Images in clinical medicine. The tale of Phineas Gage, digitally remastered.
Explore the source record for details and available documents.
Frontal Lobe↗
Biomedical subjects
Peter Ratiu
Publications and source records attributed to Peter Ratiu.
The tale of Phineas Gage, digitally remastered.
The injury of Phineas Gage has fueled research on and fascination with the localization of cerebral functions in the past century and a half. Most physicians and anatomists believed that Gage sustained a largely bilateral injury to the frontal lobes. However, previous studies seem to have overlooked a few less obvious, but essential details. This has led us to reanalyze the injury using three-dimensional reconstruction and quantitative computer-aided techniques and to propose a new biomechanical model, in order to determine the location and extent of the injury and explain Gage's improbable survival. Unlike previous studies on this subject, our findings are based on computer-generated three-dimensional reconstructions of a thin-slice computed tomography scan (CAT) of Phineas Gage's skull. The results of our image analysis were corroborated with the clinical findings, thoroughly recorded by Dr. Harlow in 1848, as well as with a systematic examination of the original skull specimen. Our results show that the cerebral injury was limited to the left frontal lobe, did not extend to the contralateral side, did not affect the ventricular system, and did not involve vital intracranial vascular structures. Although modern neuroscience has perhaps outgrown the speculations prompted by this famous case, it is still a living part of the medical folklore and education. Setting the record straight based on clinical reasoning, observation of the physical evidence, and sound quantitative computational methods is more than mere minutia and of interest for the broad medical community.
Adult↗
The Surgical Illustrator: a web enabled computer program for documenting clinical and procedural details.
The medical record not only stores information on actions taken regarding patient care but it is also a source of education for those who read it. Nurses, residents, interns, students and consulting clinicians look to the medical record to gain an understanding of clinical disease and the diagnostic studies and treatment regimens used to affect the disease. We have presented our initial findings and our framework for developing and evaluating The Surgical Illustrator, a software program that will enable clinicians to include in EMRs information that is usually hand drawn in traditional medical records. The future of the EMR will be a direct result of research and development devoted to creating innovative means of conveying clinically pertinent data. Our goal is to make a major contribution to this effort.
Humans↗
Visible Human 2.0--the next generation.
The National Library of Medicine has initiated the development of new anatomical methods and techniques for the acquisition of higher resolution data sets, aiming to address the anatomical artifacts encountered in the development of the Visible Human Male and Female and to insure enhanced detection of structures, providing data in greater depth and breadth. Given this framework, we acquired a complete data set of the head and neck. CT and MR scans were also obtained with registration hardware inserted prior to imaging. The arterial and venous systems were injected with colorized araldite-F. After freezing, axial cryosectioning and digital photography at 147 microns/voxel resolution was performed. Two slabs of the specimen were acquired with a special tissue harvesting technique. The resulting tissue slices of the whole specimen were stained for different tissue types. The resulting histological material was then scanned at a 60x magnification using the Virtual Slice technology at 2 microns/pixel resolution (each slide approximately 75,000 x 100,000 pixels). In this data set, for the first time anatomy is presented as a continuum from a radiologic granularity of 1 mm/voxel, to a macroscopic resolution of .147 mm/voxel, to microscopic resolution of 2 microns/pixel. The hiatus between gross anatomy and histology has been assumed insurmountable, and until the present time this gap was bridged by extrapolating findings on minute samples. The availability of anatomical data with the fidelity presented will render it possible to perform a seamless study of whole organs at a cellular level and provide a testbed for the validation of histological estimation techniques. A future complete Visible Human created from data acquired at a cellular resolution, aside from its daunting size, will open new possibilities in multiple directions in medical research and simulation.
Computer Simulation↗