C-arm fluoroscopy is a type of x-ray image. X-rays create an image by pointing a low-intensity x-ray beam towards an x-ray detector/image amplifier (1). While x-rays in an imaging center are commonly used for looking at issues with bones, they can also be used to ensure that certain procedures are done properly. C-arm fluoroscopic x-ray is used in orthopedic, cardiac, emergency care, and interventional pain management procedures. The C-arm fluoroscopy is a mobile x-ray that moves around two axes to allow the doctor to take an image at almost any angle. This allows the doctor to optimize the picture taken depending on what she is trying to see.
This is used by a physician doing an injection procedure to make sure that the needle is going in just the right spot. An x-ray image is taken multiple times throughout the procedure to make sure the needle does not stray off the intended path. Interventional procedures using the C-arm fluoroscopy are most commonly done in the neck and back, but it can be also utilized for injections in many other places in the body such as the SI joint, hip, and shoulder among others.
Importantly, this can also be used after the injection of contrast. Contrast is a substance commonly made of iodine, barium, or gadolinium. Importantly, contrast shows up as a dark substance on x-ray (also known as radiopaque). The injection of contrast while using an x-ray allows the doctor to do the procedure to confirm exactly where the needle is and where the therapeutic injection will go. The doctor doing your x-ray guided procedure should be extensively trained in how the contrast should flow in the area being injected or he or she will not be able to distinguish if the flow of contrast is confirming the correct needle placement. Typically doctors that are experts in this are fellowship-trained in interventional pain medicine or interventional orthopedics.
These c-arm fluoroscopy machines can be used in the office of the doctor that is seeing you. This allows you to avoid the added cost of doing your procedure inside of a surgery center, which can vary in price widely. Sometimes, the doctor doing your c-arm fluoroscopy guided procedure can have different insurance coverage than the surgery center they use for your procedure. If this is the case, even with health insurance, you run the risk of being charged thousands of dollars for use of the surgery center for even a simple 10-15-minute injection. The safest way to avoid this unexpected expense is to go to a physician who uses c-arm fluoroscopy inside their office so no surgery center is involved.
While some providers offer the treatment without image guidance, there is significant evidence showing that common back injections are safer, more accurate, and more effective when x-ray guidance is used (2,3). If you’re going to do an injection, you may as well do it the safest and most effective way possible, and using a C-arm is a way to improve accuracy and safety.
The upshot? If you are allowing someone to do an injection in your body, advanced imaging like c-arm fluoroscopy is a must to make sure it is safe and effective!
- Graham Lloyd-Jones, D., 2016. Basics of X-Ray Physics – The X-Ray Beam. [online] Radiologymasterclass.co.uk. Available at: <https://www.radiologymasterclass.co.uk/tutorials/physics/x-ray_physics_beam> [Accessed 6 May 2020].
- Barham, Guy, and Andrew Hilton. “Caudal epidurals: the accuracy of blind needle placement and the value of a confirmatory epidurogram.” European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 19,9 (2010): 1479-83. doi:10.1007/s00586-010-1469-8
- Fredman, B et al. “Epidural steroids for treating “failed back surgery syndrome”: is fluoroscopy really necessary?.” Anesthesia and analgesia 88,2 (1999): 367-72.