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3.c- Fluoroscopy

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Employees of Hospitals, Schools, Universities and Libraries may download 8 FREE medical animations from Nucleus by signing up for a free trial: http://nmal.nucleusmedicalmedia.com/free-trial-membership-a #fluoroscopy #Xray #XrayVideo MEDICAL ANIMATION TRANSCRIPT: X-ray images are like photos of the inside of your body. But X-ray videos can be made as well. They're made during a procedure called fluoroscopy. One reason your doctor may give you a fluoroscopy exam is to find out if you have certain diseases, such as problems in your digestive tract. A second reason your doctor may use fluoroscopy is to perform a procedure such as a spinal tap. A third reason is to find, locate, and identify a foreign object in your body. There are several types of fluoroscopy machines. A fluoroscope may be fixed in place in a special shielded room. Or it may be a portable machine that can be moved to you if needed. A computed tomography, or CT scan machine can also be used as a fluoroscope to see slices through the body as the images are taken. Before a fluoroscopy procedure, you may be given a contrast substance. It may be in a drink, a paste, a pill, or an injection. During the procedure, you will lie or stand on an X-ray table. An X-ray tube will be aimed at the body part to be examined. Then an X-ray beam will pass through a part of the fluoroscope that shapes the beam to just the area of your body being studied. This helps reduce your exposure to X-rays. After the beam passes through your body, it will be converted into a video seen on a monitor screen. If you receive a contrast substance, it will make the structure stand out better on the screen. If you have any questions about fluoroscopy, talk to your doctor. ANH17191


Fluoroscopy: A Detailed Introduction

1. What is Fluoroscopy?

Fluoroscopy is a medical imaging technique that uses X-rays to obtain real-time, moving images of the internal structures of the body. Unlike a standard X-ray that takes a single static picture, a fluoroscopic exam is like a live X-ray movie.

Key Analogy: If a standard X-ray is like a photograph, fluoroscopy is like a live video camera using X-rays instead of light.

2. How Does It Work?

The core components of a fluoroscopy system are:

  1. X-ray Tube: Generates a continuous or pulsed beam of X-rays that pass through the patient.

  2. Fluoroscopic Image Intensifier or Digital Detector: Captures the X-rays that pass through the patient and converts them into a visible light image.

  3. Video Camera & Monitor: The visible image is captured by a camera and displayed in real-time on a monitor for the physician to view.

  4. Image Recording System: The dynamic sequence can be recorded as a digital video file for later review.

In modern Digital Fluoroscopy systems, the image intensifier is often replaced with a flat-panel digital detector (similar to a digital camera sensor), which provides higher resolution, less distortion, and better contrast.

3. The Role of Contrast Agents

Because many internal organs and structures have similar densities, they can be difficult to distinguish on a plain fluoroscopic image. This is where contrast agents become essential.

  • What are they? Contrast agents are substances that are introduced into the body to make specific structures stand out against their surroundings. They can be:

    • Radio-opaque (appear white): These agents (e.g., Barium Sulfate, Iodine-based compounds) absorb X-rays. When placed in a hollow structure like the digestive tract or a blood vessel, they outline its shape and interior surface.

    • Radiolucent (appear black): Air or other gases, which allow more X-rays to pass through.

  • Methods of Administration:

    • Orally: Swallowed to examine the esophagus, stomach, and small intestines (Barium Swallow/Meal).

    • Rectally: Administered as an enema to examine the large intestine (Barium Enema).

    • Intravenously (IV): Injected into a vein to visualize blood vessels (Angiography), the urinary system (IVU), or other organs.

    • Through a Catheter: Directly into a specific duct or vessel.

4. Common Clinical Applications

Fluoroscopy is used for both diagnosis and guidance during procedures:

  • Gastrointestinal (GI) Studies:

    • Barium Swallow: To assess swallowing and examine the esophagus.

    • Upper GI Series: To examine the stomach and duodenum.

    • Small Bowel Follow-Through: To track the passage of contrast through the small intestine.

    • Barium Enema: To examine the colon.

  • Angiography and Angioplasty: To visualize blood vessels (arteries and veins) and guide procedures like stent placement or clot removal.

  • Cardiac Catheterization: To visualize the coronary arteries and chambers of the heart.

  • Hysterosalpingography (HSG): To examine the uterus and fallopian tubes.

