Feasibility of low-dose digital pulsed video-fluoroscopic swallow exams (VFSE): effects on radiation dose and image quality

Abstract

Background Fluoroscopy is a frequently used examination in clinical routine without appropriate research evaluation latest hardware and software equipment. Purpose To evaluate the feasibility of low-dose pulsed video-fluoroscopic swallowing exams (pVFSE) to reduce dose exposure in patients with swallowing disorders compared to high-resolution radiograph examinations (hrVFSE) serving as standard of reference. Material and Methods A phantom study (Alderson-Rando Phantom, 60 thermoluminescent dosimeters [TLD]) was performed for dose measurements. Acquisition parameters were as follows: (i) pVFSE: 76.7 kV, 57 mA, 0.9 Cu mm, pulse rate/s 30; (ii) hrVFSE: 68.0 kV, 362 mA, 0.2 Cu mm, pictures 30/s. The dose area product (DAP) indicated by the detector system and the radiation dose derived from the TLD measurements were analyzed. In a patient study, image quality was assessed qualitatively (5-point Likert scale, 5 = hrVFSE; two independent readers) and quantitatively (SNR) in 35 patients who subsequently underwent contrast-enhanced pVFSE and hrVFSE. Results Phantom measurements showed a dose reduction per picture of factor 25 for pVFSE versus hrVFSE images (0.0025 mGy versus 0.062 mGy). The DAP (µGym) was 28.0 versus 810.5 (pVFSE versus hrVFSE) for an average examination time of 30 s. Direct and scattered organ doses were significantly lower for pVFSE as compared to hrVFSE ( P < 0.05). Image quality was rated 3.9 ± 0.5 for pVFSE versus the hrVFSE standard; depiction of the contrast agent 4.8 ± 0.3; noise 3.6 ± 0.5 ( P < 0.05); SNR calculations revealed a relative decreased of 43.9% for pVFSE as compared to hrVFSE. Conclusion Pulsed VFSE is feasible, providing diagnostic image quality at a significant dose reduction as compared to hrVFSE.

Videofluoroscopy compared with clinical feeding evaluation in children with suspected aspiration

“…New technologies, such as low-dose digital pulsed video-fluoroscopic swallow examinations, might reduce radiation doses even further. 28 Our study has a number of limitations, in particular, its retrospective design and lack of control group. To enable comparison between clinical and radiological assessments, the validated 8-point penetration-aspiration score had to be adapted.…”

“…Bearing in mind our obligation to keep the radiation dose as low as reasonably achievable (ALARA), 27 VFSS was performed by intermittent screening, which might risk missing penetration and aspiration events. New technologies, such as low‐dose digital pulsed video‐fluoroscopic swallow examinations, might reduce radiation doses even further 28 …”

Clinical Feeding Evaluation and Videofluoroscopy:&nbsp;An Integrative Approach to Feeding Management in&nbsp;Children With&nbsp;Suspected Aspiration

“…Although VFSS radiation doses compare favorably with nuclear scintigraphy tests for aspiration such as a salivagram or milk scan, (27) it is expected that this will improve further, as has been described with lowdose digital pulsed video-uoroscopic swallow exams. (28) Our study has a number of limitations, in particular its retrospective design and lack of control group.…”

Clinical Feeding Evaluation and Videofluoroscopy: An Integrative Approach to Feeding Management in Children with Suspected Aspiration

“…Although VFSS radiation doses already compare favorably with nuclear scintigraphy tests for aspiration such as a salivagram or milk scan, 27 it is expected that through further technological progresses, diagnostic clarity will be achieved with even less radiation, as has been described with low-dose digital pulsed video-fluoroscopic swallow exams. 28 Our study has a number of limitations, mainly rooted in its retrospective design and lack of control group. Firstly, in a population with complex and multi-system medical diagnoses, such as ours, any attempt at clear cut diagnostic labeling is bound to be inadequate.…”