Cost Savings

(Engineering Assisted Surgery & Healthcare)

The Cost Of Treatment


What are current treatment modalities and how do they work?

Treatment planning involves clinical assessment, stabilisation and investigation using non invasive and invasive techniques. There is total reliance on the skills and performance of the clinician. In some cases resuscitation and emergency interventions are required to preserve life; in such cases secondary interventions are carried out to complete the treatment plan. When the timing of an intervention and clinical stability permits planning as a single intervention, this is essentially two dimensional with existing imaging technology that is available. The treatment plan must then be replicated and translated into a three dimensional patient. These protocols must have an association with a compromised outcome as a function of inaccuracy of plan translation, and it is to be noted that such comparable practice has been abandoned by other industries who have since demonstrated an improvement.

Successful Outcome

The parameters of successful outcome are often arbitrary and based on current practice which does not necessarily portray the best outcome possible and does not take into account recent developments especially in the field of Engineering Assisted Surgery. "Best Practice" is a complex function of many parameters in relation to accepted national standards of outcome. In the United Kingdom crucial data is not freely available, or has not been documented; there are no agreed national standards for many parameters. This has an adverse effect on clinical audit, evidence based practice and clinical governance issues.

Performance data related to other aspects of “Best Practice” throughout the Healthcare Industry is deficient, but if one considers the model of the improving quality in manufacturing industry, following the advances in computer technology and adoption of automated processes, it is likely that poor performance indicators are related to human factors.

Medical Negligence

click image for medicolegal link

EAS technology provides the opportunity for presentation of hard copy evidence for cases of personal injury. The use of biomodels may protect both the patient and clinician in medical negligence cases. The use of EAS techniques is likely to reduce the incidence of litigation related to human error. The current annual cost of NHS related medicolegal litigation runs at UK £7billion/annum. If a 14% reduction in the cost of medical negligence litigation could be achieved by the adoption of EAS technology as the “Gold Standard” of duty of care, this would result in a saving of £1billion/annum.

Applications of Engineering Assisted Surgery in Healthcare

Let us therefore examine the effects of EAS on the delivery of healthcare on the available evidence:

Oral Cancer1-4



Each year in the UK there are over 2,500 new cases of oral cancer (circa 1% of all cancer registrations) with an annual mortality of about 1,400. This compares with 1,339 deaths from cervical cancer in 1995. There is some evidence that oral cancer is becoming more common in women and younger patients in the UK and other countries. Oral cancer is twice as common in men.

Whilst the incidence of oral cancer was static in the 1980’s there are now signs of a rising incidence. Cancer registrations beyond 1991 are not yet published but the mortality in 1992 was recorded at 1,379. Four patients die of this disease every day in the UK. http://www.bda-dentistry.org.uk

Incidence and Mortality Figures1 for England and Wales 1991





Mortality



Advanced Disease - Staging of Tumours



Whereas in the 1960’s 15% of patients presented with T3 or T4 tumours, this figure had risen to 28% in the 1980’s which implies that in England and Wales around 724 patients presented in 1991 with disease that would probably have been treated complex composite free flap techniques. in the United Kingdom.

Lymph Node Status and Survival





Spiro et al5 demonstrated a 14% reduction in 5-year survival from 51% for the clinically negative neck (cN0) to 37%, if only one node was histologically diagnosed positive for metastatic tumour, in a series of 2,550 cases of epidermoid carcinoma of the oral cavity and oropharynx.

(This series of patients roughly numbers the new cases that would be expected to present annually in the UK).

Radical neck dissection was included as a part of treatment in 1,069 patients (42%). If multiple unilateral nodes were histologically positive, the 5-year survival was reduced to 24% i.e. the survival rate was nearly halved. For histologically involved bilateral nodes the 5-year survival dropped to 5%. Revision of clinical staging was performed in 744 (70%) patients as follows:

Nodal Staging: N1 Solitary mobile node, N2 Multiple mobile nodes, N3 Bilateral/contralateral fixed



From these figures 551/1069 (52%) patients restaged present as Stage III or IV have a compromised prognosis related to node status; and the the worst prognosis is seen in those patients with bilateral or contralateral fixed nodes (N3) [1974 staging procedures]. If it is accepted that the majority of deaths in oral cancer are related to local recurrence / direct extension of disease, rather than from distant metastasis, it would appear that current treatment modalities are failing in their palliative aims, most commonly within the first two years of treatment.



