Original Research

 

A Survey Based Pilot Study on Three Dimensional Images and Animated Videos in Oral Histopathology

Tamgadge Sandhya, Tamgadge Avinash

Abstract

Background: Oral Histopathology is the study of diseased tissues in a life-like manner. Unfortunately biopsy tissue gives two dimensional and static images. Additionally the descriptions of such images are in three dimensional terms such as cords, arcading, organoid etc., which most of the time is confusing to the students and readers. Therefore it becomes very difficult to correlate the descriptions mentioned in the textbooks with the images viewed under microscope. Researchers have been trying to develop various softwares to convert two dimensional images into three dimensional but again such images would still be static. Therefore three dimensional animation videos which would depict the etiopathogenesis in life like manner, should be available at each university to promote e-learning especially for oral histopathology speciality, popularity of which has been vanishing day by day. Such videos are already available for other speciality of dentistry. With this concept, a preliminary effort was been taken to design such animations for histopathological aspect of ameloblastoma and shown to students. Methods: A survey was conducted amongst bachelor of dental surgery students, interns and master of dental surgery students using questionnaire, to know the understanding level of oral histopathology through traditional teaching methods. Additionally few images and videos have been created using various softwares and feedback was evaluated. Results: Three dimensional videos were perceived as effective and efficient as E-learning tools for oral histopathology education. Conclusion: User feedback on the educational content was helpful. A website exclusively for this work was suggested and planned for E-learning.

 

Keywords: Three Dimensional; Animation; Two Dimensional; Ameloblastoma; Oral Histopathology; Videos; Website.

 

Tamgadge Sandhya, Tamgadge Avinash. A Survey Based Pilot Study on Three Dimensional Images and Animated Videos in Oral Histopathology. International Journal of Oral & Maxillofacial Pathology; 2015:6(2):02-08. ©International Journal of Oral and Maxillofacial Pathology. Published by Publishing Division, Celesta Software Private Limited. All Rights Reserved.

 


Introduction

Oral histopathology has always been a core subject which deals with final diagnosis of oral diseases. Therefore major responsibility lies on faculty to develop the interest about this subject amongst the students1,2 Teaching of oral histopathology has always been through two dimensional (2D) static images, which, in this era of technology, can’t be correlated with the three dimensional (3D) terms mentioned in the text books.3 Thus understanding would be better if along with 2D images, 3D images and 3D animated videos are also made available. 3D images and 3D animated videos can be designed with the help of various softwares available due to the advancement of electronic media.4-6 Various researchers have been trying to convert 2D histopathological images of biopsy tissues into 3D images using serial sections but such static 3D images still can’t explain the step by step process of pathogenesis in a life like manner.7 Thus 3D animated videos are the best tool for such explanation.

Literature in education psychology indicates that good interactive multimedia teaching modules for e.g. 3D animated videos may enhance understanding of the subjects.8 There have been many such initiatives in other educational field using 3D animations.3,9-12 Oral pathology has always been explained with the help of 2D static microphotographs but literature now emphasize the need of including three dimensional images13,14 which can be fulfilled by the use of various softwares. Therefore 3D animations used to depict pathogenesis and oral histopathology would help students for better understanding.15-19 Scanning electron microscope has the property to give 3D images but such images are again static.20

 

Therefore a preliminary attempt has been made to design 3D images of histopathological aspect of ameloblastoma and 3D animation videos and shown to students. Also a survey was conducted to compare the current level of understanding of oral histopathology with and without 3D animation.

 

Materials and Methods

A cross sectional study was conducted to know the level of understanding of oral histopathology using current 2D and static images amongst third year bachelor of dental surgery students and master of dental surgery students of dental colleges from Navi Mumbai. Total 23 postgraduates and 143 undergraduates were included in the study as per their availability and wish to participate in the survey. Ethical approval wasn’t considered as this study does not involve any laboratory procedures on human subjects. Preliminary 3D images and videos on few variants of ameloblastoma were designed by author using 3Dmax (Autodesk Media and Entertainment) and Adobe premiere pro 5.5 software which is a video editing software (Adobe Systems) and shown to few students. A questionnaire form was circulated and feedback in the form of answers were obtained and were analysed.

