2014 update on Carms

[Papa Lou]

I've read every post on the forum about the top two machines for fluoroscopy guided pain procedures. I am still conflicted about the top two choices. Members have compared the phillips pulsera (which seems to be favored for image quality reasons) to the oec 9900 saying the image quality is comparable. The price difference however is huge.
Salesmen keep saying the OEC is on another playing field much more capable than a pulsera, and state that getting parts and repairs of major components will be much cheaper with the OEC since they have largest marketshare and ubiquitous Carms/parts vs no 3rd party availability with phillips, and buying through the company makes it much more expensive.
But has anyone actually had to replace "glassware" type stuff that is not completely covered by service/warranty package? How much were the parts?
How much better are the images on the pulsera compared to the 9800? I'm being quoted 60s-low 70s for used 9800 with basic package nothing fancy. Of course since GE stopped making the 9800s in 2007 these machines are pretty old and when buying one I could end up with a 2001 version. I feel like the pulsera machines one can find a used 2008 model for pretty cheap.
The neglected issues typically are 1)ease of use for someone like an MA 2)ease of replacements/cost of replacements 3)how often it breaks down these are things people don't too often discuss, focusing instead on image quality (for good reason).
I liken the comparison to a PS4 vs an XBOX One. The PS has much more power/ability but when it comes to playing a basic RPG game or first person shooter..they end up performing the same. I liken that comparison to simple pain mgmt procedures where all we need is to look at bone 95% of the time and the bells and whistles are wasted money.

Still, the dearth of information out there for the Pulsera and the fact that salespeople keep dissing it does concern me a lot.

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[lobelsteve]

I've read every post on the forum about the top two machines for fluoroscopy guided pain procedures. I am still conflicted about the top two choices. Members have compared the phillips pulsera (which seems to be favored for image quality reasons) to the oec 9900 saying the image quality is comparable. The price difference however is huge.
Salesmen keep saying the OEC is on another playing field much more capable than a pulsera, and state that getting parts and repairs of major components will be much cheaper with the OEC since they have largest marketshare and ubiquitous Carms/parts vs no 3rd party availability with phillips, and buying through the company makes it much more expensive.
But has anyone actually had to replace "glassware" type stuff that is not completely covered by service/warranty package? How much were the parts?
How much better are the images on the pulsera compared to the 9800? I'm being quoted 60s-low 70s for used 9800 with basic package nothing fancy. Of course since GE stopped making the 9800s in 2007 these machines are pretty old and when buying one I could end up with a 2001 version. I feel like the pulsera machines one can find a used 2008 model for pretty cheap.
The neglected issues typically are 1)ease of use for someone like an MA 2)ease of replacements/cost of replacements 3)how often it breaks down these are things people don't too often discuss, focusing instead on image quality (for good reason).
I liken the comparison to a PS4 vs an XBOX One. The PS has much more power/ability but when it comes to playing a basic RPG game or first person shooter..they end up performing the same. I liken that comparison to simple pain mgmt procedures where all we need is to look at bone 95% of the time and the bells and whistles are wasted money.

Still, the dearth of information out there for the Pulsera and the fact that salespeople keep dissing it does concern me a lot.

Salesman doing his job. My pulsera is 7 years old. Lost 1 day total when machine went down in that time. Responsive service from Phillips and yearly checkups keeping things smooth. Would get another Phillips 100%

 

[hyperalgesia]

If I were getting a newer machine with a service contract, I'd consider a Pulsera. But for an older one without a service contract, I'd get a 9800 (or two). OECs are old-school, made when America took pride in its industrial engineering. I used to own a 9400 and disassembled the collimator and replaced some parts. Really incredible workmanship. Maybe Pulseras are like that too, I don't know.

 

[emd123]

I have a 12 yr old (!!) pulsera that I bought used 3 yr ago. Ancient, I know. I had lots of problems with it crashing until they replaced the power-pack (whatever that is). Now it's worked well for the past 1 yr or so, without problems. The warrantee was a must. Hoping to get a couple more years out of it (?????). What are new pulsera or OEC units going for nowadays?

