
standards for safe medical practice (Cottam, 1999;
Older, 2004; Waterston and Stewart, 2005).
*Correspondence to: Mr. Thomas Lewis, Warwick Medical
School, Medical Teaching Center, Gibbet Hill Road, Coventry,
CV4 7AL, UK. E-mail: T.Lewis@warwick.ac.uk
Received 29 January 2013; Revised 15 March 2013; Accepted
19 March 2013
Published online in Wiley Online Library
(wileyonlinelibrary.com). DOI: 10.1002/ca.22256

V
C 2013 Wiley Periodicals, Inc.
2 Lewis et al.
TABLE 1. Number of Randomized Trials and Systematic Reviews Retrieved by Pubmed Clinical Queries
(Broad Search) on 07 January, 2013 for the Search Strings “Medical Education” and “Anatomy Educa-
tion,” and Mobile Technology Additions to this
Date of search Search string Number
07/01/2013 “Medical education”
1“mobile”
1 “mobile phone”
1 “mobile tablet”
1 “iPad”
1 “App”
“Anatomy education”
1 “mobile”
1 "mobile phone"
1 "mobile tablet"
1 “iPad”
1 “App”
Note: some studies feature in more than one table row.
There is now an educational trend for anatomical
educators to look for innovative teaching tools and
methods that can help supplement existing teaching
styles (Drake, 1999; Irby and Wilkerson, 2003). One
such method which may have significant educational
potential involves the use of mobile tablet technology
and associated anatomy medical software applications
“apps.” One study (Ozdalga et al., 2012) suggests the
combination of versatile functionality and lightweight
form factor means tablet devices are of interest to
medical educators and students alike (Kho and Hen-
derson, 2006; Tempelhof, 2009; Davies et al., 2012;
Wallace et al., 2012). One of the many uses of tablets
in medical education is as a reference source given
their capability to store entire libraries of textbooks.
Modern tablets are portable and offer a large multi-
touch screen interface which allows users to interact
with novel anatomy applications in ways which has
not previously been possible. There are also an
increasing number of medical schools around the
world that are providing their students with tablet
devices as a required tool to support their learning.
Anatomy laboratories such as the West Midlands Sur-
gical Training Center are also embracing tablet tech-
nology to support undergraduate and postgraduate
teaching and education. Flemings VARK model sug-
gests that there are three distinct learning styles: vis-
ual, auditory, and kinesthetic (Hawk and Shah, 2007).
The benefit of mobile tablets and anatomy applica-
tions for students is that together they can present
anatomical information to students in whichever for-
mat is best for an individuals learning style. Despite
this, Table 1 shows, there has been very little research
carried out to evaluate the efficacy of this technology
on medical education and even less specifically
focused on anatomy education.
One of the challenges facing anatomy educators is
how to maximize information transfer such that stu-
dents develop an accurate three-dimensional anatomi-
cal understanding with limited resources. One current
issue with anatomy education is the need to learn
Randomized trials Systematic reviews
Percent Number Percent
5,665 100.00 18,003 100.00
21 0.37 45 0.25
16 0.28 14 0.08
0 0.00 1 0.01
0 0.00 0 0.00
1 0.02 3 0.02
696 100.00 2932 100.00
2 0.29 3 0.10
1 0.14 0 0.00
0 0.00 0 0.00
0 0.00 0 0.00
0 0.00 2 0.07
more about methods to teach and use 3D data, specif-
ically the relative long-term effectiveness of it in over-
all education (Marks, 2000). In addition Marks
believes that anatomists must become advocates for
and participants in 3D learning throughout the spec-
trum of medical education and practice. There is there-
fore an ideal opportunity to explore the potential
impact of 3D mobile applications on the overall educa-
tion of students. The use of digital 3D human models
in anatomy education is not a new concept (Schubert
et al., 1997; Estevez et al., 2010). However the
growth and increasing prevalence of mobile tablet
devices means that there is now a novel opportunity to
link advanced computer technology with the classic
dissecting room to improve anatomy education. Pre-
liminary research suggests that the tablet aided
learner has improved engagement whilst achieving
instructional objectives which has subsequently
enhanced the effectiveness and efficiency of dissection
education (Mayfield et al., 2012). Their particular
study looked at the effect of using an iPad-based mul-
timedia dissection manual during anatomy laboratory
instruction on learner’s perception of anatomy dissec-
tion activities and use of time. Three experimental dis-
section tables used iPads and three tables served as a
control for two identical sessions. Compared with con-
trols, the experimental students reported significantly
(P < 0.05) less reliance on paper and instructor resour-
ces, greater ability to achieve anatomy laboratory
objectives, clarity of the role of dissection in learning
anatomy, and experimental students indicated that the
iPad helped them in dissection (Mayfield et al., 2012).
It is our belief that mobile applications based on 3D
virtual models will help improve understanding of ana-
tomical relationships and supplement existing anat-
omy teaching. The purpose of this study was to collect
information related to the availability of these 3D
model anatomy applications for tablet computers and
qualitatively assess the features of these applications
for students and educators. Finally, areas of further
research are identified.
 Anatomy Education and Tablets in the Digital Age 3

