Departing from standard practices: Strategic application of value engineering in the anatomy laboratory to enhance formaldehyde extraction using high‐impact, low‐cost, and low‐maintenance solutions
While the use of post‐mortem human tissues for the study of anatomy remains a mainstay in both undergraduate and expert medical and dental education, the contemporary anatomy laboratory is challenged by a series of developments. On one hand, European anatomies are faced with rapidly growing student numbers in an effort to meet the needs of an aging healthcare sector, regarding both patients , and healthcare professionals. , On the other hand, student numbers and curricular change warrant new concepts for the course delivery in anatomy in condensed teaching formats. , , Anatomical dissection of human tissues for teaching purposes in medicine is well known to facilitate the training of future doctors in the most realistic manner. , , , For the purpose of human anatomy teaching, formaldehyde and other organic compounds offer an established approach to provide suitably embalmed tissues. Here lies a second challenge as formaldehyde has been classified as a type 1B carcinogen. , A number of embalming protocols have been established in recent decades in an effort to lower the concentration of formaldehyde evaporating from embalmed tissues. , , , , , , , , To date, however, no suitable replacement has been found for formaldehyde in anatomy embalming in spite of considerable research on the topic. Lowering exposure time may be an option to reduce formaldehyde concentration levels, but can hardly be (further) lowered without negatively impacting the quality of teaching. , Infrastructural enhancements may be an option to minimize the possible exposition for anatomy staff and students alike, and to meet safety regulations. So far, the most effective infrastructural upgrading has been in enhanced air ventilation technology. , , , , A common engineering approach in Central Europe involves the use of the laminar flow design, which has been adapted from operating rooms. Laminar flow systems have primarily been designed to ensure that patients are exposed to clean, filtered air, thus lowering the risk related to air contaminants in the operating room for the patient. , , At the same time, laminar flow systems have been designed to purpose‐fit a small number of operating staff surrounding a patient within the center of the airflow. The technical requirements of anatomy laboratories, however, differ markedly concerning both the quality needs and the outcome variables when compared to operating rooms. For laboratory purposes, the key priority is defined by an effective elimination of hazardous organic volatiles, while maintaining a sterile environment is secondary. Furthermore, the effectiveness of the laminar flow design is negatively affected by the thermal input of each individual residing in the field of the air ventilation. In a typical student course setting, 6–12 course participants are involved in a dissection at one table, each providing a heat abstraction approximating 120 W, totaling 0.7–1.2 kW. Such thermal intake and the shadowing effects of the individuals standing in the area of the flow will significantly deteriorate the elimination effects of laminar flow systems in the dissection room. Also, in spite of their broad use, most laminar flow systems are distributed and maintained primarily by medical product suppliers, which escalates the costs of structural enhancements multifold when compared to standard industrial air ventilation applications. This article summarizes research data‐driven process for designing, rolling out and evaluating a first‐of‐its‐type prototype large‐scale anatomy laboratory setting, presenting a versatile, low‐cost engineering solution for future needs. 

Description on the initial situation with a standard systems approach During the initial planning stage, the dissection laboratory was planned to include 78 dissection tables in line with user requirements. The primary function outlined by the laboratory planner was defined as follows: A ventilation system ensuring that the working zone of the respective dissection table meets contemporary threshold limit values (TLVs) requirements for formaldehyde of 0.37 mg/m 3 or 0.3 ppm. The initial plan included the installation of laminar flow tables, , with specifications outlined in Table , a so‐called second‐generation design. This type of installation was considered most effective to extract formaldehyde in line with a joint project of the German accident insurance and a medical device manufacturer. No specific recommendations nor legal regulations existed regarding the ventilation technology for dissection rooms according to the European authorities at the time of planning. In‐depth research on the topic of air ventilation technology, tailored for the needs of the dissection room, was missing to date. For the specifications on the laminar flow, the cost of installation approximated 28,500 € per table with all associated technical infrastructure. In an attempt to reduce costs, a lower number of exhaust air ducts and eventually a reduced number of tables, were considered. This approach was soon discontinued due to the negative effects on formaldehyde extraction. In consequence, the designer faced two major issues when using the conventional design including laminar flow tables: (a) cost excess related to the laminar flow design and (b) the absence of any guaranteed bond provided by the supplier that the formaldehyde TLV can be complied using the given ventilation concept. These two challenges formed major risks for realizing the given project within a predefined time and cost frame. The REDESIGN approach—Developing an alternative concept in air ventilation design Initiated and executed by the Facility Management Services, Medical University of Graz using the REDESIGN approach, the primary system function was revised as follows: A ventilation system has to perform in a way as to optimize formaldehyde reduction below the TLV of 0.37 mg/m 3 (0.3 ppm) based on two commonly used embalming techniques, , ensuring that a minimum formaldehyde concentration exists within the breathing zone above the dissection table. Breathing zone refers to the air volume directly above the dissection table, including an additional 50‐cm (20 in.) airspace above it, that, at a height above the floor between 1.2 m (3 ft. 11 in.) and 1.7 m (5 ft. 7 in.). This zone represents a cuboid area where air is inhaled by users. Thus, this area is crucial for monitoring formaldehyde exposure to ensure safe inhalation levels (Figure ). Considering this new primary function, the existing system conflict was defined as follows: The air