 

[Papa Lou]

Here's a page with good pricing information for pulsera vs OEC:
http://info.atlantisworldwide.com/blog/bid/343668/GE-OEC-C-Arms-Vs-Philips-Pulsera-C-Arms

Here's a page specific to a spectrum of phillips c-arm prices:
http://info.atlantisworldwide.com/blog/bid/306829/C-Arm-Prices-2013-Philips-Siemens-C-Arms

Also note this 2013 study. It compares the 2010 orc 9900-elite to a 2010 pulsera and 2009 pulsera:
Spine (Phila Pa 1976). 2013 Jul 15;38(16):1401-4. doi: 10.1097/BRS.0b013e318294e27d.
Comparison of image quality and radiation exposure from C-arm fluoroscopes when used for imaging the spine.
Prasarn ML1, Coyne E, Schreck M, Rodgers JD, Rechtine GR.
http://www.ncbi.nlm.nih.gov/pubmed/23574814

Do you guys not need the "super C" that can come with an OEC? Someone said the pulsera sometimes can't reach as far and requires tilting of table or placing towels underneath their side to get that extra bit of angle.

It's nice to see that Phillips keeps coming out with newer systems and upgrades at a faster clip than GE, which seems to take 8 years with a product before coming out with the next model. Assuming equivalent pics and usability the prices on them phillips look darned attractive.

 

[jettavr6]

After doing a lot of research into the pros and cons of various C-Arms, I ended up purchasing a Siemens ISO-C 3D (2005 model refurbished) at the beginning of the year for a very reasonable price. It has exceeded all of my expectations, and has been wonderful. It's built well, and will last a while - I just need it to last for four more years until my lease runs out at which point I'm on to another career if medicine continues its descent!

 

[Papa Lou]

After doing a lot of research into the pros and cons of various C-Arms, I ended up purchasing a Siemens ISO-C 3D (2005 model refurbished) at the beginning of the year for a very reasonable price. It has exceeded all of my expectations, and has been wonderful. It's built well, and will last a while - I just need it to last for four more years until my lease runs out at which point I'm on to another career if medicine continues its descent!

How much are you paying for the lease jettavr6?
I've been thinking it best to just buy like most here do. Funny thing is the service contracts alone are about 9-10k a year. Maybe I should rethink lease.

Anyone else lease and for how much?

 

[lobelsteve]

After doing a lot of research into the pros and cons of various C-Arms, I ended up purchasing a Siemens ISO-C 3D (2005 model refurbished) at the beginning of the year for a very reasonable price. It has exceeded all of my expectations, and has been wonderful. It's built well, and will last a while - I just need it to last for four more years until my lease runs out at which point I'm on to another career if medicine continues its descent!

I used to use a siremobil 2000 in a backup procedure suite. Good picture but tough controls to master.

 

[Taus]

Here's a page with good pricing information for pulsera vs OEC:
http://info.atlantisworldwide.com/blog/bid/343668/GE-OEC-C-Arms-Vs-Philips-Pulsera-C-Arms

Here's a page specific to a spectrum of phillips c-arm prices:
http://info.atlantisworldwide.com/blog/bid/306829/C-Arm-Prices-2013-Philips-Siemens-C-Arms

Also note this 2013 study. It compares the 2010 orc 9900-elite to a 2010 pulsera and 2009 pulsera:
Spine (Phila Pa 1976). 2013 Jul 15;38(16):1401-4. doi: 10.1097/BRS.0b013e318294e27d.
Comparison of image quality and radiation exposure from C-arm fluoroscopes when used for imaging the spine.
Prasarn ML1, Coyne E, Schreck M, Rodgers JD, Rechtine GR.
http://www.ncbi.nlm.nih.gov/pubmed/23574814

Do you guys not need the "super C" that can come with an OEC? Someone said the pulsera sometimes can't reach as far and requires tilting of table or placing towels underneath their side to get that extra bit of angle.

It's nice to see that Phillips keeps coming out with newer systems and upgrades at a faster clip than GE, which seems to take 8 years with a product before coming out with the next model. Assuming equivalent pics and usability the prices on them phillips look darned attractive.

I don't know much about the different brands, but it's really annoying to not have a Super C. Without it you can only oblique so much in one direction ie not past 40. Pita for stellates, CLO view on cesi, ctfesi etc. have to flip the table or c arm side if can't or don't want to tilt table sideways.

 

[ampaphb]

I use a 9900 super c in 3 locations, and a 9600 in one. All work well, none have ever been down for mor than half a day. The super c is like the laser site indicator - nice if u have it, no big deal if you dont. You can get a 6way table, or (heaven forbid) Position the patient to add to the obliquity. It just isn'tt that big a deal.

 

[Papa Lou]

just as an update I bought a refurbished pulsera R2 (was so close to getting the 9800 oec…). I've never used the phillips machines or even seen them live that I can recall. I'm familiar with the OECs. But based largely on the strength of what most of the veterans here have commented about the pulsera..I went ahead and made the leap. Cost me mid 50s w one year service plan, will be a 2007 or 2008 model w flat panel monitors, usb drive, 9"II, and all the trimmings of the R2 versions that started coming out in 2007. Hope I didn't overpay..let me know if I did…..

