Continued Relevance of Videofluoroscopy in the Evaluation of Oropharyngeal Dysphagia

Is there a doctor in the house? Roles and practices in videofluoroscopic swallowing assessment of structural abnormalities

PURPOSE

Increasingly, videofluoroscopic swallow studies are being conducted without a radiologist. This study explored current assessment of structural dysphagia in adults during videofluoroscopic swallow studies, both internationally and within the Australian context.

METHOD

A document analysis of available international videofluoroscopic swallow studies guidance regarding the use of videofluoroscopic swallow studies for structural dysphagia was performed, followed by an online survey of Australian speech-language pathologists seeking information regarding roles, practices, training, and self-perceived competence specific to interpreting structural abnormalities.

RESULT

Eleven international guidelines agreed that: a) identification of structural abnormalities is one purpose of videofluoroscopic swallow studies, b) radiologists are responsible for diagnostics, however, c) 55% conceded videofluoroscopic swallow studies takes place without a radiologist if unavailable. Of 139 Australian speech-language pathologists surveyed, only 11% reported constant radiologist presence with 84% requesting radiologists' input to review images. Fifty eight percent had received training to identify structural abnormalities. Self-perceived competence in identifying structural dysphagia was positively correlated with videofluoroscopic swallow studies experience (r = 0.43, p < 0.05).

CONCLUSION

International guidance varies in its advocacy for speech-language pathologist led videofluoroscopic swallow studies. Speech-langauge pathologists in Australia are often conducting videofluoroscopic swallow studies without a radiologist present and may need to determine when to request radiologist review of potential structural abnormalities. Speech-language pathology training and multidisciplinary clinical pathways are needed to mitigate the risk of missed structural diagnoses.

Videofluoroscopic swallow study training for radiologists-in-training: a survey of practice and training needs

BACKGROUND

There is a lack of formal, published videofluoroscopic swallow study (VFSS) training targeting radiologists, yet radiology senior medical officers and resident medical officers (i.e., radiologists-in-training, known in Australia as "registrars") are expected to be involved in VFSS interpretation of anatomical anomalies and reporting. This study investigated whether VFSS training is delivered to registrars during their specialist radiology training, whether it is a perceived need and, if so, to determine the desired content for inclusion in a targeted training package.

METHODS

A cross-sectional, mixed methods study design was used. An internet-based survey was circulated via convenience and snowball sampling to radiologists (both senior medical officers and registrars) and speech-language pathologists across Australia in October-November 2017. Surveys also were distributed to practitioners based in New Zealand and the United Kingdom, as they practised within similar health systems, and it was anticipated they may have similar VFSS training practices. The radiology survey contained 36 questions and the speech-language pathology survey contained 44 questions. Participants were asked the following: (1) Report their current VFSS radiology registrar training environment; (2) Advise whether radiology registrars need VFSS training; (3) Recommend the content, format, training intensity, and evaluation methods for an effective radiology registrar training package. Demographic data were analysed descriptively, and open-ended responses were analysed using qualitative content analysis.

RESULTS

21 radiology senior medical officers and registrars and 150 speech-language pathologists predominantly based at Australian tertiary hospital settings completed the survey. Most respondents (90.6%) identified that VFSS training is needed for radiology registrars. Only one speech-language pathologist respondent reported that they deliver VFSS training for radiology registrars. Specific content and teaching modalities for a VFSS training package, including diagnosing anatomical anomalies associated with dysphagia were recommended.

CONCLUSION

While most of the radiologists and speech-language pathologists surveyed did not deliver VFSS training to radiology registrars, they identified that targeted training is needed to improve radiology registrars' effectiveness and engagement in VFSS clinics. The training package content, format and evaluation methods recommended by participants will inform the development of a VFSS training package targeting radiology registrars to be piloted at an Australian tertiary hospital.

Understanding the role of speech language pathologists in managing dysphagia

Collaboration between nurses and speech language pathologists is vital to the screening and management of dysphagia in acute care settings. This article examines each discipline's role in caring for patients with dysphagia.