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Feasibility study to examine the use of replica 3-dimensional anatomical models as an adjunct to fully autonomous surgical consent

Oral Presentation 7
Prof Tim Brown

Feasibility study to examine the use of replica 3 dimensional anatomical models as an adjunct to fully autonomous surgical consent.

Introduction: It is mandatory on a statutory and ethical level to provide a fully autonomous and educated consent process setting out an individual patient’s potential course of therapy. In addition, there is a statutory requirement that this process specifies the material risks attached to that treatment as well as all other alternative therapeutic options and their inherent risks. This process requires time, dialogue and certainty that the clinician is satisfied that the patient undergoing treatment understands the risks as they have been explained. The judgment in the Montgomery vs Lanarkshire Health Board, 2015 case describes: ˜This role [consenting] will only be performed effectively if the information provided is comprehensible. The doctor’s duty is not therefore fulfilled by bombarding the patient with technical information which she cannot reasonably be expected to grasp, let alone by routinely demanding her signature on a consent form.”

The use of surgical imaging and technology is widespread within all aspects of surgical care. Images that are commonly used to outline a potential surgical problem are those acquired from Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) scanning. Images acquired are then interpreted and reported on by expert radiology doctors who describe findings. These findings are then interpreted by a surgeon whose role is to educate their patient in preparation for individualised treatment options. Comprehending images from CT and MRI scanning requires training and experience. Without training and experience, it is very difficult to translate 2 dimensional axial or sagittal CT or MRI images into an understandable anatomical mental reconstruction and is often incomprehensible to the untrained observer. Patients are commonly shown their own CT and MRI images during the consent process. Comprehension of 2 dimensional images can be confusing, is a failure of autonomous consent and violates the philosophy underpinning the statutory and ethical requirements of consent.

Aims: A pilot study to improve patient understanding of their condition using exact replica, 3-dimensional, reconstructed anatomical models as an adjunct to autonomous consent.

Methods: Axial imaging modalities were digitally segmented and sent for 3-Dimensional printing (Axial 3D). Patient specific replica 3-Dimensional anatomical models of patients complex surgical problems were created and used as educational adjuncts to aid the consent process in the outpatient clinic.

Conclusion: High fidelity 3-Dimensional reconstructions of anatomical problems were accurate. Anecdotally, there was a high satisfaction and improvement in understanding of patients using 3-Dimensional models as an adjunct to their personalised consenting process.