 

Ameloblastoma is a benign locally aggressive odontogenic tumour derived from developing tooth germ. It exhibits various histopathological patterns such as follicular, plexiform, basaloid, desmoplastic, Acanthomatous, etc.21 There are plethora of 2D histopathological images available online however, there aren’t any 3D animated videos and images which would help in understanding the pathogenesis. Therefore a preliminary effort has been made to design such images and videos to explain few types of ameloblastoma in a life like manner such as;

§  In follicular pattern, follicle, is a 3D term meaning sac like arrangement of lesional tissues which cannot be depicted in 2D images but can be better explained in 3D images (Figure 1).

§  Plexiform pattern consists of anatomising strands and cords of ameloblastic epithelium with central parts containing loosely arranged stellate reticulum like cells. Such interconnecting strands can be best depicted in 3D (Figure 2).

§  Acanthomatous pattern is similar to follicle with stellate reticulum-like cells replaced by squamous metaplasia with keratin pearl formation (Figure 3).

§  Granular cell pattern are also similar to the form of follicle with stellate reticulum like cells in the centre and ameloblast like cells at the periphery (Figure 4).

§  Desmoplastic pattern shows the presence of dense desmoplastic fibrous connective tissue that contains thin strands and nests of odontogenic epithelium (Figure 5).

§  Basal cell ameloblastoma consists of nests of basaloid cells without any stellate reticulum like cells in the centre. (Figure 6).

§  Unicystic ameloblastoma consists of a cystic lesion lined by odontogenic epithelium demonstrating nuclear palisading and reverse polarization with cytoplasmic vacuolization of the basal cells. An overlying stellate reticulum-like cells are present (Figure 7).

Feedback of all questions answered by participants were recorded and statistically analysed using chi square test. Unanswered questions were not considered for analysis.

Figure 1: Hematoxylin and Eosin stained section of Follicular ameloblastoma shows (a) lesional tissue arranged in follicles with peripherally arranged ameloblast like cells and centrally placed stellate reticulum like cells. Ameloblastic follicle in 3D (b, c & d) showing ameloblast like cells (Red Arrow), stellate reticulum like cells (Yellow Arrow) and basement membrane (black Arrow).

Figure 2: Plexiform ameloblastoma under Hematoxylin and Eosin (a) showing odontogenic tissue arranged in Plexiform pattern with peripherally arranged ameloblast like cells and centrally placed stellate reticulum like cells. Plexiform pattern in 3D (b, c, & d) showing ameloblast like cells (Red Arrow) stellate reticulum like cells (Yellow Arrow), basement membrane (White Arrow) blood vessels (blue arrows).

 

Figure 3: Hematoxylin and Eosin stained section (a) of acanthomatous ameloblastoma showing lesional tissue arranged in follicles with peripherally arranged ameloblast like cells (Red Arrow) and centrally placed stellate reticulum like cells (Yellow Arrow) which shows Squamous metaplasia (White Arrow). Ameloblastoma follicle in 3D (b & c) showing ameloblast like cells (Red Arrow) stellate reticulum like cells (Yellow Arrow), basement membrane (black Arrow) and squamous cells (white arrow).

 

Figure 4: Granular cell ameloblastoma under Hematoxylin and Eosin stained section (a) shows lesional tissue arranged in follicles with peripherally arranged ameloblast like cells (red arrow) and centrally placed granular cells (blue arrow). Ameloblastic follicle in 3D (b & c) showing ameloblast like cells (red arrow) stellate reticulum like cells (yellow arrow), basement membrane (black arrow) and granular cells with compressed nuclei, multiple granules and cell wall (blue arrow).

