Shannon Adair, Dietetic Intern Video Fluoroscopy Shannon Adair, Dietetic Intern January 17, 2013

Outline What is videofluoroscopy? Examples Risks/Side effects Indications Results Contraindications/ Limitations Nutritional issues Other tests available Criteria Treatment

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

Contraindications/ Limitations Size of patient Ability to stay in position Pregnancy Medical instability Barium allergy May not reflect real meal situations (time, viscosity, awareness)

Criteria In children/infants, make sure they are ready and willing to eat during procedure Bring in easy foods and problem foods

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

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

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 Other Tests Available No special diet prior to procedure Diet may change after procedure (consistency, amount consumed) Other Tests Available Videostroboscopy Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

Questions?

References "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/videofluoroscopics wallowstudy>. "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/>.