TIGHT FIT New C-arms have great maneuverability and can swivel and lock at almost any angle.

The newest C-arms with all the bells and whistles can run a couple hundred thousand dollars. For Joshua Gary, MD, an orthopedic trauma surgeon at the University of Texas Health Science Center at Houston, working with the latest imaging capabilities is worth every penny. The 3D C-arm he uses lets him confirm the precise placement of screws and implants around nerves and arteries — all during the case. "We never before had the ability to do that in the middle of procedures," he says.

Don't let high price tags scare you away from adding imaging technology that can improve outcomes and reduce the need for follow-up CT scans and revision surgery.

Worth a look
Dr. Gary says his hospital's C-arm provides a CT-scan-like image in the OR in around 2 minutes, while the patient's still under. "That's the information we used to have to move the patient out of the OR to a CT scanner for, and potentially back to the OR for reintubation to alter placement of hardware that was less than optimal," he explains. "Our C-arm moves that ability into the OR in a way that's not disruptive."

Hospitals have financial incentives for running CT scans after temporizing surgery to confirm the correct placement of hardware, but new C-arms that eliminate a CT scan and return trip to the OR for revision surgery could result in significant healthcare savings, according to Dr. Gary.

"Radiologists won't like it, because they don't get to read scans, and hospitals won't get to charge for it, but from a healthcare dollar standpoint, you're saving a lot of money," he says.

Gregory Jett, president of Creative Surgical Solutions in Panama City, Fla., says CMOS technology, flat-panel C-arms, 3D imaging and much more powerful imaging capabilities have hit the market in the past 3 years.

LIVE UPDATE Detailed imaging in the OR lets surgeons confirm precise placement of implants and hardware.

"With older models, there are some borders of anatomy that you can't see, because of a lack of imaging power," says Mr. Jett. "But years of research and development to improve C-arm software let surgeons see fine, small objects, even in large patients. That's the big challenge, especially in minimally invasive surgery, so imaging power is key."

Mr. Jett says you can expect to pay $90,000 for a pain management C-arm, $150,000 to $175,000 for a platform geared toward urologic procedures and $125,000 to $150,000 for a C-arm best suited for spine and ortho.

Those are significant capital outlays to be sure, but the newest platforms provide better range of motion of the C-arm itself and superior HD images when viewing small or dense anatomy, says Theresa Criscitelli, EdD(c), RN, CNOR, an assistant director of professional nursing practice and education at Winthrop University Hospital in Mineola, N.Y.

Superior images can provide enhanced visualization during surgery and optimize outcomes, says Ms. Criscitelli. "That's especially true when using real-time 3D imaging for spine surgery — the images help surgeons minimize damage to surrounding tissue and reduce procedure times," she adds.

Ms. Criscitelli says the latest C-arms have great maneuverability, which lets the arm swivel and lock at almost any angle. She also points out that models with thin, flat detectors take up less space in operating rooms, where valuable real estate is always at a premium.

Also consider the safety of your patients and surgical team, says Ms. Criscitelli. She points out that newer C-arm models are designed to reduce the amount of radiation patients, surgeons and staff are exposed to during procedures.

Ms. Criscitelli says she's always justifying cost and determining the return on investment of proposed purchases. "In this case, efficiency and safety would be my justification to add a newer C-arm to the OR," she says. "Knowing that the surgeon can obtain quality images in real time in order to make better clinical decisions is important to me. Couple that with improved staff and patient safety when it comes to radiation exposure, and this expensive purchase is worthwhile."

Finding the right fit
Two factors drove leaders at St. John Macomb-Oakland Center in Madison Heights, Mich., to invest in a pair of C-arms to service the hospital's 5 ORs: improved fluoroscopy capabilities — including data storage and retrieval — and the happiness of its surgeons, especially the orthopods.

"Our guys were asking for updated equipment because they wanted to save and download clinical data, and our previous C-arms didn't have that capability," says Pamela Borello, RN, BSN, CNOR, CSSM, the hospital's clinical nurse manager of perioperative services.

As part of its due diligence, St. John reviewed options from a handful of approved vendors, utilizing feedback from the radiology department and members of the surgical team. The hospital also trialed "a few different specialties" before committing to the investment, says Ms. Borello. Once satisfied with the capabilities, the next step was to float the price past the purchasing department and other members of the capital committee.

"We had to come up with a number," she says. "The committee was willing to negotiate, but they wanted a volume commitment, because no one is going to invest $100,000 without seeing some sort of return."

Ms. Borello says the hospital is managed like a co-management group; physicians are financially involved, and they wanted to see how much fluoroscopy the hospital was actually doing to make sure it would get a return on the investment. The hospital wound up investing around $90,000 for 2 refurbished C-arms, one of which can be used for vascular procedures.

"If [buying refurbished] is the way we have to get the equipment we need, that's what we'll do," says Ms. Borello. She advises you look for ways to get creative within your budget. "Our vendor worked together with us on the price, and we also got trade-in credit for a couple of devices we already had," she says. "The level of service we received from the vendor rep was one of the big reasons we were able to do the deal."

In the 2 years since the hospital put the pair of C-arms into service, Ms. Borello says the technology has not only enhanced imaging, but has also substantially increased the hospital's volume of fluoroscopic procedures, including new specialties.

ONE LAST CHECK C-arms let Joshua Gary, MD, confirm good surgical outcomes before patients leave the OR.

"We have a mobile urology table, so we can now use the C-arm for those procedures," she says. "In a way, the investment enabled us to do more. In order to show a better return on the investment, the idea was to get as much use out of it as possible, not just limiting ourselves to what we did before."

Embrace change
Mr. Jett says fear of changes shouldn't prevent you from considering a C-arm upgrade. One of Mr. Jett's hospital clients has been working with the same ol' reliable unit for years. The hospital affectionately calls it "The Mule." Mr. Jett calls it the Honda Accord of C-arms. "You know it'll start in the morning and run forever," he says. "But it doesn't have the latest imaging features."

Mr. Jett says the hospital is hesitant to invest in a new model. "I think that's a big mistake, because the technology and interfaces out there now provide incredible pictures and are a lot more user-friendly," he explains. "You can't be afraid to try the new stuff." OSM