Intraoperative imaging with the ISO C 3D [Intraoperative bildgebung mit dem ISO C 3D]

Computed tomography (CT) scanning is the gold standard for displaying and visualizing complex anatomic structures such as the calcaneus, pelvis, and spine, etc. In orthopedic surgery CT scanning is unfortunately not available in the OR where it would be highly effective if scans could be done prior to wound closure. The reasons are high costs, need for constructional changes in the OR, and additional staff (radiologic technologist), etc. For the first time the ISO C 3D enables the surgeon to generate multiplanar reconstruction (MPR) pictures during surgery within an acceptable time frame at a reasonable price with a familiar instrument (a modified C-arm). Since February 2001 we have been able to use the ISO C 3D in our hospital and meanwhile we have scanned 442 surgical sites including the calcaneus, cervical spine, and acetabulum, etc. The intraoperative scans revealed fracture gaps and steps, unsatisfactory fragment alignment, or incorrectly positioned implants, leading to an overall revision rate of 7.3% The ISO C 3D is a first step towards a new future for bone visualization. The next steps will bring an increase in scan area and resolution, and the high-contrast pictures will be replaced by ones very similar to modern CT slices showing certain soft tissue structures.