Fluoroscopy guided manual lymphatic drainage (FG-MLD)

You might have a specialised type of massage for lymphoedema called fluoroscopy guided manual lymphatic drainage.

Lymphoedema means swelling caused by a build up of lymph fluid in an area of the body. It sometimes happens when cancer treatments remove or damage lymph glands.

Manual lymphatic drainage (MLD) is a specialised type of skin massage that can help to reduce lymphoedema. Fluoroscopy guided manual lymphatic drainage is a type of MLD.

What is fluoroscopy guided manual lymphatic drainage?

Fluoroscopy guided manual lymphatic drainage uses specialised massage techniques to help move lymph fluid and reduce the swelling. It is also called the ‘Fill and Flush’ method.

FG-MLD is a way of doing manual lymphatic drainage based on research that used a new test. This test is called mapping of the lymphatics. It shows how fluid moves through the drainage vessels just under the skin (the superficial lymphatics) and how it builds up in certain areas.

The test allowed researchers to identify lymph drainage pathways that work and those that don't. They also found other drainage routes that can take over when certain channels get blocked.

Lymphoedema specialists need special training to do FG-MLD. Many lymphoedema practitioners in the UK can now do FG-MLD.

How you have fluoroscopy guided manual lymphatic drainage

You usually lie down to have MLD. But if you have lymphoedema in your head and neck, you sit up.

When you have FG-MLD, the lymphoedema practitioner uses particular hand movements to encourage the lymph fluid to drain. You feel pressure on the skin. The skin movements are firm but comfortable, slow, and rhythmic.

The number of treatments you have depends on the amount and type of swelling you have. Your specialist will use their knowledge of FG-MLD to adapt the way they treat your swelling.

For some people, having the lymphofluoroscopy mapping test can help the MLD to work better. 

Lymphofluoroscopy mapping of the lymphatics

Lymphofluoroscopy mapping shows up problems with the flow of lymph after lymph node treatment. Treatments like surgery or radiotherapy can change the way lymph fluid usually drains.

Mapping your lymphatics might help you to have a better response to MLD. Your lymphoedema specialist will see the unique problems you have with the flow of lymph, especially in the area where you had cancer treatment. They can then work out an individual treatment plan for you.

Having the mapping test

You have a small injection of a fluorescent dye called indocyanine green (ICG). You have it under your skin (an intradermal injection). The specialist injects it into 2 places on your hand or foot depending on where you have swelling. The dye binds to the proteins in the lymph fluid.

The specialist then shines a special infrared camera over the swollen area. The fluorescent dye in the lymph reacts to the infrared light. In this way, the specialist can see the lymph channels. They can usually observe your lymph flow within minutes.

You then leave for about 3 hours and exercise your arm or leg. This helps the specialist to see how far the dye has moved in your lymphatic system and shows up any blocked areas.

For a full mapping, you could be at the clinic for up to 4 hours.

Other benefits of having mapping

Specialists can also use lymphofluoroscopy mapping to screen people to spot lymphoedema early. By doing this, they can diagnose swelling before you can feel or measure it and treatment can start early. This can help to control the lymphoedema well.

Where you can have mapping

Mapping of your lymphatics is not available in the NHS. You can have it at a few private clinics in the UK.

You can take the results of the mapping to your lymphoedema specialist. They can use it if they've had training in FG-MLD, but it will also help them when using a different type of MLD. 

Side effects

Lymphoedema mapping using the ICG dye is safe and very few people have side effects. The area where you’ve had the injection will appear green afterwards and stay like that for about 2 weeks.


Researchers are studying this treatment to understand more about its benefits.

  • Compression Therapy: A position document on compression bandaging

    Christine Moffatt and others

    International lymphoedema framework best practice for the management of lymphedema, 2020.

  • A new dynamic imaging tool to study lymphoedema and associated treatments

    G Giacalone and others

    The European Journal of Lymphology, 2011, volume 22.

  • Commissioning Guidance for Lymphoedema Services for Adults in the United Kingdom

    The National Lymphoedema Partnership, 2019.

  • LymphVision

    Accessed April 2023 

  • All-Ireland Lymphoedema Guidelines for the Diagnosis, Assessment and Management of Lymphoedema, 2022.

Last reviewed: 
14 Apr 2023
Next review due: 
14 Apr 2026

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