Pain management, orthopedics, urology and other specialties that employ minimally invasive techniques rely on intraoperative imaging to guide the way. Intraoperative imaging, in turn, requires a specialized OR table for the most effective results. Here's how to choose a table that's compatible with your C-arms and other imaging equipment.

It starts with radiolucence
The main feature distinguishing C-arm-compatible tables from conventional surgical tables is their radiolucence: that is, their composition permits the passage of X-rays for imaging purposes. In terms of a table's construction, radiolucence is achieved by way of a metal-free tabletop, frame and imaging area as well as the use of less padding.

The tabletop is made of a carbon-fiber composite material. Carbon composite products are classified by levels, which the manufacturer will be able to disclose to you. The higher the level, the less impact the table will have on radiographic imaging and the fewer artifacts will show up in your scans.

Because a table's padding can also affect the quality of a radiographic image, a C-arm table is generally upholstered with only about an inch of padding, as opposed to a surgical table's three or four inches, for greater radiolucence.

Imaging accessibility
Another aspect unique to C-arm-compatible tables is their ability to accommodate the imaging equipment and to maneuver in order to enable optimal imaging access without having to reposition the equipment or the patient.

Since a table with four legs would limit the possible placement of a C-arm, most imaging tables include a pedestal and a cantilevered tabletop for more flexibility. In addition, the tables may also slide lengthwise on the pedestal in order to increase the area along which the imaging equipment can scan.

The length of this imaging distance, or "C-arm window," varies from model to model, and the size of the imaging area needed depends on each individual specialty. Pain management procedures, for example, often require a long imaging distance of 36 inches or more, while urological or gynecological surgeries tend to use shorter fields of perhaps 24 inches. For larger surgical sites, longer imaging distances mean less necessity to image a patient piece by piece.

Positioning the patient
From a physician-user's perspective, it may be that an imaging table's positioning and adjustment features are just as useful as its tabletop's capacity for lengthwise sliding, particularly with hand- and foot-operated remote controls.

Tables with adjustable height let you raise or lower the surgical site as required for the surgeon's comfort or the procedure's performance. A table that moves from side to side allows for imaging adjustments without repositioning the patient or the equipment. A table that tilts into the Trendelenburg position is essential for pain management and orthopedic practitioners.

When considering the purchase of a table, also keep in mind the dimensions of the C-arm you're buying it for, particularly the size of the "C" that rotates around the patient. A larger C-arm can image around almost any size table, but a smaller, mini C-arm might only be able to accommodate a narrower table width. The distance between the imaging ends can have a lot of impact on the table you buy.

Weight and transport
As with most surgical tables, a standard C-arm-compatible table is rated with a weight capacity of up to 500 pounds. If you're going to be imaging bariatric patients or others over that weight, you'll most likely want to consider tables specially rated as heavy-weight, which are based on the same table platform, but with sturdier construction and a stronger motor. The heavyweight specification is important given imaging tables' cantilevered designs and their sliding and tilting capabilities, and the stress an overweight patient would place on them over an extended period.

As we've mentioned, tabletop maneuverability is fairly essential in a C-arm table. But maneuverability of the table itself may also prove useful, as a portable table means imaging can be done in any of your ORs or procedure rooms. If you're considering a table that you can transport, be sure that its motorized operations can be powered by a rechargeable battery as well as an electrical outlet.

Is refurbished the way to go?
Obviously, everyone thinks about cost when buying capital equipment. For imaging tables, cost usually depends on the options available, most notably what the table is able to do in terms of tabletop positioning and maneuverability, as well as any padding or positioning accessories for orthopedic and other specialized procedures.

Remember, though, that you're not confined to buying brand-new. In imaging tables, as with standard surgical tables, there's a big market for refurbished equipment. If you're looking to cut costs, buying a refurbished table is one option to consider.

The ideal refurbished table will come complete with a warranty. Perhaps it's only a limited warranty, but that still offers some purchase protection. Additionally, one area you'll want to examine is whether you're buying a table with the original motor. Tables are a good option for a refurbished buy because there are so few parts to rebuild — the tabletop, the base and the casters can easily be replaced — but the motor's the part that tends to expire first. And when the motor goes, you'd just as soon buy a new table. So look for a table with the motor and electronic controls rebuilt.

Advantage Medical Systems
Advantage Smart Table
(800) 810-1262
www.advantagemedical.info
List price: $35,000
FYI: The Advantage Smart Table uses a carbon-fiber top to provide high-quality, full-body imaging, says the company. Its unique base allows the surgical team and C-arm significant access to the patient. A fully functional general surgery table, the Smart Table remembers table positions for various procedures and surgeons.

Berchtold Corporation
Operon D850 Surgical Table
(800) 243-5135
www.berchtoldusa.com/products/b850table.htm
List price: $67,600, or $70,720 with InstaDrive
FYI: Berchtold's Operon D850 Surgical Table features 1,000 pounds of lift and full articulation, a vertical travel range from a low height of 22.6 inches to an upper height of 46.4 inches, a carbon-fiber tabletop, 17 inches of linear slide, an integral X-ray cassette channel and a lateral imaging window of 18.3 inches along the entire length of the tabletop, says the company.