  • Intravenous Urogram (IVU) / Pyelogram (IVP): To assess the kidneys, ureters, and bladder.

  • Placement of Devices: To guide the accurate placement of catheters, feeding tubes, or wires (e.g., pacemaker leads).

  • Orthopedic Surgery: To guide the reduction of fractures and the placement of hardware (screws, plates) in real-time.

5. Safety: Radiation Dose and Protection

  • Higher Dose Potential: Because it involves continuous X-ray exposure over a period of time, the radiation dose from a fluoroscopic procedure can be significantly higher than from a standard diagnostic X-ray.

  • ALARA Principle: The principle of As Low As Reasonably Achievable is critically important. Physicians use techniques to minimize dose:

    • Pulsed Fluoroscopy: Instead of a continuous beam, X-rays are delivered in short pulses, drastically reducing dose.

    • Collimation: Shutting down the X-ray beam to expose only the area of interest.

    • Last Image Hold: Using a stored image on the monitor instead of live X-rays for reference.

  • Protection: Lead aprons, thyroid shields, and leaded glasses are essential for staff who remain in the room. The operator uses lead acrylic shields on the equipment and stands behind a lead barrier when possible.

FAQs (Frequently Asked Questions)

1. Q: What is the main difference between a standard X-ray and fluoroscopy?

အမေး: သာမန် X-ray နဲ့ Fluoroscopy ရဲ့ အဓိက ကွာခြားချက်က ဘာလဲ။

A: A standard X-ray produces a single, static image—like a photograph. Fluoroscopy produces a continuous, real-time moving image—like a live video.

အဖြေ: သာမန် X-ray က ဓာတ်ပုံတစ်ပုံလိုမျိုး ပုံငြိမ်တစ်ပုံကို ထုတ်ပေးတယ်။ Fluoroscopy ကတော့ တိုက်ရိုက်အချိန်နဲ့တပြေးညီ ရွေ့လျားနေတဲ့ပုံရိပ်ကို ဆက်တိုက်ထုတ်ပေးတယ် - ဗီဒီယိုတိုက်ရိုက်ကြည့်ရှုနေသလိုမျိုးပေါ့။**

2. Q: Why do I need to drink barium for some fluoroscopy exams?

အမေး: Fluoroscopy စစ်ဆေးမှုတချို့အတွက် ဘာရီယမ်သောက်ဖို့ ဘာကြောင့်လိုအပ်တာလဲ။

A: Barium is a contrast agent that is radio-opaque (appears white on X-rays). When you drink it, it coats the lining of your digestive tract, allowing the radiologist to clearly see the shape, contour, and function of your esophagus, stomach, and intestines in real-time.

အဖြေ: ဘာရီယမ်ဟာ ဓာတ်မှန်ပေါ်မှာ အဖြူရောင်ပေါ်စေတဲ့ ကွန်ထရတ်ဆေးတစ်မျိုးဖြစ်တယ်။ သင်သောက်လိုက်တဲ့အခါ၊ သင့်အစာခြေလမ်းကြောင်းရဲ့ အတွင်းမျက်နှာပြင်ကို ဖုံးအုပ်ပေးလိုက်တာကြောင့်၊ ဓာတ်မှန်ဆရာဝန်က သင့်ရဲ့ အစာပြွန်၊ အစာအိမ်နဲ့ အူတွေရဲ့ ပုံသဏ္ဍာန်၊ အနေအထားနဲ့ လုပ်ဆောင်ချက်ကို တိုက်ရိုက်အချိန်နဲ့တပြေးညီ ရှင်းရှင်းလင်းလင်း မြင်နိုင်စေဖို့ပါ။**

3. Q: Is fluoroscopy safe? The exam seems to take a while.

အမေး: Fluoroscopy က ဘေးကင်းရဲ့လား။ စစ်ဆေးမှုက ခဏကြာမယ်ထင်တယ်။

A: Fluoroscopy uses ionizing radiation, and the dose can be higher than a standard X-ray due to the longer exposure time. However, radiologists and technologists are specially trained to use the lowest possible dose (ALARA principle) to obtain the necessary diagnostic information. The medical benefit of an accurate diagnosis or guiding a life-saving procedure almost always outweighs the radiation risk.

