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Videofluoroscopic swallow studies (VFSS) are an important part of the diagnostic toolkit and arguably the current gold-standard for assessing swallow biomechanics and diagnosing dysphagia. However, the procedure does involve exposure to radiation, and any clinician requesting this should be able to justify the medical need for each patient. The authors of this paper provide an excellent overview of some of the important considerations and knowledge concepts around radiation dose to inform decision-making and justification. The paper follows a question-and-answer format in which key topics are covered: This includes: ionising radiation and dose, image quality and fluoroscopy systems, radiation protection principles and practice, maximising diagnostic benefit and minimising patient and clinician risk and, finally, a section on best practices for balancing risk and benefit in VFSS. Further to this, the authors also offer excellent guidance on practical issues for clinicians involved in undertaking the procedure, such as selecting frame rate and pulse rate to optimise the diagnostic yield. Importantly, the paper also provides a useful reference for average dose for a standardised VFSS protocol (0.27mSv) which correlates to about 32 days of natural background radiation. The average dose for a VFSS is also compared to other average doses for common imaging procedures which may help in the risk-benefit decision. Recommended reading for clinicians performing VFSS and for researchers who may be including VFSS in their research protocols.

A Tutorial on Diagnostic Benefit and Radiation Risk in Videofluoroscopic Swallowing Studies.
Ingleby HR, Bonilha HS, Steele CM.
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Roganie Govender

University College London, Head & Neck Academic Centre, UK.

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