For the most part, C-Arm is a straight shooter compare to devices like Ultrasound. (have you seen how many different types of probes you can buy?) However, there are still few core features that not all C-Arms will come with.. especially on refurbished, older units. In this article, we’re going to go through most commonly found feature and try to figure out exactly what to look for.
It it very common for a sales rep to give you pages long list of product description as shown on right. Is your C-Arm so special that it needs 7 pages just for product description? Plus another two pages for three optional items? I tend to use summarized, shorter version of product description which usually fits in one page. Don’t get me wrong, if my sale is depend on length, I can produce a 20 pages long list detailing why my product is 13 pages better than the one shown on right.
Remember last time you were at a car dealership getting a new car? How did you feel when they brought in those long, 4~5 page attached yellow paper contract with tiny fonts? Did you feel like you’re in full understanding of all the terms since it’s all laid in front of you? Or did you feel like you’re barely floating on the sea of legal paperwork? I normally pretend to read them for a bit and then just sign them because I know (or hope) California lemon law and the other consumer law will protect me if something goes wrong.
Truth is, no one likes getting an endless pages of paperwork with 1,000’s of lines of description.
That’s why bloggers are nowadays using all these clip arts and pictures they can find. (Shown below) Sorry, it’s not because we just love googling for these clip arts.
Then, why do sales reps give you such a long description? [Future Article: Sales Rep]
Here are basic features you should be aware of and look for.
C-Arm Features [Popular choices]: What it is and how to choose
Tube [Stationary / Rotating]: Aka. X-ray Generator. Tube is like an engine. It produces X-ray in order for you to be able to see through body. Two choices you will get is Stationary and Rotating anode. Simply put Stationary anode is 4 cylinder engine and Rotating anode is V6, giving you more power.
What do I need? If you’re doing a pain injections and see many patients well above 200 lbs, you need Rotating anode in order to penetrate lateral shot. Don’t believe anyone that tells you their Stationary anode can penetrate as much as Rotating anode.
Image Intensifier [9 or 12 inch]: Aka. Glass or I.I. (Image Intensifier) is simply put a huge lens. This is essentially same lens as what you see on binocular or camera but a lot bigger. There are only handful of manufacturers that makes this and Toshiba is industry leader. Your choice is usually 9 or 12″. (diameter of I.I.)
What do I need? Unless you’re looking to do heart surgery with DSA functions, you probably won’t need 12″. Unless you have extra 15~20K to spend. While it is really nice to have huge I.I, it is after all the most expensive part of the system.
Monitor [Flat Screen or CRT]: This is really depend on what year your unit was manufactured. There are few companies who tries to put flat screen into old OEC models. Expect for those rare ones, most units manufactured before 2005-ish will have older style CRT monitors and most new units will have Flat Panel monitors. CRTs usually smaller and tend to provide soft image while new units come with dual 19″ monitors that produce sharp image. Keep in mind sharp image also means slightly more grainy/dusty and soft image means blurry image.
What do I need? You don’t really have choice on this and it will be decided based on your price range. I prefer Flat panel but I had a customer who were so used to CRT, he had to buy one to use with brand new unit instead of 19″ LCD it came with.
DSA [DSA, Road-mapping, Full Angiography or Vascular]: DSA package has few different components. Simple Digital Subtraction is used for diagnosing potential blockage. Road mapping is used to guide stent surgeries, and Full Vascular package includes all tools needed to do Angiography which typically uses to check arteries, vein and heart chambers.
What do I need? This is something I can’t help you with. If you are a doctor doing procedures utilizing these features, normally you can tell me exactly what kinds of features you need and I can find that unit or add optional features.
Printer [Thermal Printer, DICOM printer]: Many units are sold with a printer. Sony thermal printer is definitely the most popular printer I know. It’s reliable and prints a great square image you can file or give to your patient. DICOM printers are also popular because it prints controlled image with perfect ratio but it’s very expensive. ($5,000+)
What do I need? You can probably start with $700 Sony printer. You can also get bigger Sony printer if you’re not satisfied with small square images. But before you make your final decision on printer, read next feature.
Digital output [DICOM, Full Digital]: Many companies will advertise their units as full digital and it has DICOM output. [Article: DICOM and PACS and EMR… and etc] But units with DICOM doesn’t always mean it’s a full digital unit. A full digital unit should be able to produce digital output to file export and to any digital printer. Ask if the C-Arm can produce JPEG, GIF, and DICOM files. And whether if printer uses Digital/USB input or Analog/BNC input? If you have a truly full digital unit with PC capabilities, you can probably even use office HP printer to print your images.
What do I need? This is a careful decision. Since most clinics are required to maintain some sort of EMR system, you’ll want to make sure your C-Arm can communicate with your system somehow. And most EMR system does not comes with DICOM server and most C-Arms only comes with DICOM client software. I prefer having different options and ways to exporting/printing my images but this is a judgement call really.
Laser pointer: Some people must have laser point installed on their C-Arm. But most doctors would go by without knowing laser pointer is even an option. These simple device adds laser cross-hairs that’s visible within the field of view. In most cases, this feature is only useful in first few times of using a new unit until you get used to where the center point of the unit is. It’s an expensive option that does very little. (Usually $800 and up)
What do I need? If you ask me, I’ll always tell you ‘You probably don’t need one’.
Terms you should be able to ignore
ABC/Auto dose – Aka. Automatic Brightness Control or Automatic Power Control. You can ignore these because most units built-in past 20 years have this feature. Yet you’ll see people talk about this all the time.
Light weight, compact – Most C-Arm are built-in very similar way. We use these term as a marketing tool more than to point out practical differences. z7 unit’s base is about 5 inches shorter than OEC units which makes it more ‘compact’. But would you make a decision because it gives your OR 5 inch of extra breathing room?
Low dose / Pulse mode – Most units built within last 10 years have some sort of pulse mode. Pulse mode automatically reduces the amount of radiation and new II and tube is designed to use less radiation and leak less. But between model to model built on the similar era, there really isn’t much of difference. And amount of X-ray required to get a nice image hasn’t really changed either. Simple fact is more radiation = better image.
Switches – Most popular switches are Foot switch and Hand switch. I would not worry about these since most units come with both. There are third-party company that produces wireless switch for OECs if you have extra few hundreds to spend.
Misc terms you can ignore (because they all have it): Horizontal slide/Super slide, Boost, Triple mode zoom, 1Kx1K CCD (except for really old units)…
There you have it. I hope this was helpful to understand how to choose between different options. And if you ever get those 20 pages long quotation, try asking for a short, summarized quotation instead. Trust me, they all got one.
Questions or comments? Look below!