The oec would have been early 2000 and 10k more expensive. I think technology wise and image-wise i'm getting something more modern and a tiny bit more relatively future proof. No super C so I guess I'll have to stack towels to tilt patients.

I hope it doesn't blow any "glassware" soon after getting it b/c I know the phillips components are more expensive and less available than GE and my service contract only offers me a prorated amount on the full price, not a complete freebie.

Anyway thanks, I appreciate the help. If anyone later has any questions or wants update once I've put some miles on it I can happily pay it forward.

 

[geauxg8rs]

Does anyone have an opinion on the new OEC Breva? Supposed to be designed for pain?

 

[powermd]

The Briva only goes up to 110 kVp. I don't see how you could get decent lateral lumbar images on typical pain management patients with that thing. Our 120 kVp images are often barely readable and useful only to tell if dye extravasates into the soft tissues.

We are shopping for a new fluoroscope now and probably going to get a 9800 Super-C. The only question is how to pay for it.

 

[pmrmd]

I just got a new 9900, my third. 2k a month. That's very doable. Getting a used unit made no sense. They overhauled everything except the tube, but the price was only 5k less. With an old machine, you have no idea how many hours of use the tube has seen and that is the most expensive piece to replace. A warranty that covers glass is damn expensive, and with a new fluoro you can probably go without the warranty for a few years and then get the warranty package at about year 4 or so. I did this twice and it worked for me. Maybe just lucky.

 

[Stinky Tofu]

In case you ever need to change the battery pack on the Pulsera, I purchased if from Portable Power based on the recommendations of a couple of former Philips technicians. I then wound up hiring someone locally to change it out. I was told by the technician that typically the batteries last 2-3 years depending on use. If you are having problems with image quality and your battery is 2-3 years old, trying changing that out first. This saved me a ton of money and this was the only maintenance I've had to do since my warranty ran out 3 years ago. The quote I got for changing out the battery ranged from $5000 - $7500 and that was just to change the battery. Diagnosing the problem and testing it afterwards would've cost another $1500 - $2500. Instead, I just spent about $1000 for the battery and about $300 for someone to swap it. Afterwards, my Pulsera was as good as new. I bought my Pulsera used and continuing the warranty after it ran out would've cost close to $10,000 per year. I took a gamble and so far it has worked out for me. If you go this route, I would suggest you schedule a preventative maintenance one month prior to your warranty running out and see if you can convince the technician to swap out the battery pack.

http://www.portablepower.com/index.php?route=product/product&product_id=993

 

[hyperalgesia]

I think these companies make most of their money on warranties. I think they are basically insurance companies that also sell c-arms. After all, "What if???"

 

[pjuer]

They can send a man to the moon, but OEC cannot figure out how to counterbalance a C-Arm. I am tired of fighting with the dam locks on these machines, would never buy another one.

 

[pastafan]

In case you ever need to change the battery pack on the Pulsera, I purchased if from Portable Power based on the recommendations of a couple of former Philips technicians. I then wound up hiring someone locally to change it out. I was told by the technician that typically the batteries last 2-3 years depending on use. If you are having problems with image quality and your battery is 2-3 years old, trying changing that out first. This saved me a ton of money and this was the only maintenance I've had to do since my warranty ran out 3 years ago. The quote I got for changing out the battery ranged from $5000 - $7500 and that was just to change the battery. Diagnosing the problem and testing it afterwards would've cost another $1500 - $2500. Instead, I just spent about $1000 for the battery and about $300 for someone to swap it. Afterwards, my Pulsera was as good as new. I bought my Pulsera used and continuing the warranty after it ran out would've cost close to $10,000 per year. I took a gamble and so far it has worked out for me. If you go this route, I would suggest you schedule a preventative maintenance one month prior to your warranty running out and see if you can convince the technician to swap out the battery pack.

http://www.portablepower.com/index.php?route=product/product&product_id=993

Great info on the battery. Thank you for posting. Last I saw on this board was that it was OEM only and unavailable.

I bought new with 2 years of warranty included. Extended warranty about 7k/year. It is expensive. Balancing risk of breakdown and downtime losses versus cost of coverage is a tough call.

 

[bronchospasm]

Bought a used 2008 9 " Pulsera 18 months ago for $35 k. No service contract but philips will charge $200 per hour plus parts to service. Annual maintainance contract offered by phillips was 6k per year for a four year contract.