အဖြေ: Fluoroscopy မှာ ionizing radiation ကိုသုံးတယ်၊ ထိတွေ့မှုကြာချိန်များတာကြောင့် သာမန် X-ray ထက် ပမာဏမြင့်နိုင်တယ်။ ဒါပေမယ့် ဓာတ်မှန်ဆရာဝန်တွေနဲ့ နည်းပညာရှင်တွေဟာ ဖြစ်နိုင်သမျှ ပမာဏအနည်းဆုံး (ALARA စည်းမျဉ်း) သုံးပြီး လိုအပ်တဲ့ ရောဂါရှာဖွေရေး အချက်အလက်တွေ ရယူဖို့ အထူးလေ့ကျင့်ထားကြတယ်။ တိကျတဲ့ ရောဂါရှာဖွေမှု (သို့) အသက်ကယ်ကုသမှုတစ်ခုကို လမ်းညွှန်ပေးခြင်းရဲ့ ဆေးဘက်ဆိုင်ရာ အကျိုးကျေးဇူးက ရောင်ခြည်ရဲ့ အန္တရာယ်ထက် အားလုံးနီးပါးမှာ ပိုများနေပါတယ်။**

4. Q: Will I be awake during a fluoroscopic procedure?

အမေး: Fluoroscopic လုပ်ထုံးလုပ်နည်းအတွင်းမှာ ကျွန်တော်/မယ် နိုးနေရမှာလား။

A: For most diagnostic exams (like a Barium Swallow), you will be awake and will need to follow instructions (e.g., "swallow now," "turn to your side"). For more complex, invasive procedures (like angiograms), you may be given sedation to help you relax, but you will often be awake. General anesthesia is rare and typically only used in complex surgical cases.

အဖြေ: ရောဂါရှာဖွေရေး စစ်ဆေးမှုအများစုအတွက် (ဘာရီယမ်မျိုချတာလိုမျိုး) သင့်အနေနဲ့ နိုးနေရမှာဖြစ်ပြီး ("အခုမျိုချပါ"၊ "ဘေးတစောင်းလှန်ပါ" စသည်) ညွှန်ကြားချက်တွေကို လိုက်နာရမယ်။ ပိုရှုပ်ထွေးတဲ့၊ ခန္ဓာကိုယ်အတွင်းဝင်ရောက်ရတဲ့ လုပ်ထုံးလုပ်နည်းတွေအတွက် (angiograms တွေလိုမျိုး) သက်တောင့်သက်သာဖြစ်စေဖို့ စိတ်ငြိမ်ဆေးပေးခံရနိုင်ပေမယ့်၊ မကြာခဏဆိုသလို နိုးနေရမှာပါ။ မေ့ဆေးပေးရတာကတော့ ရှားပါတယ်၊ ရှုပ်ထွေးတဲ့ ခွဲစိတ်မှုကိစ္စတွေမှာပဲ သုံးလေ့ရှိပါတယ်။**

5. Q: Who performs and interprets a fluoroscopy exam?

အမေး: Fluoroscopy စစ်ဆေးမှုကို ဘယ်သူက လုပ်ဆောင်ပြီး အဓိပ္ပာယ်ဖွင့်ဆိုသလဲ။

A: A specially trained radiologic technologist operates the fluoroscopy machine under the direction of a radiologist (a medical doctor specializing in medical imaging). The radiologist supervises the procedure, interprets the images, and provides a formal diagnosis to your referring doctor.

