3D Model of Airfield Clearance and a Case Study

Guest Editorial: Nurses and policy: What more is there to say?

INTRODUCTIONMidwives have a remarkable influence on various outcomes in healthcare, of which the activities related to the management during the childbirth are emphasised the most. Midwives like all healthcare workers encounter many different stressors in clinical practice, including time pressure, excessive workload, different roles, and emotional issues. The profession of the midwife requires much knowledge, competence, good attitude and self-confidence in order to cope with many different complicated situations and dilemmas. This study has been conducted under the project: ‘Increasing midwives’ ethical competence: a European educational and practice development project (INEC)’.METHODSThis is a qualitative case study. The current case study involved 7 midwives of the Women’s Clinic, East-Tallinn Central Hospital, Estonia; the midwives expressed their willingness and agreed to take part in the activities of the peer group supervisors. The aim of the case study was to find how peer group supervision as a method helps midwives to solve complicated cases and dilemmas, helping them to maintain self-confidence and therefore to manage stress at work more effectively.RESULTSAll the participating midwives shared the opinion that peer group supervision helps midwives to cope with complicated situations and dilemmas more effectively, it empowers professional skills and self-confidence, and so contributes to more effective stress management at work. Also, the midwives expressed hope that this topic would be useful for the professional midwives and to other employees working in the field of healthcare, that encounter complicated cases in their daily work, and so will form an active team of peer group supervision.CONCLUSIONSPeer group supervision is an efficient method that helps midwives solve complicated cases in the Women’s Clinic, East-Tallinn Central Hospital, Estonia.

Purpose– This paper aims to contribute to the understanding of learning-oriented leadership as being integrated in managers’ daily work. The particular focus is on managers’ efforts to change how work is carried out through indirect acts of influence. In their daily work, managers influence the organisation’s learning conditions in ways that go beyond face-to-face interaction. Neither the influencer nor those influenced are necessarily aware that they are engaged in learning processes.Design/methodology/approach– The research was part of a larger case study. The data set comprised interviews with nine middle managers about ways of working during a period of organisational change. A learning-theoretical analysis model was used to categorise managerial acts of influence. The key concept concerned pedagogic interventions.Findings– Two qualitatively different routes for indirect influence were identified concerning social and organisational structures: one aligning, that narrows organisational members’ discretion, and one freeing, that widens discretion. Alignment is built on fixed views of objectives and on control of their interpretation. The freeing of structures is built on confidence in emerging competence and involvement of others.Research limitations/implications– The study was limited to managers’ descriptions in a specific context. An issue for future research is to see whether the identified categories of learning-oriented leadership are found in other organisations.Practical implications– The learning-oriented leadership categories cover a repertoire of acts of influence that create different learning conditions. These may be significant for the creation of a learning-conducive environment.Originality/value– Managerial work that creates conducive conditions for learning does not need to be a specific task. Learning-oriented elements are inherent in aspects of managerial work, and managers’ daily tasks can be understood as expressions of different kinds of pedagogic intervention.

Background: Gamma irradiation can cause DNA damage in single and double-strand breaks (SSBs & DSBs), especially in peripheral blood lymphocytes. Radiotherapy medical radiation workers can be exposed to gamma radiation related to their daily work. The comet assay is a sensitive method for analyzing DNA damage, especially SSBs. This study explores DNA damage in medical radiation workers’ peripheral blood lymphocytes as an adaptive response using the comet assay.Methods: Blood samples were obtained from four radiotherapy medical radiation workers as a case study (MRW) and two non-medical radiation workers as controls, and then irradiated with various doses of 0, 1, 1.5, and 2 Gy. Lymphocytes were isolated by histopaque and processed by comet assay on the slide under alkaline conditions. The imaging results were analyzed using the Casplab_1.2.3b2 software. The comet assay parameters observed were Tail Length (TL), % Tail DNA (T.DNA), Tail Moment (TM), and Olive Tail Moment (OTM). The one-way ANOVA method was used to analyze statistically between treatment groups. Results: Based on the study results, an increase in TL, T.DNA, TM, and OTM values in all samples was directly proportional to the increase in radiation dose. However, there was no significant difference (P > 0.05) between the MRW group and the control group on each parameter of the comet assay.Conclusions: From this study, it can be concluded that the level of DNA damage of lymphocyte cells as part of the adaptive response in the MRW and control groups was relatively similar after exposure at doses of 0, 1, 1.5, and 2 Gy.