Figure 5: Desmoplastic ameloblastoma under Hematoxylin and Eosin stained section (a) shows lesional tissue arranged in compressed islands with peripherally arranged ameloblast like cells (red arrow) and centrally placed stellate reticulum like cells in a dense collagenous stroma. (green arrow) basement membrane (black arrow), Ameloblastic islands in 3D (b & c) showing ameloblast like cells (red arrow), stellate reticulum like cells (yellow arrow) and basement membrane (black arrow), blood vessels (blue arrow) and a dense collagenous stroma (green arrow).

 

Figure 6: Basaloid ameloblastoma under Hematoxylin and Eosin stained section (a) shows odontogenic tissue arranged in follicles consists of basaloid cells. Ameloblastoma follicle in 3D (b) showing ameloblast like cells (red arrow) and basement membrane (black arrow).

Figure 7: Unicystic ameloblastoma under Hematoxylin and Eosin stained section (a) shows odontogenic epithelial lining with basal tall columnar ameloblast like cells and superficial stellate reticulum like cells. In 3D (b, c & d) showing ameloblast like cells (red arrow) stellate reticulum like cells (yellow arrow) and basement membrane (black arrow) and cystic lumen (blue arrow).

 

Results

The first question in the questionnaire was “Do you understand oral histopathology through Lectures?” There was hardly any difference of opinion with the chi-square statistic was 0.9742 and p-value was 0.323623. This result was not significant at p<0.05 (Table 1). The response to the question “Do you understand Practical sessions of oral histopathology?” was surprising, due to their remarkable difference in opinion. The chi-square statistic was 0.4245 and p-value was 0.514716. This result was not significant at p<0.05 (Table 2). Students often experience difficulty in learning oral histopathology in practical explanations due to various causes such as, Lack of understanding towards the microscope, Complexity of histologic images, Difficulty of integrating static histologic images with dynamic physiological functions etc. In this survey it was found that complexity of the 2D images was the most common cause for not understanding the subject, with chi-square statistic being 9.0741. The p-value was 0.028322. The result was significant at p<0.05 (Table 3). Therefore it was asked if they were aware of animations used to provide background information that aids in understanding microscopic images and help students to visualize the disease process. Most of the students were aware of such technology. The chi-square statistic was 0.0566 with p-value 0.811875. This result was not significant at p>0.05 (Table 4). When they were asked whether such animations will increase interest in learning oral histopathology? Most of them were in favour of adding such technology. The chi-square statistic was 0.04. The p-value was 0.841447. This result was not-significant at p>0.05 (Table 5).

 

Yes

No

Total

p value

Under Graduates Intern

78 (75.81) [0.06]

65 (67.19) [0.07]

143

0.3236

Post Graduates

10 (12.19) [0.39]

13 (10.81) [0.44]

23

Totals

88

78

166

Table 1: Q1. “Do you understand oral histopathology through Lectures?”

Yes

No

Total

p value

Under Graduates Intern

65 (63.56) [0.03]

75 (76.44) [0.03]

140

0.5147

Post Graduates

9 (10.44) [0.2]

14 (12.56) [0.17]

23

Total

74

89

163

Table 2: Q2. ”Do you understand Practical sessions of histopathology?”

Yes

No

Total

p value

Under Graduates Intern

84 (83.48) [0]

58 (58.52) [0]

142

0.8118

Post Graduates

13 (13.52) [0.02]

10 (9.48) [0.03]

23

Total

97

68

165

Table 4: Q4. ”Are you aware of animations being used to provide background information that aids in understanding microscopic images, help students to visualize the disease process?”

Yes

No

Total

p value

Under Graduates Intern

103 (102.58) [0]

50 (50.42) [0]

153

0.8414

Post Graduates

15 (15.42) [0.01]

8 (7.58) [0.02]

23

Total

118

58

176

Table 5: Q5. ”Do you think such animations will increase interest in learning histopathology?”

