Video Fluoroscopic Contrast Swallow Study

Patient Requirements

• Patient must be able to stand erect
• Patient must be able to understand and follow verbal instructions (check language requirements)
• Patient must be free of removable artifacts such as jewellery

Clinical History

• Post-operative patients: the surgical report must be fully explored, particularly the recency of the procedure, site of procedure

Choice of Contrast Media

• Barium
• Gastrograffin
• Omnipaque

Preparation

• If using contrast such as Iodinated contrast (Omnipaque) or Gastrograffin, perforating the marshmallow with a small blunt instrument (e.g a fill needle or the straw) can increase visibility on fluoroscopy by creating a heterogenous appearance on fluoroscopy. This is due to the perforations being filled by air bubbles/pockets of contrast.
• Add the marshmallow to the cup of contrast to maximise the time the perforations can absorb contrast

Procedure

Control Images

Acquire high-dose control images of the:

1. Lateral neck
   • collimate vertically to include hard palate
   • collimated horizontally to include cervical vertebrae and the pre-tracheal soft tissue.
2. AP neck
   • open collimation maximally in the vertical direction, include hard palate superiorly
   • limit collimation in the horizontal direction to include only
3. AP thorax
   • collimated vertically to overlap with the AP neck and include left medial subdiaphragmatic space
4. Oblique thorax
   • Left anterior oblique (30-45 degrees)
   • Right anterior oblique (30-45 degrees)

Acquisition

1. Perform a single sip-test with a small volume of plain water to observe for overt signs of aspiration (coughing).
   • If the patient unsuccessfully demonstrates a safe swallow, do not use Gastrograffin contrast
2. Position the C-arm for a lateral view of the neck to acquire the cervical oesophagus and instruct the patient to perform a swallow
   • Use a higher-frame rate (3 frames/second)
   • Collimate as per the control image
   • If there is evidence of aspiration, discontinue the study and document in the patient notes accordingly
3. Position the C-arm for an AP view of the neck and instruct the patient to perform a swallow
   • The centring point will likely be lowered
   • Collimate as per the control image
4. Rotate the C-arm for an AP view of the neck and instruct the patient to perform a swallow
5. Rotate the C-arm for a left anterior oblique view of the thorax to acquire the thoracic oesophagus and instruct the patient to perform a swallow
6. Rotate the C-arm for a right anterior oblique view of the thorax and instruct the patient to perform a swallow
7. Rotate and lower the C-arm for an AP view of the abdomen to acquire a single-shot of the upper abdomen
   • Centre and collimate to include any contrast-filled stomach and small bowel
8. Tilt the table until the patient is positioned in the Trendelenberg

• 1.  

Oropharynx

• Check for 

Preamble

A fluoroscopic/gastrograffin barium swallow has been performed.

Control images demonstrate (comment on indwelling devices and other artifacts).

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Aspiration

Indications: ?aspiration

Small/moderate/large volume penetration with/without aspiration was demonstrated at the laryngeal inlet. The patient reported being insensate/sensate to this.

Presences of Zenker’s diverticulum or pharyngeal pouch.

Presence of extrinsic compression

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Surgical Anastomosis

Indications: ?post-surgical leak

Normal

There is no evidence of extraluminal contrast pooling to suggest a leak.

Abnormal

There is evidence of extraluminal contrast pooling to suggest a leak.

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Dysmotility

Indications: globus, dysphagia to solids/liquids

Tertiary waveforms in keeping with age

Contrast retropulsion

Delayed transit of contrast, constrast stasis