National Cancer Statistics (United Kingdom)





The mortality in oral cancer is to be considered in context with epidemiological data for all cancer registrations (1989) and associated mortality in (1992) for the United Kingdom. The cost to the Nation in terms of overall patient mortality is that 62% of patients will succumb to their disease.



Head and Neck Surgery

Cost of Treatment

Complex Composite Free Flap Techniques

In 1993 at the British Association of Oral & Maxillofacial Surgeons meeting in Cardiff, Lavery stated that the true cost of intra oral reconstruction utilising free flap techniques was estimated at £25,000 per case.

Average Costs of Treatment

1 live patient @ 2yrs


Composite Free Flaps

£ 85,000

10 Patients

70% Mortality @ 2 years

@

£25,000 / case
Customised Implants

£ 14,535

7 Patients

0% Mortality @ ~ 5 years

@

£14,535 / case


Average Costs of Treatment - 2 year Survival

With respect to the average cost of a two-year survival episode, this is documented at £85,000 for those patients treated with complex composite microvascular techniques (assuming a 70% two year mortality rate at £25,000 / case episode BAOMS Meeting Cardiff, 1993 - Lavery). In a pilot study of seven cancer patients treated in Doncaster Royal Infirmary with customized titanium implants, a zero mortality was recorded at 4.5 years at a cost of £14,535 / case episode for those patients treated between 1994 -1996.

Cost to the Nation



Oral Cancer

Complex composite microvascular flap reconstructive techniques are reserved for those patients with advanced disease, the majority of which affect the mandible. If the percentage of cases presenting as T3/T4 cases of 28% is accepted, around 725 microvascular oral reconstruction episodes per year are carried out in the UK, at an annual cost of £18,125,000 (assuming the estimated cost of £25,000 per episode has remained unchanged since 1993).

Simplification of treatment plans incorporating Engineering Assisted Surgery (EAS) techniques where necessary has demonstrated a reduction in cost to £14,535 / surgical intervention and, in comparison, the national annual total cost of treatment would be £10,537,875 for this option, an annual saving to the Nation of £7,587,125 with an associated improvement in long term overall mortality figures and statistical significance even on a small sample size.

Research and Development

The palliative care of patients with Head and Neck Cancer is discussed by Lovel6, who quotes Stjernsward:

“No further research is required; the knowledge of what needs to be done exists. The single most useful thing that we can do is to make sure that every patient benefits from that knowledge”.

Comment !

Mr N.S. Peckitt

FRCS FFD RCS FDS RCS

Oral and Maxillofacial Surgeon, Doncaster U.K.

"If surgical treatment is a component of such palliation, it is argued that there is still much to learn".

Comment!




Mr N.S. Peckitt

FRCS FFD RCS FDS RCS

Oral and Maxillofacial Surgeon, Doncaster U.K.

"If surgical treatment is a component of such palliation, it is argued that there is still much to learn”.


References - Head and Neck Cancer

1. Cancer Registration Statistics 1979-1989 Series MB1 nos 11-22, OPCS

2. Mortality Statistics: Cause 1979-1989 England and Wales OPCS

3. Oral Cancer Fact Sheet 1993 14.1, Cancer Research Campaign, 6-10 Cambridge.

4. Screening for Oral Cancer 1994 Department of Dental Sciences, Royal College of Surgeons of England.

5. Spiro R.H., Alphonso A.E., Farr H.W., Strong E.W. Cervical node metastasis from epidermoid carcinoma of the oral cavity and oropharynx. A critical assessment of staging. American Journal of Surgery 1974; 128, 562-567.

