Fluoroscopy

Fluoroscopy is used to study moving body structures. An x ray beam is continuously passed into the body part to be examined it is transmitted to a TV-like monitor so that the body part in motion is studied in detail. As an imaging technique, fluoroscopy is commonly employed by physicians to obtain real-time images of the internal structures of a patient during minimally invasive and microscopic surgical procedures, as well as many types of diagnostic tests like discography.

Fluoroscope: In its simplest form, fluoroscopy consists of an x ray source and a fluorescent screen between which a patient is placed. Modern fluoroscopes couple the screen to an X ray image intensifier and a video camera allowing the images to be played and recorded on a monitor. Traditional fluoroscopes consisted of an x ray source and fluorescent screen between which the patient was placed. Modern fluoroscopes have shown several improvements in screen phosphors, image intensifiers and even flat panel detectors. These allow for increase quality while minimizing the radiation dosage to the patient. Modern fluoroscopes also use the CSI screens and produce noise-limited images. This ensures minimal radiation dosage results while still obtaining images of acceptable quality.

Fluoroscopy can be adopted on an inpatient or outpatient basis. Depending upon the specific type of procedure or examination, it is determined whether any preparation prior to the procedure is required. All fluoroscopic procedures pose potential health risk to the patient. Fluoroscopy uses more radiation than standard x rays. Radiation doses depend upon the size of the patient as well as the length of the procedure. Fluoroscopy is widely used in orthopedic surgery to guide fracture reduction and the placement of metal work. Fluoroscopy is used in many diagnostic and therapeutic radiological procedures to observe the action of instruments being used either to diagnose or to treat the patient. Fluoroscopy is also used to help find a foreign object in the body, position a needle for a medical procedure or re align a broken bone. Different types of fluoroscopy procedures:

• Esophogram: x ray study of the throat.
  
• Upper GI series: is a study of the esophagus, stomach and duodenum.
  
• Small bowel series: is a study of the stomach and entire small intestine.
  
• Barium enema: is a study of colon.
  
• Hysterosalpingogram: is a study of the uterus and fallopian tubes.
  
• Intravenous Pyelography: is a study of the kidneys, ureters, and the urinary bladder.
  
• Voiding cystourethrogram: is the study of the bladder and urethra.
  
• Arthrogram: is a study of the shoulder and knee joint showing ligament and tears.
  

Barium Swallow

Barium Swallow or Upper GI series is a radiological test that allows visual examination of the esophagus, stomach, duodenum and small intestine. Nothing should be eaten for about 6 hours prior to the test. Typically, double contrast barium swallow is used. The patient is made to swallow a barium drink after swallowing an effervescent agent. The barium creates a temporary coating on the lining of the upper GI tract. Then he is asked to stand and lie in different positions to spread the liquid. An x-ray machine then takes pictures. Fluoroscopy is often used during a barium swallow.

After this test, patients are asked to drink extra fluids and water to relieve the bowels of the barium. Constipation or fecal impaction may occur if the barium isn't completely eliminated from the body. This diagnostic test is used for detecting dysphagia, hernia, peptic ulcer disease, GERD (Gastro Esophageal Reflux Disease), achalasia, generalized epigastric pain and suspected perforation.

Esophagram

Esophagram is a test whereby the patient is administered a barium sulfate compound that enables the radiologist to study the function and appearance of the esophagus. A series of x rays of the esophagus is taken after the patient has swallowed the barium. The barium solution coats and outlines the walls of the esophagus. This enables the radiologist to assess the process of swallowing. Hence it is also called barium swallow. An Esophagram is done when the patient complains of pain or difficulty in swallowing. It is also done to assess the reasons for blood stained vomit and when abdominal pain and weight loss occurs or diagnosing cases of Barrett's esophagus. The Esophagram helps the radiologist to detect narrowing, stricture, obstruction or irritation of the esophagus. It helps to study complications such as ulcers, polyps and tumors. It also helps to assess hiatal hernia.

The patient is advised not to eat or drink for 8 to 10 hours prior to the examination. The patient is asked not to smoke or chew gum at least 6 hours prior to the procedure. A patient is given a cup of barium sulfate to swallow. A radiologist watches and evaluates the swallowing process with fluoroscopy. The barium swallowed coats the lining of the esophagus, and x rays are taken to track the pathway to the stomach. The patient is placed in various positions throughout the exam so that structures are optimally demonstrated on the x rays.

The problem is that it can miss small abnormalities in the esophagus such as small erosions and ulcers. This test is not very effective for diagnosing gastro esophageal reflux associated with GERD. Pregnant mothers are advised not to undergo this procedure as the risk of radiation affects the fetus.