Fixed cath labs and high-end mobile C-arms

Catheterization laboratories, commonly referred to as cath labs, play an essential role in managing cardiovascular diseases. Cath labs are equipped with specialized imaging technology that allows physicians to visualize the arteries and chambers of the heart and treat abnormalities. This technology revolves around the use of a C-arm – a sophisticated imaging scanner integral for fluoroscopic imaging of the cardiovascular system.

Fixed cath labs are permanent installations and are equipped with advanced ceiling or floor-mounted C-arms that provide high-quality imaging and stability, essential for complex and lengthy procedures. In contrast, mobile cath labs utilize portable C-arms that are not fixed to the floor or ceiling but can be easily moved and adjusted. These mobile systems offer flexibility and can be set up in various locations within a hospital or clinic, depending on the need. They excel in environments requiring versatility and adaptability, making them ideal for hospitals that lack the space for a dedicated cath lab or for multiple locations within a larger medical facility, adapting to the needs of different patient populations or procedural requirements. While a fixed cath lab caters only to cardiac procedures or neurological procedures (typically biplane systems), a high-powered mobile C-arm can be general purpose.

Fixed cath labs are designed for high-volume use and remain in a single location, offering unparalleled stability and the capability to handle a broader range of procedures, thanks to their robust, permanent setups. They are often integrated with other hospital systems, providing seamless workflows for complex cardiac interventions. A high-power (often grid-controlled) X-ray tube and fast detector allow for very short X-ray pulses, achieving sharp image definition for fast-moving anatomy.

While mobile cath labs typically do not match the power and speed of fixed cath labs, they offer significant flexibility and often incorporate the advanced imaging capabilities and procedural efficiency of fixed labs. The technological advances in portable C-arms have significantly narrowed this gap, with many mobile units now offering advanced imaging technologies that are sufficient for a wide range of interventions. Mobile C-arms must balance portability with functionality, maintaining a lighter, more compact design while still supporting essential imaging needs.

Investing in a fixed cath lab involves significant capital expenditure, including construction, advanced imaging equipment, and maintenance costs. These labs are best suited for high-volume centers where the frequency of procedures justifies the initial investment. On the other hand, mobile cath labs represent a lower initial investment and can be a cost-effective solution for facilities with limited budgets or fluctuating procedure volumes. The flexibility of a mobile C-arm allows institutions to expand service offerings with no dedicated, permanent spaces, making it a practical choice for expanding access to cardiac care in a cost-conscious healthcare environment.

Both mobile and fixed cath labs must meet stringent regulatory standards to ensure patient safety and high-quality care. Traditionally, these systems needed to support DSA, quantitative coronary analysis, etc. The trend now is to support multimodality integration (e.g., FFR, TEE, IVUS, OCT) and, thanks to their iscocentric design, 3D reconstruction while keeping the radiation dose as low as possible besides the standard applications. Some of the future trends include AI-enabled fast collimation and multimodality image registration, and augmented reality to support operation in hybrid OTs.

The choice between a mobile and a fixed cath lab depends on several factors, including the types of procedures planned, patient volumes, available space, and budget constraints. While fixed cath labs provide stability and access to cutting-edge technology for complex cases, mobile cath labs offer remarkable flexibility and cost efficiency, making them an attractive option for facilities needing adaptable solutions.