Looking to expand and bought another used 2008. 12 " Pulsera last week. Paid $30k. I am in the process of setting up another satellite clinic.

No issues with PULSERA so far.

Hope this helps.

 

[powermd]

We just dropped $99k x2 on two brand new 9" 9800 super-C models. We're doing a straight up lease (no $1 buyout) for about $1650/mo each, solid service plan, 2 year warranty. We're happy.

 

[ampaphb]

How long is your lease? What is the buy out at the end?

 

[drpainfree]

same question to powermd...

 

[Ligament]

In case you ever need to change the battery pack on the Pulsera, I purchased if from Portable Power based on the recommendations of a couple of former Philips technicians. I then wound up hiring someone locally to change it out. I was told by the technician that typically the batteries last 2-3 years depending on use. If you are having problems with image quality and your battery is 2-3 years old, trying changing that out first. This saved me a ton of money and this was the only maintenance I've had to do since my warranty ran out 3 years ago. The quote I got for changing out the battery ranged from $5000 - $7500 and that was just to change the battery. Diagnosing the problem and testing it afterwards would've cost another $1500 - $2500. Instead, I just spent about $1000 for the battery and about $300 for someone to swap it. Afterwards, my Pulsera was as good as new. I bought my Pulsera used and continuing the warranty after it ran out would've cost close to $10,000 per year. I took a gamble and so far it has worked out for me. If you go this route, I would suggest you schedule a preventative maintenance one month prior to your warranty running out and see if you can convince the technician to swap out the battery pack.

http://www.portablepower.com/index.php?route=product/product&product_id=993

Bump for anybody else who has replaced their Pulsera battery themselves. Any tips? I'm on the verge of doing this myself.

 

[lobelsteve]

Bump for anybody else who has replaced their Pulsera battery themselves. Any tips? I'm on the verge of doing this myself.

Mine is getting done today. Part of preventative maintenance. But Philips does this for me.

 

[Ligament]

Mine is getting done today. Part of preventative maintenance. But Philips does this for me.

You have warranty I assume?

 

[lobelsteve]

You have warranty I assume?

I'm sure somebody does. We bought the machine and 2007 when I got started in this practice. Since the hospital but us and all of the equipment I guess it's their problem. I would love to be there and take pictures but I'm enjoying my afternoon. I'm off

 

[Ligament]

I'm sure somebody does. We bought the machine and 2007 when I got started in this practice. Since the hospital but us and all of the equipment I guess it's their problem. I would love to be there and take pictures but I'm enjoying my afternoon. I'm off

Its all good buddy, thanks!

 

[bronchospasm]

Bump for anybody else who has replaced their Pulsera battery themselves. Any tips? I'm on the verge of doing this myself.

Replaced battery last week. Purchased from portable power as recommended for $1000. Phillips wanted to charge $2100 to do it. Found another tech who did it for $400. Working well now. No issues so far. Speak with Caitlin at Portable power. She was very helpful.

 

[Ligament]

Replaced battery last week. Purchased from portable power as recommended for $1000. Phillips wanted to charge $2100 to do it. Found another tech who did it for $400. Working well now. No issues so far. Speak with Caitlin at Portable power. She was very helpful.

Howdy, thanks for the response. I have a few questions:
1. How do you find another tech to do it? Where do you find such a person?
2. Portable Power only sells the battery, they do not sell the charger assembly which is attached to the battery once assembled in the c-arm (see pics). Did you keep your old charger assembly and just attach it to the new battery?

My Philips tech said the Portable Power battery is indeed the correct battery for the Pulsera, however it obviously does not have a charger assembly attached.

 

[bronchospasm]

Howdy, thanks for the response. I have a few questions:
1. How do you find another tech to do it? Where do you find such a person?

GOOGLED X-ray repair techs in the state and found one that was 2 hours away. Called about 5 companies got one.

2. Portable Power only sells the battery, they do not sell the charger assembly which is attached to the battery once assembled in the c-arm (see pics). Did you keep your old charger assembly and just attach it to the new battery?

Kept the old charger. Just replaced battery.

My Philips tech said the Portable Power battery is indeed the correct battery for the Pulsera, however it obviously does not have a charger assembly attached.

Battery was replaced in under an hour by the tech. I thought that it would take a few hours but the tech was finished and gone beforeI got to the office. So obviously it is not difficult for someone who knows what they are doing.

View attachment 215600 View attachment 215601 View attachment 215603 View attachment 215604

 

[Ligament]

Thank you very much!

 

[pastafan]

Besides error messages or failure how do you know when to change the batteries?