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Current practice in paediatric videofluoroscopy

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Abstract

Use of the videofluoroscopy swallow study (VFSS), also known as the modified barium swallow (MBS), continues to increase in children. This article reviews the scope and limitations of the examination, explores the current techniques and illustrates some of the main findings. As moving images are key to the understanding of the use of this technique short videos are available in the on-line version of this paper.

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Authors and Affiliations

  1. Department of Radiology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK

    Melanie P. Hiorns

  2. Department of Speech and Language Therapy, Great Ormond Street Hospital for Children, London, UK

    Martina M. Ryan

Authors
  1. Melanie P. Hiorns
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  2. Martina M. Ryan
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Correspondence to Melanie P. Hiorns.

Electronic supplementary material

Normal rapid swallowing in an 8-year-ols child. Although the radiographic coning could be tighter for some parts of the sequence the childs movement demonstrates how difficult it can be to keep the patient in view (MPG 3.8 kb)

An infant swallow. The study starts with normal rapid swallowing but this soon slows and the trigger becomes more delayed. Although aspiration is not seen the swallow becomes more risky as time progresses (MPG 5 kb)

The first two swallows are within normal limits. The third swallow shows some delay in the trigger and there is some residue after passage of the bolus. There is delay in triggering the swallow with barium filling the pharynx before the bolus is passed. On the fourth swallow an episode of aspiration is noted before repeated penetration and then finally gross and repeated aspiration. The trachea is outlined on its anterior and posterior aspects by the barium. (The radio-opaque artefacts projected over the skull base are earrings) (MPG 1.6 kb)

Barium outlines the valleculae and the piriform fossae. There is a very delayed trigger with barium filling much of the pharynx with some nasopharyngeal reflux. As residue fails to clear, barium then spills over into the airway, first as penetration and then as aspiration (MPG 5.8 kb)

Rapid swallowing in an infant. There is a very rapid early episode of epiglottic undercoating and then as the study proceeds the upper oesophageal sphincter fails to open in a normal manner leading to aspiration (MPG 1.2 kb)

An example of a suboptimal study. The radiographic coning is poor with too much of the shoulders and too much of the skull being included. The helpers hand is briefly in the image and there are quite long periods of screening when the child is not actively swallowing, but is still being irradiated. Towards the end of the study, the upper part of the phatynx is coned off (MPG 11 kb)

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Hiorns, M.P., Ryan, M.M. Current practice in paediatric videofluoroscopy. Pediatr Radiol 36, 911–919 (2006). https://doi.org/10.1007/s00247-006-0124-3

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  • DOI: https://doi.org/10.1007/s00247-006-0124-3

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