Challenges of Using C-Arm Fluoroscopy Systems: A Mixed Method Study Investigating Orthopedic Surgeons’ Experience

Abstract

Background: Intraoperative fluoroscopy systems are widely used nowadays, where their use allows a shorter duration of procedure time and better anatomical localization. The current study aims to investigate the most common challenges of C-arm fluoroscopy systems application.
 Methods: This mixed-method study was carried out in February and March 2022. After the literature review, a qualitative study was designed using semi-structured interviews to find important themes and subthemes required to design a web survey. The web survey was completed by the Persian Orthopedic Trauma Association (POTA) event’s international presenters. 
 Results: Nine orthopedic surgeons participated in interviews and 27 participants filled out the questionnaires. Five main themes including Physical Aspect, Mechanical Aspect, Software Options, Image Quality, and Radiation Exposure were extracted. Generally, over 80% of the web survey participants agreed that the size and shape of the base of C-arm fluoroscopy systems, C-arm diameter (space between tube and detector), and maneuvering and positioning of the C-arm fluoroscopy systems can interfere with surgical procedures. 100% of the participants agreed that providing two different views (e.g., AP and lateral) from the surgical site with one shot can be beneficial. The effectiveness of real-time visualization of radiation exposure on exposure rate was acknowledged by more than 92% of the participants. 
 Conclusion: Although the C-arm fluoroscopy systems are widely used in surgical procedures, there are considerable issues regarding the application of this imaging modality in the operation room, and medical equipment companies should pay more attention to these issues to facilitate the use of these systems.