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The Role of Real-Time Intraoperative Imaging
Efficiency and accessibility were an unexpected focus of our imaging upgrade.
Pamela Barnett
Publish Date: November 3, 2015   |  Tags:   Surgical Video and Imaging
newer C-arm model SITE IN SIGHT An improvement in image clarity isn't the only advantage that newer C-arm models offer.

Our surgeons rely on intraoperative imaging to perform procedures safely, improve the quality of patient care and deliver the best possible outcomes. But when our hospital purchased 2 C-arms to replace our existing equipment a couple of years ago, we saw benefits to our surgical throughput as well.

Fluoroscopic imaging has proven to be a particularly versatile method of real-time observation. Our surgeons have found uses for a C-arm not just during orthopedic procedures and fracture care, but also in urology cases, to get the big picture on the bladder or kidney, cardiovascular assessments and repairs, and occasionally general and abdominal surgeries. Intraoperative image guidance can benefit both physicians and patients. For surgeons, it helps to locate and target anatomical structures, minimize incisions, view the progress of techniques and implant placement, and confirm the completion of the intended tasks. For patients, procedures conducted through smaller incisions tend to be shorter, with a reduced risk of infection or complications, less post-op pain and accelerated recovery.

Time to upgrade
The usable life span of a C-arm is about 10 to 15 years, after which you might start hearing physicians' complaints about the imaging equipment's failing sight. That's what led us to consider upgrading our well-used C-arm in 2013. They would attempt to use it during a case, only to complain that the images it captured were too dark or they faded out over time, and that they weren't seeing what they wanted to see.

These degraded images began to create throughput problems for us. Because our hospital only owned one C-arm, we already had to schedule cases that required the equipment — ?and there were more and more of them — back to back instead of simultaneously, which was hardly an efficient use of our ORs. Now, surgeons who were unlucky enough to schedule their cases on days when the C-arm wasn't up to par, which slowed down cases, saw the resulting bottlenecks delay their cases. While some cases could be sent to the radiology procedure room for imaging, open bone cases needed an OR, and we weren't inclined to inconvenience patients by transferring them to another facility. Time is always money, and we were burning it while waiting for C-arms in our rooms.

Advanced abilities
It's entirely possible that the most exciting part of an equipment upgrade is discovering all the innovations on the models you're trialing that didn't even exist when you bought your current workhorse.

When we set out to replace our aging C-arm with 2 new ones, we were chiefly interested in something that would deliver nice, clear images. But as it turned out, it was IT capabilities that really attracted our ortho docs to the C-arms we ended up buying. Their ability to download fluoroscopic images through a direct connection to our hospital's network means not only that we don't have to print photos or film anymore, but also that pictures and videos from the operation are accessible on physicians' tablet and laptop computers from the OR or their offices. That connectivity, along with foot-pedal controls that let physicians shoot the images themselves at the exact moment they want to capture, makes for an impressive improvement in medical records and patient education.

We chose one of the 2 C-arms specifically for its ability to serve vascular cases. It includes a pulsed fluoroscopy feature that creates cine runs, a rapid-fire series of images that enable a physician who's injected contrast dye to observe it flowing through a patient's vessels, then replay the sequence as many times as necessary. Our vascular surgeon, who we thought was going to be biggest hurdle to clear when selecting suitable C-arms, was sold after he saw the cine runs.

Some newer C-arm models can also improve the quality of the images they provide. They offer settings that program a system to distinguish different densities of anatomical structures in its imaging data — such as bone and soft tissue — and enhance the contrast between them in order to emphasize the details that physicians want to see. They also let you narrow the visual field in order to selectively focus the imaging on (and reduce the radiation around) a hard-to-view area.


What to look for
Your surgeons will want to test-drive their preferred C-arm options for 2 weeks to 30 days of surgery, but a trial period can show you a lot of things. Don't neglect your surgical staff's comments when you're collecting evaluation notes. Is the equipment easy to set up and turn on? How long does it take before it's ready for use? Keep in mind that a C-arm is a big piece of machinery, and can be unwieldy to transport to a case. Is it maneuverable around your facility, by your nurses and techs?

Cost is an important consideration, of course, but a manufacturer's service is critical when it comes to C-arms. A rep who's present during trials to in-service your surgeons and staff before and during procedures, who's accommodating and open to your questions, who's willing to address the potential obstacles noted in evaluations, in short, a rep who's dedicated to customers, goes a long way toward ensuring you'll be able to count on the technology you need when you need it.