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Speedy 3D X-rays in the operating room

It is a given that any operation is going to put a strain on the patient. In particular it is going to put strain on their physical health as they are opened up, tools inserted, and bits moved around inside. Blood loss and tissue damage are also given elements of the process, but so is the stress, and impact on their mental health. Both physical and mental health are further strained if a second operation is necessary, as the surgeon did not quite get it right the first time.

Secondary operations are more likely in the case of more complicated operations, as the more a surgeon has had to do, the less chance there is of everything going right. In order to counteract this phenomenon, the surgeon consults three dimensional X-rays to determine if the results are accurate, before completing the surgery. Unfortunately, in order to take such ~X-rays the surgeon has to stand back from the patient, and in order to check them, they have to leave the patient and examine the results on the other side of the OR, or in another room.

This does help to avoid complications, such as an improperly tied tube or a missed segment of disease, or worse a tool accidentally left inside. However, it also means interrupting the surgery, interrupting the flow the surgeon has gotten themselves into, and significantly increasing the time the patient is open.

Whereas there are many areas of surgery that can be streamlined through various technological means; none have a more critical impact than finding ways to diagnose if the surgery is a success or not, without either interrupting the surgeon's work or forcing them to leave the surgery to check.

A system being developed by the German Fraunhofer Institute for Production Systems and Design Technology IPK, has high hopes of being able to help in this regard. ORBIT is a 3D X-ray scanner that can be integrated into operations and does not – at least in theory - cause any delays.

The key concept of the system is that the X-ray machine does not have to surround the patient to capure images of a surgery in progress. It will allow the surgeon to keep working whilst images are taken. It does this by a play on the acronym that makes up its name – it orbits the operating table, continually moving.

The surgeon and technical staff receive a minute dose of X-rays as they work, but the patient receives the full dose, with the C-arm rotating to capture the full operation site, with enough accuracy to check on the position of implants and fracture fragments, so as to determine the relative positions of pieces of bone or to position implants to the milimeter. There are no preparations to make; the equipment is already in place when the operation starts, and can be activated with the push of a button at any time, to capture a 3D image of the current status of the patient.

Since it takes far less time to take an X-ray with this method and it does not prevent the surgeon from continuing to work whilst a picture is taken, the whole process is streamlined. A final advantage the system has, is the source and etector move in slightly offset planes, so distortion caused by medical screws and implants is minimised relative to traditional X-rays, purely because the slight offset allows the system to determine the precise placement of the screw or implant from multiple angles in a single pass.

The prototype system is currently undergoing trials at the Berliner Zentrum für Mechatronische Medizintechnik operating center, where it is being used in actual patient operations.


Speedy 3D X-rays in the operating room

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