Fluoroscopy - Uses, Preparation, Procedure, and Risks

Introduction:

Fluoroscopy is a medical diagnostic imaging technique used to obtain real-time images of the structures inside the body. With the use of contrast material, fluoroscopy helps in the evaluation of the structural and functional abnormalities of the various systems of the body. Fluoroscopy is not only a diagnostic tool; it can also be used as a guiding tool in treatment procedures.

What Are the Uses of Fluoroscopy?

Fluoroscopy is widely used in medical diagnosis and is a guiding tool for different medical procedures. Based on its use, it is classified as a diagnostic tool and a guiding tool.

Diagnostic Tool:

1. Barium Swallow Study (Esophagram):

For the esophagram, the technician asked the patients to drink a liquid containing barium. The technician will take a series of X-rays using fluoroscopy (X-ray video) to watch the barium pass through the gastrointestinal tract.

2. Angiography:

Angiography or angiogram is used to detect the abnormalities of the blood vessels, such as blockages. During angiography, the catheter is inserted into the artery in the groin and moved to the target area. Fluoroscopy is used to obtain images of contrast material passing through the artery.

3. Myelography:

Myelography is a medical imaging technique that uses fluoroscopy to detect abnormalities in the spinal cord and nerve roots and to visualize the subarachnoid spaces. It is recommended for patients who can not undergo an MRI (magnetic resonance imaging).

4. Hysterosalpingogram:

Hysterosalpingogram is an imaging technique used to detect the abnormalities of the uterus and fallopian tubes in which a catheter is inserted into the cervical opening and placed in the uterus through which a contrast agent is injected, and fluoroscopy is used to show the blockages in the uterus.

5. Cystography:

Cystography is an imaging technique used to detect bladder abnormalities. In this procedure, a thin, flexible tube called a catheter is inserted into the urinary bladder through which a contrast agent is injected. Fluoroscopy provides images of bladder emptying.

6. Barium Enema:

For barium enema, the catheter is inserted into the rectum through which barium liquid is administered into the colon. After that, fluoroscopy provides images of the colon at different angles.

Guiding Tool:

1. Percutaneous Vertebroplasty:

Vertebroplasty is a medical procedure that treats the vertebral compression of the spinal cord. Fluoroscopy is used to guide the procedure during the placement of cement mixture into the fractured bone through the hollow tube.

2. Stent Placement:

A stent is an expandable metal tube placed inside the blood vessels to treat the narrowed blood vessels. This procedure is performed using fluoroscopy.

3. Image-Guided Biopsy and FNAC:

The biopsy is a diagnostic procedure in which fluoroscopy is used to guide the placement of a scalpel in the process of collecting sample tissues from the body, which will be later viewed under a microscope. In FNAC (fine needle aspiration cytology), fluoroscopy is used to guide the placement of needles for the collection of fluid from the cysts.

How Do Patients Prepare for Fluoroscopy?

• For fluoroscopy procedures, the health provider may ask the patient to sign a consent form before the scan.

• Medical conditions and regular medicines of the patients should be informed to the doctor.

• The patient should inform if she is a pregnant woman or a breastfeeding mother.

• Allergic reactions to radiotracers from the previous scan of the patients should be informed.

• Patients may be asked to remove any jewelry or objects over the target area before the scan, as they affect the accuracy of the result.

How Is the Fluoroscopy Performed?

• In fluoroscopy, for some procedures, patients may be asked to swallow contrast material, or the nurse may inject the contrast material (a special dye) into their vein through an intravenous (IV) line. Patients may feel warm throughout the body when the dye passes into their veins. Contrast materials are special dyes such as barium and iodine used to outline the body structures to be examined.

• After receiving the contrast, the patient is asked to lie on the procedure table. Fluoroscopy produces X-rays that pass through the structures at different angles, and patients may be asked to change their body positions to get the required images.

• The technician may ask them to hold their breath for a few seconds at varying times. Finally, the X-ray machine produces real images of the structures in the form of video X-rays on the screen. Movement during imaging affects the quality of the images and results in blurred images.

• If the patient is a child, the caretaker or one of the parents may be allowed to stay in the room. They must wear a lead apron to prevent radiation exposure. If the child is not cooperative, they might use restraints or other techniques to hold them in place during imaging. It does not harm the child. It prevents the children from increased radiation exposure by repeating the process.

• For arthrography, before the imaging process, they may insert a needle to aspirate (remove) the fluid from the joint space. After that, the contrast agent is injected into the joint space and asks the patients to move the joint for an even spread of the contrast material in the joint space.

• For cardiac catheterization, a needle is inserted into the elbow or groin, which guides catheter placement into the target area. Finally, the catheter is removed.

• After scanning with contrast, patients are instructed to drink plenty of water to flush out the contrast materials from the body.

• Breastfeeding women are instructed to avoid feeding for about 48 hours after the scan, as the radioactive materials may pass through the breast milk.

What Are the Risks Associated With Fluoroscopy?

The risks associated with fluoroscopy are very less. They are:

• Radiation exposure in fluoroscopy is very minimal but is higher when compared to radiation exposure in X-rays. Radiation exposure in pregnant women can cause birth defects to the fetus in the womb. Hence, it is not recommended in pregnant women: except during the risk of death of the pregnant mother.

• Redness or swelling at the injection site.

• Though antibiotics are taken before and after the procedure, some patients might have infections at the injection site.

• The contrast material used in the scan may worsen the condition in patients already having kidney failure or kidney disorder.

• Allergic reactions to the contrast materials such as headache, itching, and hives (skin rashes). Some of the severe symptoms of contrast materials are difficulty in breathing, increased heart rate, low blood pressure (BP), and swelling of the body parts.

Conclusion:

Fluoroscopy is an imaging technique that provides real-time images of the internal structures of the body. This procedure can be performed easily without causing major discomfort to the patients. Fluoroscopy does not require hospitalization. Patients can continue their regular activities immediately after fluoroscopy. It is a cost-effective imaging technique compared to other imaging techniques such as MRI. Fluoroscopy is not only used in the medical field. It is used as an object scanner for security purposes in airports.