Choosing a C-arm for urology and endourology suites

Where C-arm urology procedures use fluoroscopy

In percutaneous nephrolithotomy (PCNL), fluoroscopy helps the team to puncture the collecting system, advance the wire and dilate the tract. In ureteroscopy, it confirms wire and scope position, shows stones and verifies stent placement. Retrograde studies, nephrostomy tube placement and some stricture procedures also rely on it.

Most of these procedures are short bursts of fluoroscopy within a longer case, so the key is image clarity at low dose with fast, repeatable positioning, not maximum generator power. Contrast visibility matters, because the collecting system is often defined by contrast.

Detector and image quality

A flat panel detector gives distortion-free images and good contrast sensitivity, which helps with small stones and thin wires. A 9 inch detector covers a kidney and proximal ureter comfortably; a 12 inch panel is better for following the whole ureter or when the patient is large. The Perlove PLX C22 offers 9 or 12 inch panels, with SCI or IGZO options, and software functions such as metal artefact suppression, useful near metallic stents and instruments.

Check image processing at low pulse rates, last image hold and the ability to store and replay short loops, since the surgeon will often review rather than irradiate again.

Urology C-arm table and positioning

Endourology usually uses a radiolucent table that accommodates lithotomy for ureteroscopy and prone or modified supine positions for PCNL. The C-arm must pass under or around the table, which makes the free space in the arc and the ability to tilt the beam essential. For PCNL, oblique angulation is used to align the access to the target calyx, so the C-arm must hold stable at those angles.

The PLX C22 gantry glides and holds position at any angle, with bilateral laser positioning to speed set-up. For rooms with a dedicated remote-controlled table, the Villa Apollo DRF Open uses a single-arm suspended carbon-fibre tabletop with open access from all sides, carries patients up to 230 kg and has a 43 x 43 cm dynamic flat-panel detector. It is a fixed alternative for endourology and interventional rooms. Compare it with mobile options in our article on C-arm versus fluoroscopy.

• Radiolucent tabletop with enough lateral clearance for the arc
• Floor or ceiling space for the monitor and surgeon position
• Stable oblique angles for percutaneous access
• Fluid-resistant covers and a drape for the C-arm

Dose management in urology

Urologists often work close to the beam and may repeat procedures frequently, so cumulative dose matters. Insist on pulsed fluoroscopy, low-dose modes, collimation and a dose display, and keep the tube under the table and the surgeon on the detector side where possible. Our guide to dose reduction techniques and article on protective equipment give practical steps.

Where possible, use ultrasound or direct vision to limit fluoroscopy time. Equipment can help, but technique governs most of the dose.

Planning an endourology suite

Confirm door widths, the position of irrigation and endoscopy towers, and whether the C-arm will share the room with other equipment. Ask about the covers and drapes available, cleaning procedures and how the unit handles fluid. See our article on C-arm covers for infection-control points.

Beckfinity's specialists can help you compare the PLX C22 with fixed alternatives such as the Apollo DRF Open for your procedure mix. Contact us for a consultation.