C-ARM question

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
stim4u

stim4u

Member
Removed
15+ Year Member
Joined
Dec 12, 2005
Messages
786
Reaction score
10
I am looking to purchase a C-arm quite soon. I recently visited a warehouse and tested the OEC 9400. As discussed in the forum before, the 9400 does not oblique as much to the patients left side as some other devices (ie. Ziehm). For the physicians using this device, have you been obtaining adequate views with the limited obliquity and a little right-sided tilt. Also, are there other c-arms of this caliber/cost that the board members recommend (ie. Philips, siemens, etc.). Thanks for your help.

Cheers,

stim4u
Members don't see this ad.
 
I own a 9400 for my office and have used it for 3 years without a glitch. The left side obliquity limitation makes it quite difficult to perform certain procedures unless the table is rotated 180 deg. These include right cervical TFESI and left sided entry discography. It is difficult to use table tilt given the monsterous size of my patients therefore I am stuck with a planer table.
I have used other older machines such as Siemans and Phillips and very much like both. Make sure you do not get a model with a built in cross hair in the field such as is the cases with some of these machines...it makes pain management injections extremely difficult.
 
agree with Algos.....but i hate the 9400. Would rather the Philips BE300 (?) or more expensive OEC 8800 or 9600......8800 is my favorite for ease of use, followed by Philips. OEC 8800 is pricey cuz relatively new. I used 2 different 9400's for about a year and a Siemens for about a year also. Right now i use a Philips at one ASC, an 8800 in my office, and a 9600 at another ASC.

T
 
Members don't see this ad :)
Dr. Todd:

I believe it is a Philips BV300, is that correct? I could not find the BE 300. IN anycase, it runs about 30-40k refurbished. Can you obtain steep oblique views, and perform Right Cervical TFESI's as Algosdoc referred to? I will try to sample this device in the warehouse at some point.

Also, are most of you using Digital subtractions for most of your procedures. During my training, we did not use this technology much.

Thanks for the input.

Stim4u
 
yea.....BV300. I dont ever touch it in the ASC. Tech does that.

Never used digital subtraction.

T
 
Dig subtraction is still somewhat of a luxury. It is costly and is rarely available in ASCs. I use a new 9900 OEC in one hospital but it did not come with dig subtraction.
I agree the 9400 is not optimal for viewing clear pictures. If one adjusts the brightness, contrast, averaging, and uses all the bells and whistles available, it will do almost anything a more expensive machine will do, but it requires extra time to manipulate these controls and training of the staff to know where they are on the machine. One other thing about the 9400 is that OEC no longer manufactures parts for the machine effective Dec 2005. There are still a lot of spare parts out in fluorospace to purchase for the 9400 but I would use the 9400 as a short to intermediate term machine rather than a long term machine. My hope is that the 9600 prices will eventually drop below $75K which is the low value I have seen thus far. But all C-arm prices, even the new ones, are coming down compared to 2 years ago secondary to competition.
 
Regarding lack of L oblique, for lumbar procedures you can always tilt the table or simply put a foam wedge under the patient. Positioning w/ wedges is more difficult in the c-spine
 
I got a Siemens Compact-L a few years ago for $70K. I looked at refurb'd 9400s and figured the extra $$ was worth it for something I planned to have for years to come. You can buy or lease-purchase.

The image is great. No whistles and bells, but it does everything I want.
 
SOMA Technology has a refurb BV300 Philips for $44K at this time...
I am currently at the ISIS conference and the new C-arms are available. Pulsera is the high end Philips retailing for about $130K. The high end OEC9900 sells for around $240K with a motorized remote controlled C and around $150 without. Of course the Ziehms are somewhat less...
 
I am told by one company that OEC 9400 parts are more available due to the greater market share and that its penetration in obese patients is better. On the otherhand, another group says that the BV 300 Philips is 10yrs newer/better and that parts are readily available.
Furthermore, I am not sure if GE or Philips will continue to service either of these discontinued models. Anyone have any problems with these machines and repair experiences?


Stim4u
 
I recently purchased the ziehm quantum for 90k new with tilt table after using it at a discography conference. I fell in love with the ease of use and most importantly the desired functions standard for a pain specialist. The extended oblique/compact size and usb ports are fantastic. Plus, the image quality blew away the OEC 9800 in a side by side comparison at the same conference.
 
I was told at ISIS that Ziehm fired their CEO partly because of screwups over the Quantum. I am glad they appear to be on the right track now. I was promised a Ziehm Quantum for many months but the company could not deliver due to production and software problems. Hopefully they have solved those issues now. The more competition, the better for us.
 
