THE REASON FOR THE FLUOROSCOPE

The fluoroscope has proven to be a useful tool for medical imaging and as today’s population becomes increasing older and the costs of medical care continue to rise, exams need to be efficient as well as being able to diagnose a variety of problems. Even in smaller healthcare facilities patients have access to advanced imaging machines that many people take for granted. While most people have heard of X-rays and even had one taken they may not be aware of how they were discovered or why they work. As with most advancements, new discoveries are made as time goes on which is the case of the fluoroscope. It has proven to be very beneficial in imaging departments all over and without the fluoroscope many of today’s complex imaging exams could not accurately be performed and diagnosed.

THE HISTORY OF THE FLUOROSCOPE

The fluoroscope would not have happened if X-rays were never discovered. On November 8, 1895 Wilhelm Conrad Roentgen a German physicist was working on experiments in a lab at Würzburg University.(1) During his experiments he noticed the rays coming out of the tube made a piece of cardboard with barium platinocyanide on it glow.(1) Further research was conducted and these new rays were called X-rays as the X was used for the mathematical representation for the unknown.(2)

The People That Took The X-Ray Further

In 1896 just one year later Enrico Salvioni invented the Fluoroscope; however, Thomas Edison (an American inventor) was credited with the name when he created a machine the same year.(2)

Edison’s machine differed by the use of calcium tungstate as the material used to produce fluorescence.(1) Typically copper activated zinc cadmium sulfide phosphor had been the choice which produced a Yellow-green light.(2) This was very inefficient and subjected the patient to very high doses of radiation.(2) The effects of these doses became appearent to Edison very quickly.(2)

Edison and his assistant Clarence Dally were exposed to frequent high doses of radiation while demonstrating the fluoroscope.(2) The damage was so severe to Dally that he died in 1904 of cancer due to the frequent dosage of radiation.(2) At the time of Dallys death Edison stopped all further research involving X-rays.(2) The evolution of the Fluoroscope did not stop with Edison. The names Trendelenburg, Tesla, Beclere, and others all names that are now common place in the medical field have some credit to the advancement in fluoroscopy.

The Evolution Of The Fluoroscope

Early Fluoroscopes were just cardboard tubes with a small opening at one end to observe the exam from.(3) A thin cardboard piece coated on the inside with a layer of fluorescent metal salt was on the wide end of the tube.(3) The fluoroscopic image obtained was very faint.(3) This is when Thomas Edison discovered that Calcium Tungstate screens produced a much brighter image.(3) This early design required scientist and physicians to place their heads in the direct path of the X-Rays.(3) This led to severe radiation burns.(3)

Early Problems With The Fluoroscope

Most of the early imaging rooms were very dark due to the faint images on the screens.(3) This also created problems. Physicians had to sit in dark rooms to let their eyes adjust before performing exams.(3) This made exams take longer and placed more discomfort on patients. It was not long before a solution was found. In 1916 Wilhelm Trendelenburg created Red adaptation goggles to help with the problem of dark adaptation that had been studied by Antoine Beclere.(3) The red light produced by the goggles conditioned the eyes prior to the examination and still allowed the physician to perform the exam regularly.(3)

A Side Job For The Fluoroscope

The fluoroscope in the 1940’s and 1950’s was even used in shoe stores for the proper fitment of shoes. This was poorly regulated and subjected the sales person and customer to unnecessary radiation.(4) At the time the Public Health service said that on average each dose from the shoe fluoroscope would emit between 7 and 14 roentgens but some machines could be as high a 116 Roentgens.(4) On a comparison near ground zero at Hiroshima doses were only 300 Roentgens.(4)

