Consideration of the Effects of Patient’s Real Images on Videofluoroscopic Examination of Swallowing

Abstract

Introduction：Videofluoroscopic examination of swallowing （VF） has been considered the “gold standard” in dysphagia assessment. However, it does not provide external images such as facial expression, posture, and physique, which are crucial in dysphagia management. In this study, we investigated the effects of adding the patient’s real images during VF to the VF images in dysphagia evaluation on the diagnosis of dysphagia and assessment of body posture.

Materials & Methods：Thirty-two clinicians were enrolled in this study as participants. They were divided into two groups：12 clinicians engaged in dysphagia treatment （DT） and 20 clinicians not engaged in dysphagia treatment （NDT）. We selected six cases in which postural control techniques were applied during VF. Two kinds of sample image （VFI：VF image alone；VF＋R：VF image＋patient’s real image）of the six cases were presented to clinicians random order. The participants were asked to judge the sample images in terms of diagnosis of dysphagia using the penetration aspiration scale （PAS） and assessment of the patient’s posture. To assess the patient’s posture, the positions of chin down or cervical flexion, cervical rotation （right/left bending） and lateral incline （right/left bending） of the upper body were used. The rates of agreement and accuracy of evaluations between two images in the same patients were analyzed.

Results：There was no significant difference in agreement rate of dysphagia diagnosis between VFI and VF＋R in both DT and NDT. VF＋R indicated significantly higher agreement in the rate of patient’s posture （chin down or cervical flexion, cervical rotation and lateral incline of the upper body） in both DT and NDT. Especially, patients in whom both head and body postural control techniques were applied indicated significantly higher agreement in the rate of patient’s posture than VFI in both DT and NDT.

Conclusion：The results of this study suggest that it is difficult to assess the patient’s posture accurately from VF images only. Real images of the patient during VF may help improve the accuracy of assessing the patient’s posture without affecting the dysphagia diagnosis. It is thought that accurate assessment of the patient’s posture is important information to improve the reproducibility of these techniques.