forpurchasing used &refurbishedc-arms

C-ARMBUYER’S GUIDE

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Table of Contents

The Three Big Questions ................................................ Page 1

Which C-Arm Do I Need? ............................................. Page 2

How Can I Be Sure I’m Getting a Quality Product? ........... Page 5

How Much is This Going to Cost Me? ............................. Page 9

Next Steps & Additional Resources ................................. Page 13

Copyright © 2012

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The Three Big Questions...

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For Starters...

Welcome to the C-Arm Buyer’s Guide for Purchasing Used and Refurbished C-Arms. Beginning now, your desktop/tablet/smartphone screen will gradually reveal the compiled C-Arm wisdom of Block Imaging’s 15-year history in the used and refurbished medical imaging equipment in-dustry. If a decade and a half seems like a lot to grapple with, we urge you to take the friendly advice of another very popular guide: “Don’t Panic!”

Our goal in this is to help you understand this momentous investment by building a frame of reference for you to form your own answers to “The Big Three”:

• Which C-Arm is right for me?• How can I be sure I’m getting a quality product?• How much is this going to cost me?

Hopefully, by the end of this ebook, you’ll walk away with complete consumer empowerment. We want you to be able to sally forth into the used C-Arm market and make a well-informed decision about where to spend your imaging dollar and on what. Sound good? Then read on!

C-Arm Buyer’s Guide

For a complete listing of Block’s available systems and services please visit www.blockimaging.com 1

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Which C-Arm Do I Need?

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Which C-Arm Do I Need?

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The first step to answering question one of The Big Three is to ask another question: “How do I intend to use this C-Arm system?” C-Arms are used for a variety of applications from cardiac to urology and no one set of specifications is suited to do all of them. Nailing down exactly what type of procedures your future C-Arm will be used for will help you narrow your search into a more productive funnel.

Once you have a specialty in mind, you’ll be ready to break your C-Arm options down compo-nent by component. The three most compelling pieces to be concerned with are image intensifier (II) size and magnification, generator size, and system options.

II Size The most common C-Arm II sizes are 9” and 12” (Siemens makes a 13” as well). Though most C-Arms are tri-mode and collimate down for smaller views, the 9” is far and away the most popular.

The studies most often performed with a 9” II include:

• cardiac • orthopedics• pain management• general surgery• pacemaker placements• sports medicine

Though less popular, the 12” II most certainly has its upshots. The three extra inches of diameter allow you to see more anatomy (ex: scanning both legs simultaneously instead of exposing once for each leg) and can enable you to do studies like run-offs which you couldn’t do in a single run with a 9” unit. The studies most often performed with a 12” II include:

• vascular • neurovascular • orthopedics

II Magnification Modes

Another factor to consider is the magnification modes. You will typically find that both 9” and 12” systems have tri-mode image intensifiers. In the popular OEC lines the mag modes for a 12” are 12/9/6 and the 9” units are a 9/6/4.5. This results in a higher degree of magnification for the 9” systems. This is why OEC only makes their cardiac platform in a 9” II configuration. If your specialty is of a more delicate nature, higher magnification could be a big factor in your eventual decision.

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Which C-Arm Do I Need? (Continued)

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Generator Size

Penetration power is a key feature to consider in a C-Arm. For the orthopedic or pain physician it will come into play while taking lateral abdomen or spine shots on large or obese patients. Without the proper power the image will appear too dark, and for invasive vascular surgery, the ability to do lateral abdominal shots, angiograms, and run offs is crucial.

This is where generator size comes into play. If your particular specialty is limited to extremities, it may not be necessary to spend more on a bigger generator. If you operate in a field like bar-iatrics, it will be worth your while to investigate the more powerful end of the spectrum.

System Options In addition to differences in mechanics and hardware, there are a variety of software and appli-cations suites available. Certain procedures call for more features than others and each specialty has a set of options that they will use. It’s important that you strike a balance in this portion of the selection process. Don’t let “sticker shock” keep you from getting features that you’ll want down the road, but at the same time, don’t pay for bells and whistles you’ll never get to use.

