What is Fluoroscopy mapping?

For the first time technology has made it possible for us to visualise the lymphatics in real time. What this means is by injecting a very small amount of tracer and useing a special camera, we can see the lymphatic vessels and fluid under the skin. This allows us to visualise and see how well they are working, where they are draining to and where there a lymphatic problems.

What does this involve? The patient will receive an intradermal injection (just under the skin), usually in 2 places on the hand or foot. Usually within minutes we will be able observe flow, we will watch the contractibility of the lymphatics or immediate effect of drainage. The patient will then be asked to leave for 1.5-2 hours and exercise the arm/leg so we can see drainage and how far the tracer has travelled or where there area any problems.

You will need to be at the hospital for approximately 3 hours. With lymphatic disorders, it can take a while for the tracer to travel through the lymphatics and we need time to see how your lymphatic system is working.

Fluoroscopy Guided Manual Lymphatic drainage (FG-MLD)

The Lymphoedema Training Academy (LTA) is committed to carrying out the best and most evidenced based Manual Lymphatic Drainage (MLD) training. This will ensure that people who have lymphoedema receive the most evidenced based care with aims of improving MLD outcomes, reducing treatment time and proving efficacy of MLD. This is a really exciting development for MLD and is being rolled out throughout the world through LTA.

What is Fluoroscopy Guided MLD?

By using a special Near Infrared Imaging camera, the superficial lymphatics can be visualised. This allows for the identifying and mapping the functional lymphatic vessels, the observation of dermal rerouting areas, dermal backflow areas and functional drainage pathways.  This in turn allows for the mapping of and the drawing on of the pathways of the functioning lymphatics system and allows for us to see where to work with FG-MLD on the non functioning regions.  This information can be sent to your therapist, who once properly trained in FG-MLD can drain to those pathways.  We have never previously been able to identify functioning lymphatics in real time. This development means that the therapist can ensure that they carry out an MLD technique to which they know the lymphatics are responsive and is bespoke to the patient.


LTA works with Prof JP Belgrado who is one of the world leading professors and has been working with NIR fluoroscopy for over 5 years. His works have been presented globally regarding its technique, applications and outcomes for clinical practice in lymphoedema and other related conditions. Some of the research carried out by Prof. JP Belgrado has examined over 1000 pathological lymphatic patients. This has allowed for the identification of common lymphatic pathways of differing pathologies, leading to a better understanding of lymphatic pathways and subsequent drainage. It has also demonstrated what hand contacts, movement and pressure is necessary for effective drainage of the lymphatic system.  By attending for mapping you can be sure of the best mapping and drainage available in the UK.

Can you carry out FG-MLD without mapping?

Yes you can carry out FG-MLD without a camera but having your lymphatic pathways mapped will allow for improved MLD from your therapist (if appropriately trained) and you will receive individualised MLD according to your pathology.  FG-MLD is also the term that best describes a technique that Fluoroscopy has identified as working better through unique hand movements.

What else does my appointment include?

 In addition to Lymphatic Mapping, you will be assessed by the Nurse Consultant, Jane Wigg, who will discuss the assessment and plan an individualised treatment package with you. This maybe different from your existing treatment plan. Jane will also be able to recommend a local FG-MLD therapist if this is appropriate and available.