At our recent vendor fair, tops on our shopping list was an image-guided surgery system. We only needed the system for ENT sinus cases, which greatly simplified the selection process - it's easier to please two doctors than a group of mixed-specialty surgeons. Even then, we had a hard time deciding between three machines. Here are the lessons we learned in shopping for our navigated ENT system.

1. Get surgeons' input first. There's nothing worse than spending a lot of money for a piece of equipment that subsequently isn't used because surgeons aren't comfortable with the machine. That's why you need to ask the physicians what they want in an IGS system, what they know about the systems and what they're willing to try. You could go through a lot of research just to find out they aren't willing to have an open mind about the system you, the administrator, think would work best in your facility from technology and cost standpoints. If your surgeons are not very familiar with a particular system, education and training from the vendor will be an important part of the package.

2. Check your budget options. What is the budget going to allow? Don't bring in something to try that's beyond the budget - it will only frustrate everyone. If you're worried about huge capital outlays, some companies offer flexible financing and fee-per-use options that can ease the budget strain in the short term. However, that makes it imperative that you get a firm handle on the so-called hidden costs, such as the price of disposable instruments, face masks, probes, CDs and batteries. Cost per case could go up significantly if you don't evaluate what's really needed.

Also look for the cost advantages of the system so you can present these as well. You should factor out the coding and reimbursements you'll receive for procedures performed with the IGS system so you know how many procedures you need to perform to break even.

3. Consider growth. There are three types of IGS systems: ortho, neuro and ENT, though many have the ability to add software so you can use one machine for various specialties. If you think you might need to diversify specialties later, check with the manufacturers on their systems' modular abilities.

Another factor: How will the CAT scans interface with the system you choose? Our ENT group does the CAT scans in its office and sends the CDs over to our center before surgery.

This is where the importance of trialing the equipment became clear. Each of the three machines we looked at got a one-month trial in our center. During each, both ENT surgeons used the IGS systems, then evaluated the pros and cons of each system (my primary job was to research expenses and analyze case costs). During the trial, we found that one of the systems wouldn't properly display the CAT scans from the office when brought up on the system. No matter how we fiddled, we couldn't see the top of the head on the CAT scan. Sure, we could have the company come in and try to figure out a fix, but it's not the kind of thing you want to run into later.

4. Designate users. As far as your clinical staff is concerned, it's helpful to have a few key people on the staff be the primary scrubs and circulators for these cases - both while the IGS system is on trial and after its purchase. The case volume of navigated procedures may not be very high, so keeping all staff competent on and comfortable with the system isn't feasible. General in-servicing for all the staff with the sales rep is necessary for general understanding, but surgeon-specific and equipment-specific preferences are better handled with a smaller group.

5. Have a deal-winner. Instead of looking for deal-breakers, we looked for a manufacturer to win our business. As a result, the factor that ultimately influenced the decision process was the service. During our trial, the sales rep of the system we eventually chose was honest, open and easy to work with. He was available via phone and e-mail, and at our center at 6 a.m. if needed. Ongoing support is essential when using technical equipment such as this, and he went above and beyond, also providing on-site training and education with the purchase.

A computer cart with ergonomics in mind
The new StyleView Cart is a computer workstation designed to bring mobile, easily adjustable data entry to the healthcare setting, says Ergotron, the manufacturer. Designed with input from nurses and healthcare IT professionals, the StyleView Cart has an 18-inch caster footprint, and is easy to move, the company says, because of dual casters that move on carpet, hard floors and over thresholds. Proprietary Constant Force technology lets you adjust the workstation 20 inches up or down with one-touch vertical movement, helping to ensure comfortable ergonomic data entry. The CF technology permits the use of any size monitor up to 25 pounds; the workstation is available in flat panel, laptop or tablet PC versions. The cart has an oversized work area for charts, IV bags and medications. Price is $1,650 to $3,625, depending on the version and power options. Call (800) 888-8458, visit styleview.ergotron.com, or Circle 166 on your Reader Service Card for more information.

New option for difficult airways
The DCI Video Intubation System might make performing visually controlled airway intubations easier because it allows for direct coupling of the imaging camera to the optical system of the endoscope. The result: clearer images with unobstructed lines of sight and magnification of the patient's anatomy, which let anesthesiologists more easily intubate around abnormalities and difficult pathologies, according to Karl Storz Endoscopy America, the system's manufacturer. The DCI components are available in flexible intubation fiberscopes, semi-rigid optical stylets and the new video laryngoscopes. All components are interchangeable, allowing for easy assembly and enhanced interchangeability. A simple snap-on/snap-off video camera lets you change quickly between laryngoscopes and flexible or semi-rigid fiberscopes. The company would not give a price. Call (800) 421-0837, visit www.karlstorz.com, or Circle 167 on your Reader Service Card for more information.