Can interventional procedures be done in an angio suite?

[NorthernDoc]

---

Members do not see this ad.

Hi, I was wondering if interventional pain procedures can be done in an angio suite, say the zee multipurpose from siemens. It offers C-ARM angulation , but only 45degrees of cranio caudal excursion .I has however an image panel of 30x40 cm (much larger than the standard c-arm diameter).Would this size panel interfere with the technique or visualisation? Do we often need to angle de c-arm cranially more than 45 degrees?
In my hospital, our interventional radiologists perform their vertebroplasties in the angio suite.

Any opinion would be greatly appreciated!

 

[lobelsteve]

Hi, I was wondering if interventional pain procedures can be done in an angio suite, say the zee multipurpose from siemens. It offers C-ARM angulation , but only 45degrees of cranio caudal excursion .I has however an image panel of 30x40 cm (much larger than the standard c-arm diameter).Would this size panel interfere with the technique or visualisation? Do we often need to angle de c-arm cranially more than 45 degrees?
In my hospital, our interventional radiologists perform their vertebroplasties in the angio suite.

Any opinion would be greatly appreciated!

I've done ESI's, LOA, and discos at the hospital a few years ago in the angio suite.

I'm short, and the table height is not. I needed to stand on a stool to get into position and could not use the foot pedal. THat was the only awkward part.

Not as good or comfortable as a C-arm.

 

[Pain_doc]

I've done procedures in one of the local heart hospitals cath lab. Quite nice actually. I never did quite get the hang of moving the fluoro and table, but the nurses were kind and moved everything per my request. The picture was quite awesome & better than any Phillips, Siemens, Ziehm or OEC that I use elsewhere (I'm going too many places...).

 

[Jcm800]

Hi, I was wondering if interventional pain procedures can be done in an angio suite, say the zee multipurpose from siemens. It offers C-ARM angulation , but only 45degrees of cranio caudal excursion .I has however an image panel of 30x40 cm (much larger than the standard c-arm diameter).Would this size panel interfere with the technique or visualisation? Do we often need to angle de c-arm cranially more than 45 degrees?
In my hospital, our interventional radiologists perform their vertebroplasties in the angio suite.

Any opinion would be greatly appreciated!

It CAN be done, but why? You can easily do it in the OR with a C-arm if u need a facility and are hospital based... The big pillar thing in the center drove me crazy the one or two times i did it...

 

[NorthernDoc]

please see below

 

[NorthernDoc]

please see below

 

[NorthernDoc]

this is the equipment. Im just wondering any specific worries u might have using this .the image amplifier is pretty large, but can be rotated in landscape display if needed. full c-arm movement except for cranial -caudal, limited to 45 degrees each way and 60 degrees LOA to 90 degrees ROA. But with an amplifier that large, id be surprised to need more angulation. would the amplifier block my view, hamper my technique?
The reason I ask is that my hospital does not have an OR room, but their radiology department does standard fluoro stuffand is ready to buy new equipment that could offer both.
Thanx for ur opinion.

 

[lobelsteve]

this is the equipment. Im just wondering any specific worries u might have using this .the image amplifier is pretty large, but can be rotated in landscape display if needed. full c-arm movement except for cranial -caudal, limited to 45 degrees each way and 60 degrees LOA to 90 degrees ROA. But with an amplifier that large, id be surprised to need more angulation. would the amplifier block my view, hamper my technique?
The reason I ask is that my hospital does not have an OR room, but their radiology department does standard fluoro stuffand is ready to buy new equipment that could offer both.
Thanx for ur opinion.

The C looks fine. The table has what as it's weight limit?
Do the images go PACS or DICOM? How do you save your work.

 

[NorthernDoc]

the total table load is of 340 kg, or 750 lbs. 441 pounds for the patient wieght (200kg) .
Images would be saved on either dicom or pacs.The hospital uses pacs.
Would the LOA limited at 60 degrees limit me for left transforaminals? what about the 45 degrees of cranial obliquity? is that enough?

 

[Jcm800]

this is the equipment. Im just wondering any specific worries u might have using this .the image amplifier is pretty large, but can be rotated in landscape display if needed. full c-arm movement except for cranial -caudal, limited to 45 degrees each way and 60 degrees LOA to 90 degrees ROA. But with an amplifier that large, id be surprised to need more angulation. would the amplifier block my view, hamper my technique?
The reason I ask is that my hospital does not have an OR room, but their radiology department does standard fluoro stuffand is ready to buy new equipment that could offer both.
Thanx for ur opinion.

Does not have an OR room?

meaning they dont do surgery? or they dont have a room that you would be able to use? You can use any operating room, as I'm sure you know... I guess i just dont understand.
As far as convenience, does the monitor swing to the other side? Im assuming in that picture you are facing the monitor, which for me is standing on the "wrong" side of the table, although i did this during fellowship in one of the locations... but if you are comfortable on this side, then hey, looks good.

and when you say 60 degrees, do mean that straight AP is 0, then and additional 60 degrees. counting lateral as 90 degrees? if so, then you will have problems.

