In the last few years, more and more C-arm technology has started to follow the same trends that the industry has seen in interventional labs, such as switching from traditional image intensifiers to digital flat panel detectors (FPD). As more FPD options become available, people who want to buy a C-arm are more likely to choose between analog and digital.
When making an x-ray inspection system, there are many things to consider. What’s better, a digital Flat Panel Detector (FPD) or an analog Image Intensifier (II)? That’s a good question; the answer depends on how the system is used. Image intensifiers are old technology from the late 1950s, and until around 2003 or 2004, they were the standard (other than film, they were the only option). The technology is an electron multiplier, a vacuum tube with coated input and output windows that turn photons or electrons into visible light.
When we talk to staff at ambulatory surgery centers or hospital surgical departments, one question we often get is about the technology at the heart of the C-arm system:
Should we use an image intensifier or a flat panel detector?
Even though it sounds like a simple question, the answer isn’t as simple as it seems. The truth is that no one solution can be used in every building. Every office-based lab, clinic, and healthcare system has needs that must be considered. First, let’s talk about what each of these systems is.
Flat Panel Detector
Angiography and cardiac catheterization labs now use FPD fluoroscopy systems more than any other kind. Low-end fluoroscopy equipment like gastrointestinal fluoroscopy systems and C-arm mobile units can’t be used right now because they are too expensive to buy. The smaller size of the FPD imaging chain makes it easier to move around while examining a patient. FPD systems also don’t need a TV camera to send an electronic signal to the display monitor. The image receptor (FPD) is made to send out a digital electronic signal showing how strong the x-rays that hit each detector element (DEL) are in the solid-state FPD array. Also, the whole thing is done digitally, which cuts down on image noise caused by electronic parts.
An X-ray image intensifier (XRII) is an image intensifier that turns X-rays into visible light at a higher intensity than traditional fluorescent screens can. These intensifiers are used in X-ray imaging systems (like fluoroscopes) to turn low-intensity X-rays into bright visible light. The device has a low aluminum absorbency/scatter input window, a photocathode, electron optics, an output fluorescent screen, an output window, and an output fluorescent screen. These parts are put together in a glass or, more recently, a metal/ceramic container with a high vacuum. The XRII needs less light to be absorbed because it is better at turning X-ray quanta into visible light. Its effect of making the image brighter makes it easier to see the object’s structure being viewed than on a dim fluorescent screen alone.
So, when looking into new equipment options, we talk in-depth with surgeons and the administrative team to discover their problems and what they want to achieve. We help them choose the best way to buy something, like a rent-to-own plan instead of a fleet swap or a capital investment. When we have all the facts, we suggest the technology that will give the best return on investment.
Each technology has its strengths, from system features to equipment size. If you’re looking to buy a mobile surgical C-arm so you can grow your practice, we hope the information below will help you with your research and buying decision.
Radiation dose is one of the most critical ways flat panel detectors and image intensifiers differ.
This comes into play when you use the different magnification modes on each system. In order to use an image intensifier’s Zoom 3 setting, you’ll need to increase the dose five times as much as you would in the normal full-field mode. On the other hand, the increase is about half of the II increase for the same magnification on a flat panel detector.
In order to get a higher magnification with an II, you have to collimate down. With each step up in magnification, you can see more details, but your field of vision gets smaller. On the other hand, an FPD system’s magnification doesn’t change the scale at all.
Many organizations choose the image intensifier because they are already familiar with the system. This makes it easier for the in-house team to fix problems on-site.
If keeping the dose as low as possible is your primary goal, the choice is easy: flat panel technology.
But that’s just one of many things you need to think about. Most C-arm operators have worked with image intensifiers for years, so they know how they work and can figure out what to do quickly if something goes wrong. When a part of the system breaks, it’s also not too hard to find a replacement. Image intensifiers are widely available, so you’re never too far from a vendor who can sell the part you need. There are more parts in an image intensifier that will likely need to be fixed. On the other hand, even though parts may be easier to find, an image intensifier needs more of them because of wear and tear caused by a higher radiation dose and other problems. This is a problem when you have a lot of work to do or a lot of complicated procedures.
A flat panel detector can be more complex to fix than an image intensifier, which seems like a drawback. Still, it doesn’t matter if you use a service provider certified by the Original Equipment Manufacturer. Your on-site technicians might be able to fix some problems with image intensifiers, but they might not be able to fix critical errors. This is why many facilities choose to get a service contract. Using the flat panel detector in these situations might make more sense. So, you’ll need repairs less often, and when you do need them, you’ll know you can count on the care you get.
Even though flat panel detectors are better than image intensifiers in some ways, there are other things to consider when buying a C-arm for your facility. Your budget is the most important of these. Most of the time, flat panel detectors cost more than their image intensifier counterparts. Since flat panel detectors are a newer technology, it may be hard to find a refurbished one. On the other hand, refurbished image intensifier C-arms are more common and come in a broader range of prices.
An image intensifier makes a good image. But after a few years, the image quality will get worse. Image intensifiers can last for about five years. On the other hand, a flat panel detector will give you great images over time. Image intensifiers break down more quickly than flat panel detectors. So, an image intensifier won’t last as long as a flat panel detector. But parts for image intensifiers are easier to find because they have been around longer than flat panel detectors. So, you can easily extend the life of your image intensifiers by giving them regular maintenance and moving them when problems arise.
The flat panel detector and the image intensifier are great for taking pictures. Both are good for C-arms, but each has its pros and cons. Whether you buy a flat panel detector or an image intensifier depends on your clinical needs and budget. Image intensifiers would be a good choice if you want a C-arm but have a smaller budget. If you can spend a little more, you can get a C-arm with a flat-panel detector, which will help reduce radiation exposure and improve the quality of the images.
Unless we’re talking about baseball cards or old cars, newer things cost more than older things. You also have to get spare parts from the OEM. None of the three big OEMs that make FPD C-arms now have any used detectors for sale. Even though paying thousands of dollars for a used II is not fun, they are easy to find. On top of that, a brand-new digital detector costs tens of thousands of dollars, which makes it even harder on the budget. There are many possible combinations of what you want, what you need, and what you can afford, but we can say this about machines.
Choosing Between an FPD and an II:
An FPD C-arm will give you the best image quality at the top end of C-arm systems. Keep in mind, though, that you should save a good chunk of your budget for the higher costs of parts and services.
We recommend a late-model, used II system for places with less money. Even though the image quality won’t be as good as with a digital strategy, II technology has been around for a long time and is still a good choice for most of your cases.