Multipurpose Tool
By Rebecca Montz, EdD, MBA, CNMT, PET, RT(N)(CT), NMTCB RS
Radiology Today
Vol. 26 No. 5 P. 20

Advances in Fluoroscopy

Fluoroscopy has become an essential tool in modern diagnostic and interventional medicine, transforming real-time imaging and playing a key role in guiding complex procedures across fields such as cardiology, orthopedics, gastroenterology, and IR. With recent advancements in digital imaging, motion tracking, and AI, fluoroscopy has significantly improved image quality, diagnostic precision, and patient safety. These innovations empower health care professionals to conduct procedures with greater accuracy, make faster, more informed decisions, and reduce risks during complex interventions, ultimately leading to better patient outcomes.

Industry leaders such as Siemens Healthineers and GE HealthCare are at the forefront of these advancements, consistently pushing the boundaries of fluoroscopy technology to improve both imaging processes and patient care. Their contributions have not only increased the precision of diagnostic procedures but have also transformed how medical professionals approach treatment planning, patient management, and overall clinical decision making. Through ongoing innovation, these companies are shaping the future of medical imaging, making health care more efficient, personalized, and safe.

Image Quality and Patient Safety
Fluoroscopy has undergone significant evolution, especially with the integration of advanced features traditionally found in radiography rooms. Today’s modern fluoroscopic systems seamlessly combine both fluoroscopy and radiography, offering a versatile 2-in-1 solution, says François Hensen, senior product manager for fluoroscopy at GE HealthCare.

A major technological leap in fluoroscopy has been the shift from conventional image intensifiers to dynamic flat-panel detectors, he explains. This advancement has significantly improved image quality, offering higher resolution and a broader field of view, compared with traditional systems. It has also streamlined workflows by reducing image acquisition times and enhancing procedural efficiency. Additionally, flatpanel detectors have helped reduce radiation exposure, benefiting both patients and health care professionals by delivering clearer, more detailed images.

Hensen says improvements in faster image acquisition, enhanced visualization, and the reduction of lag effects have all contributed to better patient care and safety. The combination of enhanced brightness and contrast, along with virtual collimation on the last image hold, further improves image quality while reducing unnecessary exposure.

Several key factors are essential in ensuring the safety of both patients and medical staff during fluoroscopy procedures. Hensen notes these factors include shielding, time, distance, justification protocols, dose limitations, replacing outdated equipment, and maintaining rigorous quality control practices.

Shielding is vital for protecting both patients and medical staff from unnecessary radiation exposure, while the principle of minimizing exposure time helps reduce overall risk. Distance also plays a critical role in safety; increasing the distance between radiation sources and both patients and staff significantly reduces radiation exposure. Justification protocols ensure that each fluoroscopy procedure is medically necessary, thus preventing unnecessary radiation use. Dose limitations are implemented to control the amount of radiation used, preventing excessive exposure.

Hensen also emphasizes the importance of upgrading outdated fluoroscopy equipment. Replacing older systems with modern, more efficient technology is crucial for improving both image quality and safety. Quality control practices are equally essential, ensuring that equipment functions properly and radiation doses remain within safe, predefined limits.

Recent Breakthroughs
Siemens Healthineers’ Enhanced CARE Package is a collection of advanced features aimed at improving workflow efficiency and reducing radiation exposure during fluoroscopy procedures. It enhances patient safety and supports health care providers by offering tools that optimize image quality while minimizing unnecessary radiation. Histogram-Based Dose Regulation for fluoroscopy is designed to improve dose control. Focusing on the entire field of view, instead of an automatic exposure control chamber, allows for a more consistent and accurate dose output to keep anatomy in view, even when there are differences in density. Snapshot mode lets clinicians save high-quality fluoroscopy images while on the move, using data from multiple fluoroscopy pulses.

One feature that Bland Lee, RT(R), product manager for fluoroscopy and urology at Siemens Healthineers, highlights as particularly successful is the “Fluoroloop,” which allows users to capture an entire fluoroscopy loop, rather than just a single image. This ability eliminates the need for multiple acquisitions, saving time and reducing patient exposure. According to Lee, these innovations have been effective in enhancing both efficiency and safety for patients and medical staff alike.

Recent breakthroughs in fluoroscopy technology have significantly improved safety for patients and medical staff. Modern systems now incorporate advanced features that minimize radiation exposure while maintaining high image quality. Hensen says AI is playing an increasingly important role in further reducing radiation doses. AI-powered tools help optimize imaging parameters, ensuring radiation is applied only when necessary and at the lowest effective dose. Additionally, the growing adoption of remote systems is enhancing user safety by providing more control and flexibility in imaging procedures, allowing medical staff to maintain a safer distance from radiation sources.

As these innovations become more integrated into clinical practice, they not only enhance diagnostic accuracy but also prioritize the health and safety of patients and health care workers. With technology continuously evolving, further advancements will continue to refine and optimize fluoroscopy, making it an even more effective and safer tool for medical imaging.

Versatility and Workflow Efficiency
The Siemens Healthineers Luminos Agile Max and Luminos Lotus Max are advanced imaging systems that combine fluoroscopy and radiography capabilities but differ in their architecture and user workflows. The Luminos Agile Max is designed for flexibility and simplicity, with a conventional patientside approach. This makes it useful for dynamic clinical exams, such as gastrointestinal and injection procedures, but also basic radiology exams. The system allows for easy maneuverability and patient access while minimizing occupational dose for exams performed at the system’s tableside. The elevating patient table makes it easier to transfer patients on and from the table and allows for increased use as a fully functioning radiography system when the day’s fluoroscopy schedule is finished.

