By Bernard S. Little

WRNMMC Command Communications

Fluoroscopy is a type of medical imaging that shows real-time moving images of the body’s interior, allowing surgeons, radiologists and other healthcare providers to see such things as a pumping heart, a patient swallowing, and various types of surgical procedures. It is helpful for diagnosis and therapy.

“The Defense Health Agency (DHA) requires mandatory training for all fluoroscopy operators, supervisors, practitioners, and prescribers who operate, prescribe, or supervise fluoroscopy, guided medical procedures,” said Crystal A. Green, Ph.D., a diagnostic medical physicist in the Department of Public Health-Radiation Safety Division at Walter Reed National Military Medical Center (WRNMMC).

Green and her colleagues recently designed a course now on Joint Knowledge Online (JKO) focused on fluoroscopy. JKO is the online learning program for Department of Defense personnel to enhance individual and staff proficiency in joint operations to improve the readiness of enterprises, including the delivery of military medicine.

The course designed by Green and her team titled ALARA in Fluoroscopy: Safe and Effective Fluoroscopy Use, serves as an initial and then annual requirement for all fluoroscopy users at Walter Reed, Green said. “The course will likely be used at other DHA military medical treatment facilities (MTFs). Additionally, this course will be used as part of the training for non-physician radiologist credentialing currently under development at Walter Reed,” she added.

ALARA stands for “as low as reasonably achievable,” which means for healthcare professionals should always strive for the lowest possible dose [of radiation exposure] to workers and patients while still getting the job done. Green explained that this is essential for a good safety protection program for patients and staff.

Green credits her team members for the collaborative effort in designing the course. Those team members include medical physicist Deborah Schumaker; Air Force Col. Grant Lattin, former director for clinical support at Walter Reed; Navy Cmdr. Andrew Benson, director for clinical support; Army Lt. Col. Margaret Myers, Radiation Safety Service chief and assistant radiation safety officer (ARSO); Amy O’Connor, project manager; Daniel Shaw, former ARSO; Dr. Eddie Thomas, Education and Training; and Sara Neale, from the DHA JKO team.

“The purpose of the course is to elevate the quality of patient care, ensure safety, and keep medical professionals current in the field of fluoroscopic imaging,” Green explained. The course is designed to assist professionals in “identifying basic principles of radiation protection; recognizing proper techniques to minimize radiation exposure to the patient and staff; identifying radiation dose optimization techniques specific to pediatric, adult and pregnant patients; and identifying basic factors, techniques and equipment specifications that affect overall image quality and patient does in fluoroscopy,” she shared.

The two-hour course is broken into five modules: understanding your risks; fluoroscopy operating modes; fluoroscopy optimization techniques; radiation dose parameters and skin effects; and methods to reduce your exposure.

According to the Centers for Disease Control and Prevention (CDC), a health-care provider may recommend a fluoroscopy to diagnose disease or guide treatment procedures for a particular health concern.

Fluoroscopies are commonly used to:

• Check how the stomach and intestines are working.

• Check if food is being properly swallowed and how the mouth and throat muscles are working.

• Guide medical procedures to place catheters, stents, or other devices inside the body, such as in the heart or blood vessels.

• Guide injections (shots) deep into the spine or joints.

• See broken bones and whether surgery has fixed them in the proper position to heal.

Coronary angiography is an example of a fluoroscopy procedure in which a small tube (catheter) is inserted into an artery of the heart. Contrast dye moves through the catheter into the blood vessels. The fluoroscopy shows how the blood moves through the vessels and allows the health-care provider to locate any blockages.

The benefits of fluoroscopy procedures include allowing healthcare providers to see movement and function (like in a movie) that cannot be seen in other fixed imaging studies (like a photograph). It guides sometimes life-saving surgical treatments, the CDC explains.