volume per table should be as high as possible in order to keep the formaldehyde concentration as minimal as technically possible. But equally, air volume should be as low as possible to minimize all associated ventilation technology aspects such as space usage, the cost of the installation and operation . To address the given challenge, the REDISIGN approach was used. For the REDESIGN approach, a creative–innovation‐aligned construction methodology entitled TRIZ/TIPS (Theory of Inventive Problem Solving) and VALUE ENGINEERING (Value Analysis & Cost Reduction) were combined. The TRIZ/TIPS methodology according to Genrich Saulovich Altshuller offers an “idealized systems approach”, which considers that in reality, ideal systems as such do not exist. However, according to the TRIZ/TIPS theorem, (1) all characteristics of an ideal system are fulfilled simultaneously and appropriately positioned without energetic input, material, or other resources and (2) or produce any negative side effects. The objective of the TRIZ/TIPS methodology is to resolve all conflicts which may impede progress toward higher ideality. I = a ∑ F i Q i ∑ c i + ∑ β k H k ⟹ ∞ Formula 1: TRIZ/TIPS formula according to Goldovsky . C = cost and time resource required to implement; I = degree of ideality (no dimension); F = useful function; H = harm, complications; Q = quality of useful functions. VALUE ENGINEERING is a methodology aimed at developing alternative approaches in an effort to identify a solution that fulfills the required functions at a minimal cost. The objective of VALUE ENGINEERING is to establish cost‐optimized solutions fulfilling a given function. V = function cost Formula 2: VALUE ENGINEERING formula. V = Value; function = sum of all functions the system comprises; cost = sum of all expenses. Concepts to enhance the value or degree of ideality Both an increase to the quality and quantity of “function” (increase of numerator), or a decrease in “cost” or unwanted side effects (decrease of denominator) may help enhance the degree of ideality or the value. Besides the primary function for the working zone meeting the TLV formaldehyde requirements, the following secondary functions were included to address the function: to fulfill the primary function at an air exchange rate ≤10×/h to minimize the procurement cost related to building adaptations to minimize operating and maintenance costs to create a modular system, allowing adaptation of user requirements at a minimal cost to install a robust and adjustable air ventilation system comprising of a minimal number of components and measurement and control technology to minimize the probability of user errors by means of smart design of the air extraction system, e.g., to prevent unintentional air ventilation obstruction to maximize user comfort using smart design of the air ventilation system, e.g., thermal gradients and air turbulence reduction meeting industrial standards to lever the potential, further minimizing formaldehyde concentration below the existing TLV in an effort to enhance the sustainability and longevity of the installation to meet future requirements The denominator is characterized by all measures to reduce the cost of the installation as outlined in Figure . Integrating the TIPS and VALUE ENGINEERING methodologies with the REDESIGN approach, the following third‐generation ventilation concept was established to resolve the conflict on optimal air ventilation quantities at a minimal cost (Table and Figure ). Initial VALUE estimation For the given REDESIGN approach based on the TIPS methodology, a value analysis led to the results outlined in Table as part of a pre‐validation step. Validation I: Mockup installation Human tissues for Validation steps I and III were obtained from the Institute of Anatomy, University of Leipzig in Saxony (Germany), and the Division of Macroscopic and Clinical Anatomy, Medical University of Graz in Styria (Austria). Local Saxon and Styrian regulations allow the use of donated human tissues for research and teaching. All donors provided informed consent for post‐mortem tissue donation for research and teaching purposes. Three ethanol–glycerin‐embalmed bodies were transferred to Graz for Validation I, while all Thiel‐embalmed bodies and additional ethanol–glycerin‐embalmed bodies for Validation III were sourced from Graz. Ethics approval was granted by the Medical University of Graz (33‐500 ex 20/21). Although general consent for research and educational use was obtained, image‐specific consent was not included. The human tissues used in this trial were embalmed using either an ethanol–glycerol‐based method or a modified Thiel method. Briefly, ethanol‐based embalming involved an injection solution of 47.5 L (95 vol%) technical‐grade ethanol, 2.5 L (5 vol%) glycerin, and 0.18 L formaldehyde, yielding a 0.35‐vol% formaldehyde concentration, followed by a submersion phase in 65 vol% technical ethanol. The Thiel embalming used 12 L stock solution (2.0 kg ammonium nitrate, 0.3 kg boric acid, 0.5 kg potassium nitrate, and 3.0 L ethylene glycol dissolved in 10.0 L water), 0.5 L p‐chlorocresol solution (0.03 kg p‐chlorocresol in 0.5 L ethylene glycol and 0.5 L water), 0.6 kg sodium sulfide, 0.45 L morpholine, 2 L technical ethanol, and 0.19 L formaldehyde, yielding a 1.2‐vol% formaldehyde solution. The submersion phase of the Thiel method (3 kg boric acid, 10 L ethylene glycol, 10 kg ammonium nitrate, 5 kg potassium nitrate, 9 L technical grade ethanol, 7 kg sodium sulfide, 2 L p‐cresol solution, and 0.74 L formaldehyde in 91 L water) produced a 0.6‐vol% formaldehyde solution. Based on the value estimated from the pre‐evaluation step at an enhancement factor of 70, the REDESIGN proposal underwent further testing against alternative supply air outlets, as well as a laminar flow table equipped with integrated air extraction. For this purpose, full‐scale model experiments were conducted in two iteration steps under realistic conditions. In the first step, nine bodies were selected for inclusion in the mockup experiments. Three bodies were embalmed with ethanol–glycerin, another six bodies with Thiel fixation. , BMI ranged between 20.3 ± 0.8 and 26.7 ± 1.0 to allow for a broad coverage of anatomical variation which can impact formaldehyde levels used for embalming. Prior to the dissection of the bodies, four formaldehyde measurement probes were positioned at standardized positions as outlined in Figure . The thoracic and abdominal cavities were exposed in a stepwise approach, first dissecting four subcutaneous tissue flaps, and then followed by mobilizing the muscles of the body wall. Soft tissues were removed laterally to extend to the anterior axillary line, and then by the removal of