Fluoroscopy

Fluoroscopy is a relatively old way of examining the health status of almost all internal organs. It is based on the principle of transillumination, which is achieved by exposing a certain area to x-rays. As a result, a person receives a positive image of the area under study on a fluorescent type screen.

A similar technology is used to assess the health of the gastrointestinal tract, as well as a number of other internal organs. But usually for the chest or bronchopulmonary system, it is used much less frequently. The method, like classical radiography, is considered the main format of radiodiagnosis both several decades ago and today.

How it works

There are several options for where you can do the presented type of testing. These are private clinics or public hospitals with an inpatient department. But private medical institutions are increasingly abandoning such a study of the stomach in favor of modern, safer analogues, so it is easier to find operating devices in public hospitals. There is an outdated technique that allows you to study the internal parts of the body on the basis of the obtained black-and-white “photographs”. All bone structures, together with possible foreign objects, are stained in dark colors on visualization, and the soft tissues of the abdominal cavity have lighter shades.

The main advantage of the analysis is the ability to evaluate in real time, which guarantees the provision of fresh cuts. This is relevant for situations when, during the examination, it turns out that the victim needs an emergency surgical intervention.

A popular method helps to determine not only the structure of the organ under study, but also to understand in detail its extensibility, contractility, displacement. When a patient is injected with barium sulfate, aimed at improving the final detail, it turns out to consider the patency, as well as the fullness.

Due to the control over the flow of the contrast agent, it is possible to see even the localization of the changes taking place. This was made possible by rotation during direct manipulation.

Sometimes transillumination is an obligatory phase, which is typical of the preparatory stage, if it is necessary to carry out any instrumental procedure in the future. We are talking about:

• angioplasty;
• fistulographies;
• catheter installation.

Initially, analog devices were used to obtain the necessary information, which provided for the need to wait for the results to be printed on film material. Today, the mechanism of how fluoroscopy is done is no different from the ten-year-old version, but it displays the image directly on a computer screen. A digital installation can do this. It is believed that innovative analogues, while maintaining the same data collection algorithm, load the body with a lower percentage of exposure. Against the background of this advantage and the ability to immediately see what is happening in the lungs, people prefer to use digital equipment. The visualization received from him can be stored on a disk or flash drive, or printed out through a printer on paper.

The updated approach allowed the diagnostics to get rid of several significant shortcomings, the main of which was the reduction in radiation dosage by approximately 90% compared to previous machines.

Another difficulty was the low spatial resolution. The modernized units, where there is a scopy mode, are practically not inferior in clarity to the standard radiography mode. Previously, the problem was the inability to properly monitor the functional state of some internal organs that are in dynamics. It was especially difficult to recognize the indicators of the heart. Now, thanks to enhanced stabilization, it is possible to fix the state of the organ during its vigorous activity.

The final difficulty was the impossibility of carrying out normal documentation of the information received. Thanks to digital detectors, doctors have learned to save the results of the examination not only frame-by-frame, but also in the format of a small video.

Although this type of survey diagnostic is a tool for examining soft tissues, it is occasionally used to evaluate the skeleton. The unusual direction of use is explained by the urgent need to consider the localization of complex traumatic injuries. And on the basis of the data obtained, a decision is made on which area it is worth conducting a classic X-ray, or even sending the victim for an MRI.

But if the sternum area lends itself well to inspection, then studying the characteristics of the duodenum, as well as other components of the peritoneum, is a real problem. Here you will have to involve a special solution with barium, which will “illuminate” the organs of the retroperitoneal space. The effort will pay off with differentiation, as in the traditional black-and-white “photo” of the bone structure.

When Contrast Is Indispensable

The reason for the contrast stage to come into play is to improve the quality of the final image. So, the heart muscle is perfectly visible against the background of a relatively transparent lung texture. Bones are also clearly visible, which stand out compared to softer tissues. But the indicators of the esophagus and other components of the gastrointestinal tract are completely capable of overlapping each other, blocking the view.

Artificial illumination of potentially diseased areas is aimed at expanding the possibilities of establishing a more accurate diagnosis. Based on the obtained visualization, a decision is then made whether to perform a surgical intervention, or limit itself to alternative therapy.

The way contrast is done for analog devices and digital solutions is no different, because the principle is still based on almost the same density of peritoneal components. To obtain graphic information of good clarity, the laboratory assistant must introduce a special aqueous suspension into the patient’s gastric or intestinal lumen.

Barium sulfate was chosen for this role, which has several advantages:

• does not dissolve in digestive juice;
• not absorbed into the blood;
• comes out naturally, remaining completely unchanged.

After the substance is ingested, it moves down the esophagus, passing to the stomach with the intestines. In the course of movement, the suspension coats the walls, which is the key to successful visualization, providing detailed information regarding them:

• elevations;
• recesses;
• other anatomical mucous membranes.

A standard dosage of a solution is usually used, which is designed to help recognize lesions in a number of organs at various stages of development.

But if you fill the cavities more tightly, then you can at the same time get data on:

• form;
• sizes;
• position;
• functionality.

Sometimes even this is not enough, which most often affects the ailments of the intestines or stomach. To provide the most complete summary, physicians use double contrasting. The technique is based on the introduction of a portion of air in addition to suspension.

High-density barium coats the walls of the mucous membranes, while the air is designed to inflate the area under study, which increases the contrast.

Despite the rather large popularity of the method, it has significant contraindications, the main of which involves the suspicion of perforation. The precautionary measure of refusing to diagnose is explained by the irritant effect inherent in free barium. The irritated mucous membrane of the abdominal organs can be damaged even more. To reduce the percentage of the likelihood of deterioration in well-being, it is better to look for an alternative examination format, or at least use a water-soluble contrast. It has not so high annoying characteristics.

