Equipment Rec's please

[specepic]

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Finishing fellowship this summer and new employer wants me to submit specs and budget for:

RF machine

EMG machine

U/S machine

C-arm


I am most interested in advice on an RF machine as I have some basic idea what I'm looking for in the others. The hopsital has a c-arm already but the practice wants to see if we can get another one for the office.

I will also happily receive input on U/S or EMG machines you are using and like/dislike

Cheers!

 

[PMR 4 MSK]

Finishing fellowship this summer and new employer wants me to submit specs and budget for:

RF machine

EMG machine

U/S machine

C-arm


I am most interested in advice on an RF machine as I have some basic idea what I'm looking for in the others. The hopsital has a c-arm already but the practice wants to see if we can get another one for the office.

I will also happily receive input on U/S or EMG machines you are using and like/dislike

Cheers!

RF and C-arms - lots of threads on that in the past year, including recent. My hospital has a 300 year-old RF generator. I'm pretty sure Benjamin Franklin's name is on it somewhere. The quote I had for an RF from Stryker was about $35K new, right before they were getting the bipolar program. C-arms normally start around $100K new.

US - we use GE, non-portable but on it's own cart to move from room to room - about $40K.

EMG - I'll never use anything but Cadwell. The Sierra Wave works perfectly and simply, and the report generator cannot be beat.

 

[Doctodd]

if i had to do it again, id get the Baylis RF generator.....again. See my post reviewing generators and the process.

 

[Finally M3]

I 2nd PMR4MSKs EMG rec of the Cadwell Sierra Wave. Start to finish (patient lies down until report done) of a CTS takes about 30 minutes due to the awesomeness of the report generator.

Costs about $12K?

 

[lobelsteve]

I love the Wave (but have not done more than a handful of EMG's in the past few years). I have used Teca and Neuromax as well.

Sierra is readily the easiest.

 

[Mister Mxyzptlk]

I've been very happy with my Siemans c-arm. However, I am very displeased with their service. I had some problems with it a few years ago and a service tech came out and fixed it. The problem is that he fixed it with duct tape and it wasn't until the routine service visit that it was discovered. I wrote to Siemans about it and they didn't even have the courtesy to respond.

Therefore, I am posting this as a warning to others that Siemans repair service and customer service is, in my experience, suboptimal. I think it was dangerous and irresponsible to fix a piece of medical equipment - especially high energy radiation equipment - with duct tape, and I believe the lack of response to my letter reflects a poor attitude toward customer satisfaction.

Please mention this post when talking to Siemans reps.

P.S. My ancient Neurotherm 1100 is still alive & kicking after 7 years.

 

[Jcm800]

siemens service sucks. had one, same problem. go with Phillips. OEC is a turd that is quite expensive IMHO.

I've been very happy with my Siemans c-arm. However, I am very displeased with their service. I had some problems with it a few years ago and a service tech came out and fixed it. The problem is that he fixed it with duct tape and it wasn't until the routine service visit that it was discovered. I wrote to Siemans about it and they didn't even have the courtesy to respond.

Therefore, I am posting this as a warning to others that Siemans repair service and customer service is, in my experience, suboptimal. I think it was dangerous and irresponsible to fix a piece of medical equipment - especially high energy radiation equipment - with duct tape, and I believe the lack of response to my letter reflects a poor attitude toward customer satisfaction.

Please mention this post when talking to Siemans reps.

P.S. My ancient Neurotherm 1100 is still alive & kicking after 7 years.

 

[geauxg8rs]

My employer bought a Cosman(Radionics) G4 RF about a year ago. It allows you to burn four levels at the same time. The problem I have seen has been the probes have had to go back due to failure to register a temperature. Has anyone else seen this?

 

[specepic]

Finishing fellowship this summer and new employer wants me to submit specs and budget for:


RF machine

EMG machine

U/S machine

C-arm

I am most interested in advice on an RF machine as I have some basic idea what I'm looking for in the others. The hopsital has a c-arm already but the practice wants to see if we can get another one for the office.

I will also happily receive input on U/S or EMG machines you are using and like/dislike

Cheers!

To summarize:

RF machine

I did a search of the Pain forums and came up with squat, please link to thread if a missed a great one about this.

EMG machine

Cadwell Sierra Wave appears to be the concensus.

U/S machine

GE rec'd. which model? I've used their laptop one and was not impressed. fair image quality and way too much knobology.

