Mobile or Fixed C-Arms for Interventional Programs?

When a doctor or hospital decides they are ready to build or grow an interventional program, they must decide how they are going to equip their labs. At the center of these labs is the medical imaging system – the X-ray system – that serves as the eyes of the physician during interventional procedures. Medical imaging systems then are the foundation of a lab and the decision on which system and which technology to acquire is critical.

These imaging systems are often called a C-arm. This is because they connect an X-ray source (an X-ray tube) and an X-ray detector using an arm that is shaped like a “C.” This C-shaped design allows a physician to move the system with more freedom to take images where they are needed with the best angulation. The C-arm is used to visualize a patient’s anatomy, providing real-time imaging that is particularly useful for guiding various diagnostic and interventional procedures.

C-arms have become commonplace since their introduction in the1950s. But that doesn’t mean the technology has remained the same. Far from it. Modern, innovative C-arms are designed with state-of-the-art technology and can provide benefits beyond superior imaging.

However, not all C-arms are the same. Many C-arms are designed as mobile C-Arms. Mobile C-arms are just that – mobile. A mobile C-arm is smaller than a fixed C-arm and is built on wheels for maneuverability. That maneuverability also increases their flexibility in being used by different modalities and procedures. This can be good or bad, depending on which program the mobile C-arm is primarily intended for. Their compact design also saves space, but should space be a primary factor in patient care? What mobile C-arms commonly lack is the more powerful X-ray generator, higher quality imaging, and the larger field of view (FOV) of full-size systems. This can be a real issue for programs with, or planning for, heavier caseloads or for procedures requiring the highest image quality.

Fixed C-arm systems generally have more powerful X-ray generators, larger and higher quality monitors, and a variety of technological features that smaller mobile C-arms cannot provide. One of these advanced technologies is the image processor that detects and transforms the X-rays into an image the physician can view on the display monitors. The image processors and image quality on a fixed C-arm tend to be much more advanced and of higher quality than those available on the lower technology mobile C-arms.

An important feature of many fixed C-arms is the ability to precisely adjust the source-to-image distance (SID). This is accomplished with an adjustable image receiver that can be moved closer to the patient as needed. By decreasing the distance from the source of radiation to the image receptor, the amount of scatter radiation to the physician and staff can be reduced. Mobile C-arms do not have an adjustable SID. The distance between the radiation source and the image receiver is fixed. Therefore, mobile C-arms do not allow for optimal scatter radiation protection.

A critical technology that is typically more advanced on fixed C-arms is collimation. C-arms – either mobile or fixed – use collimation to limit, or focus, the X-ray beam to a targeted region of interest (ROI). The purpose of collimation is to reduce the radiation dose reaching the patient and the scatter radiation to the staff.

But is all collimation the same? The fixed C-arms from Omega Medical Imaging go beyond a single collimator to include an automatic ultra-fast secondary collimator. This secondary collimator is unique in that it is controlled by artificial intelligence (AI). This provides hands-free radiation safety that goes beyond filtering and completely blocks radiation outside of the ROI.

Mobile C-arms are often thought to be the choice for lower radiation dose in C-arms. After all, they use a less powerful X-ray generator. But does that really mean that there is a lower dose when compared to fixed C-arms?

A study published in Digestive Endoscopy compared the performance of two fluoroscopy systems: a mobile C-arm and a fixed C-arm from Omega – the E-View.AI. In addition to using advanced collimation, the Omega system includes unique lead shielding protection on the flat panel detector and the below the table that greatly reduces scatter radiation exposure to the staff during procedures. This study conclusively showed that the AI-enabled ROI fluoroscopy system from Omega significantly reduced radiation exposure to patients and scatter effect to staff.

A study presented to The American Journal of Gastroenterology (ASG) evaluated the utility of AI-enabled ROI fluoroscopy technology (again, from Omega) to minimize radiation exposure during image-guided procedures. The results of the study conclusively showed that AI-enabled fluoroscopy significantly reduced radiation exposure to patients and scatter effect to physicians and staff. The dose area product (DAP) was 61.8% lower (2,178 vs 5,708 mGym2) while the scatter radiation to staff was 59.4% lower 0.28 vs 0.69 mSv) using AI-enabled systems compared to non-AI systems.

The advantage of using AI technology in a fixed C-arm during interventional procedures is clear – superior image quality with lower radiation exposure to the patient, physician, and staff. AI provides an automatic, hand-free solution to radiation reduction that delivers the benefit of consistent and repeatable results beyond what conventional non-AI systems can provide – either fixed or mobile. And it does so all while providing superior image quality with no change in existing workflow.

The decision on which imaging technology to purchase – either mobile or fixed C-Arms – is one with many factors. A doctor or hospital must first decide what level of program they intend to build. Will they perform advanced procedures that require the best imaging quality? Will they have a dedicated room for their program? Will they have the caseload that could overwhelm a smaller, less powerful system? And finally, are the proven results in radiation safety as provided by AI-enabled ROI technology something that they want for themselves and their patients?

Each doctor or hospital must answer these questions for themselves. Mobile C-arms are effective tools when used for procedures and facilities that best suit what they offer. Fixed C-arms are larger, more powerful systems that deliver superior imaging and functionality.

But even with fixed C-arms – there is a cut above. The fixed C-arms designed and built by Omega utilize advanced AI-enabled ROI technology that delivers the ultimate radiation protection for everyone in the room – patient, physician, and staff – using fluoro or cine methods of acquisition. This radiation reduction is proven, and it goes beyond anything else in use today. Omega can do this while delivering spectacular image quality inside and out of the ROI.

Omega has created a new standard of care – one that obsoletes all systems without this technology, whether they are mobile or fixed C-arms.

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