TABLE 2. Three-Dimensional Anatomy Applications for the Apple iPad Meeting Inclusion Criteria Identi-
fied Following a Systematic Search of the Apple iTunes App Store Carried out Between 26 February,
2013 to 01 March, 2013

Developer App name Cost Apps in collection

Visible Body collection
Pocket Anatomy collection
3D4Medical collection
Bio-Sim Corporation
• Visible body human anatomy atlas 2 £6.99–£20.99 8
• 3D muscle premium 3 $9.99–$34.99
• 3D heart and circulatory system
• 3D respiratory anatomy for iPad
• 3D reproductive and urinary anatomy for iPad 2
• 3D brain and nervous system Pro for iPad 2
• Skeleton premium 2
• 3D digestive anatomy for iPad
• Pocket body £6.99–£20.99 3
• Pocket brain $9.99–$34.99
• Pocket heart 2
• Essential anatomy £0.00–£39.99 16
• Skeletal head and neck Pro III $0.00–$59.99
• Muscle system Pro III
• Brain and nervous system Pro III
• Heart Pro III
• Ankle and foot Pro IIII
• Hand and wrist Pro IIII
• Spine Pro IIII
• Shoulder Pro IIII
• Knee Pro IIII
• Hip Pro IIII
• Elbow Pro IIII
• Student muscle system
• Orthopedic patient education
• Digital human £6.99 1
$9.99

