Lymphoscintigraphy guided MLD

This study injected a radioactive tracer into the hand of women with arm lymphedema and then used MRI to visualise areas of dermal backflow and track the uptake by axillary lymph nodes, but does not show specific lymph vessels pathways.

There were 52 women in two groups. At baseline they all had the same imaging procedure and were then treated with a standard MLD treatment using the Leduc method which was not well described. The intervention group then had a second treatment where the MLD was modified according to the individual imaging, while the control group had the same standard treatment a second time. Further imaging was done and

it's not surprising that the lymphoscintigraphy guided group had a better result.

I'm not trained in the Leduc method so all I really know about it is that it employs circular movements of the skin and has been adapted more recently by Jan Wigg and Jean Paul Belgrado to a technique now called Flush and Fill. So I'm not 100% sure what was used in this study as the specific techniques used were not stated. But I don't know that it matters much since the imaging procedures alway involve manoeuvring the tracer into the lymph vessels with retrograde massage and with skeletal muscle movements. So I never really know how much we are assessing the specific technique anyway, especially as despite between-school differences, all MLD techniques exert similar stretch and shear forces into the vessels and target tissues. What is important to note is that

As always it needs to be noted that statistics in RCTs like this can't inform you on the open pathways for the client in your clinical today. You still need your training and experience in clinical assessment skills and whatever combination of measures you have available to optimise treatment planning for clients who have not had any individual mapping. I also worry that if such imaging does become routine there will be unintended consequences for some people.

Do we know the long term effects of injecting dyes and radioactive molecules into skin where the lymph system cannot adequately clear them?

I heard at a recent conference that the ICG dye injected for fluoroscopy can stay in the skin for years and leave a green spot?? So that makes me wonder if it is the same for the radioactive tracer that is left in the non-draining area after lymphoscintigraphy? (I have not done any research on that, or the ICG claim.)

Mapping the individual lymphatic system has the potential to revolutionise how we use MLD and all our lymphedema management techniques. I hope we can find ways of achieving this without injecting anything.

I heard recently about a method of visualising blood vessels using laser and acoustic ultrasound, so using light and sound waves without the need for tracer. I'd love to know if it could be adapted to visualise lymph vessels.

In the virtual world we are entering I can imagine each of us having a 3D avatar of our own organs and systems, showing me exactly where my own lymph vessels and pathway are.