Biodex Medical Systems
Surgical C-arm Table 846
(800) 224-6339
www.biodex.com/imagingtables
List price: $18,900
FYI: Biodex's Surgical C-Arm Table 846 features a free-float tabletop for quick and comfortable patient positioning at a surprisingly affordable price, says the company. Ideal for pain management procedures, the table's cantilevered design accommodates portable or ceiling-mounted C-arms, enabling full fluoroscopic visualization and unobstructed positioning for greater image resolution.

Morgan MEDesign
Basic One
(888) 799-4633
www.morganmedesign.com
List price: $13,950
FYI: Morgan MEDesign's Basic One features motorized motion including adjustable height, lateral tilt and Trendelenburg and reverse Trendelenburg tilts, says the company. Its radiolucent, 22-inch-by-92-inch carbon-fiber composite top can carry 400 pounds of distributed patient weight.

Mizuho OSI
Allegro 6800 Mobile
Imaging Table
(800) 777-4674
www.mizuhosi.com
List price: not disclosed
FYI: The Allegro 6800 Mobile Imaging Table features a carbon-fiber, cantilever tabletop with four-way motorized movement, says the company. Its patented two-speed joystick with Interactive Proportional Speed Control lets surgeons easily move the tabletop with a full patient load at any angle and desired speed, providing maximum versatility in patient positioning and imaging capability.

Oakworks
CFPM 400 C-Arm Imaging Table
(800) 916-4612
www.oakworks.com
List price: not disclosed
FYI: Oakworks says its new CFPM 400 four-way movement C-arm table incorporates the company's reputation for quality and reliability. With a patient weight capacity of 500 pounds, the table boasts the market's largest adjustable height range, from 26 inches to 44 inches, making it ideal for low-height patient wheelchair transfers.

Schaerer Mayfield USA
Schaerer 7300 Modular Surgical Table
(800) 755-6381
www.schaerermayfieldusa.com
List price: $47,000
FYI: Schaerer's 7300 Modular Surgical Table can easily convert for use in a variety of surgical specialties, says the company. The cantilever design provides imaging access in any position. The power-elevated, independent pelvic tilt feature enhances surgical access to the perineal area without the need to put the patient in Trendelenburg.

Skytron
Essentia 1700 Surgical Table
(800) SKY-TRON
www.skytron.us
List price: $23,700
FYI: Skytron's Essentia 1700 Surgical Table is ideal for outpatient applications, says the company. Engineered to Skytron's rigorous standards for surgical table reliability and durability, it features 180-degree top rotation for enhanced full-body imaging, standard side rails to accommodate accessories, a 500-pound weight capacity, 25-degree tilt, Trendelenburg and reverse Trendelenburg, automatic four-point self-leveling safety brakes, a one-touch pendant control and more.

Steris Corporation
Surgimax General Surgical Table
(800) 548-4873
www.steris.com
List price: $38,500
FYI: Steris's Surgimax General Surgical Table offers advanced patient posturing technology and excellent imaging capability along with clinical versatility, efficiency, ease-of-use, reliability and safety, says the company. Featuring an ergonomic, six-section tabletop with motorized back and leg sections and a finitely adjustable headrest, Surgimax enables patient positioning for the most demanding procedures.

Stryker Communications
Vertier Surgical Table
(972) 410-7100
www.stryker.com
List price: $61,132
FYI: Stryker's Vertier Surgical Table is raising the bar for imaging access, says the company. The six-section modular tabletop can be stacked for optimal access to the operative site, says the company. Sixteen inches of slide and an integrated X-ray cassette channel further accommodate both C-arm and traditional cassette trays. A concave base allows optimal access for surgical staff and imaging equipment. The table is compatible with Sidne Voice Activation and can be controlled via voice or touch panel.

Surgical Tables
MAX and EconMAX Series Tables
(888) 737-5044
www.surgicaltablesinc.com
List price: MAX Series, $7,000 to $25,000; EconMAX series, $11,900 to $13,250
FYI: Surgical Tables offers five tables that range in ability from fixed-height to five movements. The company describes its MAX series as the "high-end" table, offering as many as five movements. The EconMAX models, which offer two and three movements, are described as a value product offering a combination of quality, features and budget pricing.

Trumpf Medical Systems
Trumpf Mars II
(888) 474-9359
www.us.trumpf-med.com
List price: not disclosed
FYI: Trumpf's Mars II table features interchangeable components, including a full range of carbon fiber accessories which — along with its 9.8 inches of longitudinal slide, head-to-toe X-ray channel and 100 percent C-arm access — allow unrestricted intraoperative imaging, says the company. The Mars II handles patient weighing up to 800 pounds and allows for easy mobility, even at full capacity.