အဖြေ: အထူးလေ့ကျင့်ထားတဲ့ ဓာတ်မှန်နည်းပညာရှင် က ဓာတ်မှန်ဆရာဝန် (ဆေးဘက်ဆိုင်ရာ ပုံရိပ်ဖော်ခြင်းမှာ အထူးပြုတဲ့ ဆရာဝန်) ရဲ့ ညွှန်ကြားမှုအောက်မှာ Fluoroscopy စက်ကို မောင်းနှင်တယ်။ ဓာတ်မှန်ဆရာဝန်က လုပ်ထုံးလုပ်နည်းကို ကြီးကြပ်ပြီး၊ ပုံရိပ်တွေကို အဓိပ္ပာယ်ဖွင့်ဆိုကာ၊ သင့်ရဲ့ ညွှန်ပေးတဲ့ဆရာဝန်ဆီကို တရားဝင် ရောဂါရှာဖွေချက် ပေးပို့ပေးတယ်။**
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1. The key feature that distinguishes fluoroscopy from a standard X-ray is its ability to produce: Fluoroscopy ကို သာမန် X-ray ကနေ ခွဲခြားသိရှိစေတဲ့ အဓိကအင်္ဂါရပ်ကတော့ ၎င်းက -
a) Higher resolution still images b) Real-time, dynamic moving images c) 3D reconstructed images d) Images with less radiation
2. What is the primary function of a contrast agent like barium in fluoroscopy? Fluoroscopy မှာ ဘာရီယမ်လို ကွန်ထရတ်ဆေးရဲ့ အဓိကလုပ်ဆောင်ချက်က -
a) To reduce patient pain b) To make specific structures visibly stand out on X-ray c) To protect the patient from radiation d) To speed up the imaging process
3. Which of the following procedures would MOST likely use fluoroscopy for guidance? အောက်ပါ လုပ်ထုံးလုပ်နည်းတွေထဲက ဘယ်ဟာက လမ်းညွှန်မှုအတွက် Fluoroscopy ကို အများဆုံးသုံးနိုင်ချေရှိမလဲ？
a) A standard chest X-ray for pneumonia b) The placement of a catheter during an angiogram c) A screening mammogram d) A CT scan of the head
4. Why is radiation dose a particular concern in fluoroscopy? Fluoroscopy မှာ ရောင်ခြည်ပမာဏကို အထူးစိုးရိမ်ရတဲ့ အကြောင်းရင်းက -
a) It uses a stronger type of radiation than other X-rays. b) The continuous exposure over time can lead to a higher cumulative dose. c) The images are lower quality, requiring more repeats. d) The contrast agents amplify the radiation effects.
5. Pulsed fluoroscopy is a technique used to: Pulsed fluoroscopy ဆိုတဲ့ နည်းပညာကို အသုံးပြုရတဲ့ ရည်ရွယ်ချက်က -
a) Improve the sharpness of the images b) Significantly reduce the patient's radiation dose c) Allow the use of less contrast agent d) Make the procedure more comfortable
6. How is a contrast agent typically administered for a study of the colon (large intestine)? အူမကြီးကို လေ့လာဖို့ ကွန်ထရတ်ဆေးကို ပုံမှန်အားဖြင့် ဘယ်လိုပေးသွင်းသလဲ？
a) Orally (swallowed) b) Rectally (as an enema) c) Intravenously (IV injection) d) By inhalation
7. What is the role of the radiologic technologist during a fluoroscopy exam? Fluoroscopy စစ်ဆေးမှုအတွင်းမှာ ဓာတ်မှန်နည်းပညာရှင်ရဲ့ အခန်းကဏ္ဍက -
a) To interpret the images and make a diagnosis b) To operate the equipment and position the patient under the radiologist's direction c) To decide which contrast agent to use d) To perform the surgical part of the procedure
8. The "Last Image Hold" feature on a fluoroscopy machine is a safety feature designed to: Fluoroscopy စက်ပေါ်က "Last Image Hold" အင်္ဂါရပ်ဟာ ဘေးကင်းရေးအတွက် ဒီဇိုင်းထုတ်ထားတာဖြစ်ပြီး -
a) Provide a clearer picture b) Allow the physician to study an image without using continuous radiation c) Save the video to the computer system d) Measure the amount of contrast used
9. A patient is undergoing a procedure to open a blocked blood vessel in the heart. Fluoroscopy is used to: လူနာတစ်ဦးဟာ နှလုံးထဲက ပိတ်ဆို့နေတဲ့ သွေးကြောကို ဖွင့်တဲ့ ကုသမှုကို ခံယူနေတယ်။ Fluoroscopy ကို အသုံးပြုရတာက -
a) Diagnose the blockage before the procedure b) Guide the catheter and devices to the exact location in real-time c) Take a picture after the procedure is complete d) Monitor the patient's heart rate and rhythm
10. For which of these studies would you MOST expect to drink a contrast agent? ဒီစစ်ဆေးမှုတွေထဲက ဘယ်ဟာအတွက် ကွန်ထရတ်ဆေးသောက်ဖို့ အများဆုံးမျှော်လင့်ရမလဲ？
a) A fluoroscopic-guided spine injection b) An Upper GI Series (Barium Meal) c) A cardiac angiogram d) A hysterosalpingogram (HSG)