This research aims at understanding daily work floor experiences of project leaders of Dutch housing associations who try to apply the principles of SCP. By comparing three cases it was found that: 1) despite the attention, engagement, and effort put into applying the principles of SCP, there are no indications that this lead to fundamental and structural improvement of intra- and inter-organizational collaborations. 2) intra-organizational relationships are just as important as inter-organizational relationships when it comes to implementing principles of SCP. 3) integrative activities are conducted and perceived as not rational, chaotic, contradictory, not finished and/or not followed up. Although the results may provoke practical managerial interventions, we recommend not to come to that kind of managerial interventions too quickly. Instead, we recommend getting actively involved in complex responsive processes that constitute the forming of SCP. In this way, cooperating with supply chain partners becomes a matter of a dynamic and personal process of development, rather than a managerial problem that is abstracted from daily work practice.

BackgroundThe need for and usage of electronic patient records within hospitals has steadily increased over the last decade for economic reasons as well as the proceeding digitalization. While there are numerous benefits from this system, the potential risks of using electronic patient records for hospitals, patients and healthcare professionals must also be discussed. There is a lack in research, particularly regarding effects on healthcare professionals and their daily work in health services. The study eCoCo aims to gain insight into changes in interprofessional collaboration and clinical workflows resulting from introducing electronic patient records.MethodseCoCo is a multi-center case study integrating mixed methods from qualitative and quantitative social research. The case studies include three hospitals that undergo the process of introducing electronic patient records. Data are collected before and after the introduction of electronic patient records using participant observation, interviews, focus groups, time measurement, patient and employee questionnaires and a questionnaire to measure the level of digitalization. Furthermore, documents (patient records) as well as structural and administrative data are gathered. To analyze the interprofessional collaboration qualitative network analyses, reconstructive-hermeneutic analyses and document analyses are conducted. The workflow analyses, patient and employee assessment analyses and classification within the clinical adoption meta-model are conducted to provide insights into clinical workflows.DiscussionThis study will be the first to investigate the effects of introducing electronic patient records on interprofessional collaboration and clinical workflows from the perspective of healthcare professionals. Thereby, it will consider patients’ safety, legal and ethical concerns and quality of care. The results will help to understand the organization and thereby improve the performance of health services working with electronic patient records.Trial registrationThe study was registered at the German clinical trials register (DRKS00023343, Pre-Results) on November 17, 2020.

This study investigates the types and functions of speaking employed by Desa Potato Head Bali hotel receptionists. As the first point of contact for guests, receptionists play a crucial role in shaping the overall guest experience through effective communication. To cope with the previous goal, case study was used as the research design. Additionally, observation through audio recording and interviews were implemented to collect the data. The findings of this study are: (1) one type of speaking was found, which is dialogue; and (2) eight functions of speaking were discovered, which are exchanging personal information, expressing future intentions, giving directions, giving advice & making suggestions, narrating a story, discussing opinions, describing, and interacting in social situations. However, there is a lack of research specifically focusing on the speaking practices of hotel receptionists when interacting with a diverse clientele. This study aims to fill this knowledge gap by examining the types and functions of speech receptionists in their daily work. The literature review explores the multifaceted nature of speaking, encompassing verbal and non-verbal elements, and the role of inner speech and social speech in forming and interpreting meanings. The findings of this study are expected to provide valuable insights into the communication needs of hotel receptionists and contribute to the development of targeted training programs to enhance their communication skills and ultimately improve the quality of customer service in the hotel industry.

This is a case study about the creation of open science services in the University of Eastern Finland. The library has overseen the open science services that have been actively implemented from 2010 onwards due to the development of the digitalisation of science and open science policies. A survey was conducted to determine how the UEF’s academic faculty use the services provided as well as their attitudes towards opening their own research findings in this manner. The researchers seem to be most interested in issues that influence their daily work, i.e. data management plans and opening their publications. It seems that the culture of openness is still at the development stage within UEF. The innovators, i.e. active research groups and researchers, are already practicing and encouraging openness, but the majority of the academic staff seems to be either unaware of open science or unwilling to implement it, due to the fact that incentives and career advancements still support the traditional way of conducting research.

