title: The use of low-osmolar water-soluble contrast in videofluoroscopic swallowing exams.
abstract: The selection of the contrast agent used during fluoroscopic exams is an important clinical decision. The purpose of this article is to document the usage of a nonionic, water-soluble contrast (iohexol) and barium contrast in adult patients undergoing fluoroscopic exams of the pharynx and/or esophagus and provide clinical indications for the use of each. For 1 year, data were collected on the use of iohexol and barium during fluoroscopic exams. The contrast agent used was selected by the speech language pathologist (SLP) or the radiologist based on the exam's indications. A total of 1,978 fluoroscopic exams were completed in the 12-month period of documentation. Of these exams, 60.6 % were completed for medical reasons and 39.4 % for surgical reasons. Fifty-five percent of the exams were performed jointly by a SLP and a radiologist and 45 % were performed by a radiologist alone. Aspiration was present in 22 % of the exams, vestibular penetration occurred in 38 %, extraluminal leakage of contrast was observed in 4.6 %, and both aspiration and leakage were seen in 1 % of the exams. In cases with aspiration, iohexol was used alone in 8 %, iohexol and barium were both used in 45 %, and barium was used alone in 47 %. In cases with extraluminal leakage, iohexol was used alone in 58 %, iohexol and barium were both used in 31 %, and barium was used alone in 11 %. No adverse effects were seen with the use of iohexol. When barium was used in cases of aspiration and extraluminal leakage, the amount of aspirated barium was small and the extraluminal barium in the instances of leakage was small. Iohexol is a useful screening contrast agent and can safely provide information, and its use reduces the risk of aspiration and the chance of leakage of large amounts of barium.
authors.affiliation: Physical and Rehabilitation Medicine, Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, MD, 21287, USA, jalspau1@jhmi.edu.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Harris
authors.forename: Detlef
authors.initials: D
authors.lastname: Bartelt
authors.forename: Molly
authors.initials: M
authors.lastname: Campion
authors.forename: Bob W
authors.initials: BW
authors.lastname: Gayler
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Jones
authors.forename: Andrea
authors.initials: A
authors.lastname: Hayes
authors.forename: Judith
authors.initials: J
authors.lastname: Haynos
authors.forename: Seanne
authors.initials: S
authors.lastname: Herbick
authors.forename: Therese
authors.initials: T
authors.lastname: Kling
authors.forename: Arpana
authors.initials: A
authors.lastname: Lingaraj
authors.forename: Michele
authors.initials: M
authors.lastname: Singer
authors.forename: Heather
authors.initials: H
authors.lastname: Starmer
authors.forename: Christine
authors.initials: C
authors.lastname: Smith
authors.forename: Kim
authors.initials: K
authors.lastname: Webster
mesh_terms: D057868:Anastomotic Leak / Q000000981:diagnostic imaging; D003287:Contrast Media / Q000009:adverse effects; D003679:Deglutition; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging*; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D007472:Iohexol / Q000009:adverse effects; D009994:Osmolar Concentration; D053120:Respiratory Aspiration / Q000000981:diagnostic imaging*; D012995:Solubility; D014741:Video Recording; D014867:Water
chemical_list: D003287:Contrast Media; D014867:Water; D007472:Iohexol