Fluoroscopy

Fluoroscopy is a type of medical imaging

that shows a continuous X-ray image on a
monitor, much like an X-ray movie. During
a fluoroscopy procedure, an X-ray beam is
passed through the body. The image is
transmitted to a monitor so the movement
of a body part or of an instrument or
contrast agent (“X-ray dye”) through the
body can be seen in detail.
 Components of Fluoroscope
• X- ray Tube
• Image intensifier
• Television

• An image recorder in form of Spot film ,

video recorder , digital recorder etc
Fluoroscope
Image intensifier
 Indications and Uses
Fluoroscopy is used in a wide variety of examinations and
procedures to diagnose or treat patients. Some examples
are:
• Barium X-rays and enemas (to view the gastrointestinal
tract)
• Catheter insertion and manipulation (to direct the
movement of a catheter through blood vessels, bile ducts
or the urinary system)
• Placement of devices within the body, such as stents (to
open narrowed or blocked blood vessels)
• Angiograms (to visualize blood vessels and organs)
• Orthopedic surgery (to guide joint replacements and
treatment of fractures)
• Location of foreign bodies during surgery.
 Contra-indications
There are no absolute contraindication
• Decision to be made keeping in view the benefits and
risks.
• Utmost care should be taken minimize the radiation dose to
patients and workers.
• Proper collimation of beam to reduce unnecessary
radiation.
• Proper factors to be used to get best x-ray contrast for
required information to avoid repeat examination
• Pregnant women should not be exposed unless extremely
necessary. It should be done with proper shielding.
• Exposure of sensitive parts to radiation like gonads and
eyes should be avoided . Proper shielding to be used
 X- ray Contrast Agents
Radiocontrast agents are substances used to enhance
the visibility of internal structures in X-ray-based imaging
techniques such as computed tomography (contrast CT
), projectional radiography, and fluoroscopy
• IV contrast agents.
– These contain Iodine which has large atom and thus cause high
attenuation of X-ray beam .
– Carbon di oxide.
• Oral
– Barium sulphate
– Air
– Iodine containing solutions ( gastrograffin)
 Intra venous contrast
Iodinated contrast contains iodine. It is the
main type of radiocontrast used for 
intravenous administration. Its uses
include
Organic iodine molecules used for contrast
include iohexol, iodixanol and ioversol
 Uses of I/V contrast
• Contrast CTs
• Angiography (arterial investigations)
• Venography (venous investigations)
• VCUG (voiding cystourethrography)
• HSG (hysterosalpingogram)
• IVU (intravenous urography)
• To outline sinus and fistulas tracts.
Contra indications of I/V contrast
• A history of reactions to contrast agents,
• Pregnancy,
• Chronic or acutely worsening renal
disease.
• Radioactive iodine treatment for thyroid
disease,
• Metformin use,
 Contraindications
• Renal insufficiency and hypersensitivity to
iodinated contrast media are relative
contraindications. 
• Some centers use carbon dioxide as a
contrast agent for these cases.
Digital Subtraction Angiography
(DSA)
Digital subtraction angiography (DSA) is a
fluoroscopic technique used extensively in
interventional radiology for visualizing
blood vessels. Radiopaque structures
such as bones are eliminated
("subtracted") digitally from the image,
thus allowing for an accurate depiction of
the blood vessels.
DSA
 Pre-procedural evaluation

• presence of atherosclerotic disease (e.g. prior

myocardial infarction)
• diabetes
• renal function status
• medications
• allergies and previous exposure to iodinated contrast
media
• prior surgical procedures, especially vascular
• reports from previously performed angiograms, if any
• review of any relevant vascular imaging studies, e.g.
preprocedural CT angiogram
 Indications of DSA
There are numerous indications for angiography and
their number has been on the rise ever since
interventional radiology has been shown to successfully
supplant many open vascular procedures. Salient
examples include:

• To diagnose vascular diseases

• Vascular interventional procedure
– Endovascular aneurismal repair
– arterial balloon angioplasty
– arterial stenting
– endovascular embolisation
– thrombectomy
 DSA technique
• the non-contrast image (mask image) of the region is taken before injecting
contrast material and therefore shows only anatomy, as well as any
radiopaque foreign bodies (surgical clips, stents, etc.) as would a regular x-
ray image.
• contrast images are taken in succession while contrast material is being
injected. These images show the opacified vessels superimposed on the
anatomy and are stored on the computer.
• the mask image is then subtracted from the contrast images pixel by pixel.
The resulting subtraction images show the filled vessels only.
• recording can continue to provide a sequence of subtracted images based
on the initial mask.
• the subtraction images can be viewed in real-time. Even if the patient lies
still, there is bound to be some degree of misregistration of images due to
movement between the acquisition of the mask image and the subsequent
contrast images. The effect is prominent at high-contrast interfaces, such as
bone-soft tissue, metal staples and coils, and bowel air. Pixel shifting (either
manual or automatic), i.e. moving the mask retrospectively, can minimise
misregistration, but focal movement such as bowel peristalsis, will not be
corrected.
 Digital Imaging
• These images are composed of tiny squares
called pixels.
• These are arranged in columns and rows.
• Each pixel has digital value of brightness ( gray
scale)
• Resolution of the image depends on the size of
pixel. Small the size better is the resolution.
• Contrast depends on digital value of gray scale
Digital image with different number
of pixels and gray scale