C-arm

Phillips. Turns out the practice (ortho) really wants to get a mini c-arm which I suspect will be useless to me.

 

[Jcm800]

To summarize:

RF machine

I did a search of the Pain forums and came up with squat, please link to thread if a missed a great one about this.

EMG machine

Cadwell Sierra Wave appears to be the concensus.

U/S machine

GE rec'd. which model? I've used their laptop one and was not impressed. fair image quality and way too much knobology.

C-arm

Phillips. Turns out the practice (ortho) really wants to get a mini c-arm which I suspect will be useless to me.

yes it will

 

[PMR 4 MSK]

Turns out the practice (ortho) really wants to get a mini c-arm which I suspect will be useless to me.

Mine has tried like 20 times in 5 years to convince me to to use a mini c-arm. You cannot do anything except distal extremities with them.

 

[nvrsumr]

C-arm phillips love it

us machine- mindray(chinese knock off)-pretty good and cheap

RF cosman- works great but issue with too much power output when using 4 18 g needles causing error code.

EMG- viking. hate the report generator. To make a template takes an advanced computer degree.

 

[painchas]

C arm Phillips Great picture, great service, no worries....Get the extended warranty just in case. Tubes can be very expensive.

RF Stryker for me. They will make a few deals with you for purchase.
As volume increases you can drill down the needle cost, the real expense over time. Multi burn x4 . Get the generic grounding pads for around 1$ each. That will save lots of expense. 2 years in use for me with no problems to date.

 

[stim4u]

don't go with a Ziehm c-arm, unreliable and servicee contract is $15k/year, which is crazy....

 

[axm397]

I use stryker RF, cadwell EMG and they both work great.

 

[specepic]

I appreciate so many folks chiming in

EMG: Got a quote on a Viking, waiting on Cadwell quote. I use a Viking now in fellowship/resid. so the former has that going for it.

U/S: Have used the Biosound's at conferences before and they have a pretty nice portable that I'm checking out now. The 25 Gold or something. I also want to revisit the Sonosite machines as well. The S-MSK has nice simple knobology.

Flouro: The hospital has a new Phillips, no idea what model. Its what I will use regardless.



Oh, anyone out there doing OMT?? What table are you using and has it been worth your while $ wise?

 

[stim4u]

has anybody negotiated a phillips endura for under 98K. They have increased their quote significantly in the last 2 years.

 

[jsaul]

C-arm phillips love it

us machine- mindray(chinese knock off)-pretty good and cheap

RF cosman- works great but issue with too much power output when using 4 18 g needles causing error code.

EMG- viking. hate the report generator. To make a template takes an advanced computer degree.

which model phillips?

 

[nvrsumr]

pulsera. had it for a year now with very few problems and the images are great.

 

[powermd]

pulsera. had it for a year now with very few problems and the images are great.

Our practice has a Pulsera and an OEC 9600. The images from the Pulsera are the bomb, but the thing is a real PITA to manipulate. Going lateral is such a hassle I'm often tempted not to do it even when I know I should. The problem, best I figure, is the source to intensifier distance, and mammoth size of the source. The OEC, by comparison, is vastly easier to whip around the table for a quick lateral. Btw, the tables are identical, and not super wide or narrow.

 

[ampaphb]

I have also found our OEC 9900 far easier to work with than Phillips

 

[stim4u]

OEC = $116K, anybody getting is cheaper?

 

[powermd]

OEC = $116K, anybody getting is cheaper?

I think our 9600 was $70K.

 

[DOctorJay]

we use one of the stationary Philips ultrasound units here at Mayo with Jay Smith. we have some other machines but this one is clearly superior. look in his PM&R articles for the exact model.

 

[jsaul]

I think our 9600 was $70K.

are replacement parts readily available for the 9600?

I am looking to buy a refurb 9600

 

[Jcm800]

are replacement parts readily available for the 9600?

I am looking to buy a refurb 9600

i dont recommend buying a discontinued unit like that. Cough up the extra bucks now and i think you will be happy in the long run...

 

[jpb26]

Just wondering if anyone has used the Phillips Endura? If so any thoughts on image quality, ease of use or comparisons to the Pulsera. Thanks

 

[olafa]

EMG/NCS - are you looking for a laptop style machine, or stationary?

 

[AviatorDoc]

What timing... I'm asking these very questions.

