Archive January 2020 XXI, No. 1

Thinking of Buying... Mini C-arms

Here's what to look for in a portable fluoroscopic system.

Gregory Jett

Gregory Jett, BSRT

BIO

A mini C-arm can literally run circles around a full-size C-arm, as if the fixed model was standing still, which, of course, it is.

Mini C-arms don't require a fixed residency in a dedicated room, so you can easily roll them into the OR for on-the-go, on-demand intraoperative imaging. Now, a mini C-arm can't do all the things a fixed C-arm can do. Mini Cs are designed especially for extremity imaging — hands, feet, ankles, wrists, knees, elbows — not to image the torso or the thigh of a 5-foot-5, 350-pound patient. With their smaller arcs and lower power dose, mini Cs can't accomodate or penetrate dense anatomy. Here's what else you should you know about portable fluoroscopes:

  • Cost. Mini C-arms generally cost between $60,000 and $90,000. But those aren't the only costs you need to consider. What accessories will you need, and how much will they cost? Accessories could be a laser light, a stand for an accompanying remote control or tablet, wireless foot pedals and so on. How much will service cost? Will you need to upgrade your network or electrical system? Do your surgeons want a printer, USB storage, a CD burner? As with all capital purchases, ask around, and get references from your sales reps to see what other facilities think of each machine you're considering.
  • Flat-panel detector or image intensifier? Most mini C-arms are equipped with a flat-panel detector (FPD), which produces much better images than the previous generation of products that featured CCD cameras, known as "X-ray image intensifiers." While more expensive than CCD, flat-panel technology produces a larger field of vision and eliminates distortion; you retain true resolution and clarity even when you magnify the image. Another FPD benefit: They don't hinder the surgeon's access to the patient (surgeons typically must move around a large, bulky image intensifier).
  • Positioning. Horizontal, vertical, swivel movements — what is the mini C capable of doing to image hard-to-reach areas? How intricately can you adjust the C-arm's position? You can look at specs, but your clinicians should get to know the C-arm's positioning capabilities intimately during a demo or trial.
  • Ease of use. This is vital. Will the machine facilitate better outcomes and reduce surgical time? In other words, how will a particular mini C-arm fit into your workflow? That goes for everyone's workflow — surgeons, nurses, techs, radiographers. You want a system that's intuitive. How many button pushes does it take to do something? On one device, it might take 10; on another, just 2. Get feedback from your radiographer on how easy or difficult the machine is to use during the trialing.
  • Trialing. Most vendors will happily give you a week or more to try out their mini C-arms. With this kind of product, consult your surgeons and radiographers. How does it fit in their hands? How's the image quality, the user interface? What did they think about the operation and features? Be careful though, especially if you have rotating techs or people who are not surgical specialists. Don't make a decision based on what your techs or radiographers are comfortable with, because it's evolving all the time. Often, when you ask a radiographer what they want to use, they'll say, "What I've always used." A skilled radiographer could master any mini C-arm in a couple days.
  • Electrical issues. Here's something even some vendor reps forget to consider: Is your OR's electrical system capable of accommodating a mini C-arm? Does your OR meet the power requirements? But there's another factor to think about: the "cleanliness" of your power. Are there fluctuations in voltage when the AC or an autoclave turns on, or when all the lights are on? Drops and spikes in voltage can cause problems with your mini C-arm's performance. I've seen it become a big problem.
  • Cooling. Simply put, you do not want your mini C-arm to overheat during a procedure. If you're performing very demanding, longer procedures, this is a particularly important aspect of any product. These systems need to have sufficient cooling capabilities; some do, some don't. Demand to see a product's specifications to find out.
  • Image storage. You'll be taking a good amount of pictures and video with your mini C-arm. Where are you going to store them? The first thing you should examine is how many images you can store on the device itself. Could you store a week's worth, a month's worth, a year's worth? Originally, mini C-arms could write to CDs, but like the rest of the computing world, there's been a strong move away from CD to USB storage. If you're going to be sending images to PACS after every case, or you just want to print images, storage capacity on the C-arm itself is not much of a concern. The last thing you want to do is lose critical data. I've seen customers compromise by not spending the additional money on onboard storage because they want a super high-end mini C-arm.
  • Networking and integration. Will you be sending images from the mini C-arm over your network to PACS, either wirelessly or hard-wired? Do you have the bandwidth and connectivity necessary to achieve that, or will you need to upgrade? Does the C-arm integrate well with your network? Find out.
  • Service. These products are rugged and tough, but they need TLC, too. I'd say on average they last 5 to 7 years, but I've seen perfectly operational C-arms in the field that are 15 years old or more. You want to keep the devices well-maintained, with preventive maintenance performed at least once a year. You also want a reliable partner for when things go awry. This is where different vendors set themselves apart in terms of responsiveness and reliability. Beyond the standard manufacturer warranty, I'd recommend purchasing at least 5 years of additional service that picks up after the warranty expires. You can negotiate much better pricing for extended service if you do that up front. OSM
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