What is a ( Fluoroscope, Endoscopy, Cystoscopy) ?

What is a fluoroscope? 

This is a kind of x-ray in which a special machine (the fluoroscope) takes a continuous x-ray so that the doctor can see the movement of internal organs. A fluorescent screen, coated with a special substance, is mounted in front of an x-ray tube. The x-ray shadow is cast on the screen. The fluoroscopic image can be amplified and displayed on a television screen. Fluoroscopy can show the expansion of the lung or a barium liquid passing through a patient's esophagus to his stomach. Fluoroscopic techniques sometimes provide important information which cannot be obtained in any other way.

How much radiation exposure will I get from a fluoroscope?

Fluoroscopes take longer to perform and often expose you to more radiation than do the conventional x-ray exams recorded on film. There are new machines which give better images with less exposure, particularly those which amplify the light from the fluoroscopic screen and then provide a brighter image on a TV monitor, but the exposure is still higher than for a standard x-ray film. Make sure this procedure is done only by a board certified radiologist and only when necessary.

Will the doctors use x-rays taken by someone else? 

Some doctors will not use them because they are not aware they are available, they don't want to be bothered asking for them, they don't trust the manner in which they were taken, or the resulting film is not clear or detailed enough. There may be good reason for having x-rays retaken, such as if the first set is on poor-quality film. But you should make sure that your x-rays are being redone for good reasons and not just because a doctor or hospital does not want to share them. You should keep a record of your own x-ray history so that you can tell the doctor what has already been done, especially on high-dose film such as gallbladder or GI series. More and more doctors are accepting x-rays taken by others.

How is the dose of radiation measured? 

You will hear the terms rad or rem used in describing the dose of radiation. Rad stands for radiation absorbed dose. A rem is equivalent to a rad. The terms apply to all types of radiation and take into account the energy actually imparted to the tissue. (Sometimes the terms millirads and millirems are used to describe the dosage.) The effects of diagnostic x-rays on the body depend in a complex way on a number of factors, such as the distribution of energies of x-ray photon in the beam, the total intensity or quality of radiation, the distance between the x-ray tube and the individual being x-rayed, the type and location of tissues and organs in the main beam, and the age and sex of the person being examined. The unit of exposure is the roentgen, named after Wilhelm Roentgen, who discovered x-rays in 1895. However, most radiologists now measure the absorbed dose, which is the amount of energy dumped by incident radiation into a gram of material. The dose absorbed by a gram of skin or muscle can be much less than that absorbed by a gram of bone placed in the same x-ray beam. This is because the heavy atoms of calcium in the bone absorb xrays more easily than lighter elements abundant in tissue. X-rays pass through tissue more easily and don't leave as much energy behind.

Radiation Dose, Dosimetry, and Background Radiation

What is skin dose? 

This refers to the dose of radiation immediately on the surface of the skin. The outer layers of skin absorb x-rays readily; thus, particularly with older machines, the exposure inside a body will be less than the exposure at the skin. The absorbed dose in the outer layers of skin is often referred to as the skin dose, while x-ray energy deposited in a gram of bone, tissues, or an organ at a certain location inside the body is referred to as the depth dose at that location.

Reducing peak skin dose on patients undergoing interventional procedures

What x-rays give relatively high overall radiation doses? 

Several examinations are of special concern because they involve relatively high overall radiation doses. They include examinations of the gastrointestinal system (upper and lower), thoracic spine (middle and dorsal), lumbosacral spine (lower), lumbar spine, cervical spine, gallbladder, kidney, ureter, bladder, skull, pelvis and hip or upper thigh, and fluoroscopic procedure.

What other things should I watch for when having x-rays taken? 

A good operator will measure carefully the thickness of the part of your body which is to be exposed and consult a technique chart to set the tube current, voltage, and exposure time for each type of x-ray. If the operator hurries, there is more likelihood that a poor exposure will require additional x-rays. You must be careful not to move, since blurred images mean additional x-rays. The operator must also carefully align the beam, using the minimum beamsize possibilities.

When are lead shields used?

 Shielding can help reduce the amount of scattered radiation absorbed, especially by reproductive organs. There are several kinds of shields such as lead aprons, lead lined panels, scrotal cups, flexible lead lined drape cloths, and shadow shields. If they are not offered to you, ask about them before being x-rayed. Newer machines have built in shields to avoid scattering.

What kind of x-ray is a mammogram? 

A mammogram is a soft tissue x-ray of the breast. It is but one of several techniques used in diagnosis ofbreast cancer.

What is endoscopy?

Endoscopy is the examination through optical instruments of the interior of the body. There are many different kinds of instruments designed to perform this examination on different parts of the body. Several new tools use fiberoptics for this procedure tiny flexible fibers that carry a powerful light and a telescope which allows the doctor to peer inside the body. These instruments allow the diagnosis of various kinds of cancer without performing a major operation. Sometimes they are used in combination with other tests, such as x-rays, to confirm the diagnosis.

What are some of these endoscopic instruments called? 

You can identify these instruments because they end in the suffix scope: cystoscope, hysteroscope, colposcope, laparoscope, peritoneoscope, bronchoscope, proctosigmoidoscope, esophagogastroduodenoscope, etc.

Why are these instruments important in diagnosing cancer? 

For many years, these procedures have offered a fairly simple method of detecting malignancies, precancerous growths, and non cancer related diseases without the necessity for major exploratory surgery. This means you can return to work, be free from postoperative complications, and save money. The exact location of tumors can be determined and cytology can be done without a major operation. Since the introduction of fiberoptic equipment in the 1970s, new areas of the body can be examined without surgery.

What is a cystoscopy? 

A cystoscopy exam allows the doctor to inspect the lining of the urinary bladder for the presence of diverticula, fistulas, stones, or tumors in the bladder. The bladder is first enlarged by filling it with air or water. A cystoscope a thin, hollow tube with a light at the end of it is inserted through the urethra. The doctor can then actually look at the walls of the bladder. Cystoscopic brushes can be passed along to the tract to obtain cells for microscopic examination. Small tumors can sometimes be removed through the hollow tube. This test is usually done if you have repeated urinary tract infections or if you have bleeding associated with urination.

When is a hysteroscope used? 

A hysteroscope can determine the presence of fibroid and endometrial tumors; it can also be used to help locate lost IUDs or treat cases of infertility. The hysteroscope looks somewhat like a skin diver's spear gun, with an eyepiece and a trigger that controls a flexible tip that provides a full view inside the uterus. The instrument is inserted through the vagina and threaded through the cervix into the uterus to view the uterine cavity and entrance to the fallopian tubes.


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