PROCEDURE DETAILS

Indications:

• Define physiological cause of swallow symptoms
• Determine aspiration risk
• Prescribe safe diet and fluid consistencies including compensatory strategies
• Determine rehabilitation practices
• Evaluate change in swallow function as an objective outcome measure

Frame rates (pulses/sec):

Enhanced VFSS images improves accuracy and practitioner reliability in detecting the degree of aspiration or penetration[5,6].

• Fluids = 30 frames per second ·Solids = 15 frames per second ·AP plane = 4 frames per second*

_{*note - standard protocol may vary between departments.}

Radiation exposure[7]:

• Mean effective dose = 0.44 mSv ·Mean fluoroscopic time = 2.9 minutes

Standard procedure:

A well-designed protocol provides a systematic framework to define the limits of the swallow system by testing a range of diet and fluid consistencies, bolus volumes and compensatory strategies[8].

• Speech pathologists always perform a clinical examination prior to undergoing VFSS.
• Licenced radiographer present assisting with fluoroscopic image acquisition and optimisation.
• Barium contrast is used as it is relatively benign if aspirated.
• Patient in a seated position.
• Subsequent trials of various consistencies mixed with barium pending safe and effective trial management considering factors such as airway protection / penetration / aspiration / oral and pharyngeal residue.
• Swallow is assessed in the lateral plane by default.
• AP trial(s) are performed only if indicated such as when suspected pathology is asymmetric (e.g. CVA, H&N surgery).

NORMAL ANATOMY  

See Figure 1

COMMON PATHOLOGY  

Figure 2 - Anterior cervical osteophytes:

• Impingement of the posterior pharyngeal wall.
• Reduced base of tongue to posterior pharyngeal wall contact leading to reduced pharyngeal drive and disruption of pharyngeal clearance.
• Impaired epiglottic deflection and airway protection.

Figure 3 - Cricopharyngeal Bar / Spasm

• Causes stasis at the level of the pyriform fossae or impaired transit through the upper oesophagealsphincter.
• Regurgitation from upper oesophagus to pharynx and/or airway.

Figure 4a and 4b - Pharyngeal Pouches

• Both impede pharyngeal transit, pharyngeal stasis and regurgitation.
• Symptoms of food sticking, coughing/choking, halitosis.

Figure 5 - Aspiration

• Can result in aspiration pneumonitis / aspiration pneumonia.

NOTE*

• Aspiration is considered anything that passes below the level of the vocal folds whereas penetration is anything that enters the airway above the level of the vocal folds.
• Aspiration and penetration can be intermittent and can only be confidently assessed at ≥ 30 frames per second.

Figure 2 image ©️[11] "Gupta P et al (2018) Cricoid and cervical osteophytes causing dysphagia: an extremely rare and interesting case. Radiol Bras 51(1): 67-68". 

Figures 3-5 images ©️Radiopaedia.org

DOCUMENTATION OF RESULTS  

The VFSS report is a written medical record of the procedure with a number of standardised scoring systems assisting to rate the swallow assessment [9,10].

The report provides:

• A summary of the swallowing deficits and management recommendations for safe oral intake.
• Details regarding appropriate consistencies of diet and fluids, therapeutic strategies and postural modifications including rehabilitation exercises.
• Referrals are made to other agencies (if required).

The report takes on average 1 hour to complete and is sent to the referring medical practitioner and relevant healthcare providers.