THE FIRST BIG IMPROVEMENT TO LOWER RADIATION DOSES

In the early 1950s a major advancement was made for the fluoroscope. The invention of the image intensifier revolutionized the field of fluoroscopy.(5) The image intensifier allows the radiation passing through the patient to be enhanced electronically making the image 1000 to 6000 times brighter than old screen systems.(5) Subsequently lower overall radiation doses were now used. This was significant because of the extended times required for exams. Anytime lower doses can be used is better for the patient and the physician making fluoroscopy even safer. This new technology also made the Red adaptation goggles obsolete as the image could now be seen with photopic or day vision. (5) Also, the exam could now be carried out with the lights dimmed in a comfortable illuminated room. (5) Another advantage that lowers dose is that the image intensifier could be connected to a television style monitor allowing the physician to stand further away from the harmful radiation.(3)

Computers Take Over The Fluoroscope

Now that computers are being used increasingly more in imaging the use of digitized fluoroscopy equipment is being used.(5) The computer is used for image manipulation and storage of the images making film obsolete. While the initial costs of these new digital fluoroscopy units are much higher, secondary costs such as film, processing, and storage have been dropped. Other advantages are much sharper images and even lower radiation doses. Since images can now be digitized information can now move much faster reaching physicians much quicker and allowing them to make diagnosis for critical patents in a timely manner. Digitizing also allows multiple people to view images instead of having just one film and having to make many different copies.

THE TYPES OF EXAMS PERFORMED WITH FLUOROSCOPY

Fluoroscopy today is used for many types of exams from the non-intrusive to the semi-intrusive. The imaging of internal organs can be view by the fluoroscope from the use of contrast media. This contrast media usually Barium can either be swallowed by the patient or introduced retrograde through the rectum. Since the image is not static the natural processes of the body can be viewed. By having the patient swallow barium the Radiologist can see all of the functions associated with the action.

Upper Gastrointestinal (UGI) studies show strictures, foreign bodies, anatomic anomalies, and neoplasm of the esophagus.(5) Further down the UGI system the barium hits the stomach. Pathology that shows up are polyps and ulcers of the pylorus, duodenal bulb, and C-loop of the duodenum.(5) This is also used to diagnose reflux of the stomach. Double contrast can be used to inflate the pylorus showing signs of gastritis and ulcers better.(5) Diagnosing possible hiatal hernias are done by placing the patient into a Trendelenburg position.(5) This is where the feet are higher than the head.

The lower gastrointestinal is viewed by inserting the barium rectally. The pathology demonstrated is obstructions, and intussusceptions.(5) By using air and barium or double contrast diverticulosis, polyps, and mucosal changes can be seen on the fluoroscope.(5) Double contrast is also beneficial to view air fluid levels in the gastrointestinal system. Other benefits of the fluoroscope are to view joints of the body to see ligament damage. If the patient has chronic dislocations of a joint the movement can be seen fluidly on the fluoroscope and further diagnosis can be given.

CONCLUSION

Many modern imaging exams would not be possible without the fluoroscope and the people who helped discover and create it. If Wilhelm Roentgen would not have been doing experiments the fluoroscope may have never been invented. As time went on and technology became available the fluoroscope became more efficient and safer to use. The advancements in technology and design have also helped to decrease waiting times, exam times, and radiation dosage to the patient and physician, while increasing the ability for the physician to properly diagnose any problems that may show up. This helps create a quality life for the patient and their family by possibly catching and diagnosing any problems early, allowing quicker action to correct the problem if possible.

Work Cited

1. Soyee.. The Discovery of X-rays. Soyee Products Inc.

Available at http://www.soyeeproductsny.com/Roentgenandthediscoveryofthexrays.htm. Accessed October 5, 2007

2. Piko. Physics & the Detection of Medical X-Rays. Kansas State University

Available at: http://web.phys.ksu.edu/mmmm/piko/fluor.htm. Accessed October 5, 2007

3. Houghton, Mifflin. Fluoroscopy. The American Heritage dictionaries.

Available at http://www.answers.com/topic/fluoroscopy?cat=health. Accessed October 5, 2007

4. Adams C. The straight Dope: Were those old shoe store fluoroscopes a health hazard.

Cecil’s storehouse of human knowledge. November 27, 1987

5. Bontrager K, Lampignano J. Radiographic Positioning and Related Anatomy.

Missouri: Elsevier Mosby; 2001

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