MATERIALS AND METHODS gestures to manipulate anatomy, educational

The Apple iPad currently commands the greatest mar-
ket share amongst students and clinicians (Modahl,
2011). This formed the basis of our initial search criteria.
From November 1, 2012 to November 3, 2012, a system-
atic search of the United Kingdom and United States Apple
App Store was carried out for iPad applications related to
anatomy. This was performed using combinations of
search terms including: anatomy, human, body, visible
human and three-dimensional, anatomy education.
Each application summary page was reviewed and
data collected regarding the application’s name, pub-
lisher and cost. Each application was given a primary
classification (e.g., education, clinical, reference) and
intended audience on the basis of the summary
description and screenshots. Apps which met the
inclusion criteria below were purchased downloaded
and qualitatively assessed over a number of months.
Issues such as update history and support were not
evaluated in the context of the application search.
Inclusion criteria:
• The application must contain a range of anatomi-
cal structures at a level of human anatomical ac-
curacy suitable for first year undergraduate
health sciences students (collections will be
grouped). This was the most difficult task. Appli- RESULTS
cations which did not use proper anatomical
terms were excluded e.g., “collarbone.” A total of 646 anatomy applications were identified
• The application must demonstrate a degree of using the search algorithm. This was reduced to 27 af-
interactive features. These were defined as using ter applying the inclusion criteria. The applications
functions such as quizzes, and the ability to anno-
tate images.
• The anatomy shown in the application should be
included in a virtual three dimensional format.
• The application must have a primary classification
as anatomical education.
• The application must be primarily intended for
health sciences students.
• The primary language of the application must be
in English.
There are a number of limitations in this study
which readers should be aware of. This review does
not search for or cover anatomy applications from
Android or other operating systems prevalent on the
market. Benefits and limitations of each application
are discussed purely in the context of the Apple iPad
platform which was used to review these applications.
This is currently an exciting turbulent time for mobile
applications and their potential uses in anatomy edu-
cation so the applications shown here may well be
superseded within a short time frame. However the
main focus is to recognize the potential uses for
mobile tablets to support anatomy education.
TABLE 3. A Comparison of Three-Dimensional Anatomy Applications for the Apple iPad Meeting Inclusion Criteria Identified Following
a Systematic Search of the Apple iTunes App Store Carried Out Between 26 February, 2013 to 01 March, 2013
Developer Overall impression
Visible Body • Visible Body is one of the
collection best all round applications
as it contains a compete
anatomy atlas in one
application rather than in
multiple. The graphics and
usability are impressive
which combined with the
clinical correlations and
animations mean these
applications are
recommended
Pocket Body • Pocket Body combines all
collection the information required to
learn key musculoskeletal
gross anatomy of the
human body whilst
presenting the information
in a functional and accessi-
ble manner. The relative
simplicity of this application
ensure that it is an ideal
starting point for
undergraduates
3D4Medical • The Essential Anatomy
collection application was the most
impressive application out
of all the applications
tested. The level of
anatomical complexity and
detail is high and the
combination of preloaded
sections ensures that
complex anatomical
relationships are easily
visualized
Bio-Sim • This is the weakest
Corporation application here. The poor
graphics combined with
extremely limited
anatomical detail and
content mean that in its
current stage, this
application should be
avoided
Positive features
• Contain largest range of
anatomical systems
• Contains animations of
various movements and
structures
• Preloaded sections highlight
specific anatomy
• Impressive graphics
• Clinical correlations of each
structure easily accessible
• Search function
• Contains over 50,000 words
of clinical correlations
• Useful range of anatomy
spotter and MCQ quiz
functions
• Ability to add own anatomy
pins and notes as users
explore the anatomy
• Search function
• Preloaded sections highlight
specific anatomy
• Contains the largest
number of anatomical
structures out of all the
applications here
• Impressive graphics
• Easy to isolate a single
structure
• Ability to annotate virtual
models and save for later
• Contains animations of
various movements and
structures
• Ability to display cross
sectional slices
• Ability to virtually dissect a
selected anatomical
structure by removing
layers
Negative features
• Microdetail lacking
• No ability to annotate/add
user notes
• Certain hardware
requirements to avoid
reduced performance
• 3D limited to rotation
• Limited number of layers to
remove
• Microdetail severely lacking
• User interface sometimes
not conducive to learning
• No lymphatic system
anatomy
• Some visceral systems
omitted (in this version)
• Limited lack of microdetail
• General very poor
anatomical detail including
absent labels
• No origin/insertion labels
for muscles
• No clinical correlations or
explanatory text
• Relatively basic graphics
4
Audience suitability
Lewis et al.
• Suitable for all junior
doctors and below who
need understanding of
gross anatomy. May be
suitable for junior surgical
trainees although may lack
the required microdetail
• Pocket Anatomy is the
application most suitable
for first and second year
medical students. The
focus on gross anatomy,
key anatomy concepts such
as origin, insertion, inner-
vation, blood supply and
the extensive clinical
correlations section
complete this application
• These specialist anatomy
applications are suitably
detailed for surgical trainee
grades and lower. There
are also specialist
applications aimed at
physiotherapists, dentists
and medical professionals.
The combination of
anatomy content and
accuracy ensure these are
the most advanced
applications
• This application is most
suitable for allied health
professions and potentially
first year medical students
who require a basic grasp
of anatomy concepts and
structure. The lack of detail
means its use at higher
levels is extremely limited
 Anatomy Education and Tablets in the Digital Age 5

mobile tablet. Similarly, different applications are better

at different stages of education, for example, Pocket
Body is more useful for undergraduates in their first 2
years given its high yield data content whilst Essential
Anatomy, shown in Figure 2 contains much more
detailed anatomy suitable for surgical trainees. What is
clear is that 3D4Medical, Pocket Anatomy, and Visible
Body are currently the leading developers for 3D anat-
omy applications in the Apple App store.
The exclusion criteria were specifically designed to
isolate applications which use 3D virtual models. This
excluded a number of useful anatomy applications
based on renowned textbooks available which many
students may find useful as portable anatomical refer-
ence books such as Gray’s Anatomy or Netters Atlas. It
is beyond the scope of this study to evaluate the utility
of these applications as they do not include virtual 3D
models however we acknowledge that they do exist and
have been shown in their own right to be effective in
improving anatomy education (Mayfield et al., 2012).