 

[lobelsteve]

Does not have an OR room?

meaning they dont do surgery? or they dont have a room that you would be able to use? You can use any operating room, as I'm sure you know... I guess i just dont understand.
As far as convenience, does the monitor swing to the other side? Im assuming in that picture you are facing the monitor, which for me is standing on the "wrong" side of the table, although i did this during fellowship in one of the locations... but if you are comfortable on this side, then hey, looks good.

and when you say 60 degrees, do mean that straight AP is 0, then and additional 60 degrees. counting lateral as 90 degrees? if so, then you will have no problems.

Yup, if it cannot go lateral- it cannot be used.
The table does not look like it can hold that kind of weight. must be the picture not showing the beefiness.

If you need more LAO, tilt the patient on pillows.

 

[Jcm800]

Yup, if it cannot go lateral- it cannot be used.
The table does not look like it can hold that kind of weight. must be the picture not showing the beefiness.

If you need more LAO, tilt the patient on pillows.

this is what i was trying to say but probably was unclear...if you stop at 60 degrees, and cannot go lateral you are out of luck. But if you are asking is 60 degrees enoough OBLIQUE, and you can still go lateral, which it doesnt look like it can, but if it can, you will be ok. I rarely oblique more than 45 degrees, even for L5-S1 discos. But bottome line is, you must be able to get laterals, which im not sure if you can or cannot...

 

[Tenesma]

it should work fine for 99% of your cases... the one % would require some tweaking...

however, i am right-handed (like most of us) and i prefer being able to stand on the patient's left side when they are prone.... your set-up is great for left-handed IR guys/gals...

 

[NorthernDoc]

Thank you for the opinions...I believe u can get a full lateral, but only from one side, as the equipement is attached to a wall. It can oblique all the way to 90 degrees (full lateral) on one side and ends at 60 degrees on the opposite. What about the cranial-caudal obliques? is 45 degrees enough...I think it is.
The set up can be modified.the pic shows the setup for a left handed physician. It would be in the opposite direction for a right handed one.
Hopefully , the monitors can be swung around to the other side.As per the image , for example, if right TFESI need to be done, the pt would be simply set up in the other direction and the physician would stand between the wall and the table .That would allow to get the full lateral to confirm depth.

Again thanx for the opinions!

 

[lobelsteve]

TFESI- patient lies prone, physician stand outside of table, and raches across patient to direct needle dorsal to ventral, lateral to medial.

There should be no change in patient position.

 

[PMR 4 MSK]

TFESI- patient lies prone, physician stand outside of table, and raches across patient to direct needle dorsal to ventral, lateral to medial.

There should be no change in patient position.

But if you are like me, 'vertically challenged', even with a step-stool, in a bariatric pt, this is quite the PITA. I've done it for bilaterals, but for unilateral, I really want the injected side toward me. For the skinnier folk, it's easier.

 

[Tenesma]

that's interesting..... i am SO used to doing ALL of my patients with me standing on their left side... the mere concept of having to doing things the other way would require major re-tooling of my habits/techniques...

 

[Jcm800]

that's interesting..... i am SO used to doing ALL of my patients with me standing on their left side... the mere concept of having to doing things the other way would require major re-tooling of my habits/techniques...

duringm fellowship at one location i stood on the left side, at the other location I stood on the right. It made me good from both sides, but I all but refuse to stand on the right now, haha.

 

[NorthernDoc]

so I checked out the above mentionned equipment . As impressive, modern and robotic as it is...the image amplifier which is quite large( 30 by 40 cm) causes significant blind spots when the C Arm is placed on an oblique angle for left lateral epidurals( if doc is placed on the right side of a prone lying patient). I couldnt see my hands at all under that big screen, no matter what angle i tried. Very non ergonomic. I understand that once the needle is in, u should only guide urself with the image on the screen, but still...i guesss maybe with time and practice.

Think ill go with the Orbis C-arm....

Little question...anyone do vertebroplasties with a c-arm? what about spinal stimulator installation? A c-arm would do fine right?

 

[Pain_doc]

Yes. Fluoro for vertebroplasties & SCS. Typically use 2 fluoro's for kyphoplasty since those are done in the ASC or hospital.

 

[lobelsteve]

so I checked out the above mentionned equipment . As impressive, modern and robotic as it is...the image amplifier which is quite large( 30 by 40 cm) causes significant blind spots when the C Arm is placed on an oblique angle for left lateral epidurals( if doc is placed on the right side of a prone lying patient). I couldnt see my hands at all under that big screen, no matter what angle i tried. Very non ergonomic. I understand that once the needle is in, u should only guide urself with the image on the screen, but still...i guesss maybe with time and practice.

