Cooking up a Gourmet Videofluoroscopy Exam: Analogies from the Kitchen

As a speech-language pathologist who works in the area of swallowing and swallowing disorders, it should come as no surprise to learn that I also really enjoy good food!

Although I do not consider myself a gourmet chef, I enjoy watching cooking and baking shows on TV. I particularly enjoy the challenges where contestants are expected to produce a particular dish, but limited instructions have been provided. This leaves them to guess exactly how much of a particular ingredient is needed, the order in which to add the ingredients, or, perhaps, how long to leave their dish in the oven. It is highly entertaining to see the widely varied results.

But let’s imagine, just for a moment, that this type of challenge might be comparable to the challenge of deciding how to conduct a medical test in clinical practice.

From the Kitchen to the Clinic

Imagine that you, as the clinician, are lacking guidance on the number of tasks to include in the assessment, or how to structure those tasks to reveal impairment in a patient.

These kinds of decisions are made every day by clinicians who perform videofluoroscopic swallowing studies (VFSS). Recent literature suggests that standardization of the exam itself, of the food and liquid stimuli that we use, and of the technical aspects of the exam is critical for diagnostic accuracy.¹

The VFSS Exam: 5 Questions to Consider

A VFSS exam involves radiation exposure to the patient, and it is therefore important for clinicians to conduct the exam in a way that uses radiation responsibly—consistent with the “as low as reasonably achievable” (ALARA) principle.

To do this, a clinician needs to consider five questions:

1. Is a VFSS indicated for the patient, and is it likely to be the best examination for revealing the nature and severity of their swallowing impairment?
2. What protocol should be used? This is analogous to asking what recipe should be followed in baking, with the ingredients and steps in the recipe being equivalent to the stimuli and tasks needed to answer clinical questions.
3. What is the best concentration of contrast media for revealing swallowing impairment? This is like asking how much of a key ingredient like sugar, salt, or yeast is required in a recipe.
4. Which technical settings (e.g., dose mode, frame rate) should be used during the fluoroscopy procedure to ensure optimal diagnostic accuracy while avoiding unnecessary or unjustified radiation exposure? This is similar to knowing what temperature to set the oven at and how long to leave a dish in the oven.
5. What is the impact of reducing frame rate on diagnostic accuracy? This is comparable to leaving ingredients out of your recipe. Conducting a VFSS with a frame rate lower than 30 frames per second means that the recorded examination is missing information, such as evidence of aspiration. This can result in incorrect exam results or a need for longer exams in order to collect sufficient evidence to confirm the presence of a problem—like a cupcake that needs more time baking.

All of these questions are covered in the new MedBridge 7-part series certificate program: Foundations of Best Practice in Videofluoroscopy, found in the Course Catalog.