The science of pain management is rapidly evolving. Technology has progressed, and innovative technologies are quickly gaining traction. Image-guided techniques are used in modern pain management interventions. Digital fluoroscopy, ultrasonography (ultrasound), and computed tomography are some of the imaging techniques used. Digital fluoroscopy is still believed to be the golden standard. More clinicians are using digital fluoroscopy than ever before. Clinicians are required to examine and choose the optimal method for interventional pain management treatment techniques in this era of evidence-based medicine.
Digital fluoroscopy is a technique of creating a digital radiographic image of an item that can be viewed on a computer screen. Various systems can generate digital images.
Each system operates according to its own set of principles. One of the many benefits of digital radiography is that it does not require wet chemical processing and poses any chemical risks.
Furthermore, the amount of radiation used to create a digital image is substantially lower than that used in traditional film radiography. In digital radiography, instead of x-ray film, an image capturing device is utilized to convert radiation photons into meaningful information. The idea is then transmitted from the detector to a suitable viewable media. This virtual image can be enhanced by processing it later to boost contrast, brightness, and a variety of filtering procedures. Finally, the image can be saved to a hard drive.
Fluoroscopy is the oldest digital radiography method. The system’s main flaws were its low resolution and restricted brightness. To improve image quality, the fluoroscopic image can be combined with image intensifiers. Meanwhile, new phosphor-plated image plates that can be directly read in image scanners to provide a better idea with less radiation have been developed. This method has achieved widespread medical recognition. The Flat Panel Detector (FPD) or Digital Detector Array (DDA) is a two-dimensional array of transistor-based detectors, the newest addition to digital radiography. The size of each sensor determines the image resolution.
The dangers of radiation were following the discoveries of X-rays (1885) and radium (1897). It causes cell death and damage. It has various adverse effects, including burns, DNA alterations that cause somatic mutations (affecting future generations), and radiation-induced leukemia. High radiation exposure can induce these health effects. The Food and Drug Administration (FDA) of the United States published an advisory in 1994 warning healthcare facilities about the risk of radiation-induced burns in patients during extended fluoroscopic treatments. There was no pain management procedure mentioned in the list of procedures. The chance to expose physicians and workers, on the other hand, could be the same.
Radiologists can use digital fluoroscopy to examine motion and analyze the anatomy and function of various body parts. The esophagus, stomach, initial segment of the small intestine called the ‘duodenum,’ and colon are often examined by digital fluoroscopy. These tests help doctors figure out what’s wrong with their patients. Digital fluoroscopy is also used to assess kidney function during angiography and venography operations (insertion of tubes into an artery or vein), pain management procedures, as well as some image-guided biopsies.
Oral or intravenous contrasts are frequently used in digital fluoroscopy before the tests are being performed. You will be seated on a wide flat table that may move and tilt at various angles during your exam. A mobile X-ray camera extends across a piece of the table, collects images, and delivers them to a nearby television monitor for the radiologist to view.
Radiation protection measures, such as intermittent fluoroscopy, grid removal, collimation, dose spreading, adjusting exposure to the desired level at the start of the process, dose level setting, and adequately qualified operators, are recommended to avoid these adverse effects.
Digital fluoroscopy has progressed from the most basic non-invasive imaging tool to a highly complex technology with powerful 3-D capabilities, capable of guiding life-saving intervention operations with little to no patient discomfort. Many of these image-guided minimally invasive techniques have taken the place of very invasive open surgical procedures. Smaller vessels and more subtle contrast changes can be visualized in real-time with each incremental breakthrough in technology, generally with low radiation exposure.
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