6. Lovel T.

Palliative Care and Head and Neck Cancer – Editorial.

British Journal of Oral & Maxillofacial Surgery 2000; 38, 253-254

Trauma

Incidence

A joint report from the Royal College of Surgeons of England and the British Orthopaedic Association1 was produced in July 2000 entitled “Better Care for the Severely Injured” which documented 45,253 serious injuries on UK roads in 1995. Mortality figures in 1996 were 3,740, with a fall of 39% in fatal and serious injuries. Government targets are set to reduce the number of road accidents by at least 50% by 2010. The incidence of severe trauma as determined by an Injury severity score (ISS>15) is estimated to be 4 per million per week and it has been estimated that there are between 10,000 and 10,600 patients suffering from multiple injuries in the UK each year. This on average represents one per 1,000 emergency cases admitted.

Costs to the Nation

Trauma



The Dept of Environment, Transport and the Regions (DETR) has estimated the costs of road trauma, which accounts for over a third of the 9,000 deaths due to injury each year. Costs are calculated in terms of direct medical expenditure, loss of economic activity and human aspects of grief, suffering and pain. In 1997 a fatal injury valued in this was, cost the nation £902,500, a major injury £102,880 and a minor injury £7,970. The medical costs are a relatively small part of the total costs which were calculated as follows:

Dept of Environment Transport and the Regions Figures 2000





Comment


The stated figures for medical costs are difficult to justify and almost certainly do not include the hourly costs of running an operating theatre (circa £1,000 / hour) and daily costs of intensive care (which may be as high as £2,000 / day)

The total cost savings to the Nation achieved by the prevention of road trauma using the DETR formula would be greater than £20 billion.

Major Trauma Outcomes

One third of deaths are probably preventable.

12% patients have "sub optimal" treatment.

initial management deemed unsatisfactory.

no data is available with respect to disabilities following survival of major trauma.

Key statements following this report included:

1. National coordination and systematic audit of standards of care.

2. Formation of A National Trauma Audit Committee (NTAC)

   - to set standards

   - to develop realistic outcome indicators for audit.

3. Formation of a National Trauma Audit Research Network

   - to collect data from all Hospital Trusts pertaining to major trauma

   - to develop improve and monitor standards of care

4. National Trauma Service to be based on geographical systems

5. Achievement of audited standards of trauma care / satisfactory outcomes to be the determinants of hospital’s future reception of severe injuries.

6. Improved care creates the opportunity for reducing the cost of avoidable death and unnecessary morbidity.

Conclusion

Joint Report

Royal College of Surgeons (Eng) and British Orthopaedic Association

2000

"Human suffering, and cost related to major trauma survival, are likely to be considerable, and require urgent investigation"

Head and Neck Injuries

It is estimated that 500,000 patients suffer facial injuries each year in the UK and the epidemiology has been discussed in a UK survey in 1998 conducted by the British Association of Oral & Maxillofacial Surgeons2 in a series of 6114 patients presenting to 163 A&E departments with facial injuries during a 7 day period.



  • 1003 (16%) were discharged without treatment


  • 2783 (46%) were treated in A&E


  • 1261 (21%) were referred to an oral and maxillofacial surgeon


  • 487 (8%) required admission and of these 16 were admitted to an intensive care unit


  • It would appear from this data that 0.3% of patients sustained major facial trauma and if these figures are extrapolated into annual estimates this suggests that around 1,500 major trauma episodes occur annually in the UK. If the figure of 12% of sub optimal treatment is also applicable to major facial trauma, this implies that 180 patients fall into this category.

    References

    1. Better Care for the Severely Injured. A Joint Report from The Royal College of Surgeons of England and the British Orthopaedic Association July 2000 (Review Date 2003) Link http://www.boa.ac.uk/PDF%20files/severly%20injured.pdf

    2. Hutchison I.L., Magennis P., Shepherd J.P., Brown A.E. The BAOMS United Kingdom Survey of Facial Injuries Part 1: Aetiology and the association with alcohol consumption British Journal of Oral & Maxillofacial Surgery 1998; 36, 3-13

    Trauma - Huge Cost Savings with Biomodels

    With respect to the management of trauma cases, savings are higher per unit case, as a function of the consequences of reduced surgical trauma. Savings of £30,000 are possible with projections of reduced operating times, less dependency on critical care facilities, earlier discharge from hospital, and enhanced rehabilitation.



    One case attending from the U.S.A. involved documented savings of $150,000 for the purchasers.



    References - Trauma

    1. Better Care for the Severely Injured. A Joint Report from The Royal College of Surgeons of England and the British Orthopaedic Association July 2000 (Review Date 2003) Link http://www.boa.ac.uk/PDF%20files/severly%20injured.pdf

    2. Hutchison I.L., Magennis P., Shepherd J.P., Brown A.E. The BAOMS United Kingdom Survey of Facial Injuries Part 1: Aetiology and the association with alcohol consumption British Journal of Oral & Maxillofacial Surgery 1998; 36, 3-13

    Discussion

    Engineering Assisted Surgery (EAS)



    New developments in engineering, used for the first time in oral and maxillofacial surgery, permit the manufacture of accurate anatomical biomodels of the skeleton from CAT scans (stereoscopic lithography). Biomodels have been used in treatment planning, and the design / manufacture of customized titanium implants for the single staged reconstruction of the orofacial region using very simple cost effective interventions. These may carried out without surgery from a second surgical site, and obviate the necessity for complex flap surgery.

    Implants are inserted with relatively atraumatic surgical protocols permitting, for the first time, a single staged orofacial reconstruction, including the dentition.

    Within oral and maxillofacial surgery, EAS has special relevance in the planning and treatment of complex trauma, facial deformity, craniofacial/skull base surgery and reconstructive surgery.

    There are applications in many surgical disciplines, especially orthopaedic trauma, treatment of deformity and orthopaedic implants, including customized joint replacement. EAS technology permits the design and manufacture of customized implants to an accuracy not before possible. Applications pertaining to medicolegal practice, the demonstration of personal injury and audit of outcomes, herald new standards in duty of care, and there are applications in high risk procedures where precision is of primary importance, for example in spinal surgery, where surgical precision could be improved with position and cutting jigs.

    It is advocated that as this technology is development and mastered, reappraisal of the principles of surgery in general are warranted, especially in relation to the incredible accuracy that is possible using these techniques, and the potential of the elimination of operator error.

    Resource Implications

    In oral and maxillofacial surgery there are important resource implications relating to the utilisation of:

  • single surgical teams


  • short simple operations; single site / single staged surgery


  • reduced surgical trauma


  • reduction in the use of donor sites and their morbidity if flaps are not used


  • projections of reduced morbidity


  • projections of reduced perioperative mortality


  • reduction in utilisation of critical care facilities


  • projections of reduction in hospitalisation times


  • reduction in cost of surgical episodes.


  • It is advocated that:

  • surgical planning is facilitated


  • non-mutilating reconstructions are possible


  • excellent aesthetics and immediate dental rehabilitation is possible.


  • tumour recurrence is not possible in the titanium prosthesis


  • intraoral wound breakdown is not related to failure of the technique.


  • implants can be salvaged in the presence of complications that would have resulted in total loss of alternative surgical methods of reconstruction.


  • conventional surgery can be still be employed in cases of implant failure.


  • The introductions of this technology has far reaching implications for surgery in general and further development and research is advocated with respect to:

  • implant biotechnology and design


  • treatment planning and protocols


  • morbidity and mortality studies


  • hospitalisation / rehabilitation times


  • quality outcomes; cost savings


  • Engineering Assisted Surgery - Indications



    EAS has relevance to many specialties especially maxillofacial surgery and orthopaedics:

  • To promote the accuracy of planning and delivery of surgical treatment plans.


  • To facilitate the transfer of the surgical plan from biomodel to patient.


