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Mini C-arm

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FluoroScan Mini C-arm (HealthMate, Inc., 1986)

Mini C-arm (also called miniature C-arm, mobile C-arm or extremity fluoroscope) is a compact, portable fluoroscopic X-ray imaging system designed for real-time imaging of the small bones and joints of the extremities. It takes its name from the C-shaped arm connecting the X-ray source on one end to the image detector on the other.

The mini C-arm was first released in 1985. It is used in orthopedics, emergency rooms and pediatric imaging.

Before its introduction, the only available fluoroscopy systems were full-size stationary C-arms designed for spinal and large-joint surgery, which are relatively expensive.[1]

Clinical applications

[edit]

The mini C-arm is standard equipment in hospitals, surgery centers, and physician offices.[2]

Hand and wrist surgery

[edit]

The Mini C-arm introduced portable intraoperative fluoroscopic guidance to hand and wrist surgery, including. percutaneous fixation.[3][4][5] The device also enabled wider clinical use of fluoroscopic wrist motion assessment for carpal instability, which is a dynamic condition not visible on static X-rays.[6] Wolf and Weiss reported improved operative efficiency in hand surgery, and a 2022 prospective study reported a 24 minute reduction per postoperative visit and cost savings exceeding $9,500 per patient series.[7][8]

Foot and ankle surgery

[edit]

Documentation of the Mini C-arm in foot and ankle surgery has dated since 1993.[9] Key applications of the Mini C-arm include minimally invasive hallux valgus correction, including the MICA (Minimally Invasive Chevron-Akin) technique, as well as percutaneous lag screw fixation of ankle fractures and fluoroscopy-guided K-wire fixation of forefoot deformities.[10]

Pediatric orthopedic surgery

[edit]

The Mini C-arm's lower dose profile is particularly relevant in pediatrics.[11] It is used for closed reduction and percutaneous pinning of supracondylar humerus fractures.[12] Fanelli et al. (Journal of Pediatric Orthopaedics, 2016) demonstrated a 23-minute reduction in patient waiting time per visit and improved clinical efficiency.[13]

Emergency medicine

[edit]

Emergency departments adopted Mini C-arms for closed reduction of distal radius fractures, foreign body localization, and joint aspiration.[14][15][16] Lee et al. (JBJS, 2011) established in 279 pediatric forearm fractures that Mini C-arm guidance improved reduction quality, decreased radiation exposure, and reduced the need for repeat reductions.[17] During the COVID-19 pandemic, Mini C-arm fluoroscopy enabled UK hand clinics to maintain continuity of care while avoiding patient transfers to imaging departments.[18]

Design and technical characteristics

[edit]

A Mini C-arm consists of the following principal components. Its architecture differs from full-size fluoroscopy C-arms in that it is built with a smaller physical arc, lower power generator capacity, and lighter construction, optimized for extremity imaging of hands, wrists, feet, and ankles.

  • C-arm assembly: A C-shaped arm with the X-ray tube at one end and the image detector at the other. The arm rotates around the patient's extremity, typically 120°-150°, enabling anteroposterior, lateral, and oblique views without repositioning the patient. The C-frame design allows the device to rotate through vertical, inverted, and horizontal configurations, reducing scatter radiation patterns around the operating table during live procedures.[19]
  • X-ray source (tube head): A micro-focus X-ray tube operating at low tube current and a source-to-detector distance of approximately 40 cm, producing significantly less scattered radiation.[19]
  • Image detector: Early systems used a small image intensifier, typically 4-6.7 cm diameter. The evolution from vacuum-tube image intensifiers to flat-panel detectors (FPDs) represents an important engineering advancement: FPD systems offer a smaller, more compact mechanical frame, extended dynamic range, and elimination of the spatial (geometric) distortion inherent to the curved input screen of a vacuum-tube intensifier.[20]
  • Dynamic fluoroscopy capability: The system processes both static radiographs and real-time dynamic imaging, allowing the clinician to capture moving physiological actions such as joint flexion intraoperatively.[3]
  • Monitor and processing unit: A mounted display (typically 20-24 inches) showing real-time fluoroscopic images. Digital capabilities include image capture, cine loops, zoom, contrast adjustment, and DICOM export.[19]
  • Mobile cart: A wheeled cart housing electronics, monitor arm, and C-arm mounting. Current system weights range from approximately 30-100 pounds (14-45 kg), enabling room-to-room mobility.[19]
  • Foot pedal and surgeon-operated controls: The surgeon activates X-ray exposure via a floor-mounted foot pedal. The control systems and lightweight construction are designed to be surgeon operated.[19]

Radiation safety

[edit]

