title: Integrating surgery and radiology in one suite: a multicenter study.
abstract: OBJECTIVE
  The study was performed to evaluate the performance of digital fixed-mounted angiographic C-arm systems in the operating room as used by surgeons, cardiologists, and interventional radiologists.
  
  
  METHODS
  An observational study in the operating room was performed, along with a structured questionnaire and semi-structured interviews. Twenty interventions were observed at 5 sites. Workflow was analyzed.
  
  
  RESULTS
  Integration of high-end angiographic imaging equipment in the operating room enables image-guided surgery with high-quality images, on-table quality assessment of surgical procedures, and "one-stop shopping" procedures. Integrated suites were run by surgery as well as radiology departments, and are used for a variety of procedures, including vascular, cardiothoracic, open surgical, percutaneous, and combined procedures. Operation of the angiographic system and its user interface design were not considered ideal for operating room use. Limited patient accessibility was observed, sometimes leading to uncomfortable positions for the operating physicians. Certain procedures, such as tibial artery surgery, were difficult to perform, owing to lack of accessories. Patient transfer was considered inadequate. Cleaning of the system was rated as poor. Operating room use puts an even higher demand on reliability of the system.
  
  
  CONCLUSIONS
  Integration of digital angiographic systems into operating rooms has produced opportunities for new treatments and offers a superior solution for interdisciplinary work among surgeons, cardiologists, and radiologists. However, the context of use differs radically from that in the traditional radiologic examination room; the environment, users, and procedures are all different. Integration of imaging methods into the operating room can be more successful if special operating room conditions are taken into account by medical systems manufacturers.
authors.affiliation: Interventional Centre, Rikshospitalet University Hospital, Oslo, Norway.
authors.forename: Gerben
authors.initials: G
authors.lastname: ten Cate
authors.forename: Erik
authors.initials: E
authors.lastname: Fosse
authors.forename: Per Kristian
authors.initials: PK
authors.lastname: Hol
authors.forename: Eigil
authors.initials: E
authors.lastname: Samset
authors.forename: Richard W
authors.initials: RW
authors.lastname: Bock
authors.forename: James F
authors.initials: JF
authors.lastname: McKinsey
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Pearce
authors.forename: Mark
authors.initials: M
authors.lastname: Lothert
mesh_terms: D000792:Angiography / Q000295:instrumentation*; D001291:Attitude of Health Personnel; D003258:Consumer Behavior; D004867:Equipment Design; D006804:Ergonomics; D006801:Humans; D009873:Operating Rooms / Q000458:organization & administration*; D018511:Systems Integration; D014656:Vascular Surgical Procedures / Q000295:instrumentation*