Ch 9 Exam 2 Flashcards
Indications for an Instrumental Examination
~Examination Definitely Indicated:
- Characteristics ___
- ___ or ____ issues
- Safety or efficiency a concern?
~____ May Be Indicated
- Medial condition high risk for dysphagia
- ____ changes
- Unable to ____ with clinical exam
~Examination NOT indicated
- No _____
- Too ___ ___ or _____
- ___ will not change course of treatment
~Examination Definitely Indicated:
- Characteristics vague
- Nutritional or respiratory issues
- Safety of efficiency a concern
~Examination May Be Indicated
- Medial condition high risk for dysphagia
- Swallow changes
- Unable to cooperate with clinical exam
~Examination NOT indicated
- No complaints
- Too medically fragile or uncooperative
- MBS will not change course of treatment
Overview: Instrumental Procedures(Cherney, 1994)
1. 2. 3. 4. 5. 6.
Videofluorscopy Ultrasonography Fiberoptic Endoscopy (FEES) Manometry Scintigraphy Cervical Auscultation
Clinical Selection Factors
Visualizes __ ___
Detects ____
Uses ___ ___
Can be Used ___ ___
Visualizes Complete Swallow
Detects Aspiration
Uses Natural Diet
Can be Used during treatment
Comparison of MBS vs. FEES
~Advantages of Fluoroscopy
- Initial ___
- ___ ____
~Advantages of Endoscopy
- ____
- ___ deviations
- ___
- ____ of transport
- ____ use
- ____
~Advantages of Fluoroscopy
- Initial evaluation
- Esophageal dysphagia
~Advantages of Endoscopy
- Paralysis
- Anatomic deviations
- Secretions
- Ease of transport
- Repeated use
- Biofeedback
Safety Factors of Procedures (Cherney, 1994)
~Risks: Most risk to patient to least risk to patient
~Side Effects: Most to least
~Invasiveness: Most to least
~Comfort: Most to least
~Risks: Most risk to patient to least risk to patient
~Side Effects: Most to least
~Invasiveness: Most to least
~Comfort: Most to least
Two studies Comparing Agreement between VFSS and FEES
~___ ___ VFSS: 80% FEES: 89%
~___ VFSS: 90% FEES: 86%
~___ ____ VFSS: 85% FEES: 86%
~___ _____ VFSS: 66% FEES: 61%
~Pharyngeal Residue VFSS: 80% FEES: 89%
~Aspiration VFSS: 90% FEES: 86%
~Laryngeal penetration VFSS: 85% FEES: 86%
~Premature spillage VFSS: 66% FEES: 61%
Videofluoroscopic Examinations
~What’s in a Name?
~Terminology:
- ___ ___ ___ (MBS)
- Upper ____ Series with ___
- ____ Swallow study (VFSS)
- ___ ___ ___ (VFBE)
- __ ___ ___ (VFSE)
- Rehabilitation swallow study
- ___ ____ (early Logemann!)
- _____ (Okie term!)
~Procedures – (See hand-outs)
~What’s in a Name?
~Terminology:
- Modified Barium Swallow (MBS)
- Upper Gastrointestinal Series with hypopharynx
- Videofluoroscopic Swallow study (VFSS)
- Videofluoroscopic barium examination (VFBE)
- Videofluoroscopic swallow examination (VFSE)
- Rehabilitation swallow study
- Video-esophagram (early Logemann!)
- Dysphagiagram (Okie term!)
