In dysphagia, food materials frequently invade the laryngeal airway, potentially resulting in serious consequences, such as asphyxia or pneumonia. The VFSS (videofluoroscopic swallowing study) procedure can be used to visualize the occurrence of airway invasion, but its reliability is limited by human errors and fatigue. Deep learning technology may improve the efficiency and reliability of VFSS analysis by reducing the human effort required. A deep learning model has been developed that can detect airway invasion from VFSS images in a fully automated manner. The model consists of three phases: (1) image normalization, (2) dynamic ROI (region of interest) determination, and (3) airway invasion detection. Noise induced by movement and learning from unintended areas is minimized by defining a “dynamic” ROI with respect to the center of the cervical spinal column as segmented using U-Net. An Xception module, trained on a dataset consisting of 267,748 image frames obtained from 319 VFSS video files, is used for the detection of airway invasion. The present model shows an overall accuracy of 97.2% in classifying image frames and 93.2% in classifying video files. It is anticipated that the present model will enable more accurate analysis of VFSS data.
The effectiveness of the chin tuck maneuver is still controversial, despite being widely used in clinical practice. The chin tuck maneuver has been shown to be able to reduce or eliminate aspiration in a group of patients with a number of favorable conditions, but its effectiveness in preventing or managing penetration remains unclear. This study was designed to investigate whether the chin tuck maneuver is effective in reducing penetration. Images from a videofluoroscopic swallowing study (VFSS) taken from 76 patients with penetration were collected and reviewed retrospectively. The severity of penetration was assessed by the penetration ratio (ratio of the penetration depth to the length of the epiglottis) measured and calculated from the images in which the deepest penetration was observed. The penetration ratio was significantly decreased in the chin tuck posture compared with the ratio in the neutral position (p = 0.001). Significant reducing effect was observed in 26 (34.2%) out of 76 patients. When comparing other parameters of VFSS, residues in the vallecular and pyriformis sinuses were less severe in the effective group. Chin tuck significantly decreased residues in both effective and ineffective group. The results demonstrate that the chin tuck maneuver can reduce penetration, but its effectiveness is limited.
Objective To identify the variables of videofluoroscopic swallowing study (VFSS) that are useful for predicting the risk of aspiration pneumonia in elderly patients with dysphagia.Methods A total of 251 patients (aged 65 years or more) were included and divided into a pneumonia group (n=133) and a non-pneumonia group (n=118). The pneumonia group included patients who had been diagnosed with aspiration pneumonia, and individuals in the non-pneumonia group did not have pneumonia but were referred for VFSS. The medical records and results of VFSS were reviewed and compared between the groups retrospectively.Results The pneumonia group exhibited a male preponderance and a higher 8-point Penetration-Aspiration Scale (8PPAS) score. The mean values of 8PPAS score for swallowing thick liquid and rice porridge was significantly higher in the pneumonia group. The pharyngeal delay time (PDT) and pharyngeal transit time (PTT) were significantly longer in the pneumonia group. The amounts of vallecular and pyriform sinus residue were increased in the pneumonia group. The delay in swallowing reflex and the decrease in laryngeal elevation were more frequently observed in the pneumonia group. Among those variables, PDT and PTT were identified as significant predictors of aspiration pneumonia based on logistic regression analysis.Conclusion The present study delineated the findings of VFSS, suggesting an increased risk of aspiration pneumonia in elderly patients with dysphagia. The results demonstrate that prolonged PDT and PTT are significant predictors of aspiration pneumonia.
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