For decades, Dr. John Herzenberg, FAAOS, former Director of Pediatric Orthopedics and former Director of the International Center for Limb Lengthening at the Rubin Institute for Advanced Orthopedics at Sinai Hospital in Baltimore has actively participated in providing orthopedic care and training in developing nations, but lack of access to C-arm fluoroscopy limited his ability to perform complex surgeries and procedures in these austere environments.  What he didn’t realize  was the fluoroscopy system he needed for humanitarian work would also be tremendously beneficial in his own clinic.

In 2022, Dr. Herzenberg and colleagues were preparing for a week-long trip to a small, missionary hospital in Robertsport, Liberia run by a lifelong missionary surgeon, Dr. James Appel.  At the AAOS Annual Meeting, Dr. Herzenberg was walking the exhibit hall when he came across the SMART-C® by Turner Imaging Systems.   When he saw the lightweight, battery-operated, portable SMART-C®, which fit neatly in a Pelican case, he realized this device could allow him to expand his surgical missionary work to developing nations that are not equipped with fluoroscopic image guidance. He could easily pack the SMART-C® to check on flights and would not have to worry about power outages and power surges often seen in the fragile electrical systems of developing nations.

“Liberia was the most resource-challenged country that I’ve ever been to,” said Dr. Herzenberg, “It allowed us to do some very complicated surgeries.”

Uses for SMART-C® Portable Fluoroscopy in an Outpatient Clinic

Orthopedic specialists value the SMART-C® for its ability to deliver high-quality images to guide diagnoses and treatment. Its uses in orthopedic clinic may include:

  • Diagnosing and reducing fractures
  • Stress views to diagnose instability
  • Foreign body removal
  • Image-guided injections
  • Weight-bearing views
  • Minimally invasive surgery
  • Pin insertion and removal

Utilizing the SMART-C® Back Home

Back at the Rubin Institute, Dr. Herzenberg couldn’t shake the transformative potential he witnessed in Liberia. He knew the SMART-C® could streamline workflows and improve care for patients back home, too. So, he acquired one for the outpatient clinic, and it quickly became an instrumental part of their work flow. They estimate that the practice now uses the SMART-C® about 50 times per week. Podiatrists, pediatricians, and hand surgeons find it invaluable for imaging hands, feet, elbows, wrists, and knees. The device’s agility shines when examining these intricate anatomical areas.

Beyond the clinic, the SMART-C® has also become a game-changer for our sports medicine specialists, providing real-time insights during live sporting events. Dr. Gaertner, the team doctor for the National Steeplechase Association, testifies to its value. Imagine a rider tumbles from a horse. With the SMART-C® by her side, Dr. Gaertner can rule out fractures within seconds, saving precious time and potentially avoiding unnecessary ambulance rides.

It empowers physicians to make quick, informed decisions about whether an athlete can safely return to the game.”

Fluoroscopy vs. Radiographic X-ray

While many outpatient clinics have radiography, most do not have fluoroscopy.  While radiographic X-rays offer snapshots of bones, they leave much to the imagination when it comes to movement and alignment. With fluoroscopy, the clinician can position the patient for immediate, perfectly aligned images, making it ideal for pinpointing instability, ensuring perfect image alignment, and even guiding injections with pinpoint accuracy.

“With plain X-ray you can get a static image, but if you want to see a live image while you’re moving the joint to see if there is instability, you need a C-arm,” Dr. Herzenberg said.

Improve Workflow, Saving Time and Money for Patients and Provider

The SMART-C® isn’t just a fancy gadget; it’s a workflow revolution waiting to happen. Forget the frustration of sending patients on imaging detours – the SMART-C® lets doctors capture billable views right in the exam room. 

That means greeting, examining, imaging, and treating patients in one seamless flow, without wasted time or trips to busy radiology suites involved.  Benefits extend beyond the doctor’s schedule. Patients finally get to see their images in real-time, leading to clear explanations and faster decisions about the right treatment. Often, that treatment can even be performed right there in the clinic, with the SMART-C® assisting every step of the way.

But the real value goes deeper than time savings. The SMART-C® improves clinical accuracy by providing superior images compared to radiographic X-rays. This reduces the risk of missed or delayed diagnoses, leading to better medical decisions and potentially even lower overall healthcare costs in the long run. As Dr. Herzenberg puts it, “You receive a wealth of information beyond what a standard X-ray would provide. While it’s challenging to quantify this in terms of cost, it undeniably enhances clinical accuracy, ultimately improving the quality of medical decisions”.

Learn more about SMART-C® and how it can benefit your practice. Today SMART-C® is used for imaging extremities, but other new and exciting uses in medicine may be the future of this innovative device. Contact us here or email to learn more.

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Orem, UT 84058