Lymphofluoroscopy mapping and screening

A new technique, called lymphofluoroscopy mapping and screening, which dramatically reduces or even prevents secondary lymphoedema that often follows cancer surgery, particularly breast cancer, is now available in South Africa. 

Cancer patients can now be screened prior to, during and post-surgery to enable surgeons to accurately identify and thus avoid damage to lymphatic drainage pathways. Such damage could result in lymphoedema in between 3% and 65% of patients.1 

Used for many years in cardiac surgery and ophthalmology, South Africa is one of three countries in the world and the first in Africa to introduce fluoroscopy mapping for the management of lymphoedema.

Used in combination with a new, more effective manual lymph drainage technique, called ‘Fill and Flush’- Fluoroscopy Guided Manual Lymph Drainage (FG-MLD), the treatment offers assurance and peace of mind to patients at risk of lymphoedema post-surgery.

Real-time images of lymphatic fluid flow

Lymphofluoroscopy mapping and screening assists the surgeon or therapist to view the superficial lymphatic drainage pathways in the body in real-time on a screen.

The patient is injected with fluoroscopic indocyanine green (ICG) dye, used at 100th of the dose that is used in angiology and ophthalmology or, if allergic to iodine, another plant-based dye. 

Using a Photodynamic Eye as a Near-Infrared Imaging (NIR) Camera, the healthcare professional can pick up the fluorescence on the screen in real-time, resulting in a visual map of the natural, unique pathways of the patient’s lymphatic vessels and where they drain into the lymph collectors.


This new technique offers profound benefits to the prevention and treatment of lymphoedema. 

It provides a way for patients diagnosed with breast cancer to be screened both pre-operatively and post-operatively, so that surgeons know what to expect before and during surgery. 

Patients should be screened again two weeks post-surgery to pick up any potential problems, and again two years later.

Patient self-management

Post-surgery, lymphofluoroscopy mapping is used in combination with the Fill and Flush technique.

Guided by the images on the screen, FG-MLD allows the patient to visualise their lymphatic pathways and so they understand exactly where potential problems might occur. Mapping can also identify dormant lymphoedema or areas that are struggling to drain long before the patient will notice it.

Using these latest techniques, patients are empowered with more knowledge of their pathways and are taught an effective and precise self-help FG-MLD drainage. 

This makes patients more independent and speeds up the treatment time, so management becomes cost-effective for both the patient and their medical aid. Currently, the treatment is partially covered by medical aids.  

After the procedure, patients receive comprehensive reports, images, a video of their drainage pathways and photos of any blockages. Thus, they are armed with precise data to provide to any healthcare professional who will treat possible lymphoedema.

Peace of mind

The greatest benefit is the peace of mind it offers patients. Lymphoedema is associated with profound loss of quality of life and many patients, even though they may never develop the complication, experience high anxiety and become obsessed with preventive practices.

Lymphofluoroscopy mapping and screening gives patients assurance that they need not panic as they’ll be able to identify potential problems before they feel any symptoms themselves.

LTA: Africa

Being the first person in Africa to qualify in lymphofluoroscopy mapping, there is a great need to educate patients and healthcare professionals about this breakthrough technique, which can be used on both primary and secondary lymphoedema patients. 

Forty-two patients have successfully been treated to date at my practice in Midrand. I also offer training in the techniques at LTA Africa, with the aim of expanding nationally to offer screening more widely.

For more information, call 082 491 0578

Allison Dendy is a physiotherapist and qualified lymphoedema therapist. She first qualified in the treatment of lymphoedema in the USA, in 2004, and has been running a successful practice with ongoing training in this field.

MEET THE EXPERT – Allison Dendy

Allison is a physiotherapist and qualified lymphoedema therapist. She first qualified in the treatment of lymphoedema in the USA, in 2004, and has been running a successful practice with ongoing training in this field.