Abstract
Purpose
Formal agreement studies on interpretation of the videofluoroscopic swallowing study (VFSS) procedure among speech-language pathologists, radiology house officers, and staff radiologists have not been pursued. Each of these professions participates in the procedure, interprets the examination, and writes separate reports on the findings. The aim of this study was to determine reliability of interpretation between and within the disciplines and to determine if structured training improved reliability.
Methods
Thirteen speech-language pathologists (SLPs), ten diagnostic radiologists (RADs) and twenty-one diagnostic radiology house officers (HOs) participated in this study. Each group viewed 24 VFSS samples and rated the presence or absence of seven aberrant swallowing features as well as the presence of dysphagia and identification of oral dysphagia, pharyngeal dysphagia, or both. During part two, the groups were provided with a training session on normal and abnormal swallowing, using different VFSS samples from those in part one, followed by re-rating of the original 24 VFSS samples. A generalized estimating equations (GEE) approach with a binomial link function was used to examine each question separately. For each cluster of tests, as example, all pairwise comparisons between the three groups in the pretraining period, a Hochberg’s correction for multiple testing was used to determine significance. A GEE approach with a binomial link function was used to compare the premeasure to postmeasure for each of the three groups of raters stratified by experience.
Results
The primary result revealed that the HO group scored significantly lower than the SLP and RAD group on identification of the presence of dysphagia (p = 0.008; p = 0.001, respectively), identification of oral phase dysphagia (p = 0.003; p = 0.001, respectively), and identification of both oral and pharyngeal phase dysphagia, (p = 0.014, p = 0.001, respectively) pretraining. Post training there was no statistically significant difference between the three groups on identification of dysphagia and identification of combined oral and pharyngeal dysphagia.
Conclusions
Formal training to identify oropharyngeal dysphagia characteristics appears to improve accuracy of interpretation of the VFSS procedure for radiology house officers. Consideration to include formal training in this area for radiology residency training programs is recommended.
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References
Logemann J (1983) Evaluation and treatment of swallowing disorders. Boston: College-Hill Publication
Groher M (1984) Dysphagia diagnosis and management. Boston: Butterworths
Wooi M, Scott A, Perry A (2001) Teaching speech pathology students the interpretation of videofluoroscopic swallowing studies. Dysphagia 16:32–39
Stoeckli SJ, Huisman TAGM, Seifert B, Martin-Harris BJW (2003) Interrater reliability of videofluoroscopic swallowing evaluation. Dysphagia 18:53–57
McCullough GH, Wertz RT, Rosenbeck JC, et al. (2001) Inter- and intrajudge reliability for videofluoroscopic swallowing evaluation measures. Dysphagia 16:110–118
Wilcox F, Liss JM, Siegel GM (1996) Interjudge agreement in videofluoroscopic studies of swallowing. J Sp Hr Res 39:144–152
Scott A, Perry A, Bench J (1998) A study of interrater reliability when using videofluoroscopy as an assessment of swallowing. Dysphagia 13:223–227
Ekberg O, Nylander G, Fork FT, et al. (1988) Interobserver variability in cineradiographic assessment of pharyngeal function during swallow. Dysphagia 3:46–48
Kuhlemeier KV, Yates P, Palmer JB (1998) Intra- and interrater variation in the evaluation of videofluorographic swallowing studies. Dysphagia 3:142–147
Gibson E, Phyland D, Marschner I (1995) Rater reliability of the modified barium swallow. Austral J Hum Commun Disord 23(2):54–60
Kerlikowske K, Grady D, Barclay J, et al. (1998) Variability and accuracy in mammographic interpretation using the American college of radiology breast imaging reporting and data system. J Natl Cancer Inst 90(23):1801–1809
Bryant KN, Finnegan E, Berbaum K (2012) VFS interjudge reliability using a free and directed search. Dysphagia 27:53–63
Berbaum K, Franken EA, Caldwell RT, Schartz KM (2006) Can a checklist reduce sos errors in chest radiography? Acad Radiol 13:296–304
Martin-Harris B, Brodsky M, Michel Y, et al. (2008) MBS measurement tool for swallow impairment-MBSImp: establishing a standard. Dysphagia 23:392–405
Jones J (2017) Case study: collaboration comes standard. Am Coll Rad Imaging 3:1–4
Dodds WJ, Logemann JA, Stewart ET (1990) Radiologic assessment of abnormal oral and pharyngeal phases of swallowing. AJR 154:965–974
Rosenbeck JC, Robbins J, Roecker EB, Coyle JL, Wood JL (1996) A penetration-aspiration scale. Dysphagia 11:93–98
Mason RJ, Bremner CG, DeMeester TL, et al. (1998) Pharyngeal swallowing disorders: selection for and outcome after myotomy. Ann Surg 228(4):598–608
Jamadar DA, Carlos R, Caoili EM, et al. (2005) Estimating the effects of informal radiology resident teaching on radiologist productivity:what is the cost of teaching? Acad Radiol 12:123–128
Donovan A (2001) Radiology resident teaching skills improvement. Acad Radiol 18(4):518–524
American Board of Radiology. www.theabr.org.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this study, informed consent was waived by the institutional review board where the study took place.
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Silbergleit, A.K., Cook, D., Kienzle, S. et al. Impact of formal training on agreement of videofluoroscopic swallowing study interpretation across and within disciplines. Abdom Radiol 43, 2938–2944 (2018). https://doi.org/10.1007/s00261-018-1587-z
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DOI: https://doi.org/10.1007/s00261-018-1587-z