 

Their opinion on inclusion of animations to illustrate basic histologic structures to help better visualization and understanding, was surprising as they would want such technology to be added in curriculum. The chi-square statistic was 3.2255. The p-value was 0.0725. This result was not significant at p>0.05 (Table 6). Students view on implementing an independent set up for such technologies at each medical and dental institute that will assist in teaching, patient education and research purpose was asked. They liked the concept of setting up medical animation centre at each institute. The chi-square statistic was 5.0356. The p-value was 0.024832. The result were significant at p<0.05 (Table 7). All the students had difficulty in understanding traditional teaching methods using 2D images available in text books and online. The concept of ameloblastoma was clearer after seeing 3Dimages and 3D animation videos. They also suggested creating a website exclusively for such videos for easy access by users and give opportunity to users to upload similar videos and funding for the website.


A

B

C

D

Total

p value

Under Graduate Inters

22 (28.29) [1.40]

90 (84.86) [0.31]

38 (37.71) [0.00]

4 (3.14) [0.23]

154

0.0283

Post Graduate

14 (7.71) [5.12]

18 (23.14) [1.14]

10 (10.29) [0.01]

0 (0.86) [0.86]

42

Total

36

108

48

4

196

Table 3: Q3. ”Students often experience difficulty in learning histopathology”

 


Yes

No

Total

p value

Under Graduates Intern

111 (107.58) [0.11]

31 (34.42) [0.34]

142

0.0725

Post Graduates

14 (17.42) [0.67]

9 (5.58) [2.1]

23

Total

125

40

165

Table 6: Q6. "Does inclusion of animations to illustrate basic histologic structures help in better visualization and understanding, for the students?”

Yes

No

Total

p value

Under Graduates Intern

102 (97.34) [0.22]

41 (45.66) [0.47]

143

0.0248

Post Graduates

11 (15.66) [1.38]

12 (7.34) [2.95]

23

Table 7: Q7. ”Would you suggest implementing an independent set up for such technologies at each medical and dental institute that will assist in teaching, patient education and research purpose?”

 

Discussion

Oral pathology is the speciality of the dentistry, the popularity of which is been fading amongst the students day by day. It could be due to the low level of understanding through traditional teaching methods using text and images (2D and static).1 With advancement in technology oral pathologists have higher responsibilities to adopt new teaching methods to engage, extend and enhance student learning. The modes of engagement in digital learning are rapidly morphing to accommodate these expectations. Others have already shown that learning from an interactive and E-learning through 3D images and videos has perceived by majority and creates real life like images.3,4,9

Findings of feedback from this preliminary pilot study on learning with 3D animated videos indicated that users perceived them as useful for better understanding, particularly when compared to traditional teaching using 2D and static histopathological images, or even glass slides, alone. The majority of participants were also interested in seeing more such videos. In response to comments received from participants during this preliminary survey, we were clearer in further modifications to be made in 3D images and videos.

 

As the study was unique in the field of oral histopathology, participants initially took little time to understand but the concept was very clear after watching videos. The learning and designing of the 3D images and videos by the author was time consuming and difficult. Additionally after the designing of such images and videos and its approval from animation expert was difficult as they were from non-scientific background and would overlook the pathological aspect of the content. On contrary their focus was more on technicalities. Therefore medical professionals should learn animation from medical animation institute. 3D animated videos are novel in that they depict histopathological process in a life like manner and understanding is better as compare to traditional teaching methods.3

 

Verbal forms of teaching have been augmented by pictorial forms of teaching. Although it is undeniable that verbal modes of presentation have long reigned supreme in education, the addition of visual forms of presentation have enhanced students understanding.17,22 As a matter of fact, animation or graphic illustration is preferred to verbal by most university students when dealing with dynamic subject matter.18 From an educational perspective, the advantages of adding animations using 3D animation videos described in this paper are numerous. These include: (a) Rapid access; (b) relative permanence as compared to glass slides, which are prone to fading and breakage; (c) ability to provide ideal teaching to large and/or dispersed audiences simultaneously; or incorporation into online tutorials. It was suggested by the participants that a website should be created which would have all the videos on oral histopathological aspects of oral lesions and literature shows that such initiatives have already been implemented by few universities.3 However, the preparation of educational videos requires expertise. Policy makers should fund and promote such educational initiative which would also create job opportunities for animation designers.

