Dysphagia Consultation with MassTex Imaging Show Why Choose MassTex Imaging?When to ask for a consultation? Symptoms:The modified barium swallow study (MBSS) is a widely used videofluoroscopic evaluation of the functional anatomy and physiology of the swallowing mechanism, swallowing efficiency, and airway protection. The information gained from the examination is critical for identifying and distinguishing the type and severity of physiological 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 American College of Radiology (ACR) practice parameters endorse the use of the term “MBSS” to describe this evaluation (ACR, 2017). It is important to note that different consumer and professional organizations use other terminology to describe this examination. In pediatrics, the equivalent and commonly used term is “videofluoroscopic swallow study” (VFSS). For the purpose of this review article, we will use the terminology interchangeably in the respective sections. Accurate diagnostic information attained from the MBSS, when paired with other clinical evaluations, patient history, and clinician judgment, provides the basis for determining a patient's physiological swallowing diagnoses. The MBSS is also used to identify the physiological targets for behavioral intervention that improve swallowing function. Use of a standardized, reliable, and valid protocol for acquiring and reviewing videofluoroscopic images is commonly considered best practice. It is also important to understand how accuracy may be influenced by technical parameters of the examination and to select the proper settings and requirements for the fluoroscopy unit and recording and playback devices. A risk/benefit analysis must be made related to patient safety in terms of aspiration events, as well as patient and clinician safety related to radiation exposure. Safety concerns may dictate whether an MBSS is indicated and how the examination is performed (e.g., protocol use, technical parameters). The risk/benefit analysis should be based on scientific evidence, pathophysiological reasoning, and clinical experience (Tonelli et al., 2012). Lastly, it is critical to consider the resources used for MBSS, including, but not limited to, clinician and physician training and time; efficiency and infection control issues in the fluoroscopy suite; acquisition, recording, and playback equipment; and guidelines for provider supervision. It is important to consider that MBSS best practices will often impact care not only in the inpatient/hospital setting, where the MBSS is often performed, but also in the rehabilitation, long-term care, home health, and outpatient settings where the results from the exams may be used. Collaboration between the radiologist and speech-language pathologist (SLP) assures optimized performance of the MBSS and best care for the patient. As such, this tutorial presents a series of essays by five experts who represent the interdisciplinary nature of this topic The goal of this review article is to provide the state of the science related to three main requisites of best practices: (a) acquisition of essential diagnostic information, (b) adherence with patient and clinician safety recommendations, and (c) technical standards and resource utilization.
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