Archive Hot Technology 2016

3D C-arms Transform the OR

The benefits of capturing CT-like images during surgery.

Joshua Gary, MD


3D C-arm 3D IMAGING Dr. Gary uses a 3D C-arm to intraoperatively evaluate the reduction of the fracture and the screw placement.

Are the pedicle screws precisely inserted? Is the ankle fracture perfectly aligned? Before the arrival of 3D C-arms, surgeons couldn't verify that the implant was sitting in the anatomically correct position or validate that the fracture was optimally reduced without using a separate O-arm or waking the patient and wheeling him to the radiology lab for a scan. But thanks to intraoperative 3D imaging provided by a standard C-arm, I can be certain that the screws and the bones are positioned exactly as they should be — while the patient is still in the room. In 2 minutes, our fluoroscopy tech rotates the C-arm around the patient, capturing CT-like images of our handiwork that spin in 3 planes — axial, sagittal and coronal — on the flat-screen monitor.

This is a tremendous leap forward in surgical imaging. Because I don't have to wait for the results of a post-operative CT scan, I can make a correction, if necessary, intraoperatively instead of scheduling a revision surgery or accepting a suboptimal reduction to avoid a second anesthesia. Nothing lets surgeons control the radiographic outcome of their intervention and check the results of their surgical technique like an intraoperative 3D scan.

As an orthopedic trauma surgeon at the University of Texas Health Science Center at Houston, I've been using a 3D C-arm for a little more than a year. A 3-dimensional device is best suited for intraoperative use in orthopedic and spine surgery, as well as trauma cases, when precise imaging and perfect visualization matter most.

Clinical utility
In trauma and orthopedic surgery, the precise identification and reduction of fractures and the accurate placement of implants is often critical to clinical outcomes. Several studies have demonstrated that CT scans are superior to 2D imaging for detection of malreduction and malposition of implants. Malpositioning of spinal implants can have devastating consequences, including paralysis or damage to great vessels, including the aorta.

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