DISCUSSION
Each of the applications highlighted in this study
has a number of individual strengths and weaknesses.
Individual application features are discussed below
but it should be noted that these are liable to change

Fig. 1. Screenshot from the anatomy application

“Visible Body Skeleton Premium 2” highlighting the 3D na-
ture of the digital model.

which met the inclusion criteria are shown in Table 2.

App developers which had multiple applications which
met the criteria were grouped together. There is a
trend to creating individual applications for each
system.
The main reasons for applications being excluded
were as follows:

• Anatomy localized to one region only e.g., Kidney.

• Anatomy applications did not contain any 3D
elements.
• Anatomy applications did not contain enough detail.
• Many applications were simply digital versions of
anatomy textbooks with limited interactive features.
• Some applications were irrelevant “spoof” appli-
cations such as games.

A brief overview of each application developer is

given below in Table 3 including information related to
the features of each application as well as drawbacks.
In general terms, the level of anatomical detail is best
suited to junior doctors and undergraduate medical
students alongside other healthcare professionals.
Choosing which application is “best” is difficult to
address. This will undoubtedly depend on the integra- Fig. 2. Screenshot from the anatomy application
tion of the physical laboratory setup, cadaver and “Essential Anatomy” highlighting sternoclediomastoid.
6 Lewis et al.
Fig. 3. Screenshot from the anatomy application
“Pocket Body” highlighting the gross anatomy and range
of relevant clinical information. [Color figure can be
viewed in the online issue, which is available at
wileyonlinelibrary.com.]
with software updates. Perhaps more important are
the common advantages and disadvantages of this
application subcategory and their particular impact on
anatomy education.
The main strength of these applications comes
from the interactive three-dimensional functionality as
illustrated by Figure 1 and 2. Each application
presents a virtual three-dimensional model which can
be manipulated using simple touch gestures. These
models contain viscera, musculoskeletal, nervous,
vascular, and lymphatic structures. None of the virtual
models contained fasciae. Users can rotate, and zoom
into each model and anatomical structures are identi-
fied with pins. Identifying a particular structure is of-
ten as straightforward as simply tapping on it. Each of
these applications had anatomical structures defined
by layers which could be added or removed to reveal
further detail. The majority of the applications offered
the ability to observe anatomical structures in each of
the three anatomical planes although this was not
always straightforward. There are options to hide or
fade certain structures which are all easily identified
by tapping on the structure. This often reveals a range
of further content relevant to that particular structure.
Educators can highlight particular anatomical struc-
tures or remove layers to demonstrate certain ana-
tomical structures as shown in Figure 4. Complex
anatomical relations can be illustrated by manipulat-
ing the virtual models in 3D. Demonstrators can use
these applications to highlight the path of key struc-
tures which may not be present on a particular speci-
men. Other notable features of these applications
include the inclusion of relevant anatomical details
such as the origin, insertion, innervation, and vascular
supply of certain muscles or particular clinical correla-
tions if a structure is damaged as can be seen in Fig-
ure 3. This is often supplemented by a quiz function
which can offer options including a standard “spotter”
test to a multiple choice question test. Many applica-
tions also included appropriate animations and videos
highlighting the function of certain anatomical struc-
tures, pathology, and the fundamental link between
anatomy and physiology. One way anatomy educators
can use these applications to their advantage is by
sharing the screen of their tablet device with a projec-
tor. This would allow the educator to manipulate the
anatomy in real time whilst discussing the relevant
section.
However there are a number of limitations that cur-
rently prevent the sole use of tablets in anatomy edu-
cation. These can be broadly categorized as either
anatomical issues or infrastructure issues. From an
anatomical perspective, there have been no studies to
date which have formally assessed the anatomical
accuracy of mobile tablet applications. Our informal
experience with mobile tablet applications suggests
that some such as those by Visible Body and 3D4Med-
ical advertise, and indeed provide a high level of gross
anatomical detail. However we also recognize that this
has not been formally assessed and believe future
research should investigate this to ensure a minimum
acceptable standard for anatomy education. We noted
that anatomical accuracy rapidly decreased when
looking at microstructures such as the branching of
the trigeminal nerve, the muscles of the pharynx or
the anatomical borders of the inguinal canal. There
are no formal requirements for each application to
meet regarding the accuracy of the anatomical infor-
mation contained in each application so there is also
the risk that certain structures are mislabeled or
absent. Ironically, there are occasions where the infor-
mation contained within these applications is too
detailed and as a result becomes overwhelming and
therefore not conducive to teaching and learning.
Some applications were only available by system
which meant that users would have to purchase multi-
ple applications to have a complete anatomical
reference.
From a pedagogical standpoint, there are a number
of limitations of these applications. Fascia-less virtual
models potentially point to these applications nonreal-
istic rendering of anatomical variation. The virtual
models in these applications are not based on actual
human scans but rather a graphical representation of
the anatomy. There are also more abject limitations of
using virtual anatomy applications in education which
are best summarized by Granger who notes “the dis-
section laboratory is the only place where the three-
 Anatomy Education and Tablets in the Digital Age 7

