Reducing fluoroscopic pulse rate, a method used to reduce radiation exposure from Modified Barium Swallow Studies (MBSSs), decreases the number of images available from which to judge swallowing impairment. It is necessary to understand the impact of pulse rate reduction on judgments of swallowing impairment and, consequentially, treatment recommendations. This preliminary study explored differences in standardized MBSS measurements (Modified Barium Swallow Impairment Profile (MBSImP™©) and Penetration Aspiration Scale (PAS) scores) between two pulse rates: 30 and simulated 15 pulses per second (pps). Two reliable speech-language pathologists (SLPs) scored all 5 MBSSs. Five SLPs reported treatment recommendations based on those scores. Differences in judgments of swallowing impairment were found between 30 and simulated 15pps in all 5 MBSSs. These differences were in six physiological swallowing components: initiation of pharyngeal swallow, anterior hyoid excursion, epiglottic movement, pharyngeal contraction, pharyngeal-esophageal segment opening and tongue base retraction. Differences in treatment recommendations were found between 30 and simulated 15pps in all 5 MBSSs. These findings suggest that there are differences in both judgment of swallowing impairment and treatment recommendations when pulse rates are reduced from 30pps to 15pps to minimize radiation exposure.
Purpose Guidelines and preventive measures have been established to limit radiation exposure time during modified barium swallow studies (MBSS) but multiple variables may influence exam duration. This study examines the influence of clinician experience, medical diagnosis category, swallowing impairment severity and use of a standardized protocol on fluoroscopy time. Methods A retrospective review was completed on 739 MBSSs performed on 612 patients (342 males/270 females; age range = 18 to 96 years) completed in one year at the Medical University of South Carolina with IRB approval. All studies were completed by speech-language pathologists trained in the data collection protocol, interpretation, and scoring of the MBSImP™©. Medical diagnosis category, swallowing impairment severity (MBSImP™© score), clinician experience, and fluoroscopy time were the variables recorded for analysis. Results Fluoroscopy time was not significantly associated with medical diagnosis category (p=0.10). The severity of the MBSImP©™ Oral Total and Pharyngeal Total resulted in statistically significant increases in fluoroscopy time (p<0.05). Studies by novice clinicians had longer exposure times when compared to experienced clinicians (p=0.037). Average radiation exposure time using the MBSImP©™ approach was 2.9 minutes, with a 95% confidence interval of 2.8 minutes to 3.0 minutes, which was well within the range of exposure times reported in the literature. Conclusions This study provides preliminary information regarding the impact of medical diagnosis category, swallowing impairment severity and clinician experience on fluoroscopy time. These findings also suggest that a thorough, standardized protocol for MBSSs did not cause unnecessary radiation exposure time during the MBSS.
Background: We assessed long-term patient-reported dysphagia and xerostomia outcomes following definitive surgical management with transoral robotic surgery (TORS) in patients with oropharyngeal cancer (OPC) via a cross-sectional survey study. Methods: Patients with OPC managed with primary oropharyngeal surgery as definitive treatment at least 1 year ago between 2015 and 2019 were identified. The M. D. Anderson Dysphagia Inventory (MDADI) and Xerostomia Inventory (XI) scores were compared across treatment types (i.e., no adjuvant therapy [TORS-A] vs. adjuvant radiotherapy [TORS+RT] vs. adjuvant chemoradiotherapy [TORS+CT/RT]). Results: The sample had 62 patients (10 TORS-A, 30 TORS+RT, 22 TORS +CT/RT). TORS-A had clinically and statistically significantly better MDADI scores than TORS+RT (p = 0.03) and TORS+CT/RT (p = 0.02), but TORS +RT and TORS+CT/RT were not significantly different. TORS-A had clinically and statistically significantly less XI than TORS+RT (p < 0.01) and TORS +CT/RT (p < 0.01). Conclusions: Patients with OPC who have undergone TORS+RT or TORS +CT/RT following surgery face clinically worse dysphagia and xerostomia outcomes relative to patients who undergo TORS-A.
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