Separately, situations are considered when the victim needs to evaluate the colon. For this, irrigoscopy is used. The mechanism of effects on the body remains the same, only the preparation of the patient is somewhat different. After the gastrointestinal tract is cleansed with an enema, or special pharmaceutical products of a similar spectrum of action, barium sulfate is also administered with an enema.

For the duodenum and all other organs of the peritoneum, the mixture is offered to drink. To block the gag reflex, the solution is mixed with flavorings.

Despite the fact that modern technology offers many safer testing options in terms of radiation, most doctors continue to use fluoroscopy in the old fashioned way. Patients prefer it because of its relative cheapness.

Indication for appointment

Since fluoroscopy is almost always an integral part of contrast enhancement, it is usually used to evaluate the gastrointestinal tract. The list of indications for the study of the sternum is somewhat shorter than for the abdominal cavity.

The lungs are subjected to a similar load when necessary to control the process of puncture of the pleural region, which outlines two main reasons for issuing a referral for fluoroscopy:

• pleurisy;
• pericarditis.

In all other situations, it is easier to use computed tomography, or the capabilities of a magnetic resonance imaging scanner. But for such an analysis of the gastrointestinal tract, there are more indications:

• diverticula;
• achalasia steal;
• hernia of the esophagus.

All of the above can be combined together, since in the three cases described, the contrast should be transported really simply.

The timely change of the patient’s position will help to recognize the emerging shadow of the tumor. The patient is sometimes asked to simply stand or turn around.

Much less often than for gastroenterology and pulmonology, the method is involved in:

• cardiology;
• urology;
• gynecology;
• traumatology.

The first group involves the search for areas of the heart valves that have received limescale. Due to the good permeability of the solution, large vessels are tested for the same lime inclusions. The secret of effectiveness lies in the fact that lime belongs to the camp of contrast agents.

Women who have been prescribed hyperosalpingography must also go through the stage of introducing a special suspension. With its help, it turns out to detail the state of the uterus with tubes. According to a similar algorithm, contrast is used when it is necessary to follow the process of urination. When monitoring the dynamics of the passage of urine, one cannot do without uterrography.

Traumatologists, who prefer the results of standard radiography, sometimes still have to use data with a barium suspension to combine bone fragments. The quality of the image, together with the skills of a particular specialist, will determine how well the bone will assemble, so that later it will grow together without significant functional losses for a person.

Trendelenburg study

Of particular note is the examination of the stomach in the Trendelenburg position, which has long received the status of a classic of the fluoroscopy genre. Here, too, barium is taken as the basis. But since any gastroenterologist knows how dangerous the presented substance can be in combination with radioactive exposure, experts prescribe an analysis only in exceptional cases.

If it was not possible to find a worthy alternative, then one cannot do without such testing to confirm a number of pathologies:

• stenosis of the esophagus;
• diverticula and tumors of the esophagus;
• erosion of the esophagus, or other malformations of its development;
• peptic ulcer of the duodenum, stomach;
• neoplasms of a malignant, benign nature;
• inflammatory process in the intestine;
• intestinal motility disorder.

Having received the so-called “live” image of the stomach, the expert will be able to correctly diagnose, as well as draw up a subsequent therapy program up to surgical intervention.

To obtain particularly clear visualization, 250 milliliters of barium is consumed per dose, which is drunk in one gulp. By monitoring the filling of organs in real time, the laboratory assistant manages to fix how much the substance will need to complete the phase of absolute filling.

When using the “tight” type of examination, it is possible to additionally establish a clear location of the ulcer, or confirm the presence of a neoplasm. If the presence of the latter is confirmed, then you will have to additionally go to other tests to determine the nature of a particular tumor.

All manipulations should be carried out with the patient in the Trendelenburg position. In practice, this means that in order to better view a person’s stomach, his pelvis is raised to a level of 45 degrees in relation to the rest of the body. Thanks to such a cunning trick, the laboratory assistant will easily see a possible hernia inherent in the esophageal opening of the diaphragm.

After checking in this position, the victim will be asked to roll over on his side, which is especially important when trying to find some rare congenital or acquired pathologies.

Contraindications for holding

X-ray, like most other large-scale types of diagnostics, negatively affects the health of not only the subject, but also the laboratory assistant. Despite the fact that radiation falls within the limits of permitted indicators, it can play a cruel joke on people from risk groups. The main reasons for the ban include childhood, pregnancy and reduced immunity.

The last item covers previously diagnosed malignant neoplasms of the bone marrow with metastases, as well as acute leukemia.

Pregnancy is an absolute contraindication, which means a ban on the analysis at any period of bearing a child. Such a strict limitation is explained by the ability of the fetus to respond more sharply to changes in the background radiation. If the environment becomes a source of increased load on a given part, then the development of the baby in the mental and physical direction can slow down.

Special attention should be paid to allergic patients. Due to the fact that even people who in everyday life do not suffer from a whole bunch of allergic manifestations often experience characteristic symptoms when taking a barium mixture, it is better to play it safe. To do this, the victims are additionally subjected to an allergic test, which will negate the risks of developing almost instantaneous anaphylactic shock.

Today, fluoroscopy is gradually fading into the background, being considered a relic of the past. Its capabilities are rapidly narrowing, and innovative equipment bypasses in safety. Fears adds that the traditional check of the stomach in this way is equivalent to 150 standard radiographs. Because of all of the above, doctors, together with patients, increasingly prefer other options for assessing the condition of internal organs without significant harm to the body.