page_title: Fluoroscopy
section_title: Risks
hierarchical_section_title: Fluoroscopy / Risks
caption_attribution_description: English: Injuries to back and arm from multiple prolonged electrophysiological and ablation procedures with bi-plane fluoroscopy. Wounds on back healed into scarred areas while injury on arm required grafting.
context_page_description: Fluoroscopy is an imaging technique that uses X-rays to obtain real-time moving images of the interior of an object. In its primary application of medical imaging, a fluoroscope allows a physician to see the internal structure and function of a patient, so that the pumping action of the heart or the motion of swallowing, for example, can be watched. This is useful for both diagnosis and therapy and occurs in general radiology, interventional radiology, and image-guided surgery.
  In its simplest form, a fluoroscope consists of an X-ray source and a fluorescent screen, between which a patient is placed. However, since the 1950s most fluoroscopes have included X-ray image intensifiers and cameras as well, to improve the image's visibility and make it available on a remote display screen. For many decades, fluoroscopy tended to produce live pictures that were not recorded, but since the 1960s, as technology improved, recording and playback became the norm.
  Fluoroscopy is similar to radiography and X-ray computed tomography in that it generates images using X-rays.
context_section_description: Because fluoroscopy involves the use of X-rays, a form of ionizing radiation, fluoroscopic procedures pose a potential for increasing the patient's risk of radiation-induced cancer. Radiation doses to the patient depend greatly on the size of the patient as well as length of the procedure, with typical skin dose rates quoted as 20–50 mGy/min. Exposure times vary depending on the procedure being performed, but procedure times up to 75 minutes have been documented. Because of the long length of procedures, in addition to the cancer risk and other stochastic radiation effects, deterministic radiation effects have also been observed ranging from mild erythema, equivalent of a sun burn, to more serious burns.
  A study of radiation induced skin injuries was performed in 1994 by the Food and Drug Administration (FDA) followed by an advisory to minimize further fluoroscopy-induced injuries. The problem of radiation injuries due to fluoroscopy has been further addressed in review articles in 2000 and 2010.
  While deterministic radiation effects are a possibility, radiation burns are not typical of standard fluoroscopic procedures. Most procedures sufficiently long in duration to produce radiation burns are part of necessary life-saving operations.
  X-ray image intensifiers generally have radiation-reducing systems such as pulsed rather than constant radiation, and last image hold, which "freezes" the screen and makes it available for examination without exposing the patient to unnecessary radiation.
  Image intensifiers have been introduced that increase the brightness of the screen, so that the patient needs to be exposed to a lower dose of X-rays. Whilst this reduces the risk of ionisation occurring, it does not remove it entirely.
caption: Fluoroscopy burn from long exposure
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