the rib cage anteriorly and exposing the pleural cavity and mediastinum. Following the laparotomy, the greater omentum was reverted before the small intestine was extracted followed by the abdominal recess. To quantify formaldehyde concentrations, the acetylacetone method was used according to the VDI 3484 guideline for gaseous ambient air measurements. Three different air supply systems were trialed, namely an UNO DUCT jet system (J. PICHLER Gesellschaft m.b.H., Klagenfurt am Wörthersee) and two types of slot diffusors (LSA‐V, Kurz Luftführungssysteme GmbH, Wiener Neustadt and DSC, SCHAKO Vertriebs GmbH, Vienna; all Austria). For ethanol–glycerin‐embalmed bodies, formaldehyde peak concentrations ranged between 0.07 mg/m 3 and maximum 0.16 mg/m 3 . In the case of the Thiel‐embalmed bodies, peak formaldehyde concentrations consistently remained below the lower measurement limits within a range of 0.01–0.03 mg/m 3 . Furthermore, peak concentrations within the exhaust duct reached peak values ranging between 0.21 and 0.30 mg/m 3 . The choice of air supply design had no significant influence on the formaldehyde extraction rate. The REDESIGN concept demonstrated superiority in terms of air distribution within the workspace and efficient extraction of formaldehyde within the breathing zone. As a side effect, the design feature that both air supply and air extraction were not physically attached to the table offered the possibility to make the dissection tables modular. This feature served three purposes outlined as follows: First, the tables can be removed if unused, that is, the space normally occupied by the table can be used for other purposes. Second, the removal of tables with embalmed tissues further removes formaldehyde exposure within the dissection room if these tissues are unused. Third, the use of this modular table system helped to improve workplace ergonomics, as the embalmed bodies can be manipulated directly onto the tables from tissue storage without adding extra steps. Validation II : Computational analysis The goal of the computational fluid dynamics (CFD) simulation was to validate the values calculated from the REDESIGN approach in an effort to (a) reproduce the parameters (data) collected from the mockup installation so to (b) achieve further improvements by varying them without having to repeat the costly 1:1 setup for all iteration stages (Figure ). The objective of the CFD was to compute a 30‐min average of formaldehyde concentrations following the exposure in a simulated dissection room comprised of nine ceiling diffusors (VDW, TROX Austria GmbH, Vienna, Austria; each 625 × 54 mm and 588 m 3 /h), 21 slit outlets (LSA‐V; each with a length of 2025 mm and 150 m 3 /h), and 21 exhaust air inlets (each with a 200‐mm inner radius of the duct, 596‐mm outer diameter of the baffle plate, and 400 m 3 /h), totaling an air ventilation volume of 5292, 3150 and 8400 m 3 /h at 17°C, respectively. In total, 174 persons (7–10 attendees per table, each 120 W) were placed within the space at different stations (total 20,880 W). Electronic equipment and lighting added up to another 6351 W. Formaldehyde emission rates were assumed at 138 mg/h per body (first simulation), 260 mg/h (second simulation), or at a range of 47–260 mg/h. An average formaldehyde concentration of 0.34, 0.64, and 0.47 mg/m 3 was computed for the first, second and third simulation, respectively. Formaldehyde concentrations at the attendee's face levels ranged between 0.21 and 0.76 mg/m 3 for the various tables and positions. These simulation results largely deviated from the results of the mockup installation. This was partly due to limitations regarding the model of flow mechanics of organic compounds in diffusers of different types and positions. However, the given data gave evidence on refinements regarding the number and positions of the ceiling diffusors, the position of the attendees relative to the table with the bodies, the site of the bodies during dissection and the position of the dissection tables within the facility. In consequence, the simulations helped to refine the design of the diffusers and their positioning in an effort to avoid turbulent flows. Validation III : Pilot and commissioning phase Following the construction of the new facilities and the installation of the air ventilation equipment outlined as part of the REDESIGN approach (Figure ), the mockup and numerical simulation, a number of consecutive experiments formed part of the pilot and commissioning phase. The primary objective was to quantify formaldehyde concentrations under realistic conditions. A secondary objective was to adjust the parameters of the ventilation system to enhance the effectiveness of the installation. Dissections of four ethanol–glycerin‐embalmed bodies done with 44 student attendees yielded an average formaldehyde concentration of 0.05 mg/m 3 (minimum 0.02 mg/m 3 , maximum 0.10 mg/m 3 ; Figure ). In the next trial, formaldehyde concentrations were measured following the exposition of fifteen formaldehyde‐fixed brains placed on dissection tables with the storage buckets including the fixatives left open. Peak concentrations averaged 0.028 mg/m 3 (minimum 0.019 mg/m 3 , maximum 0.037 mg/m 3 ; Figure ). VALUE analysis in operation The installed version of the third‐generation ventilation concept offered an increased value of 11.58 at a cost of 0.29, that is, a Value enhancement of 72.38 when compared to the initial plan. In financial terms of the installation, maintenance, and electricity, the following findings were observed. Concerning the central ventilation system and the equipped dissection rooms, the intended volume reduction from 78,000 to 31,200 m 3 /h resulted in a 54% cost reduction (Table ). The most significant reduction in cost was achieved within the dissection room, using a purpose‐tailored approach. The installation of slot diffusors at a volume flow of 150 m 3 /h including standard industrial galvanized, plastic or aluminum devices instead of a stainless‐steel quality laminar flow medical product at a volume flow of 750 m 3 /h resulted in a cost reduction of 95%, that is, 939,570 € for the given installation. To that end, the cost of the installation per table including all infrastructure was lowered from 28,500 € to 4906 €, that is, an 83% cost reduction. Due to the configuration, annual running costs were lowered from an anticipated 48,981 € to 20,477 € as of 2023 electricity and maintenance. Although the new technical specifications could also have reduced the space required for ventilation and other mechanical, electrical, plumbing equipment (e.g., pipework), this was not taken into further consideration due to the advanced stage of the implementation planning. 

