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Updated: Jul 5, 2025
X-ray Dose Reduction through Adaptive Exposure in Fluoroscopic Imaging
Published on: September 11, 2011
Impact of Reducing Fluoroscopy Pulse Rate on Adult Modified Barium Swallow Studies
Heather Shaw Bonilha1,2,3, Erin L Reedy4,5,6, Janina Wilmskoetter4,7
1Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 77 President Street, MSC 700, Charleston, SC, 29425-2503, USA. hbonilha@mailbox.sc.edu.
Abstract:
Modified Barium Swallow Studies (MBSS) are a critical part of the evaluation, treatment planning, and outcome assessment for persons with swallowing disorders. Since MBSSs use ionizing radiation with associated cancer risks, many clinicians have reduced radiation exposure by reducing the fluoroscopic pulse rate. However, by reducing pulse rate, we also decrease the temporal resolution of MBSSs which has been shown in pilot studies to significantly reduce diagnostic accuracy. Two hundred MBSSs from patients routinely undergoing MBSS as standard of care conducted at 30 pulses per second (pps) using the Modified Barium Swallow Study Impairment Profile (MBSImP™) standardized administration protocol were selected. A stratified sampling method ensured that a full range of swallowing impairments (etiology, type, and severity) was represented. Recordings were down sampled from 30 pps to 15, 7.5, and 4 pps. MBSSs were rated using the MBSImP components and Penetration-Aspiration Scale (PAS) score for each swallow. Percent agreement was calculated across raters for MBSImP and PAS scores by bolus type and volume. The Least-Squares Method was used for hypothesis testing. Statistically significant and clinically meaningful changes in scores of swallowing physiology and penetration/aspiration occurred when reducing pulse rate below 30pps. These changes were evident across bolus types and volumes. Given the impact on diagnostic accuracy and the low radiation risks to adults undergoing MBSSs, reducing pulse rate to 15pps or below is not aligned with the As Low As Reasonably Achievable (ALARA) principle and should not be used as a viable method to reduce radiation exposure from MBSSs.
Insights
Reducing fluoroscopic pulse rates in Modified Barium Swallow Studies (MBSS) below 30 pulses per second significantly impacts diagnostic accuracy for swallowing disorders. Lower rates compromise evaluations, contradicting the ALARA principle for radiation exposure.
Area of Science:
- Medical Imaging
- Radiology
- Speech-Language Pathology
Background:
- Modified Barium Swallow Studies (MBSS) are essential for diagnosing and managing swallowing disorders.
- Clinicians reduce radiation exposure by lowering fluoroscopic pulse rates during MBSS.
- Lower pulse rates decrease temporal resolution, potentially reducing diagnostic accuracy.
Purpose of the Study:
- To investigate the impact of reduced fluoroscopic pulse rates on MBSS diagnostic accuracy.
- To determine if lowering pulse rates below 30 pulses per second (pps) affects swallowing physiology and penetration-aspiration scores.
Main Methods:
- Two hundred MBSS recordings at 30 pps were down sampled to 15, 7.5, and 4 pps.
- Recordings were analyzed using the Modified Barium Swallow Study Impairment Profile (MBSImP) and Penetration-Aspiration Scale (PAS).
- Statistical analysis using the Least-Squares Method assessed changes in scores across bolus types and volumes.
Main Results:
- Statistically significant and clinically meaningful changes in swallowing physiology and penetration/aspiration scores were observed when pulse rates were reduced below 30 pps.
- These changes were consistent across different bolus types and volumes.
- Reduced pulse rates below 30 pps negatively impacted diagnostic accuracy.
Conclusions:
- Reducing fluoroscopic pulse rates below 30 pps in MBSS compromises diagnostic accuracy for swallowing disorders.
- The observed impact on diagnostic accuracy outweighs the benefits of reduced radiation exposure.
- Lowering pulse rates to 15 pps or below is not advisable for MBSS and contradicts the ALARA principle.
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