Evaluation of the Modified Barium Swallow Study Conducted With and Without Radiologist Supervision: A Pre- and Post-Observational Study

Purpose: Assess quality metrics of modified barium swallow studies (MBSS) with and without a radiologist present during the procedure. Methods: Retrospective review of MBSS performed on adult inpatients at a tertiary care hospital 6-months pre- and post-institutional change from having to not having a radiologist present during the examination. Factors assessed included: fluoroscopy time; study duration; number of cine loops; number of images; efficiency of collimation (using a 5-point scoring system); time to final report; radiologist-speech language pathologist report disagreement; and recalls for inadequate studies. Statistical analysis was via Welch’s t-test and a test of proportions for continuous and count data under the normal approximation. Results: 106 and 119 MBSS were analyzed from the radiologist present and radiologist absent periods, respectively. No statistically significant differences were found for: average fluoroscopy time (116.1 s vs. 126.9 s; P = 0.161); study duration (400.4 s vs. 417.3 s; P = 0.453); number of cine loops (9.3 vs. 10.2; P = 0.075); number of images (620.5 vs. 581.1; P = 0.350); or report disagreement. There was improved performance without the radiologist present for collimation (1.92 vs. 1.43; P = 0.003) and fewer non-diagnostic images (6.5 vs. 4.5; P = 0.001). Time to final report was longer with the radiologist absent due to more reports with significant delays. There were no repeated studies because of inadequate technique in either group. Conclusion: MBSS performed by technologists without radiologist supervision is not inferior to those performed with radiologist supervision on multiple performance measures. This supports technologist operated MBSS without radiologist supervision, while acknowledging a need to further address radiologist report time delay.

Visualizing the Esophagus During Modified Barium Swallow Studies: A Systematic Review

Purpose Despite the emphasis on using evidence-based practice for patient care, as clinicians, we sometimes find that there is insufficient evidence to support our clinical practices. One example of this is the “contentious” inclusion of routine, standardized visualization of the esophagus during modified barium swallow studies (MBSSs). This review sought to investigate the evidence for inclusion of routine esophageal visualization during the MBSS, a practice that is supported by the long-established interrelationship between all aspects of the oral, pharyngeal, and esophageal swallowing continuum. Method Searches were conducted in PubMed, Scopus, and CINAHL databases. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed to identify articles that met prespecified inclusion and exclusion terms. Results Five articles were included in this review, which identified that esophageal findings were present in 48.67% of those participants whose MBSS included esophageal visualization. Conclusion This review supports a standardized, validated, reliable visualization protocol of the esophagus during the MBSS as a critical component to the accurate diagnosis and formulation of treatment recommendations for patients with swallowing disorders.

Tradução para o português brasileiro e adaptação cultural da Definição de Pontuações de Componentes (Component Scores Definition) pertencentes ao Modified Barium Swallow Impairment Profile – MBSImP(™)

RESUMO Objetivo Traduzir para o português brasileiro e adaptar culturalmente a definição dos componentes e pontuação (Component Scores Definition) pertencentes ao protocolo para videofluoroscopia Modified Barium Swallow Impairment – MBSImPTM. Método Esse estudo foi desenvolvido com base nas recomendações internacionais para elaboração, tradução e adaptação transcultural em consonância com publicações nacionais para validação de testes internacionais em Fonoaudiologia. Foi formado um comitê de especialistas, composto por dois médicos otorrinolaringologistas e três fonoaudiólogas conhecedoras do exame de videofluoroscopia. A tradução para o português brasileiro foi realizada por dois otorrinolaringologistas com retrotradução de forma independente por dois nativos norte-americanos. A versão final em português brasileiro foi elaborada pelas fonoaudiólogas certificadas após a revisão das traduções e das retrotraduções com resolução de discrepâncias semânticas, idiomáticas, conceituais, linguísticas e contextuais. Essa versão foi testada pelas fonoaudiólogas membros do Comitê, que avaliaram indivíduos saudáveis, com Câncer de Cabeça e Pescoço e Comprometimento Cognitivo Leve. Resultados A tradução da definição dos componentes e pontuação do MBSImP foi realizada de forma independente e os tradutores chegaram a um consenso para a versão final. O protocolo original Modified Barium Swallow Impairment, foi traduzido para “Escala Martin-Harris para videofluoroscopia da deglutição”. Na versão final em português brasileiro alguns termos foram adaptados. A aplicação do protocolo traduzido não apresentou discrepâncias em relação ao protocolo original. Conclusão A tradução do excerto do protocolo MBSImP para o português brasileiro foi compatível com a versão original. A certificação de membros do comitê favoreceu a adaptação do material, permitindo a adaptação conceitual.

