Intraoperative CT Head Holder: Choosing Fixation for Mobile CT, O-arm and Hybrid ORs

What intraoperative CT neurosurgery demands from the holder

In intraoperative CT neurosurgery the scanner is used during the operation to confirm implant position, check for haemorrhage or update navigation. The head holder is in the image path for every scan, so any metal in the field can create streaks that hide the very structures being checked.

The holder also determines how close the patient can be brought to the gantry. Long reach and a slim base keep the head clear, while a bulky base unit can collide with the gantry or limit table movement. Always evaluate the holder with the actual scanner geometry, not with a drawing.

Radiolucent skull clamp for CT: artefacts and pins

A radiolucent skull clamp for CT reduces artefacts by using a metal-free body and radiolucent materials, and by minimising metal in the pins. Disposable skull pins, such as those used in the DORO LUCENT range, keep artefacts low and give a fresh sharp tip per patient.

The DORO LUCENT Headrest System Pro is the manufacturer's flagship system for iCT, X-ray and X-ray-based angiography. Its base unit has no lateral overhang and offers several mounting options, the long reach keeps the head clear inside the gantry, pin holders change through a plug-in mechanism, and an optional paediatric upgrade kit with 2-pin holders is available.

Small-gantry and mobile CT: O-arm head holder and XTom

Mobile small-gantry scanners have narrow openings. The DORO QR3 XTom system is designed for gantries of 32 cm (12 in) and larger. Adjustable extension arms place the head within the gantry, and combined with DORO LUCENT disposable skull pins this supports high-quality imaging on mobile CTs.

The system comes with a dedicated torque screwdriver for setting pin pressure and the DORO XTom U-Belt, which acts as a safety net in the unlikely event of head slippage. DORO LUNA, DORO COBRA and Quick-Clamp products attach to the Quick-Rail, and navigation adaptors mount close to the surgical field. If you plan an O-arm head holder purchase, ask the supplier to confirm gantry dimensions and compatibility with your exact scanner.

• Gantry opening of your scanner against the holder's stated minimum
• Reach of the base unit and clearance of the table
• Pin type and pin-force verification
• Quick-Rail and navigation interface position
• Paediatric option

Hybrid OR neurosurgery and multi-modality imaging

A hybrid OR for neurosurgery may combine CT, X-ray angiography and sometimes MR. The DORO LUCENT iXI supports intraoperative MR, CT and angiography, so bone and soft tissue can be assessed within the same surgery and several modalities combined in one procedure. It mounts directly to the transfer boards of Maquet OR tables and supports Brainlab Automatic Image Registration.

When more than one modality is planned, compare the holder's behaviour with each, and read head fixation for intraoperative MRI and the LUCENT system overview before you decide.

Questions to ask the supplier

Request a drawing of the holder in the gantry with your scanner, a list of compatible OR tables and adaptors, the pin type and its labelling, and the cleaning instructions. Ask for a trial scan with the holder on a phantom or head model to check artefacts in your own protocol.

A trial scan is also the best moment to agree responsibilities: who positions the holder in the gantry, who checks cable and line clearance, and who confirms the image quality before the patient is returned to the surgical position.

Beckfinity can coordinate such a trial and supply the DORO range. Contact our specialists to plan your imaging OR.