~Procedures – (See hand-outs)
Principles of VFSS
~X-ray tube moves __ __ ___
~X-ray projected in __ ___ through the patient to the fluoroscope on the opposite side
~Differences in ___ ___ produces varying intensity (darkness)
~Radiation dose rate ____ when thin body parts are examined and ___ with the examination of thick parts
~X-ray tube moves up and
down
~X-ray projected in straight
lines through the patient to
the fluoroscope on the opposite side
~Differences in tissue absorption produces varying intensity (darkness)
~Radiation dose rate falls when thin body parts are examined and rises with the examination of thick parts
Sequence of materials-(As recommended in text)
~Lateral View:
- __ ___ and vowel phonation
- 5 ml thick ___ ___
- 5 ml __ ___ (with pudding)
- 10 ml ____ liquid barium
- 10 ml ____ liquid barium
- 10 ml ___ ____ (pudding)
- Thick liquid taken from a ___ or through a ____
- ___ coated with barium paste
- Repeat thin liquid if…_____
~Lateral View:
- Speech sample and vowel phonation
- 5 ml thick liquid barium
- 5 ml barium paste (with pudding)
- 10 ml thin liquid barium
- 10 ml thick liquid barium
- 10 ml barium paste (pudding)
- Thick liquid taken from a cup or through a straw
- Cracker coated with barium paste
- Repeat thin liquid if residue from cracker is still there
Materials & Sequence
~Anterior View: \_\_\_\_\_ ~Swallow with head \_\_\_and \_\_ ~\_\_\_\_ techniques: -May try at any time in the examination -\_\_\_\_evaluation 1. Quick view for \_\_\_ or \_\_\_\_ 2. Some Radiologists require this view
`~Anterior View: Repeat vowel phonation and falsetto
~Swallow with head forward and turned
~Compensatory techniques:
-May try at any time in the examination
-Esophageal evaluation
1. Quick view for obstruction or dysmotility
2. Some Radiologists require this view
Observations to Obtain(See Box 10-6, page 201)
~\_\_\_\_ ~\_\_\_\_\_ movement ~\_\_\_\_ movement ~Consequences of \_\_ \_\_\_\_ ~Impact of \_\_ \_\_\_\_
``Anatomy Non-Swallow movement Swallow movement Consequences of impaired swallow Impact of compensatory maneuvers
Basic Procedures
~I. Lateral view:
- Study ___
- ___ ____
1. ___ ___ thicknesses
2. ___ ___-pudding
3. Cookie – ____
~II. A-P view:
- _____
- ___ ____ – graded thicknesses
~I. Lateral view:
- Study structures
- Food consistencies
1. Liquid- graded thicknesses
2. Barium Paste-pudding
3. Cookie – solid
~II. A-P view:
- Structures
- Liquid Barium – graded thicknesses
Warning!!!Safety Issues
~Radiation risks:
- Severe ___ ___
- ___
- ___ Injury
- ___ Exposure-
1. ___-___ more sensitive
2. Greatest during first ___ in __
~Areas of greatest risk to exposure: \_\_ \_\_\_ \_\_\_ \_\_\_ \_\_\_
~Radiation risks: Severe tissue damage Cancer Genetic Injury Fetal Exposure- 1 1/2 – 2x more sensitive Greatest during first 10 days in utero
~Areas of greatest risk to exposure:
Thyroid, lungs, breasts, active bone marrow, ovaries & testes
Safety Issues(See Kelchner, 2004)
~Radiation Protection:
- Time- ___ exposure time- less than __ ___
- Shielding-
1. Lead lined ___
2. Lead lined ___
3. Lead lined ___ ___
4. Lead lined ___ - Distance
1. ___ -____ hazard to operator
2. ___ ___ law: if distance is ___, exposure cut in ___ - Equipment & Dosimetry
1. Wear a ___ ___
2. Keep levels below ___-___ cGy (centiGrays)
~Radiation Protection:
- Time- minimize exposure time- less than 2 minutes
- Shielding-
1. Lead lined apron
2. Lead lined gloves
3. Lead lined thyroid shield
4. Lead lined glasses - Distance
1. Scatter- principle hazard to operator
2. Inverse square law: if distance is doubled, exposure cut in half - Equipment & Dosimetry
1. Wear a dosimeter badge
2. Keep levels below 0.01-10 cGy (centiGrays)
Radiation Basics
~Radiation absorbed dose (rads) measured in ___
~1 Gray (Gy)= 100 rads
~Most work in centiGrays
–1cGy= 1/100 Gy and 1 rad
Level normally encountered in Dx radiology =
0.01-10 cGy
Radiation Workers
~Radiation absorbed dose (rads) measured in Grays
~1 Gray (Gy)= 100 rads
~Most work in centiGrays
–1cGy= 1/100 Gy and 1 rad
Level normally encountered in Dx radiology =
0.01-10 cGy
Radiation Workers
