Video FluoroscopyVideo FluoroscopyShannon Adair, Dietetic

InternJanuary 17, 2013

Shannon Adair, Dietetic Intern

January 17, 2013

Outline

What is Videofluoroscopy?

•An x-ray “video” of the swallowing mechanism

• 2-3 x-ray images per second

• IP or OP

• Done by SLP and radiologist

•Also called “Modified Barium Swallow”, “Cookie Swallow”, and “Esophagram”

Indications

• Patient’s S/S inconsistent with clinical findings

• Need to confirm/assist in clinical diagnosis

• Patient identified as potential rehab candidate

• Previously diagnosed dysphagia with suspected recurrence

• Chronic degenerative disease

• Reported swallowing difficulty with unknown cause

• Coughing or choking when eating

• Weight loss

• Unusual frequency of chest infection or breathing difficulty

• Size of patient

• Ability to stay in position

• Pregnancy

• Medical instability

• Barium allergy

• May not reflect real meal situations (time, viscosity, awareness)

Contraindications/ Limitations

• In children/infants, make sure they are ready and willing to eat during procedure

• Bring in easy foods and problem foods

Criteria

Treatment

• Patient arrives at radiology department

• Patient sits next to x-ray machine

• SLP provides foods/drinks mixed with barium and asks patient to swallow them

• Progression through food volumes and consistencies

• Puree 1/2 tsp to Puree full tsp

• Nectar 1/2 tsp to Nectar full tsp

• Thin 1/2 tsp to Thin full tsp

•http://www.youtube.com/watch?v=Ri8bBhw9msQ

Normal Example

Aspiration Example

http://www.youtube.com/watch?v=1sFNMk87558

Risks/Side Effects•Radiation

•Minimal levels, low exposure time

•Barium sulfate is an irritant outside GI tract

•Aspiration

•Iodine based contrast

Results

• Determine diet progression

• Discover which foods are safe to swallow

• Discover silent aspirators and confirm suspected aspirators

• Find poorly functional areas of mouth/throat

• Determine whether certain positions or strategies improve swallowing ability

Nutritional Issues

• No special diet prior to procedure

• Diet may change after procedure (consistency, amount consumed)

• Videostroboscopy

• Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

Other Tests Available

Questions?Questions?

"Clinical Indicators for Instrumental Assessment of Dysphagia." Clinical Indicators for Instrumental Assessment of Dysphagia. American Speech Language Hearing Association, n.d. Web. 15 Jan. 2013. <http://www.asha.org/docs/html/GL2000-00047.html>.

"Intra Swallow Aspiration." YouTube. YouTube, 09 Aug. 2010. Web. 15 Jan. 2013. <http://www.youtube.com/watch?v=1sFNMk87558>.

"My Swallow Study." YouTube. YouTube, 21 Aug. 2010. Web. 15 Jan. 2013. <http://www.youtube.com/watch?v=Ri8bBhw9msQ>.

"Videofluoroscopic Swallow Study (Modified Barium Swallow)." Duke Cancer Institute, n.d. Web. 15 Jan. 2013. <http://www.dukehealth.org/cancer/health_library/care_guides/treatment_instructions/videofluoroscopicswallowstudy>.

"Videofluoroscopic Swallowing Study (VFSS)." Videofluoroscopic Swallowing Study. American Speech Language Hearing Association, n.d. Web. 15 Jan. 2013. <http://www.asha.org/public/speech/swallowing/Videofluoroscopic-Swallowing-Study/>.

"Videofluoroscopy Swallow Test." Procedures and Treatments. Great Ormond Street Hospital for Children, n.d. Web. 15 Jan. 2013. <http://www.gosh.nhs.uk/medical-conditions/procedures-and-treatments/videofluoroscopy-swallow-test/>.

References