Fluoroscopy, Practical Points for Residents/Trainees.

Oganes Ashikyan, MD

Before you press fluoroscopy button/pedal, lets talk about some common sense/practical points:

Minimize the distance from patient to receptor (image intensifier) by lowering the image intensifier or raising the table.

Position the image intensifier over the area of interest. You can do this without fluoring. With time, you will learn that you can do this pretty accurately before you use fluoroscopy.

Collimate, collimate, collimate. Many fluoroscopy units show you the collimated area margins on the screen without fluoroscopy being on. Some will start showing the collimation area after the first image comes up on the monitor screen. Learn your equipment.

Tape a marker over the area before you start fluoring looking for the entry site. With time, you will learn to use fluoroscopy for confirmation rather than as a search tool.

Make sure to choose correct fluoroscopy settings before you use them. Do you want continuous or pulsed fluoroscopy, and at what frequency if pulsed?

Do not fluoro while you are moving image intensifier searching for your entry site – that is wasted a radiation dose. Better approach is to tap the fluoro button to get an image, than adjust your position without fluoring, and then recheck with brief fluoro again.

Use the least magnification factor that is practical for a given purpose.

Do not be a “lead foot” on the pedal. As soon as you get a decent image, let the fluoro button go.

Go through these checklist steps before each fluoroscopy pedal press. You will be amazed on how you can cut the dose in at least half, just by using some common sense.

Think about what you are doing at each step. Can you avoid pressing the fluoro button during a particular step? For example, what is the purpose of fluoring for the tenth time after you clearly feel the needle on the metal part of joint replacement hardware or on the bone? Do you really need to check 25G local anesthetic needle position when patient is holding still and following your commands.

The dose to the operator predominantly comes from scatter from patient’s body. Think about where your monitor and fluoro pedal are. Remember that dose and distance are related with a power of 2 in the equation.

Communicate with your technologists. Some facility policies and state regulations allow you to delegate fluoroscopy to other team members, but some do not. A technologist may feel that they are being helpful by positioning fluoroscopy unit for you. You will have to explain what you want and do not want them to do, when you are the primary operator.