  • To replicate bone resection cuts exactly at operation with customized cutting jigs.


  • To accurately determine positions of the bones with position jigs.


  • To eliminate operator error.


  • To facilitate single stage reconstructive surgery.


  • To facilitate single site surgery.


  • To reduce surgical trauma.


  • To reduce the dependency on post operative critical care.


  • To guarantee quality of outcome related to technique


  • To facilitate audit of outcomes.


  • To promote the principles of clinical effectiveness and governance.


  • Projections of Cost Savings in NHS Practice

    It is likely that cost savings and enhanced outcome illustrated in maxillofacial surgery will be mirrored in other specialties, especially in orthopaedics where in major trauma outcomes currently:

    Better Care for the Severely Injured

    http://www.boa.ac.uk/PDF%20files/severly%20injured.pdf

    please click for link to British Orthopaedic Association

  • One third of deaths are probably preventable.


  • 12% patients have “sub optimal” treatment.


  • initial management deemed unsatisfactory.


  • no data is available with respect to disabilities following survival of major trauma.


  • Major injuries amounted to 45,253 interventions in 1985, at a unit cost to the Nation of £102,880 per case.



    Large cost savings related to the introduction of EAS techniques and potential improvement in outcome are possible in the identified "sub optimal treatment group" which currently costs the Nation £600 million / annum. Such improvements in outcome have already been documented in maxillofacial surgery related to:

  • accuracy of diagnosis


  • treatment planning


  • translation of plan to patient


  • reduction in surgical trauma and operating time


  • overall reduction in cost


  • promotion of rehabilitation / earlier return to employment


  • Orthopaedic Surgery - Customised Joint Prostheses

    According to Alan Pengelly, Materials Consultant with Technicon (Surrey UK) patients in the UK with hip joint replacements may be suffering unnecessarily with:

  • repeated joint failures


  • dislocations


  • revision surgery


  • because of lack of coordination and monitoring of implant operations and developmental research.

    The establishment of a National Coordinating Body has been advocated to gather data and monitor the provision of materials for orthopaedic implants.

    [Reference: In: Materials World 1999]

    Hip Replacement

    Annually there are about 50,000 hip replacements in the UK at a national cost of about £300 million.

    Most pelvic sockets of hip replacements are made of ultra-high molecular weight polyethylene (UHMWPE) which offers good durability with physical and chemical stability. However microscopic wear of this material has been described, which erodes the natural bone structure surrounding and supporting the implants. The Institute of Materials is has been considering the most effective way of establishing a national coordinating body.

    Knee Replacement

    Currently knee replacements in the UK have an average life span of 10-15 years and it is important that coordinated research into joint replacement includes biomodel planning and the customised design of such implants and cutting jigs, whose precise fit will mirror only that which is mandatory in other specialties such as restorative dentistry.

    It is likely that such customised implants will influence the stability and long term outcomes of such procedures and be associated with a reduction in morbidity and cost to the nation.

    Market Dimensions



    Please click icon for link to Frost & Sullivan Report




    A recent report by Frost & Sullivan predicts that new manufacturing methods, such as CAD/CAM and innovative product design will play an increasingly important role in the European orthopaedic implant market, which will be worth over $3.0 billion in 2005. The traditional orthopaedic implant sector is becoming increasing competitive and the future growth in the market for surgical implants will be largely based on an increasingly diverse range of niche products and new market sectors, such as maxillofacial surgery.

    Application of EAS to the Healthcare Industry

    Conventional techniques related to the successful outcome of clinical intervention rely heavily on human qualities of the clinician1-24. Whilst many interventions are carried out with no planning in advance, or planning only possible during the intervention, other cases are planned in advance using composite systems often involving two dimensional radiographs and computer generated scans, which do not permit the accurate replication and transfer of the plan into the three dimensional patient.

    The consequences of this modus operandi are that interventions rely heavily on (variable) human ability, performance and a complex and expensive resource network, which is inefficiently utilized. The quality of outcome must vary as a consequence of the inconsistencies related to:

  • planning variables


  • the human variable


  • the degree of clinical trauma required to achieve the outcome.