During the initial planning stage, the dissection laboratory was planned to include 78 dissection tables in line with user requirements. The primary function outlined by the laboratory planner was defined as follows: A ventilation system ensuring that the working zone of the respective dissection table meets contemporary threshold limit values (TLVs) requirements for formaldehyde of 0.37 mg/m 3 or 0.3 ppm. The initial plan included the installation of laminar flow tables, , with specifications outlined in Table , a so‐called second‐generation design. This type of installation was considered most effective to extract formaldehyde in line with a joint project of the German accident insurance and a medical device manufacturer. No specific recommendations nor legal regulations existed regarding the ventilation technology for dissection rooms according to the European authorities at the time of planning. In‐depth research on the topic of air ventilation technology, tailored for the needs of the dissection room, was missing to date. For the specifications on the laminar flow, the cost of installation approximated 28,500 € per table with all associated technical infrastructure. In an attempt to reduce costs, a lower number of exhaust air ducts and eventually a reduced number of tables, were considered. This approach was soon discontinued due to the negative effects on formaldehyde extraction. In consequence, the designer faced two major issues when using the conventional design including laminar flow tables: (a) cost excess related to the laminar flow design and (b) the absence of any guaranteed bond provided by the supplier that the formaldehyde TLV can be complied using the given ventilation concept. These two challenges formed major risks for realizing the given project within a predefined time and cost frame. 

REDESIGN approach—Developing an alternative concept in air ventilation design Initiated and executed by the Facility Management Services, Medical University of Graz using the REDESIGN approach, the primary system function was revised as follows: A ventilation system has to perform in a way as to optimize formaldehyde reduction below the TLV of 0.37 mg/m 3 (0.3 ppm) based on two commonly used embalming techniques, , ensuring that a minimum formaldehyde concentration exists within the breathing zone above the dissection table. Breathing zone refers to the air volume directly above the dissection table, including an additional 50‐cm (20 in.) airspace above it, that, at a height above the floor between 1.2 m (3 ft. 11 in.) and 1.7 m (5 ft. 7 in.). This zone represents a cuboid area where air is inhaled by users. Thus, this area is crucial for monitoring formaldehyde exposure to ensure safe inhalation levels (Figure ). Considering this new primary function, the existing system conflict was defined as follows: The air volume per table should be as high as possible in order to keep the formaldehyde concentration as minimal as technically possible. But equally, air volume should be as low as possible to minimize all associated ventilation technology aspects such as space usage, the cost of the installation and operation . To address the given challenge, the REDISIGN approach was used. For the REDESIGN approach, a creative–innovation‐aligned construction methodology entitled TRIZ/TIPS (Theory of Inventive Problem Solving) and VALUE ENGINEERING (Value Analysis & Cost Reduction) were combined. The TRIZ/TIPS methodology according to Genrich Saulovich Altshuller offers an “idealized systems approach”, which considers that in reality, ideal systems as such do not exist. However, according to the TRIZ/TIPS theorem, (1) all characteristics of an ideal system are fulfilled simultaneously and appropriately positioned without energetic input, material, or other resources and (2) or produce any negative side effects. The objective of the TRIZ/TIPS methodology is to resolve all conflicts which may impede progress toward higher ideality. I = a ∑ F i Q i ∑ c i + ∑ β k H k ⟹ ∞ Formula 1: TRIZ/TIPS formula according to Goldovsky . C = cost and time resource required to implement; I = degree of ideality (no dimension); F = useful function; H = harm, complications; Q = quality of useful functions. VALUE ENGINEERING is a methodology aimed at developing alternative approaches in an effort to identify a solution that fulfills the required functions at a minimal cost. The objective of VALUE ENGINEERING is to establish cost‐optimized solutions fulfilling a given function. V = function cost Formula 2: VALUE ENGINEERING formula. V = Value; function = sum of all functions the system comprises; cost = sum of all expenses. 

Both an increase to the quality and quantity of “function” (increase of numerator), or a decrease in “cost” or unwanted side effects (decrease of denominator) may help enhance the degree of ideality or the value. Besides the primary function for the working zone meeting the TLV formaldehyde requirements, the following secondary functions were included to address the function: to fulfill the primary function at an air exchange rate ≤10×/h to minimize the procurement cost related to building adaptations to minimize operating and maintenance costs to create a modular system, allowing adaptation of user requirements at a minimal cost to install a robust and adjustable air ventilation system comprising of a minimal number of components and measurement and control technology to minimize the probability of user errors by means of smart design of the air extraction system, e.g., to prevent unintentional air ventilation obstruction to maximize user comfort using smart design of the air ventilation system, e.g., thermal gradients and air turbulence reduction meeting industrial standards to lever the potential, further minimizing formaldehyde concentration below the existing TLV in an effort to enhance the sustainability and longevity of the installation to meet future requirements The denominator is characterized by all measures to reduce the cost of the installation as outlined in Figure . Integrating the TIPS and VALUE ENGINEERING methodologies with the REDESIGN approach, the following third‐generation ventilation concept was established to resolve the conflict on optimal air ventilation quantities at a minimal cost (Table and Figure ). 

