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Radiation Risks to Adult Patients Undergoing Modified Barium Swallow Studies

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Abstract

Modified Barium Swallow Studies (MBSSs) are a fluoroscopic exam that exposes patients to ionizing radiation. Even though radiation exposure from MBSSs is relatively small, it is necessary to understand the excess cancer risk to the patient, in order to ensure a high benefit-to-risk ratio from the exam. This investigation was aimed at estimating the excess radiation risks during MBSSs. We examined 53 adult MBSSs performed using the full Modified Barium Swallow Impairment Profile (MBSImP) protocol. For each exam, the radiation dose (in terms of dose area product), patient age, and sex was recorded. Using published methodology, we determined the effective dose and organ specific dose then used BEIR VII data to calculate the excess cancer incidence related to radiation exposure from MBSSs in adults. Excess cancer incidence risks due to MBSSs were 11 per million exposed patients for 20-year-old males, 32 per million exposed patients for 20-year-old females, 4.9 per million exposed patients for 60-year-old males, and 7.2 per million exposed patients for 60-year-old females. Radiation exposure to the thyroid, lung, and red bone marrow contributed over 90% of the total cancer incidence risk. For the 20-year-old males, the excess cancer incidence risk is 4.7%/Sv, which is reduced to 1.0%/Sv in the 80-year-olds. For the 20-year-old females, the excess cancer incidence risk is 14%/Sv, which is reduced to 1.3%/Sv for 80-year-olds. Overall, the risk per unit effective dose from MBSSs is lower than the risk estimates for uniform whole-body irradiation. Patient age is the most important determinant of patient cancer risk from MBSSs.

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Authors and Affiliations

  1. Health Sciences and Research, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC, 29425-2503, USA

    Heather Shaw Bonilha & Janina Wilmskoetter

  2. Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Ave, MSC 550, Charleston, SC, 29425, USA

    Heather Shaw Bonilha

  3. Department of Radiology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH, 03766, USA

    Walter Huda

  4. Communication Sciences and Disorders, Northwestern University, 70 Arts Circle Dr, Evanston, IL, 60208, USA

    Bonnie Martin-Harris

  5. Edward Hines, Jr. VA Hospital, 5000 South 5th Avenue, Hines, IL, 60141, USA

    Bonnie Martin-Harris

  6. Department of Radiology and Radiological Science, Medical University of South Carolina, 96 Jonathan Lucas St, MSC 323, Charleston, SC, 29425-3230, USA

    Sameer V. Tipnis

Authors
  1. Heather Shaw Bonilha
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  2. Walter Huda
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  3. Janina Wilmskoetter
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  4. Bonnie Martin-Harris
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  5. Sameer V. Tipnis
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Correspondence to Heather Shaw Bonilha.

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All authors declare that they have no conflict of interest.

Ethical Approval

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.

Informed Consent

The research study protocol was reviewed by our IRB who deemed that informed consent should be waived as MBSSs were standard of care and de-identified prior to research use.

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Bonilha, H.S., Huda, W., Wilmskoetter, J. et al. Radiation Risks to Adult Patients Undergoing Modified Barium Swallow Studies. Dysphagia 34, 922–929 (2019). https://doi.org/10.1007/s00455-019-09993-w

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  • DOI: https://doi.org/10.1007/s00455-019-09993-w

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