Visual Analysis of Swallowing Efficiency and Safety (VASES): A Standardized Approach to Rating Pharyngeal Residue, Penetration, and Aspiration During FEES

Curtis, James A.; Borders, James C; Perry, Sarah; Dakin, Avery E; Seikaly, Zeina N.; Troche, Michelle S.

doi:10.1007/s00455-021-10293-5

Cited by 39 publications

(22 citation statements)

References 65 publications

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“…Hence, the currently trained AI lacks sufficient generalization for aspiration detection but not for segmentation of vocal cords and glottis ROI. Regarding the aspiration detection task, the current model performance might be comparable to that of an untrained human examiner [ 21 ]. Hence, at present, our model does not lead to better results than comparable non-endoscopic/non-radiologic approaches [ 28 , 33 , 35 , 37 , 62 , 63 ]; but in clear contrast to them, our model outcomes, as well as the false positives and negatives, are fully interpretable and can therefore be corrected by an experienced examiner.…”

Section: Discussionmentioning

confidence: 99%

“…(PAS score 8) [ 20 ]; PAS scores 7 and 8 are, especially, highly relevant, as they indicate aspiration. Most striking are the differences between intra-RR (0.60) and inter-RR (0.29) before specific trainings [ 21 ], but overall inter-RR scores, irrespective of clinical experience, can also reach 0.85 [ 22 ]. Hence, the more differentiated the diagnostics should be and the less the staff are trained, the less reproducible human decisions become.…”

Section: Introductionmentioning

confidence: 99%

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AI-Based Detection of Aspiration for Video-Endoscopy with Visual Aids in Meaningful Frames to Interpret the Model Outcome

Konradi

Zajber

Betz

et al. 2022

Sensors

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Disorders of swallowing often lead to pneumonia when material enters the airways (aspiration). Flexible Endoscopic Evaluation of Swallowing (FEES) plays a key role in the diagnostics of aspiration but is prone to human errors. An AI-based tool could facilitate this process. Recent non-endoscopic/non-radiologic attempts to detect aspiration using machine-learning approaches have led to unsatisfying accuracy and show black-box characteristics. Hence, for clinical users it is difficult to trust in these model decisions. Our aim is to introduce an explainable artificial intelligence (XAI) approach to detect aspiration in FEES. Our approach is to teach the AI about the relevant anatomical structures, such as the vocal cords and the glottis, based on 92 annotated FEES videos. Simultaneously, it is trained to detect boluses that pass the glottis and become aspirated. During testing, the AI successfully recognized the glottis and the vocal cords but could not yet achieve satisfying aspiration detection quality. While detection performance must be optimized, our architecture results in a final model that explains its assessment by locating meaningful frames with relevant aspiration events and by highlighting suspected boluses. In contrast to comparable AI tools, our framework is verifiable and interpretable and, therefore, accountable for clinical users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

AI-Based Detection of Aspiration for Video-Endoscopy with Visual Aids in Meaningful Frames to Interpret the Model Outcome

Konradi

Zajber

Betz

et al. 2022

Sensors

View full text Add to dashboard Cite

show abstract

“…Despite being the tool(s) of choice for dysphagia evaluation [ 30 , 31 ], heterogeneity of protocols, outcome measures and lack of reliability have beleaguered clinical practice and impacted patient care [ 32 ]. More recent development of standardised and validated protocols for FEES and VFSS has enabled clinicians to become more effective in formulating clinical management plans [ 33 – 35 ]. A systematic approach to translation of US into dysphagia assessment practices acknowledges these limitations and will assist with the implementation of US in a logical and appropriate way.…”

