title: Concordance Between Aspiration Detected on Upper Gastrointestinal Series and Videofluoroscopic Swallow Study in Bottle-Fed Children.
abstract: The increasing incidence of pediatric dysphagia has raised questions about how to identify children at risk for aspiration. Multiple investigative imaging modalities are considered in diagnostic algorithms, since dysphagia may involve any or all phases of swallowing. Although upper gastrointestinal (UGI) series and videofluoroscopic swallow study (VFSS) are common procedures, the utility of UGI for detection of aspiration and the impact of oropharyngeal imaging during UGI on radiation exposure have not been well described. We hypothesized that diagnosis of aspiration on UGI would be predictive of aspiration on VFSS and screening swallows during UGI would increase radiation exposure. A retrospective review was completed of bottle-fed children undergoing UGI series within 1 month before/after standardized VFSS. UGI was imaged at 3 frames per second (fps) pulsed and VFSS at 30 fps continuous fluoroscopy. Cumulative radiation dose (CD) and dose area product (DAP) were recorded. VFSS and UGI were performed in 49 patients; however, only 21 (43 %) had documentation of swallow function on an UGI series. All children with aspiration on UGI demonstrated thin liquid aspiration on VFSS; however, 53 % without aspiration on UGI aspirated on VFSS. CD for UGI with versus without swallowing documentation was significantly higher (median = 0.33 vs. 0.21 mGy, p = 0.02) but within variability ranges reported for fluoroscopy equipment. DAP was not significantly higher for UGI with documentation of swallowing compared to without documentation of swallowing (median = 4.11 vs. 3.02 μGy cm(2), p = 0.09). UGI findings are specific but not sensitive markers for aspiration on VFSS. Imaging of swallowing on UGI may have an appreciable increase on radiation exposure.
authors.affiliation: Division of Pediatric Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Sheikh Zayed Tower, Room 4174, 1800 Orleans Street, Baltimore, MD, 21287, USA.
authors.forename: Renee
authors.initials: R
authors.lastname: Flax-Goldenberg
authors.affiliation: The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, 601 N. Caroline Street, Room 4210, Baltimore, MD, 21287, USA.
authors.forename: Kopal S
authors.initials: KS
authors.lastname: Kulkarni
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, 2024 East Monument Street, Suite 2-500, Baltimore, MD, 21287, USA.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Carson
authors.affiliation: Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, Johns Hopkins University School of Medicine, David M. Rubenstein Building, 200 North Wolfe Street, Baltimore, MD, 21287, USA.
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Pinto
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, College of Medicine, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC, 29425, USA.|Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston, SC, 29425, USA.|Ralph H. Johnson Veterans Affairs Medical Center , Charleston, SC, 29425, USA.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Martin-Harris
authors.affiliation: Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, Johns Hopkins University School of Medicine, David M. Rubenstein Building, 200 North Wolfe Street, Baltimore, MD, 21287, USA. mlefton@jhmi.edu.|Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA. mlefton@jhmi.edu.|Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA. mlefton@jhmi.edu.
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Lefton-Greif
mesh_terms: D001903:Bottle Feeding; D002675:Child, Preschool; D002933:Cineradiography / Q000379:methods; D003679:Deglutition / Q000502:physiology; D003680:Deglutition Disorders / Q000000981:diagnostic imaging*; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009960:Oropharynx / Q000000981:diagnostic imaging* / Q000503:physiopathology; D000069079:Radiation Exposure / Q000032:analysis; D011859:Radiography / Q000379:methods*; D015203:Reproducibility of Results; D053120:Respiratory Aspiration / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
keywords: Aspiration; Children; Deglutition; Radiation dosage; UGI; VFSS