The Mini C-arm produces less scatter radiation than standard fluoroscopic C-arms, primarily due to its shorter source-to-detector distance and lower tube current. Key peer-reviewed findings:

  • Athwal et al. (2005, Journal of Hand Surgery) demonstrated universally lower radiation exposure across all hand surgery configurations.[21] Singer (2005, Journal of Hand Surgery) provided quantified measurement of radiation exposure specifically to the surgeon's hands, establishing the safety basis for routine clinical use.[22]
  • Dawe et al. (2011, Foot and Ankle Surgery) documented 53% lower radiation dose area product in foot and ankle surgery.[23]
  • FESSH (2016, J. Hand Surgery European Volume) reported surgeons receive less than 3% of annual radiation limits during intraoperative hand and wrist fluoroscopy.[24]
  • A prospective series of 1,064 consecutive foot and ankle procedures confirmed all radiation exposures remained below international occupational and patient dose limits throughout daily clinical use.[25]
  • Standard radiation protection practices apply, including lead aprons, thyroid shields, leaded gloves, and the ALARA principle (As Low As Reasonably Achievable).

Origin

[edit]

The Mini C-arm was invented by American entrepreneur Larry S. Grossman.[26] He founded HealthMate, Inc. in 1982 to adapt NASA-derived low-intensity X-ray imaging (LIXI) technology into a mains-powered fluoroscopic instrument for medical use.[27][28]

The mini C-arm was derived from the Lixiscope, another portable X-ray imaging device. Grossman devised the concept of replacing the radioactive isotope used in the Lixiscope with a micro-focused X-ray tube and adding a high-voltage power supply to that device to make it controllable.[27]

History

[edit]

HealthMate introduced the FluoroScan Mini C-arm in the United States in 1985.[27][28] Following a Chapter 11 reorganization in 1989,[29] HealthMate was renamed FluoroScan Imaging Systems, Inc.

A second early mini C-arm system, the XiTec XiScan, also became available in the early 1990s. The XiScan technology has since been continued by FM Control of Vitoria-Gasteiz, Spain, whose XiScan Series 5000 is a European-manufactured mini C-arm available in European and international markets.[30][31]

FluoroScan Imaging Systems, Inc. was acquired by Hologic, Inc. (NASDAQ: HOLX), in 1996.[32][33] Under Hologic, the product line was rebranded as the Fluoroscan Insight.[34] Successive generations include the Premier, Premier Encore, InSight, InSight 2, and InSight FD. Hologic announced the end-of-sale and end-of-life for the Fluoroscan InSight FD mini C-arm, effective September 30, 2025.[35]

In 2004, OrthoScan, Inc. was established. OrthoScan introduced the OrthoScan FD with a flat-panel detector, offering 2K x 1.5K matrix resolution versus the 1K x 1K standard of image intensifier systems.[36][37] OrthoScan subsequently introduced the FD Pulse, which included a pulsed fluoroscopy option.[38] In September 2011, OrthoScan was acquired by German private investment firm Aton GmbH, which also held a majority stake in Ziehm Imaging.[39] Aton later merged the two C-arm companies and renamed the combined entity Ziehm-OrthoScan. They subsequently produced the TAU Mini C-arm brand.[40]

OEC Medical Systems, Inc. (Salt Lake City, Utah) entered the Mini C-arm market with its Mini 6600 and MiniView 6800 models. OEC was acquired by GE Medical Systems in November 1999 and the product line continued under the GE OEC brand.[41][42]

Regulatory status

[edit]

In the United States, Mini C-arms may be operated by licensed physicians, subject to state radiation control regulations. This physician operable status makes the Mini C-arm distinct from standard C-arms, which typically require a radiographer.[2][43][44]

See also

[edit]