Members don't see this ad :)
Anyone else being affected by the GE/OEC production cease?

Has anyone had any luck with a refurb?

We have 2 other OEC 9800's, we'd like to stay with OEC.

Any comments on Siemens or Phillips?

JL
 
is an excellent machine. OEC will not be putting out new machines until at least March-April of 2007.
The new Phillips Pulsera can be had for the same price as an OEC 9800 and subjectively has a far, far superior image. The OEC 9900 has a similar screen to the Pulsera and thus should put out the same image quality. Also with the Pulsera you have a USB port to take your images from the unit. If you want a hard wire connection you have to pay more to transmit images. The OEC 9900 only offers a service to export images for something like a couple of grand a year(I forget).
What Phillips does not have is the long term re-sale value that an OEC has. As well as the fact that you know you are getting an excellent unit that will last. The last Phillips Pulsera frequently broke down and has a poor reputation and low re-sale value.
 
i need a new/used c-arm for a new office in about a month or 2. Any recommendations or reputable sellers who wont price gouge? Also need a table.

thx in advance

T
 
Can anyone elaborate on the problems with getting an oblique with the OEC 9400? Will it not oblique to one particular side or something?
 
Over the top ipsilateral rotation (beam under the table and aiming towards the physician) the maximum rotation angle is only about 30 degrees. The solutions to this are cumbersome but do-able....
1. Rotate the table 180 degrees. 2. Invert the C (beam on top)
 
algosdoc said:
Over the top ipsilateral rotation (beam under the table and aiming towards the physician) the maximum rotation angle is only about 30 degrees. The solutions to this are cumbersome but do-able....
1. Rotate the table 180 degrees. 2. Invert the C (beam on top)
Click to expand...

3. Rotate the table (lateral tilt)
4. Rotate the patient (wedge pillow)

3 and 4 are easier to do (the lateral tilt on a table adds 2K to the cost, the wedge is free if you use towels, $100 for a nice wedge)
 
i used to rotate(read..push) the patient. Plus those machines are kinda loud. I heard OEC will start selling/delivering again in December.

T
 
The practice I'm thinking about joining is considering buying an Siemens Arcadis Varic. It seems a bit pricey at $115 (without table). Has anyone had any good/bad experiences with this system?
 
Algos:
what is the most compact, versatile, most mobile (left lateral rotation), best resolution, and most reasonably priced C-arm. my OEC 9400 is good, but I am sick of tilting the bed and using a bump. I need quick set up time. Also I want to do discos and stim trials which needs better thoracic penetration. I have used Zheim before, and that device seems very good except for cost and frequency error messages. I used a philips in the OR the otherday and the images were great.

can you rank your top 3 machines, again. :cool:
 
paindoc76 said:
The practice I'm thinking about joining is considering buying an Siemens Arcadis Varic. It seems a bit pricey at $115 (without table). Has anyone had any good/bad experiences with this system?
Click to expand...

We have one at our hospital. The images are beautiful but there is what I would call - for lack of a better term - "throttle lag". You know how in some cars there is a noticeable lag between when you hit the gas and when the engine responds? That's how the Arcadis feels. Siemens told us there is nothing they can do about it.

I use the foot pedal instead of having the xray tech press the button, and when I use the Arcadis I get out of synch and burn my hands. In other words, at the time when I'm used to putting my hands back in the field the beam is still active. The pain docs that work with the tech activating the beam report similar problems with timing. I suppose if that's the only c-arm you work with you'll eventually get used to it, but I work with an OEC 9600, an 9800, and my own Siemens and it's hard to get the timing down when I work with the Arcadis.

I have a Siemens Iso-C in my office and it doesn't behave that way.

I told the Siemens guys if they couldn't fix it I'd tell anyone who's interested about the problem. Well, here it is, Siemens - on the internet for all pain docs to read.

Next time fix the f**king lag!
 
Thanks Gorback. That's very helpful.
 
love the 9900

had ziehm and it would shut down mid procedure on a regular basis...

i truly think these items are way overpriced - i think it only costs about 25k to make one...

it will be interesting to see what the flat panel intensifiers are going to be like as far as quality goes...
 
Tenesma said:
love the 9900

had ziehm and it would shut down mid procedure on a regular basis...

i truly think these items are way overpriced - i think it only costs about 25k to make one...

it will be interesting to see what the flat panel intensifiers are going to be like as far as quality goes...
Click to expand...

tenesma, which ziehm did you have? I was thinking of getting the quantum...
 
I will post initial impressions on the Phillips Pulsera next week or two, comparing it to a 9000, 9400, 9600, 9800+, and Siremobil 2000. The problem with the comparison to older machines may be more related to the remanufacturer than the original imaging capabilities.