Planning towing processes at airports more efficiently

PurposeProcess-oriented behavior is a prerequisite for transforming a company into a process-oriented organization, but is difficult to achieve among employees. The purpose of this paper is to examine the effectiveness of role plays on adapting process-oriented behavior in daily work practices.Design/methodology/approachUsing the theory of cognitive dissonance, the authors investigate whether role plays are an effective learning method. This study was conducted over a period of two years and included 212 participants of a financial services provider.FindingsThe results reveal that the role play used had a persistent impact on employees’ process-oriented behavior in terms of their process knowledge, their cross-functional coordination, and their continuous process reflection, but not on their process awareness. Thus, the authors conclude that despite high application costs, role plays are beneficial for financial services companies to train their employees.Research limitations/implicationsWhile the data stem from participants within one financial service provider only, this study contributes to the understanding how process-oriented behavior can be promoted sustainably in organizations.Practical implicationsThe results indicate that companies aiming for process orientation should apply role plays to achieve a change in behavior of employees.Originality/valueThis research contributes to the understanding of role plays as an effective learning method to adopt process-oriented behavior.

A shift from traditional pen and paper to advanced industrial devices can pose significant ergonomic challenges that impede efficiency and adoption, especially among refinery workers on the front lines. Due to usability and mobility issues, frontline workers in these industries resist adopting new technology which get in the way of their daily work. Consequently, duplication of work, manual data entry and human errors become common occurrences in this safety critical environment, where accuracy and timely data collection is key. In this paper, we present a mixed-methods case study to highlight the effectiveness of a user-centric approach to enhancing technology adoption, by prioritising human factors and ergonomic design principles. A design research exercise was conducted with 15 refinery operators leading to an iterative development process with continuous feedback sessions. This systematic approach allowed us to address user pain points, optimise their daily work, and improve their acceptance and adoption of mobility devices. Post-intervention data showed a significant increase in user satisfaction from 2/10 to 8/10 and a significant surge in device usage.

