The marriage of technology with technique

EHM asked Delton Hyatt and Anthony Anderson of Ziehm Imaging how mobile c-arms capabilities are affecting the operating room.

As mobile c-arms capabilities expand to complement traditional imaging modalities, there are four major trends emerging in the surgical arena: multi-modality c-arms, incorporating imaging intelligence into the operating room, dose reduction, and the marriage of technology with technique.

Digital technology in fixed imaging rooms has allowed for interventional examinations, computed tomography (CT) and software based navigation or planning tools. We know these are state of the art but sometimes so far removed that surgeons are unable to fully benefit from these tools. By integrating these software tools within the c-arm itself, the system can be used in real time if, and when, required. These systems can now be provided in a cost effective enough perspective that they can then be considered ‘standby’ resources.

The Vario 3D’s compact design, which integrates routine 2D imaging with advanced isocentric 3-D imaging exemplifies the concept of a multi-modality c-arm. By providing these capabilities in a c-arm, interoperative imaging intelligence allows for immediate analysis of the procedure where traditionally, pre- and post-operative CT scans performed in a separate fixed room would be required to complete analysis. Integrating the display of traditional c-arm imaging alongside imaging from other modalities, such as endoscopy, is another example of this trend.

Flat panel detectors (FPDs) also have a history of proven effectiveness in fixed-imaging modalities. FDPs are digital devices that are unaffected by noise sources, such as magnetic fields, that affect traditional analog acquisition methods. This allows the medical personnel to utilize comparison tools across multiple modalities since the potential for accurate templating and calibrations is favorable. Surgeons also are able to visualize a greater dynamic range, which brings forth soft tissue visualization – possibly ventricles, structures in the nervous system, and musculature.

Flexible data management

The old ‘one size fits all’ hardware interface approach has given way to intuitive, customizable software user interfaces that improve workflow while providing intelligent image handling and cost savings. Ziehm ., has, and is continuing to re-configure our basic electronic hardware and software platforms that to allow flexible data management while minimizing obsolescence and improving upgradeability. This technology allows for seamless communication with hospital imaging networks such as the transfer of a wide range of images, including those images from other modalities to and from the c-arm.

As a fundamental basis for our product development, understanding the relationship of radiation dosage to patient and practitioner safety is a priority. Advancements in image processing technologies allow optimum image acquisition at lower dose. Other features such as virtual collimation reduces beam size while digital image rotation and laser guidance allows for positioning without radiation. Our Object Detected Dose Control (ODDC) automatically adjusts the pulse rate according to the amount of motion in subject anatomy – no one else does that. All of these methods contribute to lower dose to patient and staff, and since we have more tools available on the c-arm, like multiple exposure 3D, we want to make sure the dose is fine tuned to the lowest amount possible for any given procedure. This leads to the requirement for better techniques.

Marriage of technology to technique is a clear need in our industry. Many users have been trained to use older technology and the simplicity it appears to offer. However, the best use of low dose technology really is a balance of procedure and equipment. We believe that balance can be achieved through the fundamental collaboration in clinical research, working with other suppliers to the OR and being able to train users in a low risk but realistic environment. To help achieve that end, we recently opened the new Ziehm Academy based out of Spartanburg, South Carolina. It consists of a full learning and research lab and it serves as a clinical testing center for partnerships and integration of other OR products.

Delton Hyatt is the CEO of Ziehm Imaging Inc. with 25 years experience developing fast growth high tech companies.

Anthony Anderson, Director of Clinical Development and Training at Ziehm Imaging, has 17 years experience in the OR and has written a number of books and papers on the proper use of C-arms for different procedures.