C-arms muscle their way into surgical suites

by Jeannie Akridge

GE Healthcare's OEC 9800 MD

C-arm technology is bringing new capabilities to the operating room that are enabling surgeons to perform their jobs with more accuracy and precision than ever before. And with the growing popularity of minimally invasive surgeries, C-arms (also known as radiographic/fluoroscopic units) are becoming less of a luxury in the O.R. and more of a necessity.

"You have to have one in every good OR," said Bill Lammers, director of capital equipment at Broadlane Inc."You can’t run an OR without a C-arm."

Lammers, who started his healthcare career as a radiology technician, indicated that clinicians originally used C-arms for a limited number of procedures. "Back then, mobile C-arms in the O.R. were strictly used in orthopedics, such as with hip pinning, or with pacemakers in placing guidewires. The only other use we could see at that time was for venograms, with injecting dye into veins." he noted.

"Fast forward to today and we have real-time 3-D imaging," he continued. "Now instead of just a one-or-two dimensional shot, we can rotate the image around to see from all different angles. Perhaps the biggest thing that C-arms can contribute to the O.R. is with surgical navigation," Lammers added.

Michael Caro, surgery product manager with Siemens Medical Solutions, agreed. That’s why Siemens incorporated 3-D capabilities into one of its newest C-arm products, the SIREMOBIL Iso-C3D. To date, Siemens has installed about 350 of the C-arms worldwide. Originally developed for orthopedics, the SIREMOBIL Iso-C 3D is now being used for nearly any surgery involving bony anatomy including spine surgeries, trauma and pain management, he noted.

The 3-D imaging capabilities (sagittal, axial and coronal planes) of the SIREMOBIL Iso-C3D allow surgeons to perform their procedures without having to rely on post-operative computed tomography (CT) or magnetic resonance imaging (MRI) scans for placement verification. Now 3-D imaging can be performed intraoperatively, and if necessary, adjustments can be made before the patient leaves the O.R., according to Caro. "The real advantage is that there is now a potential to reduce the number of repeat procedures," he said.

Siemens developed its latest C-arm product with an isocentric design, which enables it to maintain a consistently centered image throughout the various projection angles. This eliminates the need to reposition patients and thus can bring potential time savings, he noted. In addition, the Iso-C3D is capable of a full 190-degree orbital rotation for added positioning flexibility in the O.R. "The isocentric design of the Iso-C3D may help realize an increase in patient throughput, thus increasing the potential to generate increased revenue," he said.

The system’s Navilink feature allows a direct connection to leading surgical navigation software, serving as a planning tool for surgeons intraoperatively.

"Customers like having the ability to import a 3-D C-arm image to a surgical navigation system,"Caro noted. "A major workflow advantage is that you don’t have to perform manual registration or matching, because the Iso-C3D automatically aligns the 3-D C-arm image with the actual patient anatomy, making navigation easier to use and also bringing potential time savings during navigation procedures."

Siemens ARCADIS Varic

Philips Medical Systems offers its line of BV mobile C-arms that include the BV Pulsera, Endura and Libra; with the Libra as the entry-level C-arm and the Pulsera on the higher end of the spectrum.

According to Dave Melin, director of surgery business for Philips Medical Systems, the Pulsera, which includes movement stopping pulsed fluoroscopy for a blur-free image, delivers high quality images at low radiation doses. Melin claims it’s among the lowest doses on the market, due to several features designed to control the amount of radiation that healthcare workers are exposed to.

Philips BV Endura

The Pulsera uses a rotating anode X-ray tube that can pulse the X-ray beam up to 30 times per second, allowing it to accommodate deep penetration, which will prove useful for larger patients.

This summer, GE Healthcare introduced the OEC 9800 MD. With its 1K x 1K real-time image resolution and 3-D imaging capabilities, the OEC 9800 MD is suitable for general, vascular, cardiac and orthopedic surgeries. With its physician tableside control feature, surgeons have full control of all imaging and positioning functions during surgery. According to GE Healthcare, the OEC 9800 MD was designed with the input of hundreds of physicians worldwide to include features such as increased heat management capabilities and multiple options to control dose.

Philips BV Pulsera

When evaluating C-arms, Lammers suggested that buyers consider a few key features. For starters, you should choose a product with 1K-by-1K resolution at minimum; but "at the end of the day, what really matters is, when you’re looking at the monitor, how clear is the image, and how much detail can you see?"