My new office manager refused to get me a reman 9400 or 9600 because of fears of service related issues and parts supplies. He said they felt I should come across as having the best fluoro, the best RF box, the best table, and the best skill set. Now I feel likethe pressure is on to perform, but I know it will be easier to do discos, GRC's, LSB's, and get a lateral C-spine on a 350 lb large American.

I'm so excited to use new equipment for the first time in my career. Anyone have a pdf of the Pulsera manual for me to read before the hard copy gets here?:oops:
 
great info......im looking for a c-arm a little more agressively now....anyone know of any ASC's closing down who want to sell their c-arms?

T
 
lobelsteve said:
Now I feel likethe pressure is on to perform, but I know it will be easier to do discos, GRC's, LSB's, and get a lateral C-spine on a 350 lb large American.
Click to expand...
I have given up on GRCs, and have instead returned to therapeutic intradiscal injections. I have done this in part because I don't think there is a way to reliably sensory stim for the GRC, and so you are basically pulsing in the dark.

I also am not aware of any legitimate coding for the procedure, and don't believe you can get paid for doing it without being more "creative" (ie. dishonest) than I am willing to be at this point in my career.
 
ampaphb said:
I have given up on GRCs, and have instead returned to therapeutic intradiscal injections. I have done this in part because I don't think there is a way to reliably sensory stim for the GRC, and so you are basically pulsing in the dark.

I also am not aware of any legitimate coding for the procedure, and don't believe you can get paid for doing it without being more "creative" (ie. dishonest) than I am willing to be at this point in my career.
Click to expand...

GRC is a sympathetic nerve block, and if you feel that is too much of a stretch you can bill it as peripheral nerve block (other). RF lesion and not pulsed.

I'll set up a study in the next few months using facet blocks, discogram, and grc's, to try and control for etiology to get a feel for grc efficacy as it relates to VAS and Oswestry. Anyone else feel like being part of a multicenter study and helping draft the protocol?
 
I am interested in the ziehms quantum but it is 100,000 new. the other interest is the bv 300 at about 50,000 refurbished, i have a small procedure room about 12x12 so that is also a factor, please help with decision. need answer before 12/31/07 for tax purposes!!! i am also on the market for a table, looking at the morgan basic for about 14,000. please i welcome any advice.
Thanx.



paindoc66 said:
I recently purchased the ziehm quantum for 90k new with tilt table after using it at a discography conference. I fell in love with the ease of use and most importantly the desired functions standard for a pain specialist. The extended oblique/compact size and usb ports are fantastic. Plus, the image quality blew away the OEC 9800 in a side by side comparison at the same conference.
Click to expand...
 
lobelsteve said:
I will post initial impressions on the Phillips Pulsera next week or two, comparing it to a 9000, 9400, 9600, 9800+, and Siremobil 2000. The problem with the comparison to older machines may be more related to the remanufacturer than the original imaging capabilities.

My new office manager refused to get me a reman 9400 or 9600 because of fears of service related issues and parts supplies. He said they felt I should come across as having the best fluoro, the best RF box, the best table, and the best skill set. Now I feel likethe pressure is on to perform, but I know it will be easier to do discos, GRC's, LSB's, and get a lateral C-spine on a 350 lb large American.

I'm so excited to use new equipment for the first time in my career. Anyone have a pdf of the Pulsera manual for me to read before the hard copy gets here?:oops:
Click to expand...

Steve could you pls follow up on this one? I'm interested. Thanks!
 
is an inferior product. Constantly breaking down. Poor image quality. Long lag time between images.

You are better off paying twice as much to get a new unit. Think about it, at the end of your 5 year lease you have a unit with some value-25K, or more(50K) if you can sell it by yourself. A new OEC 990 or a new Phillips will hold good value for 7-9 years or so. The used unit your are going to purchase will likely be laid to out to pasture after 5 years if it lasts that long, not to mention the amount of money you have to spend to maintain it.
 
You can probably get a new Siemens Compact-L (which I use) for less than $80K. It might be a little late if your goal is 12/31.

You can save a lot of money by building a table instead of buying one. I built mine for $500 out of wood and plexi-glass.
 
Since my building skills are limited to constructing things out of 2x4s, I decided to purchase a couple of tables. If you buy a table with lateral tilt, you don't have to worry about limited C oblique angulations. Plus, in building my own (which I considered), I had visions of my rather "fluffy" patients as Mike calls them, cracking the frame and tumbling to the floor, then through the wooden floor into the basement, and then who knows if they would stop even if they hit concrete....
 
Pulsera:

My Pulsera is installed. It has USB Ports for jump drives, a DVD burner (and it also plays music (no speakers installed, but has a 3.5mm audio out jack). 2 flat screen panels with 360 degree adjustment. The C-arm controls are easier to use than OEC 9000-9900. Simple layout with buttons and indicator lights, plus a small LCD panel. The motion locks are nice sized levers and the bearings are adjustable for push effort. The keyboard is located on the base unit and is a sealed unit so the keys are a little funky to push, but it has a laptop style touchpad. The keyboard and touchpad are mostly irrelevant thanks to my facilities using DICOM. They touchscreen monitors have "Get Worklist" and "Schedule" buttons so my patient list pops up at the beginning of the day and I touch over their names to start the study. We are working on having dictation attach my report templates to the RIS (radiology dept report generator- links images to reports for information management).

The image quality is superior to any OEC I have used. I need to get used to digital contrast adjustment as it was pretty easy spinning the pair of knobs on the OEC to getthings looking just right.

Complaints:

Unrelated to the unit: My room is currently 12'x13' and cannot get more than 12' in one direction. This will limits what can go in front of or behing the table. It makes getting around a real PITA and I cannot get to the other side of the table and C during a case right now. This is not the machine, just the room. I've got a wall or two to come down and I'll be at 12'x18' and I think things will be great. Helpful fluoro room setup tips: Put the monitor on the back wall over the table and push the table to the back of the room, 18" from the wall. Now the patient has a lot of room in front of them and does not have wires creeping up their arms. Get rid of as many things that go on the floor as possible. Shelving and cabinets for everything that will fit. I got rid of my Mayo stand- it is too small if I am using a catheter or leads. I use the top of a rolling cart (no lip, nonporous, and it's 24x36. Sterile drape fits over it fine and underneath can still be accessed.

Related to the unit: There is a 1/4 second delay from stepping on the pedal until the image registers. I am unsure if this is a safety measure or because of the complexity of the unit. I am adjusting but the first 10 cases or so I was moving a needle and the picture was not on the screen yet. I have heard Ziehm units had this as an adjustment (lag) and unsure but think I will learn the lag on this machine.

Overall, better than anything else I've used at work or at workshops.

It is easy when it is not your money. I think this is the best unit for my situation because of the easy to integrate DICOM, the ease of use (all new staff with no experience).

Now I need to decide who stays in the room with me. I have a nurse, an MA available, and a fluoro tech. I'm the only one who has any clue about fluoro spine procedures and I really do not want to train a dozen techs who will rotate through. I need ideas on best use of staff to maximize the time in the suite. I'd like 4 procedures per hour on average with 1-2 per day being discogram or stim, the rest being MBB, TFESI, LSB, ESI, SIJ, etc.

Anyone have best practices on getting patients on and off the table, drawing up meds, prepping the patient, gettting the image close, etc?
 
Steve, I agree on the new Philips Pulsera. All my comments above were regarding the older BV models. As a matter of fact, I have two of the new Philips units and I think they are excellent. Had some minor glitches with one unit but they had it up and running on the same day. The unit is smaller than the OEC 9900 (one procedure room is 11x12) and slightly cheaper, with my only question being if it will have the long term value of the OEC.

4 patients an hour is going to be tough in that small room. Do you plan on seeing patients on the days that you do procedures?
 
OEC is still dead in the water as far as I know, therefore any discussion of purchasing their products (new) is hypothetical. Their new products are very very expensive. I was quoted a price of around $150K for a 9900 if and when it ever hits the market again. The Pulsera 2003 and on is a good product and the latest Pulsera is a dream machine. Ziehm's newer models are also excellent but I would stay away from the 7000 due to shutting down frequently...
 
algosdoc said:
OEC is still dead in the water as far as I know, therefore any discussion of purchasing their products (new) is hypothetical. Their new products are very very expensive. I was quoted a price of around $150K for a 9900 if and when it ever hits the market again. The Pulsera 2003 and on is a good product and the latest Pulsera is a dream machine. Ziehm's newer models are also excellent but I would stay away from the 7000 due to shutting down frequently...
Click to expand...

That is interesting about OEC, they have been making "promises" about spring 08 delivery. I think we are in the process of purchasing one, I guess I should make sure this is going to happen.
 
mehul_25 said:
That is interesting about OEC, they have been making "promises" about spring 08 delivery. I think we are in the process of purchasing one, I guess I should make sure this is going to happen.
Click to expand...
They were "promising" other dates before that. All depends on the relevant governmental agencies, over which OEC has no control.
 
