Fluoroscopy: An essential diagnostic modality in the age of high-resolution cross-sectional imaging

Abstract

The importance of fluoroscopy as an imaging modality has been minimized relative to other cross-sectional modalities, including high-resolution computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound. Fluoroscopy examinations have decreased in clinical practice due to reduced appreciation of its usefulness, insufficient training of residents, fewer staff with adequate expertise, and poor reimbursements relative to other modalities. We revisit and build upon the prior literature and history of this decreased utilization. We then seek to prove continued value, through categorized examples and within multiple subspecialties, wherein fluoroscopy plays an integral part toward clinical diagnoses as well as optimizing patient outcomes. This is particularly true for motility and esophageal disorders, where structure and function with real-time evaluation is essential.  We additionally show several post-operative cases where the synergy of fluoroscopy with CT and endoscopy is apparent.  The fluoroscopic radiologist also has the unique ability to vary patient positioning, as opposed to traditional CT or MRI, where orthogonal views are employed without positional or temporal changes. We turn attention to the modern era, with synergistic and novel cases demonstrating that fluoroscopy remains instrumental toward achieving a diagnosis alongside other modalities. Our cases stress the need to maintain expertise in fluoroscopy skill, and underline its continued importance in residency training programs.  We conclude that fluoroscopy is a relatively inexpensive modality that is often under-appreciated in diagnostic radiology. We suggest that competency in fluoroscopy is crucial for future generations of radiologists to both work with their peers, as well as to aid clinicians in the optimal treatment of patients.

Keywords: Fluoroscopy; Radiology; Radiation; Ionizing; Abdomen; Pelvis; Barium

Core Tip: Although the use of fluoroscopy has diminished with the advent of high-resolution computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound, we show how fluoroscopy is essential in the diagnostic algorithm and should remain an integral part of residency training. We demonstrate in this review that fluoroscopy remains an essential modality, and build upon and reference prior concerns that outline the challenges facing fluoroscopy. We address such concerns with an optimistic outlook and case examples. We not only highlight the routine uses of fluoroscopy, but more significantly state that fluoroscopy now works synergistically with CT, MR, and other cross-sectional modalities, even in the modern age.