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

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

3. 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”

4. 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

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

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

7. 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

8. Normal Example
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9. Aspiration Example

10. Risks/Side Effects Radiation Minimal levels, low exposure time
Barium sulfate is an irritant outside GI tract
Aspiration
Iodine based contrast

11. 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

12. 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)

13. Questions?

14. 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 <
"Intra Swallow Aspiration." YouTube. YouTube, 09 Aug Web. 15 Jan <
"My Swallow Study." YouTube. YouTube, 21 Aug Web. 15 Jan <
"Videofluoroscopic Swallow Study (Modified Barium Swallow)." Duke Cancer Institute, n.d. Web. 15 Jan < wallowstudy>.
"Videofluoroscopic Swallowing Study (VFSS)." Videofluoroscopic Swallowing Study. American Speech Language Hearing Association, n.d. Web. 15 Jan <
"Videofluoroscopy Swallow Test." Procedures and Treatments. Great Ormond Street Hospital for Children, n.d. Web. 15 Jan < treatments/videofluoroscopy-swallow-test/>.