Video Fluoroscopy Shannon Adair Dietetic Intern January 17

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= Ri 8 b. Bhw 9 ms. Q

Aspiration Example http: //www. youtube. com/watch? v=1 s. FNMk 87558

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/GL 2000 -00047. html>. "Intra Swallow Aspiration. " You. Tube, 09 Aug. 2010. Web. 15 Jan. 2013. <http: //www. youtube. com/watch? v=1 s. FNMk 87558>. "My Swallow Study. " You. Tube, 21 Aug. 2010. Web. 15 Jan. 2013. <http: //www. youtube. com/watch? v=Ri 8 b. Bhw 9 ms. Q>. "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/>.