Fluoroscopy

What is fluoroscopy?

Fluoroscopy is a medical imaging procedure that uses several pulses (brief bursts) of an X-ray beam to show internal organs and tissues moving in real time on a computer screen. Standard X-rays are like photographs, whereas fluoroscopy is like a video.

Healthcare providers use fluoroscopy for two main purposes: for diagnostic purposes and to help guide certain treatment procedures (known as interventional guidance), such as surgeries and catheter placements.

Providers can use fluoroscopy to look at several body systems in real time, including:

• Cardiovascular system.
• Digestive system.
• Urinary system.
• Musculoskeletal system.
• Reproductive systems.

What is fluoroscopy used for?

Healthcare providers use fluoroscopy for diagnostic purposes and visual guidance during certain procedures (known as interventional guidance).

Diagnostic fluoroscopy

Healthcare providers use fluoroscopy for different parts of your body to diagnose several conditions, including:

• Barium swallow (esophagogram): A barium swallow is a fluoroscopy imaging test that checks for problems in your upper gastrointestinal (GI) tract, which includes your mouth, back of the throat, esophagus, stomach and the first part of your small intestine. The test involves drinking a chalky-tasting liquid that contains barium, a safe substance that makes parts of your body show up more clearly on X-ray imaging. These tests can help diagnose esophageal disorders, ulcers, hiatal hernia, GERD (gastroesophageal reflux disease), structural problems in the GI tract and tumors.
• Barium enema: A barium enema, which is also called lower gastrointestinal tract radiography, is a fluoroscopy imaging test that checks for problems in your colon and rectum (parts of your large intestine). A healthcare provider pours a safe liquid containing barium through a tube inserted into your anus. This liquid coats the inside of the large intestine and clearly shows its outline on X-ray imaging. This test can help diagnose inflammatory bowel disease (Crohn’s disease or ulcerative colitis), diverticulosis, colon cancer, polyps and colonic volvulus (abnormal twisting of the bowel).
• Angiography: Angiography, or angiogram, uses fluoroscopy to identify and diagnose narrowing or blockages in the arteries in your body. Sometimes, providers may perform an angioplasty, a procedure used to open blocked coronary arteries, during a diagnostic angiography, if necessary.
• Cystography: Cystography is an imaging test that can use fluoroscopy to help diagnose problems in your bladder. During cystography, a healthcare provider inserts a thin tube called a urinary catheter into your urethra and injects contrast dye into your bladder. This dye helps parts of your bladder show up more clearly on X-ray imaging. This test can help your provider study your bladder emptying while you’re urinating (peeing). This is called a voiding cystography. It can help show how well your bladder empties during urination and whether any urine backs up into your kidneys (vesicoureteral reflux).
• Myelography: Myelography uses fluoroscopy and an injection of contrast material to evaluate your spinal cord, nerve roots and spinal lining (meninges). It’s particularly useful for assessing your spine following surgery and for assessing disc issues in people who cannot undergo MRI testing (usually due to having a medical device, such as a cardiac pacemaker).
• Hysterosalpingogram: In this procedure, a provider uses fluoroscopy to provide images of biologically female reproductive organs. It can help diagnose certain causes of infertility.

Fluoroscopy for procedure guidance

• Cardiac catheterization: In this procedure, fluoroscopy shows blood flowing through your arteries. It can help visually guide healthcare providers in performing angioplasties.
• Catheter insertion and manipulation: Fluoroscopy can help ensure the proper placement of catheters, which are thin, hollow tubes that help get fluids into your body or drain fluids from your body. Providers can place catheters through your urethra, blood vessels and bile ducts.
• Placement of stents: Fluoroscopy can help ensure the proper placement of stents, which are devices that help open narrow or blocked blood vessels.
• Orthopedic surgery: Your surgeon may use fluoroscopy to help guide orthopedic procedures, such as joint replacement and fracture (broken bone) repair.

Why do I need a fluoroscopy test?

Your healthcare provider may recommend a fluoroscopy test if they want to check the function of a particular organ, system or another internal part of your body. You may also need fluoroscopy for certain medical procedures that require imaging guidance, such as surgery or stent placements.

How common are fluoroscopy tests?

Fluoroscopy imaging tests are fairly common since they can help diagnose several conditions and help guide many different procedures.

While the use of fluoroscopy for imaging guidance during procedures has expanded, the number of fluoroscopy tests for diagnostic purposes has been declining for decades. Researchers believe this is due to the availability of other imaging procedure options, such as CT scans, MRI (magnetic resonance imaging) and endoscopy for diagnostics. In addition, not all radiologists have expertise in fluoroscopy.

Who performs a fluoroscopy test?

Any type of healthcare provider who’s specially trained in using fluoroscopy can perform a fluoroscopy procedure. Providers who commonly use fluoroscopy include:

• Radiologists.
• Cardiologists.
• Vascular surgeons.
• Gastroenterologists.
• Orthopedic surgeons.
• Urologists.
• Pain management specialists.
• Obstetricians-gynecologists (OB-GYNs).

What is the difference between fluoroscopy, X-rays and radiography?

Radiography is the science of using radiation to provide images of tissues, organs, bones and vessels inside your body. Radiation is energy that comes from a source and travels through space at the speed of light. This energy has an electric field and a magnetic field associated with it and has wave-like properties.

