Applications and Advances in Fluoroscopic Imaging

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Recent trends and guidelines for choosing a fluoroscopic room system.

Fluoroscopy has been a foundational imaging modality for many years and its applications and use are expected to grow.

In this blog I’ll give you an overview of:

  • The increase in applications for fluoroscopy
  • New innovations including decreased dose and easier accessibility for positioning of patients
  • Considerations for choosing fluoroscopic imaging equipment

Applications in fluoroscopic imaging.

Fluoroscopy is the preferred imaging modality when practitioners need to have access to motion imaging to study specific organs such as gastro-intestinal, urinary, pulmonary or vascular procedures. It is also used to guide surgeons through specific procedures that require real time needle location, catheters or stent placement, bolus tracking or simply to identify the area of intervention in real time. Also, simple motion studies in orthopaedics can utilize fluoroscopy.

Demand for fluoroscopic imaging equipment is expected to grow at a compound annual growth rate (CAGR) of 4.8% between now and 2025, according to Research and Markets (1). The research firm attributes the expected growth to its unique imaging capability – coupled with the rising geriatric population, growing prevalence of chronic diseases, and its use in pain management.

Our DRX-Excel Plus fluoroscopy system plays a major role at Houston Healthcare in Warner Robins, Georgia, said Phyllis Briaud, MBA, CRA, RT(R)(T)(CT)(QM), director of imaging services. “We are using fluoroscopy to diagnose illnesses, evaluate pre- and post-GI gastrointestinal surgeries, and visually evaluate the GI tract, as well as for joint work, myelograms, vascular catheter placements, and port dye studies.”

The DRX-Excel plus fluoroscopy system can help healthcare workers by identifying numerous illnesses.
Demand for fluoroscopic imaging is expected to increase due to the rising geriatric population, growing prevalence of chronic diseases, and its use in pain management.

Prairie Lakes Healthcare System in Watertown, South Dakota, also uses the DRX-Excel Plus fluoroscopy system. Its list of imaging exams is lengthy: modified barium swallows, marshmallow bagel studies, UGI, small bowel, live visualization for stripping of the esophagus, and intestines, esophogram, BE, accurate guidance for placement of replacement nephrostomy tube, proper placement of contrast for arthrogram studies, myleogram, and portacath studies, according to Bryan Beckedahl, RT(R), RDMS, RDCS, RVT, radiology director.

Fluoroscopy has the advantage of “allowing us to see the patient’s physiology and determine if the patient is aspirating. It allows us to see chewing action and determine which food consistency is safest for the patient, and try compensatory strategies like a throat clearing or chin tuck,” explained Beckedahl.

Fluoroscopy reduces the overload on CT imaging.

Diagnosing COVID infections increased the demand for CT imaging. In some facilities, digital radiology/fluoroscopy (dRF) systems helped reduce the backlog of CT exams.

Having the option to do fluoroscopy helps the CT suite at Houston Healthcare with its patient volume and scheduling.  If the IR suite is overbooked, some of the studies can be scheduled with fluoroscopy in diagnostic radiology, explained Briaud.

Additionally, there are times that radiologists at Houston Healthcare order a small bowel study/BE versus performing a CT abdomen and pelvis. This results in lower radiation dose to the patient, as well as helping CT with their patient volume. In fact, the small bowel fluoroscopy study is preferred in some cases because it allows the radiologist to review the timing of the contrast as it moves through the small bowel.

Latest innovations in fluoroscopic imaging.

The most important recent innovation in fluoroscopic imaging is reduced dose levels. They are much less than in past years due to advances in the sensitivity of flat panel detectors and pulse exposure technology. The exact radiation dose received by each patient can be tracked by DAP measurements. (We strongly recommend frequent checks of quality control measures for dose tracking.)

Several years ago, Houston Healthcare discovered that procedures being performed in an older fluoroscopy room were exceeding their desired threshold, recalled Briaud. “So, we transitioned all fluoroscopy patients from our older fluoroscopy unit to our new Excel system with higher frame rates, low dose rates, and better image quality with all patients.”

The DRX-Excel features make it easier for both radiologist and the patient during exams and procedures.
Open access to fluoroscopy tables enables better positioning, which can help minimize the need for repeat imaging exams.

Another way to curtail dose is to minimize repeat imaging exams. Many repeat images are due to positioning errors. When patients are scanned through a CT or MRI, they cannot be reached or positioned. The open access to fluoroscopy tables enables better positioning. Our DRX-Excel Plus System provides full system access from every side for easier patient transfer and exam versatility. And a built-in video camera provides radiologic technologists with a live feed so they can monitor the patient’s position and overall status during the entire exam. The console’s microphone lets them give their patients added instruction or reassurance when needed.

One last important dose safeguard is for the radiologic technologists and radiologists. They can minimize their dose exposure by operating the unit from a remote console.

Guidelines for selecting a fluoroscopic imaging system.

As you can see, fluoroscopic imaging has numerous applications. And at one-third the cost of CT equipment, it is growing in popularity. To get the maximum return on investment, I recommend a dRF configuration like our DRX-Excel Plus system. The combination of fluoroscopy and radiology lets you capture a wide range of exams on a single system. As routine radiography exams represent the majority of the procedures made in a department, the system’s versatility is often a deciding factor with hospitals when they need to invest in a general radiology fluoroscopic (R/F) solution.

This all-in-one capability appealed to Catawba Valley Medical Center in Hickory, North Carolina when it was looking for a replacement for its fluoroscopy-only room. “We are using the Carestream Excel fluoroscopy unit to do our daily barium studies at our outpatient imaging center; and the radiologists say the images produced by the Excel are excellent quality,” said Mike Greene, RT(R), administrator of diagnostic services.

Also consider features for patient care and ease of use by your imaging staff. The DRX Excel-Plus has the lowest fixed-table minimal height (48cm) in the industry, making it easier for wheelchair patients. The table also features a 265kg weight capacity to accommodate heavier patients and allows for four-way table movement to facilitate easier patient positioning.

The low table height is an advantage for many patients, explained Briaud. “This makes access easier for all our patients, from the wheelchair bound to those who are tall or short.”

The ability to lower the table also has reduced the strain on technologists who are trying to lift bariatric patients on and off the table, said Briaud. “Technologists are able to fully access a patient from all sides of the fluoroscopy unit to easily transfer the patient from a stretcher, if need be. Being able to adjust the table height has decreased the potential for workplace injuries to the technologists by allowing them to be able to use proper moving techniques when moving patients on and off the table.”

Future applications and advances in fluoroscopic imaging.

There are several developments that might result in potential advances in fluoroscopic imaging in the future. One is the advent of Artificial intelligence coupled with the innovations coming from dynamic detectors that will allow manufacturers like Carestream to look into new developments and systems capable of delivering better image quality with an even lower dose in the future. 

Also, new advances for dynamic flat panels along with the latest computing capabilities and 3D software might move the market toward serial radiography as done today with our digital tomosynthesis solution; and later toward dynamic radiography where motion images can be captured to provide further diagnostic information. Ultimately, full fluoroscopic imaging with 3D reconstruction will possibly be the most advanced area where key companies will land.

Marco Riolfo is the Global Marketing Manager for Digital Radiographic Rooms at Carestream. He has more than 25 years of experience in medical imaging and is Six Sigma Black Belt Certified.

Learn more

Mobile C-arm for Intraoperative Fluoroscopic Imaging

Neonatal Fluorosopic Imaging at the Bedside

Guidelines for Choosing X-ray Room Equipment


1 Research and Markets

Customer comments in this blog originally appeared in an article published in Radiology Today.


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