What is Fluoroscopy?

1.Fluoroscopy is an examination performed dynamically with x-rays to allow depiction of motion and of contrast material within the body.

2. As the child is continuously exposed to a small dose of radiation the radiologist studies the motion of the contrast media. Images from this procedure are stored to document the findings.

3. Contrast material used in these studies consists of safely used, very dense material that is injected, instilled or swallowed by the patient. Because of its density the material absorbs x-rays and causes a shadow on a radiographic image. Most contrast material contains either iodine or barium sulfate.

4.Bodily systems studied with fluoroscopy include the urinary tract, the upper and lower digestive tracts, the airways and the cervical spine. Limb motion can be studied and is usually done in conjunction with an orthopedist.

5. All of these exams are performed in the specially designed Pediatric Imaging Unit of the Safra Children's Hospital by expert pediatric imaging physicians, with experienced technologists and with equipment designed to minimize dosage.

To make an appointment for a fluoroscopic exam:

Please call (03) 530-5310 on Sundays thru Thursdays from 8:30-1400.

In order to ease your child's experience in having an exam and even make it enjoyable, please find the enclosed video clip which shows Noam the clown going through the procedure of having and ultrasonic examination at the diagnostic imaging unit of Safra Childrens Hospital. It may take approximately 2-3 minutes to download the clip. It is worthwhile to wait and show it to your child before your arrival.

Respiratory System:

Airway Fluoroscopy:

The purpose of this examination is to demonstrate the airways (trachea (or windpipe) and bronchi), lungs, heart and great vessels as well as the diaphragm during inspiration and expiration.

The examination is performed for example to evaluate congenital stridor, noisy breathing, choking episodes and for the presence of a foreign body.

The examination is performed without adminstriation of contrast material and no prior preparation is required.

The test is quite short and a parent can accompany the child during the procedure.

Digestive Tract :

Upper GI Series/ Barium Swallow:

The purpose of this examination is to image the upper digestive tract including the esophagus, stomach and duodenum.

The exam is performed to demonstrate abnormalities of the upper GI tract such as excessive vomiting and even some respiratory abnormalities such as congenital stridor, searching for abnormal external pressure on the esophagus and the adjacent trachea or gastro-esophageal reflux.

During this examination, the child is asked to drink a mildly flavored suspension of barium sulfate, an inert thick substance that is cleared by the digestive tract without absorption and is used for diagnostic purposes alone. Additional flavors and sweetening can be added if requested.

While the child is drinking the movement and location of the barium is followed by fluoroscopy, or "X-Ray TV."

During the examination the parent may stay in the room and if the child is small assists in helping the child drink the material.

The examination is short and painless; aside from the presence of the parent no sedative is required.

Stools are usually whitish after this exam.

Preparation for this exam:

Fasting:

Small Bowel Follow Through:

The purpose of this examination is to demonstrate the lumen of the small bowel along its entire length from the duodenum through its transition to the large intestine.

This exam is performed to evaluate digestive tract abnormalities such as abdominal pain, diarrhea and weigh loss.

For this exam the child is given one to two cups of a dilute, mildly flavored suspension of barium sulfate, an inert, mildly thick substance that is cleared by the digestive tract without absorption and is used for diagnostic purposes alone.  Additional flavors and sweetening can be added if requested.  Images are performed at 20 to 30 minute intervals until the contrast medium reaches the distal portion of the small intestine, the terminal ileum. Fluoroscopic images of the small bowel are then performed as well as the connection to the colon or large intestine.

This exam takes approximately two hours, but can be shorter or longer depending on the transit time of the contrast material through the small bowel.

Stools are usually whitish after this exam.

Preparation for this exam:

Fasting

Barium Enema:

The purpose of the exam is to demonstrate the lumen of the colon, or large intestine.

This examination is performed primarily for the work up of congenital and/or persistent constipation.

During this examination the lumen of the large bowel is filled with a dilute suspension of barium sulfate, an inert, mildly thick substance that is cleared by the digestive tract without absorption and is used for diagnostic purposes alone. This material is instilled into the rectum via a small catheter while the patient is being imaged by fluoroscopy, or "X-Ray TV."  When the colon is filled additional conventional images may be obtained with the patient lying in varying positions.