I think the OEC 9800 is a pretty good machine but its features and technology are ancient. Even the OEC 9900 Elite has no USB port. I wonder why, with all the difficulties obtaining an OEC, people are not looking at the Philips, Ziehm, Siemens?
 
Ligament said:
I think the OEC 9800 is a pretty good machine but its features and technology are ancient. Even the OEC 9900 Elite has no USB port. I wonder why, with all the difficulties obtaining an OEC, people are not looking at the Philips, Ziehm, Siemens?
Click to expand...
Because prior to their difficulties, OEC was the clear market leader. Afterall, "It's good to be the King".
 
ampaphb said:
Because prior to their difficulties, OEC was the clear market leader. Afterall, "It's good to be the King".
Click to expand...

Yeah that makes sense ampaphb, but still...it's a six figure machine you are buying, I'd think people would "explore the market," you know? Not a big deal to me really but OEC does not seem to be worth all the trouble people are going through to (try to) get one.
 
DrTodd:

what carm and table did you go with?

looks like the best carm are:
1. Phillips pulsera
2. OEC 9900
3. Zhiem quantum
4. others....

agree?;)
 
i ended up taking the OEC8800 from the office i left....i have no experience with those you listed. If i had to buy new i would have bought the Siemens Siremobile Compact L for 81K+ with twin LCD monitors.

T
 
stim4u said:
DrTodd:

what carm and table did you go with?

looks like the best carm are:
1. Phillips pulsera
2. OEC 9900
3. Zhiem quantum
4. others....

agree?;)
Click to expand...

I'd replace the quantum with the Ziehm Vision which is a better unit and a their top of the line C-arm (unless you are looking at the Vision FD which is a flat panel all digital II which costs 320K!!!! I'd love to see this thing in action but I doubt any pain docs are using it due to price, it may be the best c-arm as far as image quality in existance)
 
I have been using a Ziehm Quantum for about 18 months now. I chose it over the OEC9400 refurb due to fears of not having replacement parts and OEC9800 new because of price (got new for about $85,000). I had used OEC9800 previously and there were some issues with it breaking down.

The Quantum had some advantages over the OEC 9800:
1) no console unit so it takes up less space in a small room
2) the screen facing you has two screens
3) there is a thrid screen for the x-ray tech
4) no lag time between when you puch on the pedal and when the machine images.
5) use with procedures is very good especially since it comes with a 45 degree tilt.
6) foot pedal control to image and store images is very convenient.

However, there have been some disadvantages:
1) image management is worse than the OEC9800. We back up images at the end of the month and it takes about 20 minutes to choose patients, choose the same patients again in another menu to mark their images to save, then save to USB. Take the USB to computer to burn on CD. It has a CD/DVD burner, but it is very slow and locks up about half the time after about 10 minutes. We don't have the DICOM option since it was $5,000.
2) from month 6-12, there was a software problem so when you tried to save an image, it would bring up the previous image saved, even when it was from the previous patient. This was solved with a software upgrade. However, they couldn't just put in a CD. There is no way to do a firmware upgrade, so they had to replace the CPU
3) recently on start-up the small screen for the tech does not show up. This is crucial since it is a touchscreeen used to enter patients/control the machine. It required us to restart up to 5 times sometimes and waste 10 minutes of the morning. They recently said they upgraded the software again so hopefully this has been fixed.
4) entering patients info is a little slow since it uses a touchscreen keyboard. There is no attached real keyboard.
5) image quality is great for most patients. however for the lumbar latera on a 350 pound patient, there is no digital spot view like the OEC 9800 has.

Overall, I like it, but wish these software issues could be addressed with newer models. Just my 2 cents. I wonder what the GE Fluorostar will be like. Two years ago it only had one screen for everyone (physician and x-ray tech) but they said they would change it.
 
I want to buy new and dont want to buy in the >$100k range. I am more comfortable in the $80k range. I have narrowed down to two choices.

1) Siemens Compact L

or

2) Ziehm Quantum

Does anyone have any input regarding the better unit between these two similarly priced models?

Thanks!
 
You must log in or register to reply here.
Next unread thread

Similar threads

T
Anyone used this c-arm, Fujifilm persona C?
Replies
3
Views
532
paindoctor2014
P
C
C-arm table recommendations?
Replies
19
Views
752
BobBarker
BobBarker
TeslaCoil
Good Reliable and Cost Effective C-arm
Replies
2
Views
763
TeslaCoil
TeslaCoil
bedrock
C arm history
Replies
3
Views
393
Doctodd
D
bronchospasm
Back up power for C -arm
Replies
15
Views
819
bronchospasm
bronchospasm
Top