References

[edit]
  1. ↑ van Rappard JR, Hummel WA, de Jong T, Mouës CM (2019). "A Comparison of Image Quality and Radiation Exposure Between the Mini C-Arm and the Standard C-Arm". HAND. 14 (6): 765–769. doi:10.1177/1558944718770210. PMC 6900691. PMID 29661071.
  2. 1 2 "C-Arm Technology Update". Radiology Today. 11 (2): 22. 2010.
  3. 1 2 Swindells MG, O'Brien CM, Armstrong DJ, Arundell MK (2011). "The use of the Mini C-arm in the outpatient setting: Evolving practice". Journal of Plastic, Reconstructive & Aesthetic Surgery. 64 (5): 688–689. doi:10.1016/j.bjps.2010.08.012. PMID 20870477.
  4. ↑ Ammari T, et al. (2021). "Establishing local diagnostic reference levels for Mini C-arm use in upper limb surgery". The Surgeon. 19 (6): e338–e343. doi:10.1016/j.surge.2020.08.007. PMID 32994124.
  5. ↑ Chan KW, McAdams TR (2004). "Central screw placement in percutaneous screw scaphoid fixation: a cadaveric comparison of proximal and distal techniques". Journal of Hand Surgery (American Volume). 29 (1): 74–79. doi:10.1016/j.jhsa.2003.09.002. PMID 14751108.
  6. ↑ Protas JM, Jackson WT (1980). "Evaluating carpal instabilities with fluoroscopy". American Journal of Roentgenology. 135 (1): 137–140. doi:10.2214/ajr.135.1.137. PMID 6771978.
  7. ↑ Wolf JM, Weiss AP (1999). "Portable mini-fluoroscopy improves operative efficiency in hand surgery". Journal of Hand Surgery (American Volume). 24 (1): 182–184. doi:10.1053/jhsu.1999.jhsu24a0182. PMID 10048535.
  8. ↑ Kesler K, Buckwalter JA (2022). "Efficiency Benefits of Live Fluoroscopy in Hand Clinics". Iowa Orthopaedic Journal. 42 (2): 118–121. PMC 9769344. PMID 36601224.
  9. ↑ Gehrke JC, Mellenberg DE Jr, Donnelly RE, Johnson KA (1993). "The Fluoroscan Imaging System in Foot and Ankle Surgery". Foot & Ankle International. 14 (9): 545–549. doi:10.1177/107110079301400912. PMID 8314193.
  10. ↑ Ozdemir E, Aynardi M (2024). "Minimally Invasive Bunion Surgery for Hallux Valgus: A Surgical Technique". Lower Extremity Review.
  11. ↑ Gendelberg D, Hennrikus W, Slough J, King S (2016). "A Radiation Safety Training Program Results in Reduced Radiation Exposure for Orthopaedic Residents Using the Mini C-arm". Clinical Orthopaedics and Related Research. 474 (2): 578–584. doi:10.1007/s11999-015-4631-0. PMC 4709301. PMID 26566977.
  12. ↑ Hsu RY, Lareau CR, Kim JS, et al. (2014). "Effect of C-Arm Position on Radiation Exposure During Fixation of Pediatric Supracondylar Fractures of the Humerus". JBJS. 96 (15): e129. doi:10.2106/JBJS.M.01076. PMID 25100782.
  13. ↑ Fanelli MG, Hennrikus WL, Slough Hill JM, Armstrong DG, King SH (2016). "The Mini C-arm Adds Quality and Efficiency to the Pediatric Orthopedic Outpatient Clinic". Journal of Pediatric Orthopaedics. 39 (6): e1097–e1099. doi:10.3928/01477447-20160808-01. PMID 27504650.
  14. ↑ "Procedural Use of a Mini C-arm in the Emergency Department". Academic Life in Emergency Medicine (ALiEM). December 31, 2025.
  15. ↑ Kumar R, Muzzammil M, Maqsood K, et al. (2017). "Role of Mini C-arm in Orthopedic Emergency Department". Journal of Trauma and Critical Care. 1 (2): 34–37.
  16. ↑ Odom MR (2020). "Foreign Bodies in the Skin: Evaluation and Management". American Family Physician. 101 (12): 740–747. PMID 32538598.
  17. ↑ Lee MC, Stone NE, Ritting AW, et al. (2011). "Mini-C-Arm Fluoroscopy for Emergency-Department Reduction of Pediatric Forearm Fractures". Journal of Bone and Joint Surgery (Am.). 93 (15): 1442–1447. doi:10.2106/JBJS.J.01052. PMID 21915550.
  18. ↑ Nagy M, Ashwood N, Abouelela A, Suryawanshi S, Sidhu GA, Kitsis C (2022). "The Use of Fluoroscan in Hand Clinic During the COVID Pandemic to Optimise Conservative Treatment". Cureus. 14 (9) e29494. doi:10.7759/cureus.29494. PMC 9595256. PMID 36312667.
  19. 1 2 3 4 5 US 6,234,672, "Miniature C-arm apparatus with C-arm mounted controls" Fig. 3(A-D)
