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. 2024 Oct;281(10):5527-5533.
doi: 10.1007/s00405-024-08785-9. Epub 2024 Jul 8.

Bedside diagnosis of silent aspiration using mobile dynamic digital radiography: a preliminary study

Yuji Koyama  1   2 , Yukuo Morohoshi R A  3 , Tetsuji Ohta Slp  4 , Minoru Toyokura  5 , Katsuhiro Mizuno  5 , Yoshihisa Masakado  5
Affiliations

Bedside diagnosis of silent aspiration using mobile dynamic digital radiography: a preliminary study

Yuji Koyama et al. Eur Arch Otorhinolaryngol. 2024 Oct.

Abstract

Purpose: This study aimed to assess reliable options for bedside diagnosis of silent aspiration in the intensive care unit by examining the use of default grayscale images (DGI) obtained using a mobile, general-purpose, radiography system capable of dynamic digital radiography (M-DDR) and inverted grayscale images (IGI) of DGI.

Methods: This cohort study (exploratory and preliminary) involved 18 adult patients (mean age, 89.0 years) for whom a swallowing assessment request was received from their primary physicians. Fifty-six IGI videoclips were evaluated by three specialists using the penetration-aspiration scale (PAS), with the gold standard being the consensus reading of all three specialists. Another three speech-language pathologists (SLPs) assessed 56 DGI and IGI videoclips using the PAS. PAS scores 1 and 2 were classified as normal range, PAS scores 3-5 as pathological laryngeal penetration, and PAS scores 6-8 as aspiration. The correct rates with IGI and DGI were then determined, and the level of agreement of IGI and DGI evaluations was evaluated.

Results: The correct rate of all evaluators was 100% for normal range, 80-100% for pathological laryngeal penetration, and 83-100% for aspiration with IGI and 100% for normal range, 90% for pathological laryngeal penetration, and 83% for aspiration with DGI. The kappa coefficient for IGI and DGI showed almost complete agreement for abnormal conditions.

Conclusion: Dynamic imaging of swallowing 2-5 ml of liquid using M-DDR performed for elderly patients at the bedside showed that aspiration assessments by SLPs obtained from DGI videos immediately after imaging are acceptable.

Keywords: Bedside diagnosis; Mobile dynamic digital radiography; Silent aspiration; Speech-language pathologists.

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Conflict of interest statement

This study was reviewed for conflicts of interest by the Tokai University Isehara Campus Conflicts of Interest Management Committee. The provision of the DDR imaging system was confirmed to have not adversely affected the transparency of study implementation or the reliability of the results, and approval was obtained.

Figures

Fig. 1
Fig. 1
Bedside diagnosis of silent aspiration using mobile dynamic digital radiography. (a) The tube is turned toward the window side where no people are present, and the detector is affixed to a holder at the side of the patient. (b) Barium swallow is conducted using a 5-ml syringe under lateral imaging. (c) Videoclips are reproduced on the M-DDR monitor immediately after imaging to confirm whether aspiration is present
Fig. 2
Fig. 2
Default grayscale images and inverted grayscale images. From 1 to 6, chronological changes of swallowing. (a) Default grayscale images. (b) Inverted grayscale images
See this image and copyright information in PMC

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