A fluoroscopy exam allows healthcare providers to see movement and function that can’t be seen with other fixed imaging tests. It can help doctors diagnose diseases like cancer, locate foreign bodies and guide medical procedures like stent placement in the heart or blood vessels. Modern improvements in screen phosphors, digital image processing, and flat panel detectors have led to lower radiation exposure for patients and more precise positioning of the fluoroscope.

Minimizing the Need for Preparation

Unlike the conventional C-Arm, which must convert x-rays to light photons and electrons before generating images, mini C-Arms can immediately produce results digitally on a flat panel detector. This reduces the amount of radiation exposure for both the patient and the radiologist. Additionally, the small size of a mini C-Arm, such as the ones at Minicarm.com, requires less space and is, therefore, more easily maneuvered in surgical settings. Because fluoroscopy is so helpful in diagnosing a range of conditions, including it as part of any radiology residency program is essential. This is particularly true because it provides synergistic value with other lower-cost modalities, such as CT, in achieving diagnoses. It also allows for the elucidation of a malignant or benign stricture in patients undergoing a gastrointestinal esophagram. This is illustrated through the case of a 64-year-old male with an esophageal malignancy and long-segment stricture that is easily visualized on serial fluoroscopic exams. In addition, it is helpful for the evaluation of musculoskeletal abnormalities and fractures.

Minimizing Radiation Exposure

While fluoroscopy may seem less important with the advent of more advanced cross-sectional imaging modalities, like CT and MRI, it continues to be a vital diagnostic tool. This is demonstrated by several illustrative cases in which fluoroscopy has provided synergistic value toward achieving diagnoses not initially made on preliminary cross-sectional imaging, highlighting its enduring utility. Unlike traditional CT scans that require patients to remain supine, real-time repositioning of the patient with fluoroscopy allows radiologists to visualize structures not readily apparent from a supine exam. This is especially important for evaluating musculoskeletal pathologies, such as arthritic joints or fractured bones. Fluoroscopy can also be used for image-guided medical procedures such as cardiac catheterization, lumbar puncture, arthrography or visualization of joints, barium X-rays, placement of intravenous catheters and needle biopsies, and injections of image-guided contrast into the spine and other sites in the body. It is also an invaluable adjunct to GI examinations such as the esophagus and upper gastrointestinal series.

Minimizing the Need for a Radiographer

Unlike CT and MRI, which employ a dedicated imaging technician to capture and process images, fluoroscopy requires radiologists to operate the system. A fluoroscopic exam will often produce higher radiation exposure to the interventional radiologist than a comparable CT or MRI scan. It’s important to keep radiation exposure as low as possible. This can be done by using lead shutters to focus the X-ray source on only the area of interest, limiting radiation scatter and increasing image clarity. Radiation dosimeters can measure the surgeon’s and staff’s exposure and ensure proper positioning techniques are followed for optimal image quality and patient dose parameters. Despite these challenges, it is still widely accepted that fluoroscopic examinations have unique clinical utility in several settings, particularly in evaluating vesicoureteral reflux and abnormal bladder morphology (such as duplication or a dilated collecting system). These examinations are often performed with the fluoroscopic voiding cystourethrogram (VCUG) procedure.

Minimizing Complexity

During the procedure, you lie on a table and may be given a contrast agent to see your body’s internal structures more clearly. Your doctor will move the fluoroscope around the area to be examined while taking pictures in real-time. No big MRI machine, no CT scans, no anesthesia, no image techs, and separate appointments. The images are shown on a monitor so you can watch what’s happening during your procedure, also to the benefit of the doctor. Some imaging procedures require a contrast dye injected into the bloodstream through an IV line in your hand or arm, though that’s generally not needed with a C-arm exam. This non-radioactive dye helps your doctor see your organs or joints and identify any problems. While fluoroscopy requires significant skill from radiologists and technologists to ensure optimal image quality and proper positioning of both the imaging machine and patient, it’s still something that can be done rather easily. That said, modality can be labor intensive for radiologists who must perform and interpret these exams in addition to their regular workloads. These factors can limit its utilization in some healthcare settings, so consider getting training for other authorized personnel on the c-arm units around the facility.