In contrast, the 2-in-1 universal, remote-controlled Luminos Lotus Max focuses on streamlining workflow and enhancing operational efficiency. This system integrates fluoroscopy and radiography into a single unit, eliminating the need for multiple machines, reducing setup times, and providing consistent image processing, thanks to an all-in-one user interface. With a single device, the Lotus Max allows for smooth switching between modalities, improving both image quality and reducing the need for multiple machines.

Designed for flexibility, the Luminos Lotus Max features a single control element, enabling operation from either the control room or examination room. It combines essential components into one system, such as a unified imaging system, generator, and wireless foot switch. The integration of a single generator cabinet in the room saves floor space. According to Lee, this has proven to be a highly valued feature for health care providers, as it enhances both the functional and spatial aspects of their clinical environments.

Lee highlights the significance of the 17- x 17-inch square detector used in current applications, which provides digital imaging with greater coverage. This expanded coverage allows clinicians to capture a larger area of the patient in one exam, minimizing the need for multiple imaging steps. The digital technology also enables lower radiation doses, saving time and reducing unnecessary procedures. Rather than shifting between regions such as the stomach, small bowel, and colon, everything can be captured in one field of view.

The ability to operate the Lotus Max remotely from either the control room or the examination room makes it convenient for medical staff to manage imaging procedures without having to reposition equipment. Additionally, the system uses advanced software and sensitive digital detectors to ensure high-quality imaging with minimal radiation. While the Luminos Agile Max provides a traditional workflow, the flexibility of the elevating table and integrated radiography plane in the Luminos Lotus Max is better suited for environments that require highly flexible workflows and examination coverage.

Optimizing Diagnostic Precision
In the rapidly evolving field of medical imaging, health care providers are increasingly seeking versatile, high-performance systems that can streamline workflows and enhance diagnostic accuracy. The GE Precision 180° Radiography and Fluoroscopy System and the Precision CRF Radiography and Fluoroscopy System are imaging solutions that integrate radiography and fluoroscopy, but each offers unique features designed to address specific clinical requirements.

The Precision 180° System offers 180° rotation, allowing clinicians to capture images from multiple angles. This feature enhances workflow efficiency, reduces the need for patient repositioning, and improves patient comfort, making it particularly useful in complex diagnostic imaging and surgical procedures. The Precision CRF System delivers reliable radiography and fluoroscopy functions but lacks the same rotational capability. In terms of applications, the Precision 180° System is designed for a broad range of diagnostic and surgical procedures where flexibility and real-time imaging from various angles are crucial. The Precision CRF System can be used for a wide variety of clinical applications, with a focus on routine diagnostic exams rather than more advanced surgical or complex procedures.

Both systems are equipped with advanced digital detectors and user-friendly interfaces that ensure high-quality imaging while minimizing radiation exposure. The Precision 180° System includes additional features such as automated imaging adjustments, which optimize image quality with minimal radiation. The Precision CRF System, though similar, offers different features suited for routine diagnostic tasks. The Precision 180° System enables seamless transitions between fluoroscopy and radiography modes. The Precision CRF System is tailored more to general diagnostic imaging, rather than specific, high demand procedures.

Transforming Fluoroscopy
The future of fluoroscopy is set for transformative advancements, driven by emerging technologies aimed at improving image quality, workflow efficiency, and patient safety. According to Lee, a key focus will be on making systems more intuitive and user-friendly, minimizing the need for complex training. Siemens Healthineers has centered its development on creating systems that are both advanced and simple to operate. Userdriven innovation plays a critical role in shaping the future of fluoroscopy. By involving clinicians in the design process, Siemens Healthineers ensures that future systems address real-world needs.

Looking ahead, AI and machine learning are expected to optimize the imaging process and assist in diagnosis, enhancing both efficiency and accuracy while reducing radiation exposure. These technologies will also help clinicians interpret results more effectively, ultimately improving patient care. Advancements in detector sensitivity will further improve image quality with lower radiation doses, enhancing diagnostic accuracy and prioritizing patient safety. AI’s role will expand beyond dose reduction, helping to identify key areas for diagnosis and detect abnormalities more accurately. As technology evolves, fluoroscopy will become more efficient, safer, and capable of delivering higher-quality patient care.

Fluoroscopy has evolved from a basic X-ray technique to a vital tool in modern diagnostic and interventional medicine, with advancements in digital imaging, AI, and radiation reduction enhancing its safety, effectiveness, and clinical use. Companies such as Siemens Healthineers and GE HealthCare have helped drive these innovations, improving image quality, patient safety, and procedural accuracy.

As personalized medicine grows, fluoroscopy will increasingly be adapted to meet the needs of individual patients, including those with unique anatomies or complex conditions. This shift will improve diagnostics and optimize treatment plans. Additionally, lowdose imaging technologies are advancing to reduce patient radiation exposure while maintaining high image quality, addressing a major concern in medical imaging.

While challenges such as adoption and technological limitations remain, the future of fluoroscopy looks promising. Innovations such as hybrid imaging, AI integration, mobile systems, and further developments in low-dose technologies will revolutionize patient care, improving efficiency, safety, and outcomes. As industry collaboration continues, fluoroscopy will remain essential in diagnosing and treating various conditions.

— Rebecca Montz, EdD, MBA, CNMT, PET, RT(N)(CT), NMTCB RS, has worked at the Mayo Clinic Jacksonville and University of Texas MD Anderson Cancer Center in Houston as a nuclear medicine and PET technologist.