VALUE estimation For the given REDESIGN approach based on the TIPS methodology, a value analysis led to the results outlined in Table as part of a pre‐validation step. 

Human tissues for Validation steps I and III were obtained from the Institute of Anatomy, University of Leipzig in Saxony (Germany), and the Division of Macroscopic and Clinical Anatomy, Medical University of Graz in Styria (Austria). Local Saxon and Styrian regulations allow the use of donated human tissues for research and teaching. All donors provided informed consent for post‐mortem tissue donation for research and teaching purposes. Three ethanol–glycerin‐embalmed bodies were transferred to Graz for Validation I, while all Thiel‐embalmed bodies and additional ethanol–glycerin‐embalmed bodies for Validation III were sourced from Graz. Ethics approval was granted by the Medical University of Graz (33‐500 ex 20/21). Although general consent for research and educational use was obtained, image‐specific consent was not included. The human tissues used in this trial were embalmed using either an ethanol–glycerol‐based method or a modified Thiel method. Briefly, ethanol‐based embalming involved an injection solution of 47.5 L (95 vol%) technical‐grade ethanol, 2.5 L (5 vol%) glycerin, and 0.18 L formaldehyde, yielding a 0.35‐vol% formaldehyde concentration, followed by a submersion phase in 65 vol% technical ethanol. The Thiel embalming used 12 L stock solution (2.0 kg ammonium nitrate, 0.3 kg boric acid, 0.5 kg potassium nitrate, and 3.0 L ethylene glycol dissolved in 10.0 L water), 0.5 L p‐chlorocresol solution (0.03 kg p‐chlorocresol in 0.5 L ethylene glycol and 0.5 L water), 0.6 kg sodium sulfide, 0.45 L morpholine, 2 L technical ethanol, and 0.19 L formaldehyde, yielding a 1.2‐vol% formaldehyde solution. The submersion phase of the Thiel method (3 kg boric acid, 10 L ethylene glycol, 10 kg ammonium nitrate, 5 kg potassium nitrate, 9 L technical grade ethanol, 7 kg sodium sulfide, 2 L p‐cresol solution, and 0.74 L formaldehyde in 91 L water) produced a 0.6‐vol% formaldehyde solution. Based on the value estimated from the pre‐evaluation step at an enhancement factor of 70, the REDESIGN proposal underwent further testing against alternative supply air outlets, as well as a laminar flow table equipped with integrated air extraction. For this purpose, full‐scale model experiments were conducted in two iteration steps under realistic conditions. In the first step, nine bodies were selected for inclusion in the mockup experiments. Three bodies were embalmed with ethanol–glycerin, another six bodies with Thiel fixation. , BMI ranged between 20.3 ± 0.8 and 26.7 ± 1.0 to allow for a broad coverage of anatomical variation which can impact formaldehyde levels used for embalming. Prior to the dissection of the bodies, four formaldehyde measurement probes were positioned at standardized positions as outlined in Figure . The thoracic and abdominal cavities were exposed in a stepwise approach, first dissecting four subcutaneous tissue flaps, and then followed by mobilizing the muscles of the body wall. Soft tissues were removed laterally to extend to the anterior axillary line, and then by the removal of the rib cage anteriorly and exposing the pleural cavity and mediastinum. Following the laparotomy, the greater omentum was reverted before the small intestine was extracted followed by the abdominal recess. To quantify formaldehyde concentrations, the acetylacetone method was used according to the VDI 3484 guideline for gaseous ambient air measurements. Three different air supply systems were trialed, namely an UNO DUCT jet system (J. PICHLER Gesellschaft m.b.H., Klagenfurt am Wörthersee) and two types of slot diffusors (LSA‐V, Kurz Luftführungssysteme GmbH, Wiener Neustadt and DSC, SCHAKO Vertriebs GmbH, Vienna; all Austria). For ethanol–glycerin‐embalmed bodies, formaldehyde peak concentrations ranged between 0.07 mg/m 3 and maximum 0.16 mg/m 3 . In the case of the Thiel‐embalmed bodies, peak formaldehyde concentrations consistently remained below the lower measurement limits within a range of 0.01–0.03 mg/m 3 . Furthermore, peak concentrations within the exhaust duct reached peak values ranging between 0.21 and 0.30 mg/m 3 . The choice of air supply design had no significant influence on the formaldehyde extraction rate. The REDESIGN concept demonstrated superiority in terms of air distribution within the workspace and efficient extraction of formaldehyde within the breathing zone. As a side effect, the design feature that both air supply and air extraction were not physically attached to the table offered the possibility to make the dissection tables modular. This feature served three purposes outlined as follows: First, the tables can be removed if unused, that is, the space normally occupied by the table can be used for other purposes. Second, the removal of tables with embalmed tissues further removes formaldehyde exposure within the dissection room if these tissues are unused. Third, the use of this modular table system helped to improve workplace ergonomics, as the embalmed bodies can be manipulated directly onto the tables from tissue storage without adding extra steps. 

