Common indications
dysphagia (difficulty swallowing) due to neurological or structural disorders
eval of aspiration risk in stroke, ALS< parkinsons, or myasthenia gravis
post surgical assessment of swallowing function
assessment of oropharyngeal dysphagia and esophageal motility issues
eval of zenkers diverticulum, pharyngeal constriction or weak swallowing reflex
absolute contraindications
severe respiratory distress or uncooperative patient who cannot safely swallowing contrast
known severe contrast allergy
severe aspiration risk without airway protection
relative contraindications
recent aspiration pneumonia
patients with suspected esophageal perforation (water-soluble instead)
fluoroscopy equipment and contrast supplies needed
fluoro unit
barium sulgate suspection in different consistencies (thick, nectar-thick, honey-thick, and pudding thick)
water-soluble contrast if perforation is suspected
effervescent granules (if needed to assess reflux or esophageal clearance)
various swallowing materials (applesauce, pudding, crackers, thickened liquids, solid food)
positioning and supportive equipment needed
adjustable fluoroscopy chair
spoons, straws, and cups for controlled contrast administration
suction equipment in case of aspiration
speech language pathologist (SLP) to guide the study
pre-procedural prep
patient fasting (NPO for at least 4 hours)
collab with speech
patient education (explain swallowing instructions like single sips, sequential swallowing, controlled bolus intake)
What scout images are taken and why?
AP and lateral views of the oropharynx and upper esophagus to assess structural abnormalities before swallowing contrast
what is the perferred patient positioning?
upright in fluoroscopy chair
What is the sequence different consistencies?
thin liquid barium, nectar thick, honey thick, pudding thick, soft solid, hard solid
What do the different contrast consistencies eval?
bolus formation, oral propulsion, pharyngeal transit, and esophageal clearance
What is the lateral view eval?
oral, pharyngeal and laryngeal function, aspiration risk, and penertration
What is the AP view used for?
assesses symmetry of bolus passage and pharyngeal constriction
What is the oblique view used for?
used if abnormal anatomy prevents clear lateral or AP visualization (35-40 degrees)
What modification would you do if there was a severe aspiration risk?
use smaller bolus volumes or thickened liquids
What modifications would you do if there was oral weakness or poor coordination?
modify with positioning maneuvers (chin tuck, head turn)
What modificaiton would you make if there was a suspected esophageal dysfunction?
extend study into esophageal transit assessment
What modification would you make for neurologic patients (stoke, ALS, parkinsons)?
consider compensatory swallowing strategies
What is aspiration and what can it cause?
contrast enters the trachea, can cause pneumonia, requires swallowing therapy
What is penetration and what does it indicate?
contrast enters laryngeal vestibule but does not go below the vocal cords, indicates high aspiration risk
What is delayed pharyngeal swallow and what patients is it usually seen in?
bolus stagnates in vallecula or piriform sinuses before triggering swallow, seen in stroke and neurological disorders
What is weak pharyngeal constriction and what can it lead to?
residual contrast in pharynx after swallow, can lead to chronic aspiration and malnutrition
What is cricopharyngeal dysfunction and what may it require?
bolus stops at upper esophageal sphincter, may require dilation or botox therapy
What is esophageal retention and what does it suggest?
delayed passage of bolus into the stomach, suggests GERD, achalasia, or esophageal dysmotility
What is considered diagnostic success?
bolus movement through the oral, pharyngeal, and esophageal phases is visualized without aspiration
no excessive pharyngeal residue or impaired clearance
correct identification of aspiration risk and safe swallowing strategies