Think ill go with the Orbis C-arm....

Little question...anyone do vertebroplasties with a c-arm? what about spinal stimulator installation? A c-arm would do fine right?

I've never seen SCS or Vplasty done without fluoro.
I can do PNS leads (occipital) without fluoro, but thats different.

 

[axm397]

so I checked out the above mentionned equipment . As impressive, modern and robotic as it is...the image amplifier which is quite large( 30 by 40 cm) causes significant blind spots when the C Arm is placed on an oblique angle for left lateral epidurals( if doc is placed on the right side of a prone lying patient). I couldnt see my hands at all under that big screen, no matter what angle i tried. Very non ergonomic. I understand that once the needle is in, u should only guide urself with the image on the screen, but still...i guesss maybe with time and practice.

Think ill go with the Orbis C-arm....

Little question...anyone do vertebroplasties with a c-arm? what about spinal stimulator installation? A c-arm would do fine right?

Have you done any vertebroplasties or stimulators? And if so, if you didn't use a c-arm, what did you use?


Also, why would you want to see your hand on the screen? You want to purposefully irradiate your hands while doing the procedure?? I get upset if I see my hand on the screen.

 

[Jcm800]

Little question...anyone do vertebroplasties with a c-arm? what about spinal stimulator installation? A c-arm would do fine right?[/quote]


as opposed to...

 

[NorthernDoc]

I believe I was misunderstood...Of course both vertebroplasties and spinal cord stimulators require fluoroscopy.Thats a given. However, many will preach only doing vertebroplasties in an angio suite. A) because of the higher image resolution. B) often using a biplane allowing realtime vison of both lateral and AP at the same time to make sure the ciment is not leaking.
So my question was: do any use a simple , mobile C-arm to do vertebroplasties? Is the image quality sufficient?? (only one view at a time, requiring movement to each plane repetedly, and to see the roadioopaque ciment?)

For stimulators, I think a simple c-arm would do fine.

As for stimulators, do many of you install them permanently after a successful test trial , or do you refer to a surgeon for that step?

 

[NorthernDoc]

BTW, of course i dont want to irradiate my hands. What i meant by screen is the flat detector of the machine . When standing to the side of the patient, Trying to do a left TFESI is awkward cause the flat detector blocks your view from every angle of the patients back. (It is quite large, and rectangular )

 

[axm397]

However, many will preach only doing vertebroplasties in an angio suite. A) because of the higher image resolution. B) often using a biplane allowing realtime vison of both lateral and AP at the same time to make sure the ciment is not leaking.
So my question was: do any use a simple , mobile C-arm to do vertebroplasties? Is the image quality sufficient?? (only one view at a time, requiring movement to each plane repetedly, and to see the roadioopaque ciment?)

We use two c-arms to get both the AP and the lateral at the same time. I have seen some use one - basically put the cement in with the lateral view, stop as soon as you see any kind of posteior flow. I have seen some use bilateral approach and others that use unilateral.

 

[Tenesma]

i have seen a lot of missed leakage w/ single-planar vertebroplasties.... ie: patients with continued back pain, get further imaging (CT scans/x-rays) and you can see these long streaks extending into various veins --- a few reaching as high as just below the atrium!!!.... i then get the op. report and the technique used was single-planar... i think single planar is JUST too risky... of course, we'd need studies showing worse outcomes or higher embolization episodes...

 

[Jcm800]

i have seen a lot of missed leakage w/ single-planar vertebroplasties.... ie: patients with continued back pain, get further imaging (CT scans/x-rays) and you can see these long streaks extending into various veins --- a few reaching as high as just below the atrium!!!.... i then get the op. report and the technique used was single-planar... i think single planar is JUST too risky... of course, we'd need studies showing worse outcomes or higher embolization episodes...

i do them with two c-arms... but everytime i do i always say "man i should just do this with one, it would be so much less cumbersome during set up..."

but i never do. I still think it is faster for operative time, for me atleast, but probably not in overall time... I spend a long time injecting the cement, very slowly...

 

[lobelsteve]

Vplasty this AM at L3.

Single C-arm.

20 min from gloves on to gloves off.
I am not a cowboy, but this is as easy as an epidural in the right patient.
Gave her 1n1 and she snored through the procedure.
I could have been done in 15min but I wanted a bx and forgot to get one on the first pass, so I backed up and put a little superior torque on the hub to get bone into the bx needle.

Inject slow, back off the threads to prevent ongoing cement deposition.

I cannot see the need for two C-arms. It takes 20 seconds to go lateral to AP to check, and get back lateral again. Maybe you guys need a little TW.






TW= http://www.facebook.com/people/Tracey-Williams/602091553#/profile.php?id=775970476&ref=ts