Class 9 Flashcards
When would you definitely need to perform an instrumental exam?
If the person had a history of pneumonia and recent coughing/choking incidents that were severe in nature.
On the first day of your externship at St. Francis Hospital in Tulsa, your supervisor tells you to recommend a client for a “dysphagiagram.” You check your textbook but there is no mention of such a test. What is he/she talking about?
A Modified Barium Swallow (MBS)
A Videofluoroscopy/Modified Barium Swallow test is essentially a movie of an X-ray event.
True
Why do you need to mix foods with barium during an MBS?
Barium is radiopaque and appears black on an image making it easier to see and track.
If time and circumstances allow, it is a good idea to practice your compensatory maneuvers during a videofluoroscopy evaluation to determine effectiveness for your particular client.
True
According to your textbook and the Kelchner article, the radiation exposure of an MBS is minimal and extended or repeated exposure poses no risk to either patient or examiner.
False
Which of the following would be considered a disadvantage of choosing to perform a Fiberoptic Endoscopy (FEES) exam over the MBS for a client with suspected dysphagia?
You can view esophageal dysphagia as well as oral and pharyngeal stages.
Martin-Harris stated in her 2008 article that the MBSImp program was initially designed to___________.
Improve the interrater reliability of MBS results among speech-language pathologists.
In the article on radiation safety, Kelchner recommended which of the following safety measures for the SLP performing multiple evaluations per week? (Choose all that apply.)
Wearing a lead apron during all MBS/VFSS procedures.
Increasing the distance from the source of the radiation.
Minimizing the exposure time for you and your patient.
Indications for an Instrumental Examination (Text: Box 10-2)
◦ 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
◦ Videofluorscopy ◦ Ultrasonography ◦ Fiberoptic Endoscopy (FEES) ◦ Manometry ◦ Scintigraphy ◦ Cervical Auscultation
Clinical Selection Factors
◦ Visualizes Complete Swallow ◦ Detects Aspiration ◦ Uses Natural Diet ◦ Can be Used during treatment *Handout Table 5-3
Comparison of MBS vs. FEES
◦ 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
Two studies Comparing Agreement between VFSS and FEES
Langmore, Shatz, & Olson, 1991 and Wu, Hsiao, & Chen, 1997
◦ 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?
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!)
Principles of VFSS
◦ 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:
Speech sample and vowel phonation (to find VFs in MBS, evaluate vocal quality)
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: Repeat vowel phonation and falsetto
◦ Swallow with head forward and turned
◦ Compensatory techniques:
May try at any time in the examination
◦ Esophageal evaluation
Quick view for obstruction or dysmotility
Some Radiologists require this view
Observations to Obtain
See Box 10-6, page 201
◦ Anatomy ◦ Non-Swallow movement ◦ Swallow movement ◦ Consequences of impaired swallow ◦ Impact of compensatory maneuvers
Basic Procedures
◦ I. Lateral view: Study structures Food consistencies Liquid- graded thicknesses Barium Paste-pudding Cookie – solid ◦ II. A-P view: Structures Liquid Barium – graded thicknesses
Warning!!! Safety Issues
◦ 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- minimize exposure time- less than 2 minutes Shielding- Lead lined apron Lead lined gloves Lead lined thyroid shield Lead lined glasses Distance Scatter- principle hazard to operator Inverse square law: if distance is doubled, exposure cut in half Equipment & Dosimetry Wear a dosimeter badge Keep levels below 0.01-10 cGy (centiGrays)
Radiation Basics
◦ Radiation absorbed dose (rads) measured in Grays
◦ 1 Gray (Gy)= 100 rads
◦ Most work in centiGrays
o 1cGy= 1/100 Gy and 1 rad
o Level normally encountered in Dx radiology =
• 0.01-10 cGy
o Radiation Workers < 0.5 cGy per month