  • New Concepts – Engineering Assisted Surgery™ (EAS)1- 6

    In the 1960’s a major developments occurred in the manufacturing industry as a consequence of advances in engineering technology, largely as a result of the use of computers, which:

    automated reverse engineering technology for efficient prototype production standardized the quality of product reduced human related error in the manufacturing process improved the efficient use of resources and productivity

    It is therefore reasonable to examine applications of engineering technology to the Healthcare Industry, which still relies heavily on the “art and craft skills” of its clinically based workforce.

    We propose to term this concept Engineering Assisted Surgery™ (EAS).

    The practice of medicine and surgery has traditionally been regarded as an art or craft acquired through apprenticeship. The reliance on human performance does not lend itself to efficiency and homogeneity of outcome, and has been superceded in industry by new reverse engineering planning technology, rapid prototyping, automation and standardization of the production processes.

    Whilst dental casts of the teeth and jaws have been used successfully for many years in treatment planning, it is only recently that new advances in engineering technology have made EAS possible for sister specialties. These advances include:

  • the discovery of osseointegration
  • transmucosal / transcutaneous implant systems
  • new (bio)engineering materials
  • advanced computer technology
  • computer assisted diagnosis, design and manufacture
  • rapid prototyping, reverse engineering and biomodel manufacture
  • new manufacturing processes
  • customized templates, jigs and implants
  • applications in customized tissue engineering


  • These developments herald the introduction of new Gold Standards in the provision of Healthcare, with an improvement in efficiency and quality, already seen in other industries.

    Engineering Assisted Surgery – Maxillofacial Surgery Model

    In maxillofacial surgery Engineering Assisted Surgery techniques have been shown to facilitate:

  • accuracy of diagnosis / treatment planning


  • translation of plan to patient


  • reduction in surgical trauma and operating time


  • accuracy in existing interventions


  • treatment in cases previously thought impossible using established interventions


  • the creation of new procedures which simplify treatment


  • the conversion of staged multiple interventions into a single intervention


  • overall reduction in cost


  • promotion of normal aesthetics and functional rehabilitation


  • earlier return to employment


  • clinical audit


  • EAS technology has a wide application across many specialities24-167:-

    1. Orthopaedics

       - trauma management24,96, congenital and acquired deformity53,93, customized prostheses38 limb prostheses for amputees, customised templates jigs, joint prostheses, spinal surgery94,131, hand/foot96 surgery, customized distraction osteogenesis.

    2. Neurosurgery69

       - diagnosis and treatment planning of cranial tumours, spinal surgery94,131, tauma136, stereotaxy134, nerve root pain, tumour resection; customised templates, jigs and implants62,136, customized distraction osteogenesis.

    3. Maxillofacial Surgery1,2,6,101,107,108

       – photomorphanalysis (i.e. digital photographic planning and image prediction of outcome, audit and informed consent), cosmetic facial surgery, trauma, orbital surgery61,68,80, congenital/acquired deformity50-52,54,78-79,83-84,88 , cleft lip and palate100, tumour resection, colour stereolithography65,74 and tumour mapping1,65, reconstructive surgery, temporomandibular joint Surgery36, customized distraction osteogenesis1,39,55, customized templates jigs and implants67,70,72,103, oral rehabilitation45, diagnosis and treatment of facial and nerve root pain1.

    4. Orthodontics http://www.aligntech.com

       – the Invisalign System154-167 has centralised consultant orthodontic treatment planning services and the making orthodontic splints with digital transmission of data and reverse engineering techniques. Simple splints are distributed to general dental practitioners to instigate treatment and obviate the need for traditional orthodontic “braces”.

    5. Craniofacial and Skull Base Surgery

       – photomorphanalysis, trauma, congenital118/acquired deformity35,71,73,81,86,97,112-114, tumour resection, reconstructive surgery62,63,129, customized templates, jigs and implants and prostheses37,59, customized distraction osteogenesis, cranial base surgery66,130,132.

