VFSS, also known as modified barium swallow, is a radiographic procedure that provides a direct, dynamic view of oral, pharyngeal, and upper esophageal function during swallowing. During this procedure, the SLP presents food and liquid mixed with barium. The barium is necessary to view structures via videofluoroscopy during the swallow.
A VFSS is indicated when there is
The VFSS shows the characteristics of the swallow and the patterns of bolus movement, including, but not limited to, initiation of the swallow, nasopharyngeal reflux, pharyngeal clearance, and laryngeal penetration and aspiration.
The VFSS can also be used to explore the effectiveness of modifications to improve swallowing safety, including
Radiation safety is important for all who are present in the room during the procedure. Special care is taken to use the lowest radiation dose possible while producing the best images for evaluation.
Acceptable radiation exposure levels are set by the radiology department and controlled by the radiologist. The SLP and radiologist work together to ensure that the radiation dosage amount is As Low as Reasonably Achievable (ALARA) without affecting the accuracy of the swallowing assessment, as recommended by the International Commission on Radiological Protection (ICRP).
Adults in the fluoroscopy suite wear protective equipment (lead aprons, gloves) to minimize exposure to scattered radiation (although dosage levels for children are generally considered acceptable for adult observers). Pregnant women might not be permitted in the examining room during the study. If permitted, a pregnancy-specific lead apron is worn—be aware of facility guidelines.
Dosimeter badges are worn by the radiologist and SLP who typically conduct these studies. The badges record radiation exposure and are used in most hospitals. See ASHA’s resource on radiation safety for the SLP. See also Video Fluoroscopic Swallowing Exam (VFSE) for consumer-friendly information about this procedure.
Arvedson, J. C., & Lefton-Greif, M. A. (1998). Pediatric videofluoroscopic swallow studies: A professional manual with caregiver guidelines. San Antonio, TX: Communication Skill Builders.