Slightly different question... Does anyone know about required building specs to put a C-arm in your office? I understand the reps will give you all of that info, but does anyone have a general idea?

 

[specepic]

EMG/NCS - are you looking for a laptop style machine, or stationary?

really either is ok.

I've pretty much narrowed it to cadwell sierra wave or viking, I already use viking but would like a better report generator.

U/S: deciding b/t philips cx-50 ($$$$), biosound mygold25 ($$-$$$), and sonosite S-MSK ($$), or turbo ($$$?)

RFA: likely Baylis as it is what I use now in fellowship

 

[Ligament]

Love the Baylis and use the multi-burn capability all day long, saves me SO MUCH TIME. love it. Never had one problem with the RF generator. Probes break as they do with all manufacturers.

We are buying the Philips CX50 after comparing it to all the other available laptop U/S units by comparing imaging of my left arm on each unit. The philips had the best image quality by far. Also the most expensive.

I got a Philips Pulsera after comparing it to ALL the major competitors, I posted the image results of my lumbar, thoracic, and cervical spine on the private physicians forum. I felt the Pulsera had better image quality and user interface than any of the others. One year later and I still love the Pulsera. Its c-arm is VERY well counterbalanced, far better than the 9900 in my opinion (I have a Pulsera with a 9" image intensifier). It has been very reliable, operating 730AM till 5PM two days per week...

Which is the best cryoablation unit? Anybody have recommendations? Wallach wants $25,000 for their "Pain Blocker" cryo machine...WAY expensive!!!!

 

[Pain_doc]

I've used the frigitronics cryo unit a couple of times recently. The rep was willing to give the facility the machine if they bought the probe. I think the probe was $1500. Obviously there's some recurring disposables that they can sell.

 

[specepic]

really either is ok.

I've pretty much narrowed it to cadwell sierra wave or viking, I already use viking but would like a better report generator.

U/S: deciding b/t philips cx-50 ($$$$), biosound mygold25 ($$-$$$), and sonosite S-MSK ($$), or turbo ($$$?)

RFA: likely Baylis as it is what I use now in fellowship

Well if anyone gives a rip here is what i decided on after many many hours of demos and research (thats just the way I buy stuff--I really drive the car salesman nuts )

1) EMG- Cadwell Sierra wave

2) U/S- Biosound MyLab25 Gold. Better image than Sonosite, and not far off from the really $$$$ machines. same $ as Sonosite M-turbo (under 40K with 2 probes, cart, etc.)

3) RF- Bayliss

Now all I need is a new minivan

 

[axm397]

Got quoted $1300 - 2300 per probe for RFA probe for Stryker - is there a better place to get these and if so, where?

 

[specepic]

Ok, going to highjack my own thread here to some degree. As I ponder private practice life next year and likely not having the luxury of 1) 30 minutes to do a unilateral sij 2) an anesthesia/pm&r resident to set up my tray I'm trying to figure out how to save time vs. how I do things now.

I know a lot of physicians here (from prior threads) don't use a pre-set up block tray for cost savings but I'm thinking about time savings as well. Cracking open those glass vials, using two different needles (sometime 3) to numb the skin and subq (usually progressively larger needle), etc.

Here's what I'm thinking and tell me what you are doing that is time efficient if you please:

1) a.m. of procedure/flouro day draw up (using sterile technique) enough separate 12 ml syringes with my typical 0.5% lido and then affix a capped 27 gauge 1.25". Keep these is some type of sterile 'bucket' or tray with a lid or drap over it. When I start a case reach in with my gloved hand and grab one and numb away.

2) same with contrast syringes, affix tubing instead of needle

3) same with common steroid mixtures

This way I walk in, pt already on table; prep, prep, glove, drape, mark, numb, inject, done.

What do you think?

 

[hyperalgesia]

1) a.m. of procedure/flouro day draw up (using sterile technique) enough separate 12 ml syringes with my typical 0.5% lido and then affix a capped 27 gauge 1.25". Keep these is some type of sterile 'bucket' or tray with a lid or drap over it. When I start a case reach in with my gloved hand and grab one and numb away.

2) same with contrast syringes, affix tubing instead of needle

3) same with common steroid mixtures

This way I walk in, pt already on table; prep, prep, glove, drape, mark, numb, inject, done.

What do you think?