II : Computational analysis The goal of the computational fluid dynamics (CFD) simulation was to validate the values calculated from the REDESIGN approach in an effort to (a) reproduce the parameters (data) collected from the mockup installation so to (b) achieve further improvements by varying them without having to repeat the costly 1:1 setup for all iteration stages (Figure ). The objective of the CFD was to compute a 30‐min average of formaldehyde concentrations following the exposure in a simulated dissection room comprised of nine ceiling diffusors (VDW, TROX Austria GmbH, Vienna, Austria; each 625 × 54 mm and 588 m 3 /h), 21 slit outlets (LSA‐V; each with a length of 2025 mm and 150 m 3 /h), and 21 exhaust air inlets (each with a 200‐mm inner radius of the duct, 596‐mm outer diameter of the baffle plate, and 400 m 3 /h), totaling an air ventilation volume of 5292, 3150 and 8400 m 3 /h at 17°C, respectively. In total, 174 persons (7–10 attendees per table, each 120 W) were placed within the space at different stations (total 20,880 W). Electronic equipment and lighting added up to another 6351 W. Formaldehyde emission rates were assumed at 138 mg/h per body (first simulation), 260 mg/h (second simulation), or at a range of 47–260 mg/h. An average formaldehyde concentration of 0.34, 0.64, and 0.47 mg/m 3 was computed for the first, second and third simulation, respectively. Formaldehyde concentrations at the attendee's face levels ranged between 0.21 and 0.76 mg/m 3 for the various tables and positions. These simulation results largely deviated from the results of the mockup installation. This was partly due to limitations regarding the model of flow mechanics of organic compounds in diffusers of different types and positions. However, the given data gave evidence on refinements regarding the number and positions of the ceiling diffusors, the position of the attendees relative to the table with the bodies, the site of the bodies during dissection and the position of the dissection tables within the facility. In consequence, the simulations helped to refine the design of the diffusers and their positioning in an effort to avoid turbulent flows. 

III : Pilot and commissioning phase Following the construction of the new facilities and the installation of the air ventilation equipment outlined as part of the REDESIGN approach (Figure ), the mockup and numerical simulation, a number of consecutive experiments formed part of the pilot and commissioning phase. The primary objective was to quantify formaldehyde concentrations under realistic conditions. A secondary objective was to adjust the parameters of the ventilation system to enhance the effectiveness of the installation. Dissections of four ethanol–glycerin‐embalmed bodies done with 44 student attendees yielded an average formaldehyde concentration of 0.05 mg/m 3 (minimum 0.02 mg/m 3 , maximum 0.10 mg/m 3 ; Figure ). In the next trial, formaldehyde concentrations were measured following the exposition of fifteen formaldehyde‐fixed brains placed on dissection tables with the storage buckets including the fixatives left open. Peak concentrations averaged 0.028 mg/m 3 (minimum 0.019 mg/m 3 , maximum 0.037 mg/m 3 ; Figure ). 

The installed version of the third‐generation ventilation concept offered an increased value of 11.58 at a cost of 0.29, that is, a Value enhancement of 72.38 when compared to the initial plan. In financial terms of the installation, maintenance, and electricity, the following findings were observed. Concerning the central ventilation system and the equipped dissection rooms, the intended volume reduction from 78,000 to 31,200 m 3 /h resulted in a 54% cost reduction (Table ). The most significant reduction in cost was achieved within the dissection room, using a purpose‐tailored approach. The installation of slot diffusors at a volume flow of 150 m 3 /h including standard industrial galvanized, plastic or aluminum devices instead of a stainless‐steel quality laminar flow medical product at a volume flow of 750 m 3 /h resulted in a cost reduction of 95%, that is, 939,570 € for the given installation. To that end, the cost of the installation per table including all infrastructure was lowered from 28,500 € to 4906 €, that is, an 83% cost reduction. Due to the configuration, annual running costs were lowered from an anticipated 48,981 € to 20,477 € as of 2023 electricity and maintenance. Although the new technical specifications could also have reduced the space required for ventilation and other mechanical, electrical, plumbing equipment (e.g., pipework), this was not taken into further consideration due to the advanced stage of the implementation planning. 

This given report offers a research‐driven approach to designing, implementing, and trialing of air ventilation technology in an anatomy laboratory environment. It demonstrates the application of the REDESIGN approach to implement Value Engineering and the Theory of Inventive Problem Solving to create a validated air ventilation design in a large‐scale anatomy dissection laboratory. On the evolutionary development of anatomical laboratory facilities Based on existing designs for air ventilation technology, the following classification into three different generations makes an attempt to outline key differences in technical specifications and formaldehyde air concentrations that can be achieved. First‐generation ventilation systems (Figure ) usually can be found in buildings commissioned prior to the 1990s. Such installations are characterized by mixed ventilation technology, with no specific ventilation adjustments for formaldehyde peaks occurring in the proximity of the dissection tables. The air exchange rate is comparably low. In consequence, the first‐generation ventilation technology insufficiently removes formaldehyde or other organic volatile components to meet the contemporary TLV regulations. Second‐generation tables (Figure ) are characterized by a laminar air flow (TAV) design for the dissection tables, exhaust air extraction from