In addition to capturing a single moment in time on radiographs, it’s possible to record live, real-time X-ray studies. This is known as fluoroscopy.

So, what is fluoroscopy used for in vet med? And how can vets choose which fluoroscopy machine is right for their practice? Read on to learn more about veterinary fluoroscopy…

How Does Fluoroscopy Work?

Fluoroscopy uses x-rays to create video studies rather than still images. These videos can be viewed in real-time, and depending on the system and software, clips can also be saved as part of the medical record and shared for consultations.

Generators for fluoroscopy can be classified as continuous or pulsed. Continuous generators produce x-ray output for the entire length of the study. Pulsed generators, on the other hand, produce X-rays in short bursts—similar to a frame in a video.

Since fluoroscopy generates images and videos using X-rays, radiation safety protocols must be followed, just as they would while taking traditional radiographs. 

This means wearing appropriate PPE and badges (including a ring badge for fluoroscopy), increasing distance away from the machine as much as possible during exposures, using the lowest possible exposures/x-ray output, and keeping hands out of the primary beam during exposures.

Common Uses of Fluoroscopy in Vet Med

While not a replacement for standard radiographs, fluoroscopy can provide additional value. The real-time imaging capabilities of fluoroscopy can capture movement in addition to just still images. 

For that reason, fluoroscopy can offer a dynamic, functional view into many parts of the body—especially for conditions that are difficult to capture in the split-second exposure of a regular X-ray study.

Common examples include swallowing studies and diagnosing tracheal collapse. Both of these things are notoriously difficult to catch on regular x-ray images since perfect timing is needed to produce a diagnostic image—an X-ray image that captures just the right moment in time when the abnormality is visible.

Fluoroscopy has additional diagnostic and interventional uses in vet med, too. One example is urinary studies. Moving the patient around in real-time can help to break up bladder sludge to differentiate it from uroliths or abnormalities/thickening of the bladder itself. Real-time fluoroscopy also has value when performing contrast studies of the bladder (to evaluate for bladder ruptures, radiolucent uroliths, etc.) or procedures such as a retrohydropropulsion of urethral stones.

Skull and jaw X-ray studies can be time-consuming and technically challenging. The same is true for diagnosing joint laxity or small fractures within a complex joint. These may require multiple x-ray views—including stress views. Vets may find that fluoroscopy studies add value by showing the anatomy in real-time, from various angles, and with dynamic movement. This could make for a much quicker and easier alternative to taping the patient perfectly into position for each separate shot.

A few more examples of diagnostic uses for fluoroscopy include evaluating for nasopharyngeal polyps and dynamic hernias, as well as real-time movement during GI transit studies.

As for interventional procedures, fluoroscopy may assist during certain orthopedic surgeries or aid in guided aspirates or placement of feeding tubes. The degree of invasiveness of the procedure may determine which type of fluoroscopy unit is required (more on this below).

Fluoroscopy Machines Available to Veterinarians

For a long time, the primary option was C-arm technology, which is expensive and bulky. 

Sometimes, a C-arm is the preferred option. For example, when used in the surgery suite (such as with major orthopedic surgeries performed with the aid of fluoroscopy guidance), a C-arm is typically the only option for working around the surgery table.

However, newer and less expensive options are coming to the market. For example, there is a 2-in-1 digital x-ray and fluoroscopy combination unit available from JPI. This is convenient because it takes up less space and there’s no need to buy two separate machines. 

The limitations of the x-ray/fluoroscopy combo would be the lack of a horizontal beam and the inability to use fluoroscopy intraoperatively in major surgeries since it is attached to the x-ray table. However, less invasive procedures could be performed on the x-ray table with fluoroscopy guidance.

Each practice would need to decide which option is best for them. However, it is good to see new technology becoming available that could increase the accessibility of fluoroscopy to general practitioners. 

Right now, demand for veterinary services is high. So, fluoroscopy could be one additional, unique service for vets to offer to their patients and clients.

Written by: Dr. Tammy Powell, DVM

Watch the swallow with Fluoroscopy!