Effect of a standardized fluoroscopic procedural approach on fluoroscopy time during infant modified barium swallow studies

Background: Pediatric dysphagia is a term used to describe dysfunctional feeding and swallowing in infants and children. It is estimated that about 1% of children in the United States are affected by these swallowing problems annually. The modified barium swallow study (MBSS) is considered by many as the gold standard in oropharyngeal swallowing assessment. Despite its diagnostic benefits, MBSS exposes infants to ionizing radiation, which carries potentially deleterious long-term effects for the pediatric population. Objectives: Test the effect of a standardized MBSS procedural protocol on fluoroscopy time when compared to a non-standardized procedural approach. Materials and methods: A retrospective review of infants ≤12 months who underwent a MBSS between 2011 and 2017 was conducted. Charts were reviewed for fluoroscopy time, age, primary diagnosis, MBSS indication, and severity of swallowing deficits. Infants were categorized as non-protocol or standardized protocol based on the utilized method of videofluoroscopic swallow study execution. Results: A total of 1378 MBSS’ were included in the analysis. Swallow studies conducted using the standardized procedural protocol had significantly shorter fluoroscopy times (1.5 min) when compared to non-protocol group (2.0 min) (p < 0.001). Patients who aspirated had significantly longer fluoroscopy times when compared to patients who did not aspirate across both groups (p < 0.001). Conclusion: Fluoroscopy time is influenced by both procedural and patient factors. Use of a standardized fluoroscopic procedural protocol appears to reduce fluoroscopy time and variability across patients.