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Influence of frame rate in detecting oropharyngeal aspiration in paediatric videofluoroscopic swallow studies - An
Thuy T Frakking1, Michael David2, Anne B Chang3
1Research Development Unit, Caboolture Hospital, Queensland Health, McKean St, Caboolture 4510, Queensland, Australia; Child Health Research Centre, Faculty of Medicine, The University of Queensland, Herston 4101, Queensland, Australia; Speech Pathology Department, Gold Coast University Hospital, 1 Hospital Boulevard, Southport 4215, Queensland, Australia; School of Health Sciences & Social Work, Griffith University, 1 Parklands Drive, Southport, Gold Coast 4222, Queensland, Australia.
Insights
Lowering radiation dose in pediatric videofluoroscopic swallow studies (VFSS) is possible. A 15 frames per second (fps) capture rate is as accurate as 30fps for detecting aspiration in children, especially with thin fluids.
Area of Science:
- Pediatric radiology
- Swallowing disorders
- Medical imaging
Background:
- Videofluoroscopic swallow study (VFSS) is the gold standard for assessing aspiration in children.
- Minimizing radiation exposure, adhering to the ALARA principle, is critical in pediatric imaging.
- Current adult guidelines suggest 30 frames per second (fps) for VFSS, but optimal pediatric rates, especially for thin fluids, are unclear.
Purpose of the Study:
- To determine if a 15fps capture rate alters aspiration detection accuracy compared to 30fps in pediatric VFSS.
- To evaluate the diagnostic performance of lower frame rates for thin fluid consistencies.
Main Methods:
- Seventeen speech-language pathologists (SLPs) evaluated 2,356 swallow loops from 13 children.
- Swallow loops were randomly presented at 15fps and 30fps for aspiration presence/absence rating.
- Area under the receiver operating curve (aROC) compared accuracy; intraclass correlation coefficient (ICC) assessed rater reliability.
Main Results:
- Aspiration detection accuracy was nearly identical between 15fps (aROC: 0.97) and 30fps (aROC: 0.96).
- High inter-rater (ICC: 0.82) and intra-rater (ICC: 0.89) reliability were observed.
- No significant difference in diagnostic accuracy was found between the two frame rates.
Conclusions:
- A 15fps capture rate is as effective as 30fps for detecting aspiration of thin fluids in pediatric VFSS.
- Implementing 15fps can reduce radiation dose in line with ALARA principles.
- 15fps is recommended for pediatric VFSS when assessing thin fluid aspiration.
Objectives:
The videofluoroscopic swallow study (VFSS), currently the gold standard for assessing aspiration in children, incurs radiation. Adhering to the ALARA principle is crucial in minimising radiation dose whilst obtaining accurate diagnostic information in children. International adult VFSS guidelines recommend a capture rate of 30 frames per second (fps). Higher capture rates increase radiation yet there is limited evidence on best practice VFSS capture rates in children, particularly on thin fluid consistency-the fastest viscosity with the highest potential for missed aspiration on slower capture rates. We aimed to determine if image acquisition at 30fps versus 15fps alters the accuracy of detecting aspiration when assessing thin fluids during paediatric VFSS.
Materials & Methods:
Seventeen speech language pathologists (SLPs) blindly rated a total of 2,356 swallow loops for the presence/absence of aspiration from VFSS recordings of 13 infants/children drinking thin fluids. 76 swallow loops were randomly presented at 15 versus 30fps, on two occasions. Area under receiver operating curve (aROCs) was used to compare the accuracy of aspiration ratings at 15 versus 30fps compared to a comparison set. The intraclass correlation coefficient (ICC) was used to examine rater reliability.
Results:
Accuracy for detecting aspiration was near-identical at 15fps (aROC:0.97; 95%CI:0.96-0.97) and 30fps (0.96; 95%CI 0.96-0.97). Good inter-rater (ICC:0.82; 95%CI:0.72-0.89) and intra-rater reliability among the raters (ICC:0.89; 95%CI:0.82-0.93) was found.
Conclusion:
Using 15fps in paediatric VFSS when assessing thin fluid consistency aspiration provides a similar detection rate to using 30fps. As 15fps would have a lower radiation dose than 30fps, we recommend using 15fps when undertaking VFSS in children.
Clinical Relevance Statement:
Adhering to the ALARA principles, a capture rate of 15fps should be used in paediatric VFSS for assessment on thin fluids.