Introduced in China in the late 1990s, Peripherally Inserted Central Catheters (PICCs) have undergone rapid development and are widely used to deliver chemotherapy for cancer treatment and to establish adult postoperative parenteral nutrition pathways (Zhong, 2007). The technologies and methods related to PICC insertion have also developed rapidly. The United States Infusion Nurses Society and Oncology Nurses Society have published a number of clinical nursing practice guidelines for vascular access devices (Alexander, 2011; Camp-Sorrell, 2011), which present the best practice evidence for multiple steps of the PICC insertion process, such as the selection and preparation of the puncture site and catheter insertion. Such guidelines aim to standardize the procedures, effectively utilize limited health resources, and protect the patients’ interests. The current PICC insertion procedure in our hospital was developed from experience-based standards and processes are mechanically executed. To address this practice problem, we conducted a project to explore how to effectively implement the best practice of PICC insertion in our hospital. Our hospital is a tertiary cancer care center, affiliated with Fudan University with approximately 400 PICC insertion cases per month. The vascular access care outpatient clinic is led by PICCs specialty nurses and currently staffed with 1 chief nurse, 5 full-time PICC insertion nurses, and 11 full-time point-of-care nurses. This clinic is also equipped with three vascular ultrasound systems. The PICO (Population, Intervention, Comparison, Outcome) question that guided the project was as follows: In patients receiving a PICC line insertion (P) how does use of best practice affect insertion procedures, (I) how does it compare to experience-based insertion procedures, (C) how does it affect patient outcomes and nursing outcomes (O)? Between October and December 2012, the following databases were systematically reviewed: The Joanna Briggs Institute Library (1998–2012), EMbase, Elsevier (1990 to present), Web of Knowledge, Ovid, China National Knowledge Infrastructure (CNKI, 1990–2011) and the Chinese Wanfang database. A Web-based review of relevant guideline websites and professional websites, including the National Guideline Clearinghouse (NGC) and the Registered Nurses' Association of Ontario (RNAO), were also conducted. Five PICCs insertion-related guidelines that were currently in use in the United States, the United Kingdom, and Canada (Alexander, 2011; Camp-Sorrell, 2011; O'Grady et al., 2011; Pratt et al., 2007; Registered Nurses' Association of Ontario, 2008) were obtained. The key terms used in this project included peripherally inserted central catheters or PICCs and best practice or ultraso* or modified Seldinger technique or insertion or chlorhexidine or maximum sterile barrier or catheter tip location and position or complications. Fudan University Evidence-based Nursing Center is one of the cooperation centers of Joanna Briggs Institute (JBI) so the JBI evidence grading system version 2010 in Chinese was used for appraisal (Yan Hu, 2012). When determining appropriate catheter length, a PICC insertion nurse should use a measuring tape to measure from the point of venipuncture, over the course of the selected venous pathway, across the shoulder to the right side of the sternal notch, and down to the third intercostal space (Level III; Camp-Sorrell, 2011; Claasz & Chorley, 2007). Two percent of chlorhexidine gluconate ethanol solution is recommended to disinfect the skin at the catheterization site (Level I; Camp-Sorrell, 2011; Registered Nurses’ Association of Ontario, 2008). During the PICC insertion process, a maximum sterile barrier should be established. The operators should wear masks, hats, sterile powder-free gloves, a sterile gown and spread large, sterile sheets; the patients should wear masks and hats, and their entire body should be covered with sterile sheets (Level I; Alexander, 2011; O'Grady et al., 2011; Pratt et al., 2007). Vascular ultrasound guidance combined with the modified Seldinger technique should be used to insert the PICC catheter into the upper arm, especially the right upper arm, which lead to improved puncture and catheterization success rates and reduced complications related to mechanical damages (Level I; Li, Yan, & Zhang, 2013; Zhang et al., 2011). The optimal position for the catheter tip is from the lower third of the superior vena cava to cavoatrial junction; however, the catheter tip should not enter the right atrium (Level I; Infusion Nurses Society, 2006; National Association for Vascular Access Networks, 1998). Markers for determining the optimal position of the PICC tip on chest X-ray films include the carina of the trachea, the right main bronchus angle, and the upper right edge of the heart shadow, and position 4 cm or two thoracic vertebrae below the carina of trachea are considered appropriate (Level III; Baskin, Jimenez, Cahill, Jawad, & Towbin, 2008; Liu, Zhao, & Wang, 2011; Mahlon & Yoon, 2007). When the PICC have been inserted to the predicted length, an ultrasound probe can be used to detect the jugular vein on the catheterization side to exclude the possibility that the catheter tip entered the jugular vein and to facilitate timely adjustment (Level II; Bullock-Corkhill, 2010; Schweickert et al., 2009). Vascular ultrasound system is recommended to distinguish arteries, veins and nerves or nerve bundles to prevent the accidental perforation of arteries or nerves (Level II; Jin, 2005). The steps of the PICC insertion procedure in our hospital were formed based on the nurses’ experiences. This situation was not conducive to establishing and implementing a best practice. In order to ensure the safety of patients and improve the quality of care, we needed to use the current, best scientific evidence that was available to guide our PICC insertion practices. Before applying the body of evidence to our practice, we formed the project team. The team was led by the nurse researcher, directed by the head nurse of the clinic and supported by the director of hospital nursing service department. The seven-member team ultimately included PICCs insertion nurses, the head nurse, the director of the nursing department, a diagnostic radiologist and an interventional radiologist. The process utilized for integrating the evidence into practice included five steps. A situational assessment and analysis was conducted prior to the clinical implementation of the evidence: (a) an assessment of hospital resources and facilities, current rules or processes, the staff workload, the use of related materials; (b) interviews were conducted with the head nurses and PICC insertion nurses related to attitudes toward the existing PICC insertion process, the practical difficulties expected for evidence implementation, and director's support for and attention to the process; (c) an assessment of the feasibility and complexity of the planned implementation of best evidence for PICC insertion in hospitals, with or without an increase in the workload of the PICC insertion nurses and the nurses’ acceptance of the practices. Based on the assessment of evidence from the literature and our existing procedure, supports or barriers were identified and analyzed, and strategies of maximum resources utilization and evidence-based implementation were developed. For example, the mark, which used to detect the PICC tip position in our hospital, was the count of the rib on X-ray images. It was quite different from the best evidence synthesized at the beginning of the project. Therefore, the recommended detection of the PICC tip position was one of the revised items in PICCs insertion procedure. Additional evidence-based changes were: The implementation of 2% chlorhexidine for disinfectants and a maximum sterile barrier for patients; the use of vascular ultrasound technology; the identification of artery, vein, nerve and the catheter migration into the jugular vein using vascular ultrasound. The vascular access management software was improved by adding information about the catheter tip location, the one-puncture success rate, the tube insertion success rate, and the incidence of complications during catheterization, such as primary catheter malposition. The preliminary investigation conducted before the evidence-based changes were implemented revealed that although the nurses had received the Shanghai Institute of Nursing PICC insertion competency certificate, their training had mainly focused on technical operations; the nurses lacked theoretical training, and their basic knowledge of evidence-based nursing was relatively weak. Before the evidence was implemented, PICC insertion nurses and managers who participated in this project were educated on the updated evidence related to PICCs, new PICC insertion process and relevant documentation requirements. A video demonstrating the new PICC insertion process was produced for training PICC insertion nurses. As a result, full preparation for the transition to the new, evidence-based PICC insertion practice was provided. After receiving permission from the hospital's institutional ethics review board, the PICC insertion checklist and newly revised PICC insertion process was implemented in clinical practice. Core team members were available to answer questions, address issues that arose during the implementation, and provide timely feedback and solutions. It was vital to build in structures and processes to ensure continued and appropriate use of the interventions. A PICC insertion checklist was developed to monitor the quality of PICC insertions conducted by the nurses. This documentation form included the patient ID number and patient identity verification and recorded all the steps according to the PICC insertion process and each item could be marked as “conform” or “did not conform.” The checklist was spot-checked and completed by the chief nurse on the unit. Meanwhile, case study meetings were organized to discuss prevention and treatment measures for common complications that arose during the catheterization processes. After the completion of the clinical implementation, the managers and all PICC insertion nurses met for a discussion and summary to determine areas for further improvement. The data for 867 patients who underwent PICC insertion in the vascular access care outpatient clinic was collected in July and August 2013 before the evidence-based practices were implemented. The period from October 2013 to February 2014 was the implementation phase for evidence-based PICC procedures. The data with 742 patients were recorded and then compared with those before the implementation of the evidence-based protocol. With the provision of additional education, the average knowledge score of nursing staff increased from 110.7 to 118.3 out of a possible total score of 120 on a PICC line insertion knowledge test designed by the team. As part of the education program, all five PICC insertion nurses were trained about PICC insertion updated knowledge about upper arm catheterization under ultrasound guidance combined with the modified-Seldinger technique. The implementation of this evidence-based intervention improved the quality of care in the vascular access outpatient care clinic, as reflected in the following patient outcome indicators: The percentage of patients who chose the upper arm instead of traditional forearm catheterization increased from 98.96% (858/867) before the implementation of evidence-based practices to 99.87% (741/742) after the implementation. The result of Fisher exact probability method showed the difference to be significant (p < .05). The PICC insertion nurses’ updated knowledge related to selection of the catheterization arm also improved patient outcomes. The results of the chi-square test indicated that the percentage of patients (81.4%, 604/742) whose PICC catheter tip reached the optimum position was significantly higher than that (75.78%, 657/867) before the changes (p < .05). Finally, implementing improvements in the methods for measuring the PICC catheter insertion in vitro improved the patient outcome of accurate targeting of the PICC catheter tip in the lower 1/3 of the superior vena cava or cavoatrial junction, and not into the right atrium. Before the changes were implemented, the nurses adjusted the catheter in 19.39% (32/165) cases with the PICC catheter tip positioned too deep. The percentage increased to 47.37% (45/95) cases after the evidence-based practice change. This finding was statistically significant (p < .001). The results showed that the ability of nurses to detect the PICC tip position on X-ray image significantly improved when the catheter tip was positioned too deep. One difficulty in the implementation of evidence-based practices is the normalization of such practices. In addition to training, an effective way to continuously strengthen practices is to integrate them into the daily work of nursing. In this study, we revised the PICC insertion procedures and conducted training to integrate evidence-based practices into the operational procedures. The operational procedures could change the behaviors of the nurses and ultimately enable them to achieve mastery of evidence in their daily work while normalizing the new practices. Continuous strengthening of the evidence and monitoring of implementation measures are key factors in normalizing best practices (Aitken et al., 2011). The primary role of monitoring is to ensure the effective implementation of the evidence-based measures, and the normalization of the changes. In addition, continuous monitoring could reveal whether the current measures required modification or whether new measures needed to be added. The implementation of evidence-based innovations in this project was monitored by the chief nurse using the PICC insertion checklist. During the group discussion on evidence implementation that was part of this project, the nurse researcher and PICC insertion nurses found that some barriers influenced the adherence to evidence-based PICC procedure, such as the inconsistencies between what “they knew” and what “they do.” The key to overcoming this barrier and reduce these inconsistencies was to allow the learned knowledge to be effectively applied in clinical practice. The evidence informs the practitioners about what to do, but the specific procedures still need to be further refined and developed by researchers and practitioners according to specific clinical scenarios, including details pertaining to time, frequency, objects, methods, approaches, recording, and feedback. It is important to progress from experience-based practice to evidence-based practice, and use scientific evidence to guide our practices, to ensure the safety of our patients and improve quality of our care. During the best practices implementation process, it was essential to take full advantage of the functional roles played by researchers, care managers and PICC insertion nurses; apply effective strategies consistent with the clinical context; and make efforts to apply the evidence to daily work to ensure effective implementation. The outcomes of the implementation project were reported to the nurses in the clinic, the IV-team members, and the nursing quality supervisors in our hospital. The implementation protocol was introduced across the hospitals affiliated with Fudan University. Project results were disseminated through oral presentations at four regional and international doctoral student forums and oncology nursing conference. The best evidence on PICCs insertion developed in this project will be published on the website of Fudan University Evidence-based Nursing Center.

