R_Bibb_Medical_Modelling_The_Application_of_Adv.pdf

Case studies 107
full co-operation of the surgical departments, the radiology department, the
IT department and the RP service provider. The implications for the various
departments will differ depending on which technical solution is adopted.
The chosen procedure should refl ect the overall needs of the patient whilst
taking due account of economic factors. Consequently, the organisational
considerations relate to:
• economics and budgeting;
• staff workload and responsibility.
It is widely acknowledged that hospital departments must operate within
strictly controlled budgets. Therefore, it is crucial to obtain the support and
commitment of senior hospital management at the outset of a project such
as this. The costs involved in setting up the service will have to be met, but
there is likely to be pressure within departments to pass on as much of the
cost to other sources of funding, thus minimising the impact on departmental
budgets.
In terms of workload, it is likely that each of the departments will be
running at capacity, which may lead to confl icts between departments when
the workload is distributed. Departments will try to resist any increase in
their budget requirements or workload. There may be economic reasons
for transferring workload from one department to another.
Careful thought will have to be given as to who takes responsibility for
the key decisions taken during the medical modelling process. It is likely
that clinical departments will want to maintain the maximum amount of
responsibility and control whilst minimising workload and expenditure.
The only practical method of resolving this diffi culty is to try different
procedures and determine which one best meets the clinical need. It should
then be a matter of using this sound knowledge to apply for the correct
budgeting and resources from hospital management.
It is worth emphasising that the use of medical models may drastically
reduce theatre time and its associated costs as well as improving the quality
and accuracy of surgery. However, cost savings have to be seen in context.
For elective cases in the British NHS, the operating time available to surgeons
is fi nite and spare time will be taken up by other cases. Therefore,
the principal effect in a public funded healthcare system will be on waiting
lists and waiting times for surgery. Quality of patient care and costeffectiveness
of care will improve, but the need for a three-dimensional
model will impose an additional charge on tight budgets. Clinical control
of the process can, however, enable many of these problems to be minimised.
For example, Fig. 6.4 shows a three-dimensional CT reconstruction
of a skull with a fronto-zygomatic bone defect (left). A model was required
to enable a cranioplasty plate to be constructed and to assist planning for
the placement of craniofacial osseointegrated implants. By eliminating