The exam, including disrobing, placement of the catheter and taping the buttocks as well as filling of the colon and additional images will take approximately 20-30 minutes to complete. For small infants even less time is required. The parent may stay with the child throughout the examination to help relieve anxiety.  Occasionally an additional film is required on the following day.

Preparation for this exam:

No preparation is required. No cleansing enema, rectal exam or even rectal temperature measurement should be taken within 24 hours of this exam.

The Urinary Tract:

Voiding Cystourethrography (VCUG):

The purpose of this examination is to image the urinary bladder and the urethra (The tube that connects the bladder to the outside).

This exam is primarily performed to investigate causes of urinary tract infection (UTI) and abnormal dilatation, or widening, of the urinary tract (hydronephrosis).

The primary purpose of the exam is to exclude or diagnose the presence of vesico-ureteral reflux. It is also performed to investigate a suspicion of bladder outlet obstruction due to valves in the posterior urethra or a stricture anywhere in the urethra.

During the examination a small catheter will be placed into the urinary bladder via the urethra in a sterile fashion using an anesthetic gel.

Sterile iodinated contrast material is then instilled into the bladder with intermittent fluoroscopy, or "X-Ray TV."

Images are obtained and stored of the anatomy and to document abnormalities such as vesico-ureteral reflux.

As the examination progresses the bladder will fill and the child will be asked to void, or urinate. During voiding the catheter is removed and images are taken of the bladder, urethra and if reflux is present, the upper urinary tracts.

What Is Vesico-Ureteral Reflux (VUR)?

VUR is a condition where there is reversal of flow of urine from the bladder up into the ureters and, possibly in to the kidneys. This condition can lead to infection as it allows the urine to remain in the urinary tract for a longer period than normal. In the presence of infection reflux can also spread an infection from the bladder to the kidneys and allow scarring to occur.

When a child has a UTI, an ultrasound examination is performed to demonstrate the anatomy of the urinary tract and a VCUG is also performed to exclude reflux.

Preparation for this exam:

Antibiotic coverage is usually given in Israel for three days: the day before, of and after the exam with the dose according to the instructions of the referring physician.

Over the age of two years, sedation is offered and suggested.

Voiding Cysto-Urethrography with Sedation:

This exam is performed exclusively in the Pediatric Imaging Unit.

Although placement of a catheter in the bladder is not a particularly painful procedure, it is uncomfortable and generates anxiety in a young child before the exam.

The purpose of sedation is to diminish this anxiety, to relax the patient during the exam which will allow the procedure to proceed more smoothly and to provide general amnesia to the event.

The exam is performed under the supervision of a pediatric radiologist who performs the exam and a dedicated pediatric nurse anesthetist appointed by Safra Children's Hospital.

On the day of the exam, the patient will be received by the nurse who will obtain all relevant medical information from the parents.

The parents will be asked to sign a consent form for sedation.

The type and amount of sedation is tailored to the patient's age and personality.

The sedation agents used in our department are:

Midazolam (Dormicum or Versed) which is given orally in a syrup, by nasal drops or rectally.

The time of onset of the sedation varies with the child and route of administration, usually taking effect in 15-20 minutes and lasting about an hour after it was given.

A possible side effect is crying on awaking.

Nitrous Oxide or 'Laughing Gas' administered by mask.

This type of sedation is appropriate with a child who can cooperate by wearing a mask.

The onset of sedation and recovery time is very quick, within minutes.

Under the influence of this sedative the child will appear sleepy and may occasionally smile or laugh, appearing to be dreaming.

Most children when awaking have no memory of the event.

These agents are safely administered with monitoring and under medical supervision and are therefore used primarily in a hospital setting.

The child will be discharged after the procedure when fully awake, responsive and active for his age and is able to drink.

Preparation for this exam:

Fasting for the three hours before the exam, allowing clear liquids such as water or tea up to one hour before the exam.

Antibiotic coverage is usually given in Israel for three days: the day before, of and after the exam with the dose according to the instructions of the referring physician.

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General Guidelines for Fasting before Sedation by Age: