Name of the Procedure:

Fluoroscopy-Assisted Procedures (e.g., nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy)

Summary

Fluoroscopy-assisted procedures involve the use of real-time X-ray imaging to guide a physician or other qualified health care professional during certain medical interventions, such as nephrostolithotomy (kidney stone removal), ERCP (Endoscopic Retrograde Cholangiopancreatography), bronchoscopy, and transbronchial biopsy. This technique allows for precise visualization and navigation within the body, enhancing the safety and effectiveness of the procedure.

Purpose

Fluoroscopy is used to enhance the visualization of internal structures, ensuring accurate placement of instruments, real-time monitoring of the procedure, and effective treatment of the targeted area. The goal is to improve outcomes by providing clear, dynamic images that assist in the diagnosis, treatment, and evaluation of medical conditions.

Indications

• Diagnosis and removal of kidney stones (nephrostolithotomy)
• Diagnosing and treating conditions of the bile ducts and pancreas (ERCP)
• Examining airway structures and obtaining tissue samples (bronchoscopy, transbronchial biopsy)
• Guiding minimally invasive procedures
• Confirming placement of medical devices (e.g., stents, catheters)

Criteria making fluoroscopy appropriate include:

• Complex anatomical structures requiring real-time imaging for precise intervention
• Procedures requiring accurate navigation within the body
• Need for continuous real-time assessment during interventions

Preparation

• Patients may need to fast for several hours before the procedure.
• Certain medications might need to be adjusted or temporarily discontinued.
• Pre-procedure imaging, blood tests, or other diagnostic assessments may be required.
• Patients should inform their healthcare provider of any allergies, especially to contrast dye or iodine.

Procedure Description

1. The patient is positioned on an X-ray table.
2. Protective gear is provided to minimize radiation exposure.
3. Depending on the procedure, local anesthesia or sedation may be administered.
4. A fluoroscope, which is an X-ray machine that provides real-time imaging, is used to guide the physician.
5. The physician maneuvers instruments or catheters while visualizing the patient’s anatomy on a monitor.
6. Contrast dye may be injected to improve image clarity.
7. The physician performs the necessary interventions (e.g., stone removal, biopsy, stent placement).
8. Final images are taken to confirm the success of the procedure before the instruments are removed.
9. Post-procedure monitoring is carried out to ensure patient stability.

Duration

The procedure typically takes more than one hour, depending on the complexity and specific requirements of the intervention.

Setting

Fluoroscopy-assisted procedures are performed in hospitals, outpatient clinics, or specialized surgical centers equipped with fluoroscopic imaging technology.

Personnel

• Nonradiologic physician (e.g., urologist, gastroenterologist, pulmonologist)
• Radiologic technologist
• Nurses
• Anesthesiologist (if sedation or general anesthesia is required)

Risks and Complications

Common risks include:

• Exposure to radiation
• Allergic reactions to contrast dye
• Infection at the intervention site
• Bleeding or injury to surrounding tissues

Rare complications may include:

• Organ perforation or damage
• Adverse reactions to anesthesia
• Prolonged recovery or additional interventions

Benefits

• Enhanced precision and safety of diagnostic and therapeutic procedures
• Real-time visualization leading to improved procedural outcomes
• Minimally invasive approach reducing the need for open surgery
• Faster recovery times and fewer complications

Recovery

• Post-procedure monitoring for a few hours
• Specific care instructions for the intervention site, if applicable
• Pain management with prescribed medications
• Follow-up appointments to assess recovery and effectiveness of the procedure
• Recovery time varies but most patients resume normal activities within a few days to a week.

Alternatives

• Non-imaging guided procedures
• Open surgical approaches
• Alternative imaging techniques (e.g., CT, MRI) Each alternative has its own pros and cons regarding accuracy, invasiveness, and recovery time.

Patient Experience

During the procedure, patients might feel minimal discomfort due to local anesthesia or sedation. Post-procedure, some soreness or mild pain may be experienced at the intervention site. Pain management measures include prescribed medications and rest. Patients generally feel better within a few days and can expect a gradual return to normal activities with proper follow-up care.