    6. Plastic Surgery

       – photomorphanalysis, treatment planning of cosmetic surgery40, trauma, congenital/acquired deformity44,49,64,110, tumour resection, reconstructive surgery56, (head and neck surgery114-116, hand surgery, customized distraction osteogenesis, amputees) customized templates, jigs and implants, customized stencils for scar revision,

    7. Otorhinolaryngology

       – photomorphanalysis, treatment planning of cosmetic facial surgery, rhinoplasty, rhinometry34, trauma, congenital/acquired deformity, tumour resection, head, neck99 and laryngo-pharyngeal reconstructive surgery98, customized templates jigs and implants, scar revision, planning inner ear surgery92, petrous bone training workshops77,82.

    8. Vascular Surgery

       – diagnosis and treatment planning, customised vascular stents conversion of major procedures to minimal access procedures ( eg management of aortic aneurysm) cerebrovascular biomodelling135

    9. General Surgery

       – diagnosis and treatment planning, general surgery, cardiaothoracic surgery29-30,32, surgical oncology, urology31, obstetrics and gynaecology, paediatric surgery128,138, reconstructive surgery, biomaterial science.

    10. Surgical Pathology

       – photomorphanalysis ( superimposition of clinical photographs on scans/biomodels) biomodel tumour mapping of hard and parenchymal tumours, identification of lymph node metastasis using microstereolithographic techniques148-153, in vitro biological testing systems, cerebrovascular biomodelling135, biomodels for surgical workshop training77,82.

    11. Medicolegal Practice

       – medical reports have a major effect on expert evidence and are the basis for cross examination. EAS techniques, PowerPoint computer presentation, photomorphanalysis and biomodels, provide a hard copy description of personal injury and audit of outcomes. Medical negligence claims against the NHS currently run at £7billion/year. Improved outcomes with EAS will reduce this burden on resources.

       – Forensic medicine applications have been described43,75.

    12. Radiotherapy

       – tumour mapping, radiotherapy planning, mask device manufacture

    13. Medicine

       –general medicine42 photomorphanalysis, parenchymal biomodels, cardiology48,85, neurology1, pharmacology and therapeutics, drug delivery systems, oncology133, cerebrovascular biomodelling135, tumour mapping, tissue engineering.



    Engineering Assisted Surgery involves:

  • Bringing industrial concepts of service, accurate planning, automated delivery and predictable quality to the Healthcare Industry.


  • Adoption and adaptation of efficient proactive management and IT systems, proven in the manufacturing industry.


  • Centralisation of Consultant Planning Teams (hub and spoke concept for delivery)


  • Inclusion of (bio) engineers within the clinical team


  • The use of Engineering Assisted Surgery technology in clinical interventions.


  • A universal improvement of quality and standardisation of outcome.


  • More appropriate use of available resources


  • Reduction in administration procedures and costs


  • Reduction in medical negligence litigation


  • Minimising disability and promoting return to normal function


  • Reduction in cost to the Nation


  • EAS may be used in conjunction with:

    the planning and facilitation of established interventions i.e. current practice new surgical procedures customized implants

    Use of stereoscopic lithography (CAT scanning) enables the creation of accurate anatomical biomodels of the skeleton, which can then be translated into customised titanium implants. This technique enables a single surgical reconstruction procedure to be used rather than multiple procedures. Engineering-assisted surgery has the potential to be used in a wide range of indications and has received a SERNIP classification C for midface surgery.

    Clinical Audit

    It is clear that National Audit Standards have to be determined with implementation of External Audit for all clinical procedures if the this process is to be effective in monitoring and the raising of standards the National Health Service.

    Only when relevant data is collected and processed centrally, can appropriate planning of services be undertaken.

    It is clear that an effective audit process is multidisciplinary, complex, time consuming and requires the funding of a full time commitment that is not possible to deliver within the normal clinical framework of NHS practice.