Welfare systems in Sweden and internationally have gone through major changes regarding modes of operation and means of government in New Public Management (NPM) reforms, which have sought to balance autonomy and control. There is a lively debate about NPM, but research is scarce. NPM indicates improved performances but also unintended consequences and inconsistencies concerning ideas, demands on the services and performance incentives – such as tensions between medical and social professional autonomy and knowledge on the one hand and administrative control, auditing and a growing bureaucracy (e.g., procurement, inspections, documentation) on the other. The research project used addiction treatment with different organisations and professions as a case for studying the impact of NPM on the daily work in regional health care and municipal social services organisations. We charted the broad steering and organisation of addiction treatment. We analysed the extent to which tendencies of NPM have conveyed advantages or created conflicting logics by comparing addiction treatment in three regions and six municipalities with varying degrees of NPM. The study used official statistics, documents, interviews and a web survey. A total of 85 interviews were made with 93 individual state, regional and local policy-makers and officials (including the previously unstudied procurers) and public and private care providers (managers and treatment professionals) in 2017–2018. The interviews formed the basis for a web survey among professionals in Sweden in 2019. Purchasing addiction services was further examined by observing a large procurement process, by organising a workshop with Nordic procurement experts, and by interviewing civil servants in Finland, Denmark and Norway. The study shows how addiction treatment is governed and organised, highlighting developments over time with special emphasis on various NPM features. The interviews addressed advantages and tensions in the daily work and if and how professionals seek to adapt to new, perhaps inconsistent, demands. The web survey allows for comparisons across organisations and professional groups. This technical report presents the background and aims of the study and describes in detail the Swedish study setting, and the study design, methods and data sources used.

