In 2010, Jeffrey Sorenson, MD, began a project known as the Rhoton Collection. It proved to be an enormous undertaking. And it is possibly not yet halfway finished.
Sorenson, a neurosurgeon on staff at Semmes Murphey, met Dr. Albert Rhoton Jr. when the renowned neurosurgeon from the University of Florida came to Memphis in 2002 to give an annual lecture for a skull base surgery course at the Medical Education Research Institute. Sorenson was highly impressed, and so began a relationship with Rhoton that would last for years, up to and beyond Rhoton’s death last year at age 83.
“From the very beginning of his career,” said Sorenson, who calls Rhoton the most accomplished neurosurgical anatomist ever, “his emphasis was to study anatomy in detail.”
Rhoton’s work in neurosurgery dates to the 1960s, when surgeons first started using the operating microscope. Until then, Sorenson said, “the outcomes were not very good for a lot of the operations.”
With the operating microscope, he added, “they could see a lot of things that they never saw before.”
Rhoton set about documenting and photographing his dissections with the operating microscope with the intent of increasing knowledge of anatomy and producing better outcomes for all neurosurgeons.
“That was his life mission that he worked on until the day he died,” Sorenson said. “He really revolutionized neurosurgical anatomy.”
In his lectures, Rhoton showed his dissections in 3D. The first time Sorenson saw them, he said, “it was an incredible experience, like the first time you walk into the Sistine Chapel.”
Over 40 to 50 years, Rhoton produced tens of thousands of slides, with material stored in boxes stacked in his house. Drs. Jon Robertson and Bill Couldwell, who were in leadership positions at the American Association of Neurological Surgeons, became concerned as Rhoton grew older about preserving his work.
They ultimately arranged for the AANS to fund the effort to archive the material. This is where Sorenson became involved. From the time his parents gave him a Commodore Vic-20 when he was a youngster growing up in Lake Jackson, Texas, he had been learning about computer programming.
“I was interested in trying to accelerate learning using database and web technologies to organize knowledge and move beyond the static textbook format,” Sorenson said. “So I’d been doing some of the preliminary work already when this project began.”
“Our proposal was to take all of Dr. Rhoton’s images and put them in a huge online database so that they could be easily used as building blocks for other educational materials such as slide shows and movies.”
Sorenson, Robertson and Couldwell went to Gainesville, Florida, in October 2010 to present their plan to Rhoton.
“We brought a 3D TV,” Sorenson said. “At that time, 3D TVs were just getting in stores. When he saw his material on the 3D TV, the effect was even better, the colors were more vivid, and he remarked that he’d never seen his images look so beautiful.”
Rhoton was sold and decided to donate all of his material.
“We termed it the Rhoton Collection because I’d always thought of his work as a collection of art,” Sorenson said. “It all makes sense if you go back in the history of medicine and anatomy.”
Whereas Galen’s landmark anatomy book, Sorenson pointed out, had no art, Vesalius came along during the Renaissance and saw the importance of using artists to help communicate the science.
“Dr. Rhoton just took it to the next step by combining these incredible dissections with 3D photographs,” Sorenson said. “He viewed the dissections as sculpture and as much art as they were science.
“He had fellows who would come in from all over the world. They would spend a year in his lab working on his dissections, very meticulous dissections, and it would take them several months to get good enough at them to even have something worth photographing.”
Some scientific collections are available to those who pay. Rhoton, Sorenson said, wanted his collection to be free, to have the greatest impact across the world that it could have.
A retinal surgeon friend of Sorenson’s, Dr. Jorge Calzada, had started generating interest by posting images on Instagram. It got Sorenson’s attention.
“Social media doesn’t come naturally to my generation,” he said. “But I finally gave in and said, ‘OK, I’ll do this,’ and then of course it’s a perfect fit for images.
“So now I’ll take some of Dr. Rhoton’s images and make a small movie, and within minutes I can see that people from around the world are viewing it. This was unimaginable when I started medical school.”
Sorenson believes that Instagram, because of its popularity, may be the place where the most people come in contact with the Rhoton material (rhoton.collection).
From an online database there is now a website: Rhoton.ineurodb.org. There is indexing of key words, a drawing tool for highlighting different structures, an anatomy atlas that is a work in progress, apps for mobile phones and other devices to allow the material to serve as an interactive tool or a presentation tool. In short, anything Sorenson can imagine to make understanding and teaching more possible to as many people as possible.
The website also facilitates worldwide collaboration to develop topics. From the very beginning, contributions from many medical students and residents have been vital.
“You can also narrate into the website and stitch those slides together into a movie,” Sorenson said. “So the same set of slides, the same drawings, the same captions can be used for three different scenarios – passive learning from a movie, interactive learning on the website and the presentation mode from a podium.”
Sorenson now is working on creating a tool whereby anatomical terms in articles on the Journal of Neurosurgery website can be highlighted so that a reader can click on the highlighted term and pull up an image, a caption and possibly even a video “to quickly refresh your memory about the anatomy,” he said.
When he started the project, Sorenson said, “we thought maybe after five years we’d have everything fleshed out and done. Over time it became clear there is no end to it.”
From pictures to drawings on top of the pictures, to slide shows that can be built into movies, “the idea was to make it sort of a living thing instead of just a static collection,” Sorenson said. “That’s been a real challenge.”
Last year, Sorenson’s work was acknowledged in an editorial in the Journal of Neurosurgery, which described his efforts as “indefatigable.”
A large part of the challenge has been finding the time to do the work.
“It turns out that it’s difficult to do anything else while practicing neurosurgery,” he said. “I have a full-time practice and teaching responsibilities, so all of this work occurs during nights or weekends. Family time can also suffer.
“I do not have the same number of journal publications that I might otherwise have at this stage of my career because I’ve been doing this instead.
“But on the flip side, I think that taking on this project has made me into a better surgeon because it led to a much more nuanced knowledge of anatomy. Of course, this was Dr. Rhoton’s main purpose in the first place.
“The other wonderful thing about the project is that I’ve been able to meet and collaborate with so many interesting people around the world that I probably would not have otherwise known. So even though it’s a tremendous amount of work, it’s also been a great deal of fun.”
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