To help you get an idea of how to achieve this balance, take a look at the breakdown of com-mon option bundles below:

Bundle Type Common Features UseGeneral Surgery Digital Spot, Pulsed Fluoro, Aver-

aging, Edge EnhancementOrtho, Sports Medicine, Pain Mgmt, Basic Surgery

Extended General Surgery

General Surgery Features plus Ad-dtl Image Storage, Digital Zoom and Roam

Ortho, Sports Medicine, Pain Mgmt, Basic Surgery

Vascular Extended Surgery Features plus DSA, Roadmapping, 15 fps Cine

Pacemaker Placement, Angio, Peripheral Vascular

Neurovascular Vascular Features plus 30 fps Cine Pacemaker Placement, Angio, Peripheral Vascular

Cardiac Vascular Features plus 30 fps Cine (note: all Cardiac c’s have 9” II)

Pacemaker Placement, Angio, Peripheral Vascular

extremities bariatrics

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Which C-Arm Do I Need? (Continued)

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As the table on page 3 indicates, a practice performing basic orthopedic procedures will likely never need a feature like 30 fps (frames per second) Cine. So why pay for it? Conversely, a practice performing delicate Cardiac procedures may want to consider paying extra to get a higher frame rate than is generally available with a Vascular platform. As with the mechani-cal and hardware options discussed earlier, the rule of thumb is this: the op-tions platform your future C-Arm will have will be determined primarily by the specialty you intend to use it for.

Bundles of Bundles The table above references option bundle types in a general way. The features that are named are common across most C-Arm types, but because there are so many makes and models of C-Arms on the market, it becomes very difficult to explain feature-by-feature exactly what will be found in each option bundle.

Luckily, most OEMs make basic technical data available for their equipment. Searching for these documents can let you know which features are standard and which are optional so that when you are ready to approach a sales representative in the third-party market, you’ll know what to ask about and what to dismiss from the discussion as inapplicable. Click here for an OEM example of free technical data.

The DICOM Question:

One feature in particular that you’ll want to be aware of is DICOM (Digital Imaging and Communications in Medicine). DICOM gives C-Arm users the ability to interface their unit with remote viewing stations. Essentially, a C-Arm with DICOM can send the pictures it takes to the facility network for viewing at multiple terminals and often through web access.

Some C-Arm models, generally newer, will have DICOM built into them. Older C-Arms can still convert their images to DICOM, but will require an accessory, known as a DICOM box, to convert them to the universal format that other workstations will recognize.

DICOM is a feature that most C-Arm buyers will opt for. While paper and film printing is still available and in use today, storing images and accessing in a digital format is most common.

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How Can I Be Sure I’m Getting a Quality C-Arm?

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How Can I Be Sure I’m Getting a Quality Product?

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After you’ve decided what you’re looking for, the next logical step is to find a good place to get it. Believe us; this is not always that easy!

While we at Block Imaging currently operate our own C-Arm refurbishment program, this was not always the case, and over the course of those 12 or so years we had plenty of chances to get a feel for what makes for a good C-Arm refur-bishment vendor and what doesn’t.

This next section will guide you through some methods to do your homework on your vendor and the machine you intend to buy before it leaves their warehouse. We’ll also touch on what your in-house inspection should look like once the unit arrives at your facility.

Vendor Homework The basic principle of vendor homework can be summed up in five words: Don’t be afraid to ask! If a vendor is the real deal, they’ll be able to comfortably answer any questions you have. Here are a few things to ask about:

Ask your vendor for a list of their refurbishment steps. If you are working with an ISO certified vendor, this will be a document that they have on hand. Below is an example. Most good refurbishment programs will include all of these steps or very similar ones:

• Evaluate C-Arm: examine C-Arm functioning and identify components needing repair or replacement This involves an initial evaluation report including Piranha data report (examines qual-ity of radiation), confirmation of tube, II, and image save functionality, general perfor-mance, ABS, tube performance, and resolution testing.

• Decontaminate: remove biohazards Block Imaging performs internal and external cleaning plus dust removal; and fully decontaminates the C-Arm including deleting patient data for HIPAA Compliance.

• Cosmetic Reconditioning: restore original body This phase involves restoring the C-Arm to its original state. Covers are prepped for paint — dents and scratches removed, C-Arm is completely repainted including foot switch, and new decals, key pad overlays and logos are placed.

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• Component Replacement: repair or replace damaged components What is most important to note is that NEW monitors and batteries are installed. Plus damaged high voltage cables, brake pads, foam seals, switches, connectors, break-ers, fuses and/or wheels are replaced.

• Calibration: ensure C-Arm is performing optimally Block Imaging makes sure the C-Arm is performing optimally by completing a thorough technical calibration including dose adjustment. Then beam alignment, vertical column, power supply, steering, locks, handles, collimator, battery charger, video system and C-Arm bearings are repaired and/or adjusted.

Ask your vendor about their timeframe. C-Arm refurbishment should take time. Every-thing should be checked from the casters, to cables, to electronics, connections, brake pads, monitors, keyboards, workstation software, removal of previous patient information, and calibra-tions to name a few things. If your supplier tells you that they’ll begin working on your C-Arm after the sale is made, any ETA under two weeks should raise an eyebrow. Remember, most systems will spend several days on a truck in transit to your site. So, unless your system has been completed in advance, that seven to ten day turnaround that seems like such a selling point might suggest that corners are being cut somewhere in the refurbishment process. Block Imaging refurbished C-Arms come with an RTI Piranha Dosimeter data report itemizing system performance and calibration specs. Requesting documents like this from your supplier is another way to ensure that important steps aren’t being skipped. These records also come in very handy when your physicist inspects the unit post-installation.

