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Does Reducing Videofluoroscopy Frame Rate Affect DIGEST Grades in Modified Barium Swallow Studies?

Shitong Mao1, Carla L Warneke2, Sheila N Buoy1

  • 1Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., 77030, Houston, TX, USA.

Dysphagia
|May 16, 2025
PubMed

Insights

The Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) system reliably assesses swallowing safety and efficiency, even with reduced Modified Barium Swallow (MBS) frame rates. This finding supports using lower frame rates in clinical practice.

Area of Science:

  • Medical Imaging
  • Speech-Language Pathology
  • Gastroenterology

Background:

  • Modified Barium Swallow (MBS) studies are crucial for assessing swallowing disorders.
  • Reduced frame rates in MBS may impact the reliability of swallowing safety and efficiency ratings.
  • The impact of frame rate reduction on the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) system is not well understood.

Purpose of the Study:

  • To evaluate the reliability of the DIGEST grading system under reduced frame rates (30, 15, and 7.5 FPS).
  • To determine if frame rate variations affect the assessment of swallowing safety and efficiency using the DIGEST system.

Main Methods:

  • Analysis of 315 Modified Barium Swallow (MBS) videos from 278 patients, predominantly those with head and neck cancer.
  • Pairwise comparison of DIGEST grades and its components (Safety, Efficiency) at different simulated frame rates (30, 15, 7.5 FPS).
  • Statistical analysis using Weighted Cohen's kappa and exact agreement metrics.

Main Results:

  • Weighted Cohen's kappa values consistently exceeded 0.84, indicating "almost perfect" agreement across all frame rate comparisons.
  • Exact agreement for all DIGEST grade comparisons surpassed 85%.
  • The DIGEST system demonstrated high reliability irrespective of the tested frame rates.

Conclusions:

  • The Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) system is robust to variations in frame rate.
  • Reduced frame rates do not compromise the reliability of DIGEST assessments for swallowing safety and efficiency.
  • Findings support the potential use of lower frame rates in clinical MBS studies without sacrificing diagnostic accuracy.

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