Video Fluoroscopy
Shannon Adair, Dietetic Intern
January 17, 2013
Outline
What is
videofluoroscopy?
Indications
Examples
Risks/Side effects
Results
Contraindications/
Limitations
Nutritional issues
Criteria
Other tests available
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
•
•
Reported swallowing difficulty
with unknown cause
Need to confirm/assist in clinical
• Coughing or choking when
diagnosis
eating
• Patient identified as potential
• Weight loss
rehab candidate
• Unusual frequency of chest
• Previously diagnosed
infection or breathing difficulty
dysphagia with suspected
recurrence
•
Chronic degenerative disease
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
•
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-andtreatments/videofluoroscopy-swallow-test/>.