Ask your vendor about full repainting and new decals. Touch-up paint is not the same as a full paint job and it pays to be careful with that distinction. At Block Imaging we’ve seen paint jobs done with spray cans or hand rollers. There have also been situations where covers were not removed but painted while still on the system. This is a huge no-no and can lead to paint getting through the cover seams and onto the internal electronics.

How Can I Be Sure I’m Getting a Quality Product? (Continued)

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How Can I Be Sure I’m Getting a Quality Product? (Continued)

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Warehouse Inspection Always make sure you have the right to inspect your finished product or have someone inspect on your behalf. Getting a “man on the ground” in your vendor’s facility will help ensure that they’re giving their best effort. Nothing lights a fire under a service provider quite like putting a face on who will be receiving the service. If a sales person or refurbishment team knows that they will be accountable for their work in person, they will make certain that even the smallest details are in order.

At the very least, ask your supplier to send you photos of the completed unit. This will demon-strate the cosmetic condition and overall cleanliness of the unit. Make sure the photos include a shot of the serial tag to verify that you’re getting pictures of the same machine listed on your sales agreement. Photos that demonstrate image quality are also a must.

Below is an example of one of the best C-Arm image-quality photo in-spections we’ve ever received to use as your guide:

Our typical request begins with digital pictures of the monitor. Using a hi-res camera, start with pictures of an empty field set to “auto” in normal, magnification level 1, and magnifica-tion level 2:

“Auto” normal “Auto” magnification 1 “Auto” magnification 2

Next, we like to see a repeat of the above with a phantom or metal object, like a key, in the image field:

Key normal Key magnification 1 Key magnification 2

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In-House Inspection

The final portion of your C-Arm QA check will be to inspect the unit in your own facility. This step begins with a basic system inventory. Get out your sales documentation and compare what’s on your loading dock to what was listed. Do you have a footswitch? A printer? A skin spacer? If anything is missing, con-tact your salesperson immediately. Chances are, the missing item is sitting on a workbench in the refur-bishment shop and they can send it to you in the mail.

Fire up the system and repeat the steps pictured above. If the imaging chain was not properly cleaned during refurbishment, vibrations from truck-ing can shake loose dust and debris that will show up in your pictures. This step will also confirm that the high voltage circuit and x-ray tube are okay.

The End Result The questions and requests above will all serve you well as you interact with your vendor. If you are not afraid to ask them to demonstrate what they intend to do and what they have done, you’ll be able to avoid sub-par vendors from the outset and a potential host of irritating quirks and surprises post-installation.

How Can I Be Sure I’m Getting a Quality Product? (Continued)

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How Much is This Going to Cost Me?

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And finally, we come to the Great-Granddaddy of all C-Arm purchasing questions. This segment of the guide is intended to demonstrate relative price ranges in the current market and to list in detail the options and accessories that will be a part of your cost.

In addition to all that, because we’re nice, we’ll be sure to clue you in on some of the costs that will not come from your C-Arm seller but will still be involved in the process of getting your newly-refurbished C-Arm into active use.

Current Ranges The current price range in the used/refur-bished market is approximately $5,000-$140,000 (and new C-Arms can cost more than $200,000). We know; that’s a pretty big range. Unfortunately, the num-ber of models, features, and associated services make it very difficult to put a spe-cific price tag on any one system without building a list of specifications at a buyer’s direction.

Obviously, older models like the GE Ste-noscop or the Philips BV 29 will cost less because of their age and their relatively low number of features while late-model, feature-rich systems like the Ziehm Vision R or the OEC 9900 will be toward the high end of the scale. Adding in reconditioning, delivery, and install will also change where your future C-Arm lands in the range de-pending on the condition of the system and your proximity to your vendor.

The best thing to remember here is that this purchase is an investment. The overall value is every bit as important, if not more important, than the actual price. If you succumb to “sticker shock” you can end up paying even more on the back end of your purchase to get your c-arm where you really needed it in the first place.

The first step should be to determine your needs. Only after that should you begin considering price.

How Much is This Going to Cost Me?

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Accessories Aside from the onboard option bundle you choose for your C-arm purchase, there are some acces-sories that are common enough to bear noting: Printers, DICOM boxes, and C-arm tables.

Printer

Used C-Arm printers range anywhere from $500-$5,000. These print in a variety of sizes and on a variety of media. On the low end of the spectrum are Polaroid-sized paper printers. Readers who have children probably saw their first ultrasounds from this type of printer. In the middle of the spectrum one can expect to find film printers in the 8”X10” size. The most expensive printers will be hybrids that print on both paper and film in sizes up to 11”X14”.

