Best Practices in Modified Barium Swallow Studies

Abstract

<jats:sec> <jats:title>Purpose</jats:title> <jats:p>The modified barium swallow study (MBSS) is a widely used videofluoroscopic evaluation of the functional anatomy and physiology of swallowing that permits visualization of bolus flow throughout the upper aerodigestive tract in real time. The information gained from the examination is critical for identifying and distinguishing the type and severity of swallowing impairment, determining the safety of oral intake, testing the effect of evidence-based frontline interventions, and formulating oral intake recommendations and treatment planning. The goal of this review article is to provide the state of the science and best practices related to MBSS.</jats:p> </jats:sec> <jats:sec> <jats:title>Method</jats:title> <jats:p>State of the science and best practices for MBSS are reviewed from the perspectives of speech-language pathologists (SLPs) and radiologists who clinically practice and conduct research in this area. Current quandaries and emerging clinical and research trends are also considered.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>This document provides an overview of the MBSS and standards for conducting, interpreting, and reporting the exam; the SLPs' and radiologist's perspectives on standardization of the exam; radiation exposure; technical parameters for recording and reviewing the exam; the importance of an interdisciplinary approach with engaged radiologists and SLPs; and special considerations for examinations in children.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The MBSS is the primary swallowing examination that permits visualization of bolus flow and swallowing movement throughout the upper aerodigestive tract in real time. The clinical validity of the study has been established when conducted using reproducible and validated protocols and metrics applied according to best practices to provide accurate and reliable information necessary to direct treatment planning and limit radiation exposure. Standards and quandaries discussed in this review article, as well as references, provide a basis for understanding the current best practices for MBSS.</jats:p> </jats:sec>

Assessment of Gastrointestinal Autonomic Dysfunction: Present and Future Perspectives

“…The modified barium swallowing test can also be utilized in the diagnosis of these disorders. This examination permits the dynamic visualization of content movements through the upper GI system in real time with the use of videofluoroscopy [56]. The role of the modified barium swallowing test is not limited to the diagnose of dysmotility but can add to the understanding of the physiologic swallowing deficit, which can be useful to maximize the benefit of swallowing therapy [57].…”

The Modified Barium Swallow Study for Oropharyngeal Dysphagia: Recommendations From an Interdisciplinary Expert Panel

“…Furthermore, high-resolution digital image recording should be used to optimize the clarity of structures and diagnostic accuracy. In addition, for most patients, both lateral and anterior-posterior projections should be obtained to evaluate symmetry of oropharyngeal function, the impact of applied compensatory strategies, and gravity-assisted esophageal clearance in the upright position (Hazelwood et al, 2017;Martin-Harris, Canon, et al, 2020).…”

“…Thus, radiation exposure to a clinician wearing lead shielding is extremely minimal Hayes et al, 2009). Nevertheless, clinicians should adhere to the "As Low As Reasonably Achievable" principle, including routinely using personal protective equipment, increasing the distance from the radiation source, and limiting unnecessary exposure Galgano et al, 2019;Martin-Harris, Canon, et al, 2020;Peladeau-Pigeon & Steele, 2013). Due to the low radiation exposure to and related cancer risks for adult patients, and the extremely low radiation exposure to and related cancer risks for clinicians, clinicians should not shorten MBSSs of adults in a manner that would impact the acquisition of information that would be of value to patient care due to radiation exposure concerns .…”

“…Although data support that each swallowing task has sufficiently high probability to capture the most severe physiologic swallowing impairment, the clinical condition of the patient may dictate an exception to a standard protocol. "Standardized" is not meant to equate to "rigid" or "inflexible," but rather an understanding that a minimum, validated standard should be achieved to consider the exam comprehensive (Hazelwood et al, 2017;Martin-Harris, Canon, et al, 2020).…”

“…The MBSS is a real-time fluoroscopic motion study used to assess swallowing physiology and airway protection. Optimally, the exam is performed by a speech-language pathologist (SLP) together with a radiologist, assisted by a radiologic technologist, to evaluate anatomy and swallowing physiology simultaneously in real time (Martin-Harris, Canon, et al, 2020). The objectives of the MBSS are to (Martin-Harris, Canon, et al, 2020;Martin-Harris, Steele, & Peterson, 2020) • identify and distinguish the presence, type, and estimated severity of physiologic swallowing impairment;…”