Another key feature should be a rotating anode X-ray tube. A rotating anode versus a fixed anode, allows for greater power with a higher degree of cooling, according to Lammers, "A rotating anode can run five times longer, and on thicker patients, you can use more x-ray energy which allows for better penetration without overheating the tube," he said.

Another option, particularly for cardiac work, is an injector interface used to time an injection study while filming the heart study. Without a C-arm, the other alternative would be a much less reliable hand injection, he said, "You only have one shot to do it, and if you mess it up, you have to wait at least 48 hours to repeat a study using contrast," he added.

SIREMOBIL Iso-C from Siemens Medical

Beyond pricing considerations, buyers should opt for a dual-monitor system that allows for both live and static views. When considering ROI on your investment into new mobile C-arm technology, Lammers says, "I see more applications for mobile C-arms in the future that will increase billing opportunities in the OR. Obviously, the more you use the C-arm, the more you’re working towards your ROI."

In fact, with tools like 3-D imaging and surgical navigation, surgical suites may soon find it necessary to have two or more C-arms in operation. "With more scheduled cases requiring a C-arm, I think you’re going to have a tough time with one C-arm, particularly when you have four or five overlapping cases in a day," he concluded.

C-arm economics

As a helping hand for purchasing decision-makers, GE Healthcare offers a calculator on its Web site (http://www.gehealthcare.com/rad/savi/surgery/breakeven.html) that calculates payback on a purchased system in terms of patient volume required to recoup the cost of a C-arm, as well as a breakeven calculator for leasing options. HPN

Athletes at the upcoming ATHENS 2004 Olympic Games will greatly benefit from advances in medical technology. Using digital medical imaging and information equipment from Eastman Kodak Company, images of injured athletes can be sent electronically to medical specialists in remote locations.

The technology will enable radiologists at the Polyclinic, the primary medical center for the Games located in the Olympic Village, to send digital x-ray images, CT scans and other medical images and accompanying reports to specialists at the ATTIKO University Hospital in metropolitan Athens, which will assist in serving Olympic athletes and officials.

This technology includes a Kodak picture archiving and communications system (PACS) and a Kodak radiology information system (RIS) at the Polyclinic, along with a Kodak PACS/RIS workstation at the University Hospital; which will enable physicians to view and make diagnoses from the medical images and written reports transmitted by the Polyclinic. In addition, Kodak will equip the Polyclinic with systems that capture x-ray images digitally in seconds.

Kodak DIRECTVIEW DR 900

Kodak also installed a digital medical imaging capture system at KAT Hospital, one of the largest trauma treatment hospitals in Greece, to also assist in serving individuals associated with the Olympic Games.

The Polyclinic is expected to perform medical imaging studies for up to 140 patients per day and to complete more than 2,000 imaging exams over the course of the Games. After the Games, Kodak digital imaging equipment will continue to provide medical imaging services for the citizens of Athens. "What is unique about the Athens Games is that the Olympic Village Polyclinic will remain after the Games have concluded," said Dan Kerpelman, President of Kodak’s Health Imaging Group and a senior Vice President of Eastman Kodak Company.

Remote imaging at home

Hospitals in the United States are adopting remote imaging capabilities in growing numbers. More than a year ago, Central Suffolk Hospital of Riverhead, NY installed a Kodak computed radiography system and a Kodak Directview Web Distribution System in its emergency room to capture trauma exams digitally and to make them available immediately via an electronic network to on-site or remote clinical specialists including orthopedists and neurologists. This equipment expedited access to imaging studies, while eliminating the time required for on-call specialists to travel to the hospital, which is located in a rural community. The hospital is now establishing a digital workflow in its radiology department with the purchase of Kodak digital image capture and information management systems.

"Our first venture into digital imaging was driven by the desire to improve care for our trauma patients by providing immediate access to exams and by enabling us to transmit images electronically to our on-call specialists for after-hours review," said Arthur Crowe, Central Suffolk’s Administrative Director of Radiology. "The advantages of digital imaging are so compelling that we decided to convert our entire radiology department."

Kodak DIRECTVIEW PACS System 5

"Initially, digital imaging technology was primarily targeted at large, teaching hospitals but we are now seeing a strong rate of adoption for our digital image capture, management and output solutions at small to mid-size hospitals as well," said L. Jeffrey Markin, General Manager of Healthcare Information Systems and Vice President, Kodak’s Health Imaging Group. "This is great news for the millions of patients that are served by smaller healthcare facilities, as well as the staff and referring physicians that benefit from the enhanced convenience and efficiency of a digital imaging workflow." HPN