An X-ray exposes you to a small dose of ionizing radiation to produce pictures of the inside of your body. X-rays are the oldest and most often used form of medical imaging.

Fluoroscopy and X-rays are both imaging tests that use radiation to take images of your internal tissues.

The difference is that X-rays take snapshots of internal tissues in a single moment, whereas fluoroscopy can provide continuous, real-time images of your internal tissues using several pulses (brief bursts) of radiation.

Other types of imaging tests that use radiation include computed tomography (CT) and mammography.

There are also imaging tests that use radioactive materials ingested or inserted inside your body. These tests include nuclear medicine imaging and positron emission tomography (PET).

Do I need to do anything to prepare for a fluoroscopy test?

Your preparation will depend on the type of fluoroscopy procedure and why you’re getting it. Some procedures don’t require any special preparations. For others, your provider may have you avoid certain medications and/or fast (not eat or drink anything except water) for several hours before the imaging procedure.

In any case, your provider will let you know if you need to do any special preparations.

If you’re pregnant or there’s a chance you may be pregnant, it’s important to let your provider know. Radiation from fluoroscopy can be harmful to a developing fetus.

If your fluoroscopy procedure involves contrast dye, it’s important to let your provider know if you have any allergies or have had issues with contrast dyes in the past.

What should I expect during a fluoroscopy test?

Depending on the type of procedure, you may have your fluoroscopy at an outpatient center or as part of your stay in a hospital. For some fluoroscopy procedures, you can be awake during it. For other procedures, such as one that involves surgery, you will go under general anesthesia so that you’re asleep during the surgery.

Your fluoroscopy may include some or most of the following steps:

• You may need to remove any clothing and/or jewelry that may interfere with the procedure. If you need to remove clothing, your provider will give you a hospital gown.
• Some fluoroscopy procedures require a contrast dye, which is a safe substance that makes a part of your body show up more clearly on an X-ray. If this applies to you and your procedure, you will either drink a liquid containing contrast dye, your provider will insert a contrast dye liquid into your vein through an IV or your provider will insert the liquid through an enema, which is a procedure that flushes the dye into your rectum.
• Your provider will then have you lay on an X-ray table. Depending on the type of procedure, your provider may ask you to move your body in different positions or move a certain body part. They may also ask you to hold your breath for a brief period.
• If your procedure involves getting a catheter, your provider will insert a needle in the appropriate body part. This may be your groin, elbow or another area.
• Your provider will then use a special X-ray scanner to create the fluoroscopic views, which they will be able to view on a computer screen.

What are the risks of fluoroscopy?

Fluoroscopy carries some of the same risks as other X-ray procedures due to radiation exposure. Because of this, you should not have a fluoroscopy procedure if you’re pregnant or think you may be pregnant. Radiation can be harmful to a developing fetus.

When used appropriately, fluoroscopy for diagnostic purposes results in very low levels of radiation exposure.

When healthcare providers use fluoroscopy for certain invasive procedures or surgeries, it may result in greater levels of radiation exposure. Radiation-related risks associated with fluoroscopy for these purposes include:

• Radiation-induced injuries to your skin and underlying tissues (“burns”), which occur shortly after radiation exposure.
• Radiation-induced cancers, which may occur later in life.

The likelihood of experiencing these side effects is very small. If the procedure is medically necessary, the benefit of the procedure outweighs the possible radiation risks.

If contrast dye is part of your fluoroscopy procedure, there’s a small risk of an allergic reaction. Be sure to tell your provider if you have any allergies or if you've ever had a reaction to contrast material.

What are the benefits of fluoroscopy?

Fluoroscopy and other imaging tests are non-invasive procedures that provide visual guidance for certain medical procedures and allow your healthcare provider to diagnose diseases and injuries.

The medical benefit of fluoroscopy outweighs the small radiation risk.

Is a fluoroscopy test painful?

Fluoroscopy imaging itself is painless and non-invasive. However, if your healthcare provider is using fluoroscopy as imaging guidance during a procedure such as surgery, you may experience pain due to the surgery, not the fluoroscopy. If this is the case, your provider will let you know what kind of pain levels you can expect during and after your procedure.

Will I be sedated for a fluoroscopy test?

Healthcare providers use fluoroscopy for many different reasons. If your provider is using it as imaging guidance during surgery or stent placement, you may be sedated (get general anesthesia).

Other fluoroscopy uses that are purely for diagnostic purposes are painless and actually require you to be awake during the procedure so that you can move certain body parts and/or hold your breath for a short period.

In any case, your provider will let you know if you will have anesthesia for your procedure or not.

What do my fluoroscopy results mean?

The type and interpretation of your fluoroscopy results will depend on which part of your body was examined or treated and why your healthcare provider had you undergo it. Fluoroscopy can help diagnose several different health conditions. Your provider may need to send your results to a specialist or do additional tests to help determine a diagnosis.

If you have questions about your results, don’t be afraid to ask your provider.

A note from Cleveland Clinic

Fluoroscopy is a common imaging procedure that healthcare providers use to monitor and diagnose certain conditions and to help guide certain procedures. While the risks of fluoroscopy radiation are pretty small, it’s important to let your provider know if you are pregnant or might be pregnant before undergoing the imaging test. Each fluoroscopy procedure is unique, so don’t be afraid to ask your provider questions about your procedure. They’re there to help you.