within the table and combined with a second installation to ventilate the surrounding space. To date, this system has been considered state‐of‐the‐art in the dissection room. The laminar flow design has been adapted from operating rooms. The effectiveness of second‐generation ventilation systems in eliminating formaldehyde or other organic volatile components is comparably low, considering the high air exchange rates required and the complex infrastructure. Installation and operating costs are the highest among all systems. Furthermore, second‐generation laminar flows are vulnerable to thermal intake and obstruction of the exhaust air duct. This setting has been proposed by the chief architect for the dissection room air ventilation in Graz. Third‐generation ventilation systems (Figure ) are characterized by non‐laminar flow design with high efficiency in eliminating formaldehyde or other volatile organic compounds. Such systems offer high modularity, industrial standard user comfort, low installation costs and moderate maintenance costs. Furthermore, the given design requires no physical attachment to the dissection table, with the air ventilation infrastructure, offering enhanced workplace ergonomics and ease of maintenance. This third‐generation system has been developed using the REDESIGN approach and meets contemporary and likely future TLV standards. A number of existing anatomy laboratories operate dissection rooms with first‐generation ventilation systems—often with high emission values of formaldehyde due to ventilation systems with limited effectiveness. Isolated reports of partial operational closures are mentioned. An upgrade of existing ventilation systems may be a potential alternative. In a recent study, Zdilla presented a low‐cost downdraft table installation in an attempt to effectively remove formaldehyde from dissection tables, combined with a low‐cost ventilation system. This system was presented for single use, and accompanied by a noise level of 69.2 dBA, which would not comply with the European standards for laboratories (1). Durongphan and coworkers suggested organizational measures to effectively reduce the formaldehyde content to an absolute value in the breathing zone of 0.48 ppm, meeting their standards, which however, would not be considered sufficient in the EU. Pfeil et al. used long‐throw nozzles above the dissection table combined with the application of urea as a neutralizing agent, thereby achieving 0.1 ppm or less in the anatomy dissection laboratory. However, it became obvious that, in their setup, the modified ventilation system alone failed to achieve the TLV for formaldehyde. The here‐shown third‐generation ventilation system helped to effectively reduce the formaldehyde exposition to below 0.1 ppm at a noise level ranging between 24 and 27 dBA for as many as 40 tables per dissection room. The third‐generation ventilation system using the REDESIGN approach implemented at the Medical University of Graz for 78 tables anticipates compliance for future years, even if there are significant reductions in the TLV for formaldehyde or other pollutants. The technical configuration of the third‐generation ventilation system fundamentally allows for an upgrade from first‐generation systems with relatively little effort through room‐side adaptation of the ventilation technology—provided that the existing conditions allow for it. The existing infrastructure supplying the dissection rooms may likely be retained—possibly with moderate adjustments of the central units. By potentially customizing the ventilation system, it seems possible to achieve or establish a notable enhancement in working conditions, ensuring compliance with legal and professional standards while optimizing operational costs, with minimal effort required in terms of finances, organization, and time. On the future of formaldehyde in the anatomy laboratory While it can be assumed that formaldehyde will unlikely be abandoned in the near future, given the lack of alternatives to embalm post‐mortem human tissues, a clear trend can be seen toward reduced TLV. , , Statutory threshold values of 0.3 ppm were first recommended by the German Research Foundation (Deutsche Forschungsgemeinschaft) in 2000, aiming to reduce concentrations from as much as 6 ppm prior to 1971. Meanwhile, the value of 0.3 ppm (0.37 mg/m 3 ) had broadly been implemented by most institutions in an effort to adhere to legal regulations (Figure ). , Considering the classification of formaldehyde as a 1B carcinogen, it must be anticipated that, in future, anatomy facilities will need to meet even lower TLVs to ensure safety of both staff and students. Consequently, contemporary ventilation systems for anatomy laboratories should be capable of achieving lower formaldehyde exposure without necessarily relying on “low‐formaldehyde” injectives or reducing exposure times in the anatomy laboratory. Our here‐proposed REDESIGN approach for dissection room design offers one of a potential variety of concepts to provide high‐impact, low‐cost and low‐maintenance solutions for state‐of‐the‐art dissection laboratories. The given system ensures that formaldehyde levels in the anatomy dissection laboratory meet the indoor air guideline value recommended by the Austrian Ministry of Sustainability and Tourism (0.10 mg/m 3 ) and remain below the safe level of 0.12 mg/m 3 , at which current knowledge indicates no increased risk of cancer. Figure offers a graphical comparison of the established approach for anatomy laboratory design and the REDESIGN approach including a mockup installation, computational fluid analysis, and a pre and post evaluation phase. The outcome of this complex, research‐driven approach to designing the dissection laboratory is, as demonstrated, a simple solution using a minimal number of standard components. The extensive validation steps ensured precise planning and resulted in a demand‐responsive ventilation system. This given concept warrants long‐term testing to ensure its longevity and sustainability. 

