Fluoroscopy is "real-time" x-ray that can be seen on a monitor. Fluoroscopy is used in clinical medicine to guide such procedures as cardiac catheterization, and pulmonary biopsy procedures. Individual images can be collected at any time either on standard x-ray film, instant x-ray film, or digitally. These images can document the site of an anomaly or the location of a biopsy or artifact prior to retrieval. The advantage of fluoroscopy as related to videoendoscopy is that fluoroscopy can allow the operator to guide the VE with much greater assurance of direction and location within the mummified remains. We have used fluoroscopy in conjunction with endoscopy to assist in the retrieval of 21 coins from the posterior oral pharynx and proximal aspect of the esophagus of a late 19th century mummy housed at the Auman Funeral Home in Reading, Pennsylvania. Since there were so many coins, fluoroscopy provided real-time images of the coin locations (Conlogue et al. 2008a). During this procedure, we employed standard postural drainage and percussion techniques commonly used in clinical medicine to mobilize pulmonary secretions. Using alternate posturing of the mummy required repeated assessment of the coin positions in order to locate them endoscopically. In another case, we needed to directly visualize via endoscopy, the fracture characteristics of a skull fracture on the inner table of an Incan mummified head. We used fluoroscopy to successfully direct the VE to the exact location of the fracture within the cranial vault (Figure 4.20). In this case, the internal characteristics of the fracture and the swollen appearance of the dura mater just below the fracture suggested that the fracture likely caused a hematoma in the region and may have contributed to the death of the individual. The VE image also demonstrated that the fractures occurred perimortem, as there was no evidence of bone healing along the fracture margins. The major disadvantage of fluoroscopy is that the instrumentation is bulky and not easily transported. Additionally, there is a much greater risk of x-ray exposure associated with continuous systems such as fluoroscopy. Generally, videoendoscopy in association with fluoroscopy is limited to laboratory research; however, industrial units are available that are portable and lightweight. The major drawback to the portable field units is that they have a small field of view.

Figure 4.20 An example of fluoroscopy used to direct the endoscope to a specific target within the mummified remains, in this case, the internal characteristics of a skull fracture seen in several endoscopic images.

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