Fig. 4. Comparison screenshots from the anatomy application “Essential

Anatomy” highlighting the ability to fade and highlight various structures. [Color figure
can be viewed in the online issue, which is available at wileyonlinelibrary.com.]

dimensional structure of the human body is reinforced
by visual, auditory, and tactile pathways” (Granger,
2004). There is no foreseeable way that an isolated
virtual computer model can reproduce these aspects
of anatomy from dissection laboratory and this poten-
tially limits the utility of these applications to a purely
supportive role.
The infrastructure issue is related to successfully
implementing these tools into modern anatomical
curriculums. The initial cost of purchasing the tablet
devices and anatomical applications is high and this
increases considerably if institutions wish to purchase
multiple anatomical applications. There are also
potential security implications in terms of mobile pho-
tography and the human tissue act, theft and acciden-
tal damage. There are also practical considerations
such as how to protect the devices when dealing with
“wet” specimens.
However for all the limitations described above,
there is still a clear role for tablet technology to sup-
port anatomical education. We propose that educators
use mobile tablets in conjunction with anatomical
specimens when demonstrating. We believe that the
use of an interactive tablet anatomy atlas alongside a
cadaveric specimen will enable students to grasp ana-
tomical concepts and relations more efficiently than
compared to a standard textbook or personal
computer although further research is required to
properly ascertain this.
The lack of formal literature in the mobile tablet
technology and anatomy education domain means
that this article raises many questions which require
answering. Initially, a survey of anatomy departments
and their perception and use of mobile tablets could
inform best practice educational guidelines. Research-
ers should also aim to address the accuracy of the
anatomy applications discussed and their potential
impact on anatomy education by running case control
studies comparing educational outcomes from anat-
omy teaching supplemented with tablets and without.
This could be compared to existing work being carried
out to evaluate the efficacy of mobile tablets in medi-
cal education. Ultimately, further research needs to be
carried out to evaluate the student perception and
response to three-dimensional virtual anatomy
bodies. This study has shown that these applications
meet basic criteria to be trialed in educational scenar-
ios to accurately assess the impact on student
engagement, learning and overall utility.
One point to note is the rapid pace of development
in the quality of these anatomical applications from
both a visual perspective but also in terms of anatomi-
cal detail and accuracy. It is not unreasonable to
expect this rate of development to continue as
8 Lewis et al.
hardware and software considerations allow. It is
therefore likely that the strengths of mobile tablet
devices in anatomical education will also continue to
grow which should improve the long-term viability of
their use as a complementary learning tool. This also
poses a number of issues for those considering
research in the area of anatomy education as it is rec-
ognized that applications often evolve and update at
such a pace that they are often out of date by the
time the final study is published.
The combination of portability and accessibility
combined with the vast range of medical content
available means that tablet devices are likely to play a
central role in future anatomy education. Continuing
hardware and software development means that the
issues regarding anatomical detail and accuracy may
decrease. Further research needs to be carried out to
evaluate the effectiveness of this novel technology on
anatomy education and overall knowledge outcome.
In the meantime, this analysis can help anatomists
identify key applications to use, as well as guide the
development and integration of future mobile applica-
tions. The next major leap in mobile anatomy educa-
tion will be applications which have 3D models of
actual cadaveric specimens which can be manipulated
using similar features to those described above. How-
ever there are a number of technological barriers and
important research efficacy questions which must be
answered first.
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