But each time you reach into your bucket/tray with your gloved hand, if you have touched the patient, you will be contaminating your tray and have to reset for next pt. You could take everything out for each pt at the beginning of the procedure I guess. But you can't really use the same syringes with each pt and claim to be sterile. I wonder if anyone uses the "no touch" technique with fluoro procedures...

 

[specepic]

But each time you reach into your bucket/tray with your gloved hand, if you have touched the patient, you will be contaminating your tray and have to reset for next pt. You could take everything out for each pt at the beginning of the procedure I guess. But you can't really use the same syringes with each pt and claim to be sterile. I wonder if anyone uses the "no touch" technique with fluoro procedures...

I guess I envisioned only taking out syringes with a freshly gloved hand at the beginning of the case and if I needed something after that -- drawing it up fresh.

That being said do you reglove if you need a new syringe and you've touched a prepped/draped pt? Sometimes if I just want to get started and the whole tray is not set up or its an anxious pt I'll draw up my local, numb, then draw up everything else while the local goes to work. I think others do this too and it would not really be any different from an infection control perspective?

 

[PMR 4 MSK]

Pre-drawn = clean not aseptic. It is only sterile if you do it in the OR with mask, gown and glove.

Clean is higher risk of infx than aseptic. Anything into the spine or a joint, or other relatively avascular area should be done at least aseptic. Clean is for TPIs, nerve blocks, tendons and ligaments done in the office.

You should not really be concerned with a part of a procedure that takes a few seconds - You hold the syringe while someone holds up a bottle for you to draw from aseptically. If you do have an infx and a lawyer gets involved, don't yuo want to be able to testify that you did everything reasonably prudent to avoid an infx and not have something in your testimony that alludes to "I just wanted to save time" ?

 

[Finally M3]

Accept that you will be running behind for procedures. The sooner you accept this, the happier you will be.

I work in a pretty efficient ASC, and we still run behind. Granted, I talk a lot, but getting informed consent (double check no anticoagulants, patient sx, review pertinent imaging), quick exam, getting patient positioned takes up ~5 -10 minutes. Patient is positioned while I draw up meds (1-2 minutes), procedure (2-5 minutes), patient on the way back to recovery. Ideally, takes 15 minutes.

Of course, I am scheduled for every 15 minutes, with the sporadic double book, so I am pleased when I finish 10 patients from 1245-1430 scheduled at 1510.

Only in practice for 6-ish months. Would get freaked out about how behind I am when I first started. Now I don't care, and my BP is a lot lower.

 

[specepic]

Accept that you will be running behind for procedures. The sooner you accept this, the happier you will be.

I work in a pretty efficient ASC, and we still run behind. Granted, I talk a lot, but getting informed consent (double check no anticoagulants, patient sx, review pertinent imaging), quick exam, getting patient positioned takes up ~5 -10 minutes. Patient is positioned while I draw up meds (1-2 minutes), procedure (2-5 minutes), patient on the way back to recovery. Ideally, takes 15 minutes.

Of course, I am scheduled for every 15 minutes, with the sporadic double book, so I am pleased when I finish 10 patients from 1245-1430 scheduled at 1510.

Only in practice for 6-ish months. Would get freaked out about how behind I am when I first started. Now I don't care, and my BP is a lot lower.

For most basic procedures 15 minutes seems fine. I wonder if part of the reason we use more time (in addition to training residents and fellows and MDs being responsible for wheeling pts in/out ) is that we do a lot of TLC. Current practice is to numb 2-3 times over and check with flouro that local needle is dead on track to target. I also wonder how many folks out there are doing, for tfesi's, digital subtr, test dose, wait 2 minutes, that takes time too of course. Double burn on RF, etc.

 

[specepic]

Pre-drawn = clean not aseptic. It is only sterile if you do it in the OR with mask, gown and glove.

Clean is higher risk of infx than aseptic. Anything into the spine or a joint, or other relatively avascular area should be done at least aseptic. Clean is for TPIs, nerve blocks, tendons and ligaments done in the office.

You should not really be concerned with a part of a procedure that takes a few seconds - You hold the syringe while someone holds up a bottle for you to draw from aseptically. If you do have an infx and a lawyer gets involved, don't yuo want to be able to testify that you did everything reasonably prudent to avoid an infx and not have something in your testimony that alludes to "I just wanted to save time" ?

I certainly would draw these up with mask, gloves, sterile technique. Then place them in sterile container for that 1/2 days procedures only.