The bolus is used to cover tumors in the shallow skin of cancer patients for a desired dose distribution in the high-energy radiotherapy. This research develops methods to improve the accuracy of bolus shaping by unfolding the human surface model for refolding. A surface segmentation method is proposed to separate a non-developable surface into a few pieces based on a clustering method to increase flattenability. In the segmentation process, a 3D surface model is embedded into a spectral space using a Laplacian matrix to combine the surface segmentation saliency and geometric characteristics. A smooth common boundary is designed based on clustering results to simplify the shape of each part. The 3D surface model is unfolded into 2D patches by the coordinate transformation and optimized using a mass-spring model. Case studies are conducted to verify the effectiveness of the proposed method in the bolus shaping.

Three-dimensional models have played important roles in medical simulation and education. Surface models can be manipulated in real time and even online; surface models have significant features for an interactive simulation system. The objective surface models are obtainable from accumulation of each structure's outlines, followed by surface reconstruction. The aim of this research was to suggest the arranged methods of surface reconstruction, which might be applied to building surface models from serial images, such as computed tomographic scans and magnetic resonance images. We used recent state-of-the-art sectioned images of a cadaver head in which several structures were delineated. Four reconstruction methods were regulated according to the structure's morphology: all outlines of a structure are overlapped and singular (method 1), overlapped and not singular (method 2), not overlapped but singular (method 3), and neither overlapped nor singular (method 4). From the trials with various kinds of head structures, we strongly suggested methods 1 and 2, in which volume reconstruction before surface reconstruction accelerated the processing speed on 3D-DOCTOR. So as to use methods 1 and 2, how to make the neighboring outlines overlapped in advance was discussed. The surface models of detailed head structures prepared in this investigation will hopefully contribute to various simulations for clinical practice. The value of the surface models are enhanced if they are placed over the original sectioned images, outlined images, and magnetic resonance images of the same cadaver.