Over the past decade, the continuing development of fixed C-arm technology and clinical innovations have been shaping how fixed C-arms are used, and the distinction between the traditional cardiac cath lab vs. interventional radiology (IR) lab has become blurred.  Such equipment can be installed, not only in radiology-related departments (e.g., radiology, imaging, interventional radiology, special procedures, angiography labs), and cardiology-related departments (e.g., cath labs, cardiology, cardiovascular, vascular, endovascular, electrophysiology labs), and but also in surgery-related departments (e.g., hybrid OR, surgery departments), with multiple physician specialties having access to the labs.

Interventional procedures, once the exclusive domain of interventional radiologists, then embraced by cardiologists for performing diagnostic and therapeutic procedures in cath labs, is now being adopted by surgeons as an essential tool for minimally invasive surgery.

Department leaders in all three of the department types that currently have fixed C-arms all share optimism that procedures conducted on their fixed C-arms are growing, with 75% of the respondents indicating that a top priority for their department (giving ratings of “6-7” on a 7-point rating scale) is to manage increased procedure volume on their fixed C-arms.

Typically, regardless of the department in which the fixed C-arms are located, a variety of physician specialties utilize the fixed C-arms, and satisfying “the needs of the surgeons and interventional physicians who use the fixed C-arms” is a top priority for all the department administrators.  The top two physician types currently performing procedures using fixed C-arms, regardless of the department, are interventional radiologists (74% of sites) and interventional cardiologists (67%), followed by vascular/endovascular surgeons, electrophysiologists, cardiac/cardiovascular surgeons, each involved in about one third of the sites.

The top use of the fixed C-arms in all three department types is to perform diagnostic and therapeutic interventional procedures, but their use for other clinical purposes differs significantly by department type, which results in different needs for equipment capabilities and workflow.  Not surprisingly, the surgery-related departments are more likely to be conducting open surgery and other hybrid procedures using their fixed C-arms, while the cardiology-related departments are more likely to be performing angioplasty/PCI procedures.

The trend towards increased use of fixed C-arms for minimally invasive procedures is bright, as 41% of the respondents gave high “6-7” ratings for the opinion statement “more minimally invasive procedures will be performed using fixed C-arms over the next 2-3 years, shifting away from open surgery procedures” resulting in an overall average of 5.0.  Surgery-related respondents are more optimistic about this trend, giving a significantly higher average of 5.5, compared to radiology- and cardiology-related respondents (4.9).

The current mix of fixed C-arms in surgery-related departments is still in its early adopter stage, which IMV estimates comprise 8% of the hospital departments having fixed C-arms, but having only 6% of the fixed C-arm units.  Going forward, purchase plans show that 58% of the surveyed sites are “yes” or “maybe” planning to buy in 2019-2022, with 27% of the planned units being planned for surgery-related departments which will primarily be first-time placements, whereas for radiology-related and cardiology-related departments, replacement will be a key purchase driver.

However, certain market inhibitors that may influence the actual purchase rate, with the top issue limiting their hospital’s ability to offer minimally invasive procedures being “the need to increase the numbers and types of specialty physicians skilled to perform such procedures.”  Not surprisingly, the radiology-related respondents are more likely to be seeking to attract or retain interventional radiologists, the cardiology-related respondents are primarily seeking interventional cardiologists, and the surgery-related departments are seeking vascular/endovascular and other types of surgeons.

For surgery-related departments, additional issues include the “need to renovate and/or expand their physical space/facility” and having state-of-the-art C-arm technology, clinical applications, visualization software, and improved scanning/imaging protocols as key needs.

As minimally invasive surgery is an image-guided treatment procedure, an interdisciplinary team approach is often sought to improve outcomes, with the cardiology/surgery respondents significantly more likely to seek to strengthen the way interdisciplinary teams work together.  As one respondent stated, “the collaborative approach opens new perspectives for patient treatment leading to better outcomes.”

While the use of fixed C-arm technology is increasing in surgery-related departments, portable/mobile C-arms continue to be an important tool, particularly for image guidance to perform open surgery.  Virtually all of the hospitals with fixed C-arms reported they use portable/mobile C-arm units in the surgery/OR department.  Orthopedic and general surgeons are most likely to be using portable C-arms at 80% or more of the hospitals, followed by vascular/endovascular surgeons, GI physicians, and neurosurgeons.

Lorna Young is senior director of market research at IMV Medical Information Division in Des Plaines, IL.

IMV’s 2019 Fixed C-arm Market Outlook Report explores trends in the use of fixed C-arm systems in radiology, cardiology, and surgery-related departments in U.S. hospitals.  The report chapters cover respondent opinions on their department priorities & their future outlook, estimates for patient case volume & procedure mix, the installed base of fixed C-arms by department type, replacement cycles, purchase plans for fixed C-arms, and manufacturer installed base share and brand loyalty.  In addition, the report covers the relative size of the installed base and purchase plans for portable/fixed C-arms, and compares the physician types routinely using fixed vs. portable C-arms, by department type.  Manufacturers covered in this report include Canon, GE, Hologic, OrthoScan, Philips, Shimadzu, Siemens, and Ziehm.

The report is based on survey responses to an IMV-hosted online survey of conducted in March-April 2019 with over 190 radiology, cardiology, and surgery/hybrid OR department leaders in U.S. short-term general hospitals who provided information regarding over 390 departments having or planning to acquire fixed C-arms at their facilities.  Key statistics from the survey have been projected to the IMV-identified universe of over 2,950 hospitals that have at least one fixed C-arm system installed in over 5,300 radiology, cardiology, and surgery-related departments in those hospitals.   

For information about purchasing IMV’s 2019 Fixed C-arm Market Outlook Report, visit the corporate website at https://imvinfo.com/product/2019-fixed-c-arm-market-outlook-report or call 773-778-3080 x1033 to speak with a representative.  

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