See What's New in C-arms

C-arm technology has improved by leaps and bounds in recent years with compact mobile units producing images that rival the quality of those produced by higher-end, fixed room platforms, according to Gregory C. Jett, BSRT, president of Creative Surgical Solutions in Panama City, Fla. Here are just a few of the advanced imaging capabilities and user-friendly features found on the latest C-arms.

• Improved imaging. Flat-panel CMOS image detectors use low-dose radiation to capture pictures of incredible quality. The detectors also allow surgeons to magnify images without losing clarity or increasing the radiation dose, points out Mr. Jett. Newer systems let surgeons zero in on small anatomical landmarks and display captured images on large 4K monitors with advanced clarity.

Surgeons can review the high-resolution images without diverting their attention from the patient. The ability of newer machines to capture intermittent images instead of a continual stream of pictures lets surgeons obtain usable views with the minimum effective radiation dose.

• Ease of use. Flat-panel image detectors let surgeons work with more freedom of movement within the sterile field. The overall footprint of the latest C-arms is smaller, meaning the units take up less valuable real estate in outpatient ORs, where more complex cases requiring the advanced imaging technology are being performed.

Improved motorized mechanisms allow for pinpoint control when maneuvering the C-arm into position. Smart anti-collision features alert staff if the arm is in danger of coming into contact with the table — or, worse, the patient — and shut down the unit if it's moved any closer.

Mr. Jett says the latest C-arms have user-friendly touchscreen controls, which make programing settings during set-up between cases as intuitive as calling up a Netflix show on your tablet. He points out that anatomic- and procedure-specific profiles let you calibrate C-arms for cases with the push of a button. The profiles change the entire scale of the captured images and adjust contrast brightness to optimize the unit for abdominal, pediatric or extremity surgeries. The settings also automatically adjust the radiation dose, differentiating between the amount needed to capture images during extremity surgeries and major spine procedures.

Surgeons can set the arm to an exact position, save the position and return the arm to within a few millimeters of it.

Mr. Jett points to "position save and recall" features as key recent advances in C-arm design. "Surgeons can set the arm to an exact position, save the position and return the arm to within a few millimeters of it with the push of a button at any time during the procedure," he says. "That reduces the need to capture a series of images or constantly reposition the arm to achieve the original desired image or viewing angle."

• Cooling systems. C-arms are imaging workhorses, cranking away for hours at a time to capture needed anatomical views. Overheating can be an issue, especially during grueling orthopedic or spine cases. When C-arms go offline, the procedure grinds to a halt until a tech retrieves a replacement machine or the unit cools off. Neither option is desirable — surgeons grow frustrated and patients are anesthetized longer than they should be.

Some C-arms employ a fan and heat sink set-up to keep units cool during procedures. Others use cooling coils to draw heat away from the generator and imaging tube. "Perhaps the best option is an advanced liquid cooling system, which maintains a constant circulation of fluid through the imaging tube and a cooling reservoir," says Mr. Jett. "C-arms outfitted with this high-tech cooling system can run for hours at a time without overheating."

• Image management. Advanced software systems on newer machines capture digital images for storing or for sending to electronic medical records or picture archiving and communication systems (PACS) through a secured network.

Faster image processing and the ability to manipulate images at the tableside help surgeons gauge the effectiveness of the procedure in real time and make needed adjustments on the fly.

Surgeons can confirm that surgical screws and implants have been optimally placed, possibly eliminating the need for a revision surgery.

• Seeing in 3D. Capturing 3D images of targeted anatomy has yet to be clinically proven to improve overall surgical outcomes, but Richard Yoon, MD, believes the imaging technology can help surgeons better reduce distal radial joint fractures. "We know we're not perfect in getting that right, and we're trying to get better," says Dr. Yoon, the director of the division of orthopaedic trauma and adult reconstruction at Jersey City (N.J.) Medical Center. "I think that's where 3D C-arms have an application."

The field of view afforded by 3D C-arms — and not possible with conventional fluoroscopy — lets surgeons achieve the axial cut, which helps them reduce the tibia or make sure the reduction is properly placed during repairs of tibial plateau fractures," adds Dr. Yoon.

Current suture management systems used during fracture repairs are designed to help surgeons achieve bone reduction and syndesmosis in an optimal spot, according to Dr. Yoon. He says clinical studies showing the efficacy of these systems were completed using post-op CT scans and believes 3D imaging could further enhance outcomes.

"It would let surgeons check to make sure syndesmosis is perfect in the OR, a benefit that would enhance outcomes," says Dr. Yoon. "That's one area where I feel the C-arms can clearly help surgeons improve how they perform surgery." OSM