[citation needed] The repair of diseased heart valves and the surgical treatment of rhythm disturbances and aortic aneurysms can benefit from the imaging capabilities of a hybrid OR.

[citation needed] The shift toward endovascular treatment of abdominal aortic aneurysms also pushed the spread of angiographic systems in vascular operating room environments.

[citation needed] Procedures to diagnose and treat small pulmonary nodules have also recently been performed in hybrid operating rooms.

Interventional image guidance thereby offers the advantage of precisely knowing the position of the nodules, particularly in small or "ground-glass" opaque tumors, metastases, and/or patients with reduced pulmonary function.

This approach also delivers the potential to spare healthy lung tissue by knowing the exact position of the nodule which increases the quality of life for the patient after the operation.

While this procedure speeds up recovery and potentially reduces complications, the loss of natural vision and tactile sensing makes it difficult for the surgeon to locate the nodules, especially in cases of non-superficial, ground-glass opaque, and small lesions.

Using advanced intra-operative imaging in the operating rooms helps to precisely locate and resect the lesion in a potentially tissue-sparing and quick fashion.

In order to be able to use image guidance during video-assisted thoracoscopic surgery, rotational angiography has to be performed before the introduction of ports, thus before the lobe in question deflates.

[citation needed] Fluoroscopy is performed with continuous X-ray to guide the progression of a catheter or other devices within the body in live images.

Image quality needed for cardiac applications can only be achieved by high powered fixed angiography systems, not with mobile C-arms.

While standard fluoroscopy is predominantly used to guide devices and to re-position the field of view, data acquisition is applied for reporting or diagnostic purposes.

To achieve a sufficient image quality for diagnoses and reporting, the angiographic system uses up to 10 times higher X-ray doses than standard fluoroscopy.

From the acquired DSA sequence, the image frame with maximum vessel opacification is identified and assigned to be the so-called road-map mask.

The clinical benefit is better visualization of small and complex vascular structures without distracting underlying tissue to support the placement of catheters and wires.

[22] Modern angiographic systems are not just used for imaging, but support the surgeon also during the procedure by guiding the intervention based on 3D information acquired either pre-operatively or intra-operatively.

The software algorithm that stands behind this process is called registration and can also be done with other DICOM images, such as CT or magnetic resonance tomography data acquired preoperatively.

Without additional contrast agent injection the surgeon can observe device movements simultaneously with the 3D overlay of the vessel contours in the fluoroscopy image.

Recently, applications have been released which support the surgeon in selecting this optimal fluoroscopy angulation or even drive the C-arm automatically into the perpendicular view to the aortic root.

Algorithms purely based on C-arm CT images acquired in operating rooms by the angiographic system are inherently registered to the patient and show the present anatomy structures.

With such an approach, the surgeon does not rely on pre-operative CT images acquired by the radiology department, which simplifies the workflow in the operating room and reduces errors in the process.

[citation needed] Improvements of the C-arm technology nowadays also enable perfusion imaging and can visualize parenchymal blood volume in the OR.

[21] A CT system mounted on rails can be moved into and out of an operating room to support complex surgical procedures, such as brain, spine, and trauma surgery with additional information through imaging.

The Johns Hopkins Bayview Medical Center in Maryland describes that their intra-operative CT usage has a positive impact on patient outcomes by improving safety, decreasing infections, and lowering the risks of complications.

As it holds an imaging modality, the radiology department could take the lead responsibility for the room for expertise in handling, technical, maintenance, and connectivity reasons.

[27][28] This may require professional project management and several iterations in the planning process with the vendor of the imaging system, as technical interdependencies are complex.

[22] In summary, the key topics for planning the surgical light system include: The most common imaging modality to be used in hybrid ORs is a C-arm.

It is not recommended to implement a biplane system if not clearly required by these clinical disciplines, as ceiling-mounted components may raise hygienic issues:[29] In fact, some hospitals do not allow operating parts directly above the surgical field, because dust may fall in the wound and cause infection.

Cardiac and vascular surgeons, in general, have less complex positioning needs, but based on their interventional experience in angiography may be used to having fully motorized movements of the table and the tabletop.

In summary, important aspects to be included considered are the position in the room, radiolucency (carbon fiber tabletop), compatibility, and integration of imaging devices with the operating table.

Dose should be as low as possible, but image quality can only be reduced to the level that the diagnostic benefit of the examination is still higher than the potential harm to the patient.