Technical Aspects of a Videofluoroscopic Swallowing Study

Dysphagia management has become a core area of practice for Speech-Language Pathologists (S-LPs). Videofluoroscopy is a readily available tool used to determine swallowing safety and efficiency as characterized by airway protection, penetration or aspiration and excess oral or pharyngeal residue. Performing a swallowing study successfully requires proper balance of many features. While many of the technical aspects are controlled by the radiology staff, it is important for the conducting S-LP to have a basic understanding of the technical aspects that can impact the quality and integrity of the video. This article describes the types of fluoroscope available, factors influencing the image contrast, the creation of a contrast impregnated fluid, imaging techniques (pulsed versus continuous), imaging resolution (spatial and temporal) and safety considerations. This article hopes to clarify concepts to avoid future misuse of fluoroscopic imaging terminology as applied to a swallowing study. In addition, this article hopes to provide the foundations for S-LPs to be able to communicate effectively with the radiology staff, as the optimal videofluoroscopic exam can only be successfully obtained when both parties work together as a team.