 

In this study the videos were designed by author, however it is difficult to get such videos designed with the help of animators who are into film animations as they do not understand various scientific terms and most of them aren’t from scientific educational background. Additionally, such videos are extremely expensive. Therefore, set up for medical animation centre should be promoted so that there are enough videos for all medical specialities for e-learning.

 

Additions of 3D animations would surely build up confidence in students as well as faculty as far as teaching of this subject is concerned. Few researchers have compared teaching methods using traditional text and images with 3D animation. Surprisingly students scored highest marks who had been taught using animations.4,12,23 Histopathological sections can’t depict 3D terms of ameloblastoma such as cords, follicles as well as morphology of all the lesional cells. Author made an preliminary effort to design such terms in a 3D pattern which was well perceived by the students. The interconnecting cords in Plexiform ameloblastoma could actually be interconnecting tubules in 3D, which are internally lined by ameloblast similar to endothelial cells of blood vessels and are filled with stellate reticulum like cells. But in histopathological 2D sections it appears to be lined by double rows of ameloblast-like cells and stellate reticulum like cells in the centre.

Similarly, in follicular ameloblastoma follicle resembles pouch or a bubble in 3D. Therefore it could be hypothesized that in follicular, acanthomatous, granular and basaloid ameloblastoma numerous such bubbles or pouches are packed with odontogenic cells which has been depicted in the 3D images. Same follicles are compressed in desmoplastic ameloblastoma due to dense collagenous stroma.

 

Conclusion

Access to large sets 3D animated videos on histopathological aspects of oral lesions has the potential to guarantee better understanding of the subject. Therefore subsequently more and more students would opt for advanced studies and research. Videos designed for this preliminary pilot study were well received through anonymous feedback. This highlights the importance of the developing videos on all lesions ,included in oral pathology curriculum, which other dental specialities have. Various softwares are available to design 3D images and videos of such lesions for better understanding but require experts to design.

 

Designing educational materials with the aid of the mentioned software is a really promising avenue to improve the learning process. Teachers would be able to feel more confident in developing interest amongst students. Three dimensional animation videos should be designed for histopathological aspects of all the oral lesions. We look forward that this study is likely to have wide benefits in the field of oral histopathology. This initiative was well accepted by the participants as seen in our non-significant statistical results in most of the questions.

 

Compared with static images and text, animations can present procedural more explicitly as they show the steps in an orderly manner. Policy makers in education system should promote such projects and should release funds to design website exclusively for 3D animated videos for oral histopathology so that students could easily access for e learning. This study and initiative could be further modified in future with equal number of participants in each group.

 

Acknowledgement

Mr. Harishankar Agnihotri and Mr. Bhavesh, faculties of “Maya Academy of Advanced Cinematics” Mulund West, Mumbai Maharashtra, for teaching  various softwares to author (Dr Sandhya Tamgadge), to create 3D images and videos.

 

Author Affiliations

1.Dr.Tamgadge Sandhya, Prof & PG Guide, 2.Dr.Tamgadge Avinash, Prof, Dept. of Oral & Maxillofacial Pathology and Microbiology, Padmashree Dr. DY Patil Dental College & Hospital, Sector-7, Nerul, Navi Mumbai, Maharashtra, India.

 

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Corresponding Author

Dr Sandhya Tamgadge,

Gace –C 802, Vasant Oscar, LBS Marg,

Mulund West Mumbai-400080, India.

E-mail: sandhya.tamgadge@gmail.com


 

 

Source of Support: Nil, Conflict of Interest: None Declared.

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