If you've ever worked with a surgeon who has required 2 c-arms during a procedure, it can be quite intimidating the first time you are asked to set one up. Here's a simple method for doing so... and depending on the procedure, remember you can alter positions of each c-arm to achieve the same result.
Bring your first c-arm in like you were doing a simple AP:
Angle the c-arm 30-34 degrees and lock it in place. Then orbit the c-arm into a lateral projection.
Drive c-arm #2 into place from the head of the table. I would suggest extending the arm as far out as it will go when aligning so that if the surgeon needs it moved to work, all you have to do is retract the arm while leaving the base locked. If you collide with the arm of the first c-arm, feel free to angle it more to provide a clearance.
After the initial setup is complete, make sure to orientate both images to appear how the surgeon wants them on the monitors.
*Note: try to avoid fluoro on both c-arms at the same time during the procedure unless the surgeon actually needs it. The image intensifiers will receive scatter from either c-arm if both operate simultaneously, degrading the quality of your images. You should be able to off-set the timing by a split second if the surgeon requires a single shot of each.
You are now ready to provide the surgeon with AP and lateral projections without any c-arm manipulation!
This really helps. There is a neuro surgeon at my hospital that does this sometimes. I have never went in on any of his cases, but I hear other techs talk about it. I just know that one day I will have to go in there, and not know what to do with the C-arms. But not anymore. Thanks!
ReplyDeleteI'm glad it was somewhat helpful. There's a bear of a learning curve if you've ever had to set one of these up without being shown before!
ReplyDeleteI'm glad it was somewhat helpful. There's a bear of a learning curve if you've ever had to set one of these up without being shown before!
ReplyDeleteHow are you supposed to set up C-arm #2 at the head of the table when anesthesia is in the room?
ReplyDeleteI have seen it set up a variety of ways... if you're looking at the final image, you can still set up your c-arm providing the AP image to the right or left of the lateral c-arm. You can come in with the base of the c-arm at a 30-45 degree angle to the base of the lateral c-arm on either side... just rotate your lateral c-arm so that the "c" is on the opposite side. Doing this is probably better anyways because you have hand controls of both c-arms within a short reach instead of having to walk there. In either method, you can still provide the physician the foot pedals while you make any adjustments needed for positioning or technique.
ReplyDeleteYou can have a c-arm on both sides of the table with anesthesia at the head. You will still angle the ap, however, you will rainbow the lateral toward anesthesia and drape it in.
ReplyDeleteI've seen quite a few setups for this... we do kyphoplasties with both c-arms on the same side where I work right now. I suppose there's more than one way to skin a cat.
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