Imaging Techniques for Studying Swallowing Flashcards
What are the 4 imaging techniques we use to assess for dysphagia?
ultrasound
scintigraphy
FEES
VFSE/MBS
What does FEES stand for?
ON EXAM
Fiberscopic endoscopic evaluation of swallowing
ON EXAM
What does VFSE stand for?
Videofluroscopic swallowing evaluation
ON EXAM
What does MBS stand for?
Modified barium swallow study
Describe the ultrasound imaging technique
Used to observe tongue function & to measure oral transit times & motion of the hyoid bone.
Cannot visualize the pharynx b/c of the mix of tissue types (bones, muscles, cartilage).
Thus, limited to oral phase study for tongue function & biofeedback for various oral tongue exercises.
This isn’t very common
Describe the Scintigraphy imaging technique
Nuclear medicine test where the patient swallows measured amounts of radioactive substances.
The bolus is imaged & recorded by a gamma camera.
Amount of aspiration & residue can be measured but not the physiology to determine the cause of the problems.
Often used in the esophagus to watch for reflux.
**Not common
ON EXAM
Describe FEES
FEES is a type of Videoendoscopy
Videoendoscopy may be done with a flexible scope (nose) or rigid scope (mouth)….can’t swallow though w/ rigid scope.—so a fees is never done with a rigid scope!
Examines the oral & pharyngeal structures from above.
Examines the pharynx/larynx before & after swallowing
Usually uses green food coloring for better viewing of the boluses
Inserted into the nose usually to the level of the soft palate.
Does not view the oral stage of swallowing. –This is a con!
The moment of the actual swallow is not viewed due to the pharynx closing around the endoscopic tube & blocking the image (“White Out Period”)—
Clinicians must infer the nature of the physiology from the location of residue when the image returns to view.
May be used as biofeedback.—meaning you can use this during swallowing therapy.
ON EXAM
What are some pros to using FEES?
Portability (can be done at bedside)
Flexibility w/ regards to positioning
Time/length of exam
Speech therapy only
No radiation exposure
Gomes, G.F. (2004) Found both FEES & MBS present similar sensitivity, specificity & predictive values
ON EXAM
What are some cons to using FEES?
Invasive
Aspiration during the swallow can only be inferred (white out period)**
Need specialized equipment (endoscope, standard FEES cart)
Increased training due to invasiveness of the procedure (ENT monitoring, etc…)
What is the gold standard imaging technique for assessing for dysphagia?
MBS
Describe the VFSE/MBS
Most frequently used technique.GOLD STANDARD
Usually follows Clinical/Bedside Swallow Evaluation for patients in the hospital. For outpatients, may go directly to VFSE/MBS.
If any pharyngeal red flags noted during the Clinical/Bedside Swallow Evaluation, you should proceed to an imaging technique.
Can be digitally recorded in a computer or on a disc for review.
Patient only receives a relatively small amount of radiation per study.
A variety of consistencies/textures are used.
Always done in the “Lateral View” w/ supplementing an “Anterior-Posterior View” (A-P).—always shoot for doing both so that you can screen the esophagus with the A-P view!
Describe the VFSE/MBS set up
Radiology table usually can be turned upright for our studies.
This is usually done by the radiology technologists.
Not all Radiology rooms have fluoroscopy capabilities–we need those…
Describe Seating for the MBS
May sit on the foot pedal of fluoroscopy table (Not very comfortable)
Hausted Chair
VESS Chair
Transmotion Chair
Bed/Gurney if extendable arm on machine
ON EXAM
Describe the 3 things radiation safety guidelines when administering a MBS
barrier
distance
time
ON EXAM
describe the barrier for radiation safety
lead apron & thyroid wrap (2 main areas that you need to protect are the thyroid and your privates–most susceptible to cancer due to radiation)
lead glove
ON EXAM–know terminology!
Describe Time
Dosimeters: measures the amount of radiation we get (RADS)
What uses barium sulfate in order for material to be seen via x-ray?
MBS study
How long until the barium is cleared from your lungs if you aspirate it?
72 hours
What various consistencies does barium come in?
powder to mix with water for various textures
liquid (usually nectar consistency)
paste
cookies
tablets
Who chooses which consistencies to mix barium with and how?
depends on the SLP, facility, and patient needs… everybody kind of has their own way of doing it.
What are some consistencies/textures that may be given in an MBS?
Thin liquid
thick liquid
pureed
wet soft
dry soft (bread)
meat
dry-crumbly (cracker)
tablet/pill
What are the side effects of barium?
Can REALLY constipate people
What consistency should you begin with in an MBS?
Some say start with the safest consistency for that patient.
I start with thin liquid about 98% of the time. Otherwise, the rest of the study is confounded by residue from thicker material.
Should ultimately be patient dependent
ON EXAM
what profile attempts a standardized protocol for administration of an MBS?
MBSImP—Modified barium swallow impairment profile