Based on existing designs for air ventilation technology, the following classification into three different generations makes an attempt to outline key differences in technical specifications and formaldehyde air concentrations that can be achieved. First‐generation ventilation systems (Figure ) usually can be found in buildings commissioned prior to the 1990s. Such installations are characterized by mixed ventilation technology, with no specific ventilation adjustments for formaldehyde peaks occurring in the proximity of the dissection tables. The air exchange rate is comparably low. In consequence, the first‐generation ventilation technology insufficiently removes formaldehyde or other organic volatile components to meet the contemporary TLV regulations. Second‐generation tables (Figure ) are characterized by a laminar air flow (TAV) design for the dissection tables, exhaust air extraction from within the table and combined with a second installation to ventilate the surrounding space. To date, this system has been considered state‐of‐the‐art in the dissection room. The laminar flow design has been adapted from operating rooms. The effectiveness of second‐generation ventilation systems in eliminating formaldehyde or other organic volatile components is comparably low, considering the high air exchange rates required and the complex infrastructure. Installation and operating costs are the highest among all systems. Furthermore, second‐generation laminar flows are vulnerable to thermal intake and obstruction of the exhaust air duct. This setting has been proposed by the chief architect for the dissection room air ventilation in Graz. Third‐generation ventilation systems (Figure ) are characterized by non‐laminar flow design with high efficiency in eliminating formaldehyde or other volatile organic compounds. Such systems offer high modularity, industrial standard user comfort, low installation costs and moderate maintenance costs. Furthermore, the given design requires no physical attachment to the dissection table, with the air ventilation infrastructure, offering enhanced workplace ergonomics and ease of maintenance. This third‐generation system has been developed using the REDESIGN approach and meets contemporary and likely future TLV standards. A number of existing anatomy laboratories operate dissection rooms with first‐generation ventilation systems—often with high emission values of formaldehyde due to ventilation systems with limited effectiveness. Isolated reports of partial operational closures are mentioned. An upgrade of existing ventilation systems may be a potential alternative. In a recent study, Zdilla presented a low‐cost downdraft table installation in an attempt to effectively remove formaldehyde from dissection tables, combined with a low‐cost ventilation system. This system was presented for single use, and accompanied by a noise level of 69.2 dBA, which would not comply with the European standards for laboratories (1). Durongphan and coworkers suggested organizational measures to effectively reduce the formaldehyde content to an absolute value in the breathing zone of 0.48 ppm, meeting their standards, which however, would not be considered sufficient in the EU. Pfeil et al. used long‐throw nozzles above the dissection table combined with the application of urea as a neutralizing agent, thereby achieving 0.1 ppm or less in the anatomy dissection laboratory. However, it became obvious that, in their setup, the modified ventilation system alone failed to achieve the TLV for formaldehyde. The here‐shown third‐generation ventilation system helped to effectively reduce the formaldehyde exposition to below 0.1 ppm at a noise level ranging between 24 and 27 dBA for as many as 40 tables per dissection room. The third‐generation ventilation system using the REDESIGN approach implemented at the Medical University of Graz for 78 tables anticipates compliance for future years, even if there are significant reductions in the TLV for formaldehyde or other pollutants. The technical configuration of the third‐generation ventilation system fundamentally allows for an upgrade from first‐generation systems with relatively little effort through room‐side adaptation of the ventilation technology—provided that the existing conditions allow for it. The existing infrastructure supplying the dissection rooms may likely be retained—possibly with moderate adjustments of the central units. By potentially customizing the ventilation system, it seems possible to achieve or establish a notable enhancement in working conditions, ensuring compliance with legal and professional standards while optimizing operational costs, with minimal effort required in terms of finances, organization, and time. 

While it can be assumed that formaldehyde will unlikely be abandoned in the near future, given the lack of alternatives to embalm post‐mortem human tissues, a clear trend can be seen toward reduced TLV. , , Statutory threshold values of 0.3 ppm were first recommended by the German Research Foundation (Deutsche Forschungsgemeinschaft) in 2000, aiming to reduce concentrations from as much as 6 ppm prior to 1971. Meanwhile, the value of 0.3 ppm (0.37 mg/m 3 ) had broadly been implemented by most institutions in an effort to adhere to legal regulations (Figure ). , Considering the classification of formaldehyde as a 1B carcinogen, it must be anticipated that, in future, anatomy facilities will need to meet even lower TLVs to ensure safety of both staff and students. Consequently, contemporary ventilation systems for anatomy laboratories should be capable of achieving lower formaldehyde exposure without necessarily relying on “low‐formaldehyde” injectives or reducing exposure times in the anatomy laboratory. Our here‐proposed REDESIGN approach for dissection room design offers one of a potential variety of concepts to provide high‐impact, low‐cost and low‐maintenance solutions for state‐of‐the‐art dissection laboratories. The given system ensures that formaldehyde levels in the anatomy dissection laboratory meet the indoor air guideline value recommended by the Austrian Ministry of Sustainability and Tourism (0.10 mg/m 3 ) and remain below the safe level of 0.12 mg/m 3 , at which current knowledge indicates no increased risk of cancer. Figure offers a graphical comparison of the established approach for anatomy laboratory design and the REDESIGN approach including a mockup installation, computational fluid analysis, and a pre and post evaluation phase. The outcome of this complex, research‐driven approach to designing the dissection laboratory is, as demonstrated, a simple solution using a minimal number of standard components. The extensive validation steps ensured precise planning and resulted in a demand‐responsive ventilation system. This given concept warrants long‐term testing to ensure its longevity and sustainability. 

The study acknowledges several limitations. First, the ventilation approach presented here is tailored specifically to the unique environment and requirements of the Medical University of Graz. Factors including room configuration, the number of dissection tables, and local regulatory thresholds may impact adaptability to other institutions. Future studies might explore the applicability of this approach for different facility layouts and requirements. Second, there are limitations in formaldehyde emission metrics between different types of anatomical embalming. Differences in formaldehyde and other volatile organic compounds will likely result in emission variability, which may not be fully captured by the two embalming techniques, ethanol–glycerin and Thiel, presented here. Embalming protocols and donor variability introduce inherent difference. These variances may limit the extrapolation of formaldehyde reduction metrics to other anatomical laboratories using alternative preservation methods. Long‐term performance and system maintenance warrant further study, particularly regarding the potential wear of components not designed for high‐formaldehyde environments. Further limitations exist regarding future standards on TLVs and noise levels. While the current system meets all European standards at this stage, future iterations may benefit from further assessment and refinements. Lastly, the CFD simulations presented here need to be considered with caution, as limitations exist in accurately modeling the flow mechanics of volatile organic compounds under various diffuser arrangements, which affected predictive accuracy. 

Jürgen Russ: Conceptualization; data curation; formal analysis; investigation; methodology; writing – original draft; validation. Niels Hammer: Conceptualization; investigation; writing – original draft; methodology; validation; formal analysis; data curation; funding acquisition; resources. 

