When a hospital is looking to purchase a new mobile C-arm, it can be a challenging experience, especially since cutting costs and improving outcomes is governing their decisions. Mobile C-arms with flat-panel detectors can cost between $280,000 and $300,000, and those with image intensifiers can be between $120,000 and $170,000, according to MD Buyline. There are many features to choose from and the issue of radiation dose must be kept in mind. The service that comes along with the system is also something important to think about.

Many vendors, including GE Healthcare and Siemens Healthcare, aim to be a complete solution for all of a hospital’s needs. Gustavo Perez-Fernandez, the president of surgery at GE, and Lisa Reid, director of the surgery and urology segments at Siemens Healthcare, spoke with HealthCare Business News about the questions a hospital should keep in mind when purchasing a new C-arm.

HCB News: When a hospital is purchasing a new C-arm, what questions must be asked?
GPF: That really depends on the specific clinical needs and financial situation of the facility. Once you gather that information, you can analyze the individual needs and challenges of the customer, and provide options to satisfy what’s needed. We believe that hospitals should not invest in technology for the sake of technology, especially when certain functionality and features are not needed. At GE, our team is composed of registered radiology technologists that understand our customers’ needs and can help them determine the best solution. We consider factors like the number of operating rooms they have to accommodate, the volume and diversity of cases and budget. Based on all of that information, we build a tailored solution for the hospital.

LR: When you look at C-arms, most companies have over three different models. While they all pretty much do the same things, of course, some perform different procedures better. One of the things I would think would be important is what types of surgery procedures they are doing. If it’s mostly orthopedic types of procedures, then they should consider a smaller C-arm. You don’t quite need as much power because you’re not X-raying soft tissue. If they are doing a lot of vascular, gastrointestinal and urology procedures then they might want a bigger, more powerful type of C-arm. They should make sure that they are getting the right kind of C-arms for the procedures they are performing.

HCB News: What are some ways a hospital can cut costs when purchasing a new C-arm?
GPF: On one side, it’s ensuring that they have enough versatility in the solutions they are looking to purchase to satisfy the specific clinical task, but it’s also important to make sure the technology accommodates their case mix. By encouraging them to take a close look at their broad mix of cases, it’s important to ensure a level of standardization exists that allows the hospital to achieve economies of scale on supporting the infrastructure. Examples of that include training for the technologists, the cost of running the operation and familiarity with the ergonomics. The two areas that we think hospitals should look at are having solutions that are versatile, but also achieving a level of standardization within their flee
LR: Once they have decided what their procedure mix is, they should diversify the fleet. We sell image intensifier systems, which are a little less expensive and a little less powerful, all the way up to high-end flat panel and vascular systems. They should look at how many of the different types of procedures they are doing, and then purchase different types of systems, so they can utilize them appropriately and then save money by purchasing some lower-cost C-arms.

If they are evaluating whether they need 3-D imaging in the operating room, they should consider looking at 3-D C-arms if they are looking to save money, not necessarily going with a [mobile] CT. Depending on the procedure mix and how many procedures they are doing, sometimes a 3-D C-arm might be perfectly suitable for what they need.

HCB News: How is the technology that mitigates dose concerns evolving?
GPF: We should not be looking at dose alone — it’s really an image quality/dose equation. We believe that the answer is a combination of an optimized image chain and enabling users to achieve the expertise required to make full use of it. The answer is not simply to add more raw power. We truly believe that the right answer is to achieve a balanced image quality/ dose equation. We are investing in a number of technologies around next-generation, low-dose flat panel detectors that will provide our customers with the high image quality they have come to expect. Ultimately, it’s not just about technology, but rather having clinically relevant technology in combination with the users’ expertise that will deliver on the promise of better image quality at low dose.


LR: I think the companies are moving toward more pulse fluoroscopy instead of continuous fluoroscopy, and that can significantly decrease the dose. They are also offering a lot of features like radiation-free collimation — being able to collimate off the last image that they have acquired — and newer algorithms and filters that can help reduce dose, but maintain image quality.

HCB News: What are the essential Carm features that a hospital on a budget should spend the extra money on?
GPF: I have a broad definition of “features.” There are “product features” that allow the surgeons to be more efficient at their jobs — aspects such as image quality, dose management and system reliability, all of which are critical for a clinician to accomplish that efficiency.

LR: I know more hospitals are looking at doing minimally-invasive vascular procedures, which have their own set of needs. If these are the types of procedures they are doing, then flat-panel detectors are one of the things they should definitely consider. It is a little bit more cost, but the flat-panel detector systems give better image quality and they have better gray scale, so that when they are doing vascular procedures, they can better visualize the catheter and guidewires.

Also, these types of systems can be backups to hybrid operating rooms or any type of fixed fluoroscopy room. This saves money as well, if you’re thinking about whether you need another angiography lab and how much you’ll be able to accommodate it. If they have some overflow of patients then maybe they can just use a vascular flat-panel detector system to accommodate those studies.