videofluoroscopy

Videofluoroscopy is a dynamic radiographic imaging technique in which X-ray fluoroscopy is used to visualize moving structures in real time. In swallowing assessment, it is commonly performed as a videofluoroscopic swallow study (VFSS) or modified barium swallow study (MBSS). The patient ingests contrast agents while a continuous X-ray video records the swallowing process, allowing assessment of the oral, pharyngeal, and esophageal phases and related airway protection.

Procedure and equipment: Conducted in radiology with a fluoroscopy unit and a video capture system. The patient is positioned seated or standing. Contrast is given as thin liquid, nectar-thin, honey-thick, and paste consistencies, often with barium or similar radiopaque substances. The clinician directs the patient through a series of swallows of varying consistencies and volumes while the video is recorded. The resulting study evaluates bolus transit, timing of movements (notably hyoid and laryngeal elevation, epiglottic closure), airway protection, and any penetration or aspiration events.

Indications and interpretation: Used to assess dysphagia, especially neurogenic disorders after stroke or brain injury, oropharyngeal phase disorders, pediatric feeding difficulties, and preoperative or postoperative swallow evaluation. Practitioners describe findings in terms of timing, efficiency, presence of penetration or aspiration, residue, and esophageal clearance. The results guide management, including postural strategies, diet modification, therapeutic exercises, or feeding method decisions.

Safety and limitations: It involves ionizing radiation; exposures are minimized by standard radiological safety practices. It requires patient cooperation and may be limited by reduced visibility in some patients or by aspiration risk during the study. It complements endoscopy and other swallow assessments, providing functional visualization rather than structural imaging alone.