The Videofluorographic Swallowing Study: A Review of Literature

The videofluorographic study is indicated for diseases potentially causing dysphagia and aspiration, such as gastrointestinal reflux disease, cancers of the oropharynx and esophagus, and certain neurologic diseases needing swallowing assessment. The study is designed to survey the anatomy and physiology of swallowing to diagnose any swallowing impairment and is standardized using scales such as the Modified Barium Swallow Impairment Profile (MBSImP). The procedure requires the patient to swallow a barium contrasted bolus which helps to visualize and obtain a real-time result. There are certain complications of the procedure including radiation exposure which requires necessary safety protocols to be followed.

ECOG-ACRIN 2399: analysis of patient related outcomes after Chemoradiation for locally advanced head and neck Cancer

Background We conducted a correlative study for E2399, a function preservation trial for resectable locally advanced oropharynx and larynx cancer, to prospectively assess effects of chemoradiation (CCR) on quality of life (QOL), swallowing and voice. We correlated the results of swallow assessments done via questionnaires and objective assessments by modified barium swallow (MBS). Methods The Functional Assessment of Cancer-HN (FACT-HN), the Performance Status Scale – Head and Neck (PSS-HN), swallow assessments (including modified barium swallow studies), and voice assessments: Voice Handicap Index (VHI), the Voice Disability Assessment (VDA), and American Speech-Language Hearing Association’s Functional Communication Measure (FCM) were conducted at baseline and periodically post-treatment for 2 years. Results Baseline QOL and swallowing function predicted overall survival. Patients experienced a marked decrease in QOL, swallowing, and speech post CCR although the decrease in vocal function was modest. Function and QOL returned towards baseline in the majority of patients by 12 months post treatment. Less than 10% of patients had severe dysphagia and were PEG dependent at 12 months post treatment. There was a high degree of correlation between the FACT-HN and PSS-HN swallow items. Statistically significant correlations were found between subjective and objective measures of swallow function. Conclusions Patients experience marked loss in swallowing function post CCR which returned to baseline in the majority of patients. The correlations between the FCM and self-report swallow items on the PSS and FACT-HN appear to be sufficiently strong to justify their use as a surrogate marker for swallowing disability in large therapeutic trials.

Factors Influencing Initiation of Pharyngeal Swallow in Healthy Adults

Purpose The purpose of this study was to investigate factors influencing the initiation of pharyngeal swallow (IPS) in healthy, nondysphagic adults. Method A total of 195 healthy participants ranging in age from 21 to 89 years participated in a modified barium swallow study. IPS was quantified using the Modified Barium Swallow Impairment Profile standardized scoring system across nine swallowing tasks observed in the lateral viewing plane for each participant. Results Large variability for bolus head location at time of hyoid burst (IPS) was observed within this healthy cohort, ranging from the ramus of the mandible to the pyriform sinuses. Significant effects of bolus volume, viscosity, sex, and race were also observed. Conclusion Study findings indicate that IPS is variable in healthy adults and influenced by volume, viscosity, sex, and race. Thus, variability in IPS may be considered typical in otherwise nondysphagic adults. The clinical significance of high Modified Barium Swallow Impairment Profile IPS scores in dysphagic patients, therefore, must be considered within the context of other swallowing impairments. Supplemental Material https://doi.org/10.23641/asha.12735935