  20. ↑ Nickoloff EL (2011). "AAPM/RSNA Physics Tutorial for Residents: Physics of Flat-Panel Fluoroscopy Systems—Survey of Modern Fluoroscopy Imaging: Flat-Panel Detectors versus Image Intensifiers and More". RadioGraphics. 31 (2): 591–602. doi:10.1148/rg.312105185. PMID 21415199.
  21. ↑ Athwal GS, Bueno RA, Wolfe SW (2005). "Radiation Exposure in Hand Surgery: Mini Versus Standard C-Arm". Journal of Hand Surgery (American Volume). 30 (6): 1310–1316. doi:10.1016/j.jhsa.2005.06.023. PMID 16344194.
  22. ↑ Singer G (2005). "Radiation Exposure to the Hands from Mini C-arm Fluoroscopy". Journal of Hand Surgery (American Volume). 30 (4): 795–797. doi:10.1016/j.jhsa.2005.01.007. PMID 16039374.
  23. ↑ Dawe E, et al. (2011). "A comparative study of radiation dose and screening time between mini C-arm and standard fluoroscopy in elective foot and ankle surgery". Foot and Ankle Surgery. 17 (1): 33–36. doi:10.1016/j.fas.2010.01.001. PMID 21276563.
  24. ↑ "FESSH Abstracts 2016 - A-0021: Hand and body radiation exposure during mini C-arm fluoroscopy". Journal of Hand Surgery European Volume. 2016. doi:10.1177/1753193416644553.
  25. ↑ "Prospective analysis of intraoperative radiation dose in foot and ankle surgery using mini-C-arm: 1,064 procedures". Orthopaedics & Traumatology: Surgery & Research. 105 (3): 503. 2019.
  26. ↑ Bell, Bonnie (September 16, 1995). "Picture Brightens for Pioneer in X-ray Systems Technology". Crain's Chicago Business.
  27. 1 2 3 Chandler, Susan (June 23, 1985). "New Firm Banks on Technology and People". Chicago Sun-Times.
  28. 1 2 Darby, Edwin (October 16, 1985). "2 Hope FluoroScan Healthy Future". Chicago Sun-Times.
  29. ↑ Gornstein, Leslie (September 24, 1994). "IPO Provides X-ray Equipment Firm a Clearer Growth Picture". Crain's Chicago Business.
  30. ↑ "XiTec XiScan 1000 mini C-arm unit". Health Devices. 25 (11): 413–425. 1996. PMID 8913780.
  31. ↑ "XiScan Series 5000 Mini C-arm". FM Control (Vitoria-Gasteiz, Spain).
  32. ↑ "Hologic Inc. (company history and FluoroScan acquisition)". Axis Imaging News. 2006.
  33. ↑ "Agreement and Plan of Merger (Hologic, Inc. and FluoroScan Imaging Systems, Inc.), Form S-4 Registration Statement". U.S. Securities and Exchange Commission, EDGAR. July 18, 1996.
  34. ↑ "Annual Report on Form 10-K for Fiscal Year 2018". Hologic, Inc., via U.S. Securities and Exchange Commission EDGAR. 2018.
  35. ↑ "Annual Report on Form 10-K for Fiscal Year Ended September 28, 2024". Hologic, Inc., via U.S. Securities and Exchange Commission EDGAR. 2024.
  36. ↑ "Orthoscan FD Digital Mini C-arm Review". Block Imaging (independent equipment evaluation). 2024.
  37. ↑ "510(k) Premarket Notification K133174". U.S. Food and Drug Administration, Center for Devices and Radiological Health. March 28, 2014. Retrieved 2026-05-21.
  38. ↑ "510(k) Premarket Notification K161976". U.S. Food and Drug Administration, Center for Devices and Radiological Health. October 6, 2016. Retrieved 2026-05-21.
  39. ↑ "ATON Acquires OrthoScan, Inc". PR Newswire. September 27, 2011.
  40. ↑ "OrthoScan, Inc. launches new TAU family of mini C-arms - the first mini C-arm designed for use with pediatric patients". Ortho Spine News. 2019.
  41. ↑ "GE Makes Bid for OEC Medical to Broaden Interventional Offerings". Diagnostic Imaging.
  42. ↑ "GE Medical Systems". Axis Imaging News. 1999.
  43. ↑ Daner WE 3rd, Ryan PM, Domson GF, Sima AP, Isaacs JE (2021). "Quality of Mini C-Arm Imaging in Post-Reduction Evaluation of Distal Radius Fractures". Osteology. 1 (3): 105–111. doi:10.3390/osteology1030011.
  44. ↑ Groover ME, Bamberger HB, Evans M, Gazaille RE, Hinkley A, Gerow E (2019). "The Effect of Metal Instrumentation on Patient and Surgical Team Scatter Radiation Exposure Using Mini C-Arm in a Simulated Forearm Fracture Fixation Model". J Am Acad Orthop Surg Glob Res Rev. 3 (11): e045. doi:10.5435/JAAOSGlobal-D-18-00089. PMC 6917351. PMID 31858073.
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