DICOM Box

As discussed before, DICOM allows your C-Arm to send its images to a number of other viewing stations on your facility’s network. A used DICOM box averages around $3,000 while a new one sells for around $12,000. If you’ve purchased a newer C-Arm, chances are this feature is already activated and ready for integration to your PACS system.

Surgical Table

The most expensive C-arm accessory is the surgical table. The price of a surgical table will vary by style, weight capacity, and articulations.

• A brand-new “diving board” style table, the most basic surgical table type, will vary in cost between 8,000 and 20,000 dollars depending on movement capabilities.

• Brand-new float style tables (commonly used in vascu-lar cases), capable of 4-way articulation will run in the range of 25,000 to 40,000 dollars.

• Bariatric tables, many of which have increased patient weight capacity at or nearing 1,000 pounds will be in the neighborhood of 25,000 to 35,000 dollars on the primary market.

Prices will also vary on the secondary market, but on average, a buyer can anticipate finding a used table for anywhere from 25 to 35% less than the list cost.

How Much is This Going to Cost Me? (Continued)

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Additional Costs There are a number of things on the back end of a C-Arm install that can affect your price dramatically. Most of these are not optional, and only some of them are likely to be available from the vendor that sold you the C-Arm. Below is a breakdown of the costs you’ll probably run across:

Leaded PPE

This equipment includes things like lead aprons, radiation goggles/glasses, and leaded gloves and is a must for anyone who will be operating your C-Arm. Your cost will vary depending on the number of operators you have and whether or not any of them are the same relative size and could potentially share some of the gear.

Physicist Visit

This is another non-optional cost. In order for a site to comply with federal radiation regulations, a newly-installed radiation producing machine needs to be inspected by a certified radiation physicist. These inspectors are private contractors, so pricing for this inspection will depend en-tirely upon which one you choose. A list of these contractors is likely to be on file and available with your state Department of Health.

How Much is This Going to Cost Me? (Continued)

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Field Engineer in C-Arm PPE

• Aprons average $200-300 each _____________

• A variety of goggles and glasses are avail-able beginning at $55 per pair with some varieties costing as much as $250 per pair

• A variety of gloves are also available beginning in the $130 per pair range and topping out around $250 per pair

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How Much is This Going to Cost Me? (Continued)

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Lead Shielding

Here’s another one that will warrant a call to your state DOH. Regulations regarding the level of lead shielding you need vary from state-to-state. In some locations portable shields and aprons suffice. In others, leaded drywall might need to be hung in the OR. You can download a list of State Radiological and Health Department Links to answer questions about your particular state.

Service Package

When making an investment as valuable as the purchase of a refurbished C-Arm, we recom-mend accompanying that investment with some type of warranty or service plan. The features of these C-Arm service contracts will vary from vendor to vendor as will pricing, but hopefully, the homework you did when selecting a vendor included looking into some of their service options.

Block Imaging offers service packages on C-Arms that average 20-30% below OEM service pricing. We can’t guarantee that we’ll have the cheapest service agreement in town but we’ll certainly offer the most coverage for the price. If something looks like a better price than Block Imaging, be careful. Make sure that major components aren’t excluded and compare overtime coverage to com-pare apples to apples. Have your own engineer on staff? Ask us about parts-only warranties to reduce your risk of out-of-pocket expenses down the road and technical phone support.

The Long and the Short

Now that you’ve read all the details, let us give you the short answer to your cost question: Prices will vary too much for an easy answer. The best thing you can do is shop around, ask as many questions as possible, and let your vendors know what their competitors are charging. Gather-ing this knowledge, and applying it, will help you build yourself a better cost scenario.

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Next Steps & Additional Resources

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As we said in the intro to this ebook, our goal was to build you a frame of reference to inform your C-Arm purchasing decisions. Our hope is that you now have at least some idea of what type of C-Arm you intend to purchase, what a quality refurbished product should look like, and a ballpark figure of what you should be budgeting.

Well, do you feel confident enough to hit the market running and make a deal on your first refur-bished C-Arm purchase? If the answer is yes, just know that we’re cheering for you on the other end of your internet connection.

Call us… 517.668.8800! We’d love to help you out with other questions you may have.

If, in reading, you liked the cut of our jib we would like that even better! Block Imaging sports an inventory with a variety of C-Arm makes and models as well as refurbishment services, parts and accessories, and maintenance service contracts. We’d appreciate the chance to show you our products and services as you’ve read them described in the preceding pages.

Your Next Move...

See More C-Arm Resources

Are You Ready Now?

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