By: 16 December 2013

Chief Physician, Department of Orthopaedics and Traumatology, Klinik am Eichert, Göppingen, Germany

Q Dr Mattes, how many patients do you treat each year on average? How many conditions can be categorised as spinal surgery procedures and hip and knee operations?

A Our centre performs about 600 hip and pelvic surgeries and approximately 500 spinal procedures each year. Particularly in the field of spinal surgery and complex pelvic operations with joint-preserving procedures and pelvic fractures, a trend has emerged towards minimally invasive surgery. This reduces postoperative pain and functional limitations. Patients can thereby experience faster recovery times.

Q What is the role of intraoperative imaging in minimally invasive surgery?

A Intraoperative imaging plays a crucial role throughout the entire procedure. The ability to generate live images in 2D and 3D before, during and after the operation gives the surgeon an added level of certainty for his or her work. The depiction of anatomical structures in full detail during so-called keyhole surgery is a deciding factor in the success of the procedure and the rapid recovery of the patient.

Q Why did your clinic choose the mobile C-arm Ziehm Vision RFD to work with?

A I had already worked with Ziehm Vision FD Vario 3D during my time at the University Hospital Ulm. This system offers both 2D and 3D x-ray imaging with a compact C-arm. When I started at the clinic in Göppingen, I campaigned for acquisition of Ziehm Vision RFD. This C-arm can be used in interdisciplinary work and fulfils most of the imaging requirements that my colleagues and I demand of a C-arm.
In everyday clinical applications, our C-arm provides detailed images of anatomical structures and implant positions during orthopaedic and trauma surgery. Any necessary corrections can be made immediately. Optimised fracture reductions and correction osteotomies are thereby made possible and potential secondary interventions can be avoided. The same is true for procedures involving the spine that are performed with intraoperative imaging as a matter of principle. With digital flat-panel technology, the dose can be reduced by up to 75 percent, which is very important for myself and my team in our daily work. The flexibility of the mobile system in different operating rooms speaks in favour of Ziehm Vision RFD, because it ensures that the system is available for use in multiple departments on short notice.

Q How has your working method changed following the acquisition of the imaging system?

A The digital flat-panel detector with a size of up to 30 x 30cm increases the field of view during the procedure and improves visualisation, particularly during pelvic and spinal surgeries. With the large field of view, it is not necessary to reposition the C-arm during the operation in order to depict other structures. During pelvic procedures and hip TEP implants, I can use just one setting while operating to obtain the same image as with the classic pelvic overview. With Ziehm Vision RFD, I gain more image information per exposure. This can contribute to shorter operating times, and it saves patients and the OR team from unnecessary dose.

Q What are the advantages of mobile imaging compared to fix installed systems?

A At the top of the list is definitely the mobility of the C-arm. With its easy handling, the system can be rapidly up and running for use in multiple ORs. Ziehm Vision RFD can be deployed in our clinic by orthopedic and trauma surgeons, cardiologists and vascular surgeons. The cost factor also plays an important role in this regard. Thanks to its interdisciplinary application, the device achieves optimal utilization. The space-saving mobile C-arm fits compactly in today’s often cramped operating rooms and can be rapidly deployed when needed. This is where I see the advantages over fix installed systems.

Q What are your expectations or suggestions with regard to the further development of intraoperative imaging?

A For me as a user, image quality and image size are a priority.  We expect an even better image quality with lower dose for the patient and personnel. Technical progress will also bring with it several motorised versions of this device which will provide even simpler operation; this means reduced operating time in the OR and lower costs as a result.