Recently, there has been increasing discussion in clinical meetings about the use of ionising radiation in swallowing assessments and the associated cancer risks. This is therefore a timely publication to inform discussions around whether reducing pulse rate from 30 pulses per second (pps) to lower (15 or 7.5) during an x-ray swallow, is an appropriate strategy for reducing radiation exposure. The authors of this paper have done considerable work in this field and are well-regarded experts on the topic. They propose that whilst decreasing pulse rate may reduce radiation exposure, it also reduces the number of unique images that can be captured during the oropharyngeal swallow which only lasts about one second. They argue that specific physiological components of the swallow occur in tight synchrony and may not be captured at pulse rates lower than 30. This compromises the diagnostic accuracy of the procedure and the clinician’s ability to identify relevant targets for treatment. They examined the swallow studies of 200 participants across a wide age and diagnosis range. They found that 12 of the 17 components of the Modified Barium Swallow Impairment Profile were impacted when pulse rates were reduced from 30 to 15 pps. They therefore advocate that given the very low cancer risks associated with videofluoroscopy in adults, together with the poor diagnostic yield and compromise to clinical judgements, the lower rate of 15 pps should be avoided. Changing from 30 pps to 15 pps is not aligned with the ALARA principle (As Low As Reasonably Achievable) as it compromises diagnostic accuracy.
Reducing pulse rate in videofluoroscopy: less is not best!
Reviewed by Roganie Govender
Impact of Reducing Fluoroscopy Pulse Rate on Adult Modified Barium Swallow Studies.
CONTRIBUTOR
Roganie Govender
University College London, Head & Neck Academic Centre, UK.
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