All about Fluoroscopy

There are a lot of different types of imaging studies that your child’s provider may want to obtain to help answer a clinical question. One of the more unique studies is called fluoroscopy and it’s one you may have questions about.

• • What is Fluoroscopy?

Fluoroscopy is a type of study that uses x-rays, much like the typical x-ray you may get of your chest or knee, but it has the special ability to pulse these x-rays several times a second allowing for real-time imaging. What does this mean? Fluoroscopy is a like a live x-ray video of your child.

Video swallow study shows dynamic imaging of swallowing

It gives the radiologist and clinician information such as the anatomy of certain structures with quick results; it also provides dynamic information that may help answer why a certain symptom is present. It can be used to determine if a child is aspirating, to place tubes in a child with feeding difficulties, and to assess for abnormal things like reflux (from the stomach and the bladder). Additionally, this a radiology service that can help diagnose emergent conditions such as volvulus (bowel twisting on itself) and even treat emergent conditions such as intussusception (bowel telescoping into itself).

• What is this stuff my child has to drink?

Studies ordered by your pediatrician such as an upper GI, esophagram, small bowel follow through, or video swallow study require your child to drink a material called contrast. The contrast is composed of a material that is radiodense, meaning that it shows up well on x-ray. This allows the radiologist to see structures like the stomach and small intestines better during the study. This contrast is inert and does not get absorbed by your child, eventually passing in his or her stool. While it might not be the best tasting thing in the world, our staff does their best to help sweeten it up with Kool-Aid flavors (go for fruit punch!).

• Who are all of the people in the room?

While the fluoroscopy suites are relatively big rooms, by the time everyone is standing around the table, it can get quite crowded. With this large crowd of people, you or your child might be wondering who all of these people are or what their titles mean.

1. Attending radiologist: This is the staff radiology physician, the boss for the day. She or he has completed years of medical training including medical school, residency and fellowship and is now licensed to practice on his or her own. They are the teachers to the trainees. Sometimes they observe, while other times they are helping with the studies.
2. Fellow: This is a radiology trainee physician who is near the end of their training. They have completed all of medical school, a five-year radiology residency, and are now in their final year (or two) of their training before becoming an attending.
3. RPA, RRA: This is a medical professional who did training specific to radiology, often focused on radiology procedures. They run cases independently as well as assist and teach trainees.
4. Resident: This is a radiology trainee physician, someone who has completed medical school and is anywhere between one and five years into post-medical school training.
5. Technologist: This is often the first person you meet. The technologist went to school specifically to learn how to operate/obtain/position/reformat/etc. imaging studies. They often explain the procedure to you and your child, set up the room, assist moving the child, and take the x-rays in addition to other responsibilities.
6. Child Life Specialist: This person may or may not be present depending on the need. He or she is a specially trained individual who assists with cases that could be stressful for your child. He or she provides support to you and your child.

• My child doing a lot of rolling around on that table. Why is that happening?

Fluoroscopy is a dynamic study. Often to see everything we need to see, your child will need to be constantly repositioned during the study (x-rays are 2D pictures and human bodies are 3D objects). Think of it like the roller coaster of radiology with lots of movement. The bed can even tilt head first and feet first, all the way to the upright position.

• What is that big box moving over my child?

That is essentially the panel that receives the x-rays. The x-rays are generated from under the table and go through the table, your child, and then land on that box. After some convoluted physics, the image is generated and displayed on a screen.

• Why am I wearing lead again?

X-rays are a form of radiation and the lead vest helps limit the amount of exposure vital organs receive. There are older blogs that go into more detail regarding radiation safety that I suggest you check out if you have more questions.

I hope this helps answer a little about an imaging modality that you may not know much about. Any questions you or your child may have will happily be answered at the time of your appointment by our wonderful staff at Cincinnati Children’s.

Dr. James Morris, author; Glenn Miñano, BFA, editor; Meredith Towbin, copyeditor