Three steps
to the perfect
vascular image

Proper radiation exposure protection

In addi­tion to a ceiling-mounted expo­sure pro­tec­tion panel made of lead acrylic, the ideal pro­tec­tion for person­nel requires radi­a­tion pro­tec­tion attached below the table. The OR staff should wear not only the classic expo­sure pro­tec­tion vests and gowns, but also pro­tec­tive glasses or visors in addi­tion to special gloves and hoods.

The proper operating table

A floating, X-ray trans­lucent, carbon table ele­ment is ideal. With just one hand, the patient can be brought into the best posi­tion with respect to the C‑arm in all four direc­tions. The table top can also be imaged with­out creating any arti­facts.

Optimized system usability

There are two con­trol modules that enable the physi­cian to steer all func­tions of the C-arm. One is a touch­screen that oper­ates the whole system. The other is a joy­stick that con­trols the motor­ization. Both control modules can be mounted in the sterile field — either on the table or on a special trolley. The wire­less foot­switch can be placed within easy reach of the oper­ator, enabling intu­i­tive and customizable use.

Positioning the system properly

The C‑arm should be posi­tioned opposite the sur­geon to ensure opti­mum free­dom of move­ment. To reduce scatter radia­tion and maxi­mize the field of view (FOV), the patient should be posi­tioned as close to the detec­tor as possible.

Accurate system positioning

The laser can be used to set the region of interest (ROI) with­out expo­sure, so the C‑arm can be posi­tioned ideally and quickly, with­out addi­tional dose. The table top floats, so the sys­tem doesn’t have to be moved. With the assis­tance of col­li­ma­tors along the course of the blood vessel, the smallest pos­si­ble radia­tion field is displayed.

Using the Anatomical Marking Tool (AMT)

The AMT makes it easy to save mark­ings and notes onto the live images: e.g. left/right side mark­ing, draw­ings of blood vessels, ana­tom­ical land­marks or implant posi­tions. This also makes the use of a con­trast agent unnecessary.

Intuitive workflow with SmartVascular

SmartVascular enables inde­pen­dent switching among fluo­ro­scopy, digi­tal sub­trac­tion angi­og­ra­phy (DSA), and road­mapping. The physi­cians can oper­ate the sys­tem with the wire­less foot­switch with its custom­izable config­u­ra­tion. Further func­tions can also be accessed via touch­screen directly from the ster­ile field with one click.

Using contrast agent

To make vessels visible during X‑ray moni­toring, a con­trast agent is injected. To improve effec­tive­ness and patient com­fort, the con­trast agent can be diluted. To obtain the best image quality, even in com­pli­cated proce­dures, the C‑arm auto­mat­ically triggers the injector for the con­trast agent.

Selecting the right contrast agent

For patients for whom a con­ven­tional con­trast agent can­not be used due to con­tra­in­di­ca­tions, CO₂ repre­sents an advanced, safe, and cost-efficient alter­native. CO₂ can also be used in a diluted state to keep the stress on the body as low as possible.

Advantages of CO₂ as a contrast agent

With the special CO₂ pack­age, the imaging adapts per­fectly to changed con­di­tions. How­ever, all of the work­flows and tools remain unchanged for the user, so it appears that an imme­di­ate inver­sion of the sub­trac­tion image has occurred. The sur­geon sees a famil­iar image — the CO₂ in the blood vessels is shown in black; the con­trast and image quality remain unchanged.

Single frame roadmapping

If an image is less than opti­mum due to patient move­ment during the DSA, single frame road­mapping can be applied. In this case, the entire DSA sequence is no longer used for road­mapping, but instead, only the best image. This effec­tively elimi­nates the move­ment arti­facts in the sequences, so the DSA with the injec­tion of con­trast agent doesn’t need to be repeated.

Breathing stop for better image quality

To keep patient move­ment to a mini­mum during the DSA and get the best possible image quality with­out move­ment arti­facts for the sub­trac­tion, breath­ing can be inter­rupted. If this is known in advance, the patient can be hyper­oxy­genated beforehand.