Section: Introductionmentioning

confidence: 99%

Translating Ultrasound into Clinical Practice for the Assessment of Swallowing and Laryngeal Function: A Speech and Language Pathology-Led Consensus Study

et al. 2022

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Ultrasound (US) has an emerging evidence base for the assessment of swallowing and laryngeal function. Accessibility and technological advances support the use of US as a clinical assessment tool; however, there is insufficient evidence to support its translation into clinical practice. This study aimed to establish consensus on the priorities for translation of US into clinical practice for the assessment of swallowing and laryngeal function. Nominal Group Technique (NGT) was used as a formal method of consensus development. Clinicians and academics, all members of an international US working group, were invited to participate in the study. Two NGT meetings were held, where participants silently generated and then shared ideas. Participants anonymously ranked items. Rankings were aggregated before participants re-ranked items in order of priority. Discussions regarding rankings were recorded and transcribed to inform analysis. Member-checking with participants informed the final analysis. Participants (n = 15) were speech and language pathologists, physiotherapists and sonographers representing six countries. Fifteen items were identified and prioritised 1–13 (including two equally ranked items). Reliability, validity and normative data emerged as key areas for research while development of training protocols and engagement with stakeholders were considered vital to progressing US into practice. Analysis revealed common themes that might be addressed together in research, in addition to the ranked priority. A measured approach to the translation of US into clinical practice will enable effective implementation of this tool. Priorities may evolve as clinical and professional contexts shift, but this study provides a framework to advance research and clinical practice in this field.

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“…Usually, temporal, spatial, and volumetric variables are employed [ 6 , 7 ]. Available scales to evaluate the pharyngeal residues severity in FEES include ordinal scales [ 8 , 9 , 10 , 11 , 12 ], estimation scales [ 13 , 14 ] and binary scales [ 15 ]. Recently, in two reviews focused on psychometric qualities of visuoperceptual scales, the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS) [ 11 ] showed good/excellent reliability [ 7 ] and met the criteria for a valid and reliable residue severity rating scale based on FEES [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Reliability and Construct Validity of the Yale Pharyngeal Residue Severity Rating Scale: Performance on Videos and Effect of Bolus Consistency

et al. 2022

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The Yale Pharyngeal Residue Severity Rating Scale (YPRSRS) provides an image-based assessment of pharyngeal residue in the fiberoptic endoscopic evaluation of swallowing (FEES). Its performance was investigated only in FEES frames. This study analyzed the reliability and construct validity of the YPRSRS in FEES videos and the influence of bolus consistency. Thirty pairs of FEES videos and frames, 8 thin liquids (<50 mPa·s), 11 pureed (2583.3 mPa·s at 50 s−1, 697.87 mPa·s at 300 s−1), and 11 solid food; were assessed by 29 clinicians using the YPRSRS; 14 raters re-assessed materials at least 15 days from the first evaluation. Construct validity and intra-rater reliability were assessed using weighted Cohen’s Kappa. Inter-rater reliability was assessed using weighted Fleiss Kappa. Construct validity and inter-rater reliability were almost perfect or excellent for frames (0.82 ≤ k ≤ 0.89) and substantial or intermediate to good for videos (0.67 ≤ k ≤ 0.79). Intra-rater reliability was almost perfect for both frames and videos (k ≥ 0.84). Concerning bolus consistency, thin liquids had significantly lower values of construct validity, intra-, and inter-rater reliability than pureed and solid food. Construct validity and inter-rater reliability were significantly lower for solid food than for pureed food. The YPRSRS showed satisfactory reliability and construct validity also in FEES videos. Reliability was significantly influenced by bolus consistency.

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Visual Analysis of Swallowing Efficiency and Safety (VASES): A Standardized Approach to Rating Pharyngeal Residue, Penetration, and Aspiration During FEES

Cited by 39 publications

References 65 publications

AI-Based Detection of Aspiration for Video-Endoscopy with Visual Aids in Meaningful Frames to Interpret the Model Outcome

AI-Based Detection of Aspiration for Video-Endoscopy with Visual Aids in Meaningful Frames to Interpret the Model Outcome

Translating Ultrasound into Clinical Practice for the Assessment of Swallowing and Laryngeal Function: A Speech and Language Pathology-Led Consensus Study

Reliability and Construct Validity of the Yale Pharyngeal Residue Severity Rating Scale: Performance on Videos and Effect of Bolus Consistency

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