Videofloroskopik yutma çalışmalarında azaltılmış kare hızının kinematik analizlere etkisi

Öz

Amaç: Videofloroskopik Yutma Çalışması (VFSS), yutma fizyolojisinin değerlendirilmesinde altın standart kabul edilmektedir. Ancak VFSS iyonizan radyasyon içerdiğinden, maruziyetin en aza indirilmesi önemlidir. Bu çalışmanın amacı, 25, 20 ve 15 kare/saniye (fps) hızında yapılan kinematik analizlerin doğruluğunu 30 fps ile karşılaştırmaktır. Yöntem: Yutma bozukluğu olmayan ve T-EAT-10 puanı <3 olan 24 sağlıklı birey (13 kadın, 11 erkek; ort. yaş 23,96 ± 3,59 yıl) çalışmaya dahil edildi. Katılımcılardan elde edilen 30 fps kuru yutma VFSS kayıtları retrospektif olarak incelendi ve MATLAB/Python kullanılarak 25, 20 ve 15 fps’ye indirildi. Hyoid’in süperior ve anterior hareketleri STAMPS yazılımı ile ölçülerek karşılaştırıldı. Bulgular: Toplam hyoid hareketi ve süperior hyoid hareketi kare hızına göre anlamlı farklılık gösterdi (p<0,001). Post-hoc analizlerinde 30 fps ile 20 fps (p<0,001) ve 15 fps (p<0,001) arasında anlamlı fark bulundu; ancak 25 fps ile 30 fps arasında fark yoktu (p=0,075). Anterior hyoid hareketi kare hızları arasında farklılık göstermedi (p=0,434). Sonuç: Kare hızının 25 fps’ye düşürülmesi total ve süperior hyoid kinematik analizlerinin doğruluğunu korurken, daha düşük kare hızları (20 ve 15 fps) doğruluğu azaltmaktadır. Bu bulgular, 25 fps'nin hyoid kinematik değerlendirmesi için yeterli olabileceğini ve aynı zamanda radyasyon maruziyetinin azaltılmasını sağlayabileceğini göstermektedir. Bu çalışma sağlıklı bireyler ve kuru yutma görevleriyle sınırlı olduğu için yutma bozukluğu olan hastalarda ve bolus yutmayı içeren daha ileri çalışmalar gereklidir.

Anahtar Kelimeler

• Yutma bozuklukları
• Larenks
• Radyasyondan korunma

Impact of reduced frame rate on kinematic analyses in videofluoroscopic swallowing studies

Öz

Purpose: Videofluoroscopic Swallowing Study (VFSS) is considered the gold standard for evaluating swallowing physiology. However, as VFSS involves ionizing radiation, minimizing exposure is crucial. This study aimed to compare the accuracy of kinematic analyses performed at 25, 20, and 15 frames per second (fps) with those obtained at 30 fps. Methods: Twenty-four healthy adults (13 women, 11 men; mean age 23.96 ± 3.59 years) without dysphagia and with T-EAT-10 scores <3 were included. VFSS recordings of dry swallow at 30 fps were retrospectively analyzed and downsampled to 25, 20, and 15 fps using MATLAB/Python. Superior and anterior hyoid displacements were measured with STAMPS software and compared across frame rates. Results: Total hyoid displacement and superior hyoid displacement significantly differed by frame rate (p<0.001). Post-hoc tests showed significant differences between 30 fps and both 20 fps (p<0.001) and 15 fps (p<0.001), but no difference between 25 fps and 30 fps (p=0.075). Anterior hyoid displacement did not differ among frame rates (p=0.434). Conclusion: Reducing the frame rate to 25 fps maintained the accuracy of total and superior hyoid displacement measurements, while lower frame rates (20 and 15 fps) reduced measurement accuracy. These findings suggest that 25 fps may be sufficient to assess hyoid kinematics while reducing radiation exposure. Since this study is limited to healthy adults and dry swallowing task, further studies including patients with dysphagia and bolus swallows are needed.

Anahtar Kelimeler

• Deglutition Disorders
• Larynx
• Radiation Protection

Kaynakça

1. 1. Rommel N, Hamdy S. Oropharyngeal dysphagia: manifestations and diagnosis. Nat Rev Gastroenterol Hepatol. 2016;13:49-59.
2. 2. Martin-Harris B, Canon CL, Bonilha HS, et al. Best practices in modified barium swallow studies. Am J Speech Lang Pathol. 2020;29:1078-1093.
3. 3. Serel Arslan S, Azola A, Sunday K, et al. Effects of submental surface electrical stimulation on swallowing kinematics in healthy adults: an error-based learning paradigm. Am J Speech Lang Pathol. 2018;27:1375-1384.
4. 4. Yaşaroğlu ÖF, Serel Arslan S, Cengiz E, et al. Swallowing kinematics and submental muscles activation during a newly designed maneuver called Mouth Open Swallowing Maneuver: A comparative study. PLoS One. 2024;19:e0299845.
5. 5. Hong JY, Hwang NK, Lee G, et al. Radiation safety in videofluoroscopic swallowing study: systematic review. Dysphagia. 2021;36:73-82.
6. 6. Bonilha HS, Huda W, Wilmskoetter J, et al. Radiation risks to adult patients undergoing modified barium swallow studies. Dysphagia. 2019;34:922-929.
7. 7. Newman B, Callahan MJ. ALARA (as low as reasonably achievable) CT 2011—executive summary. Pediatr Radiol. 2011;41:453.
8. 8. Steele CM. The blind scientists and the elephant of swallowing: a review of instrumental perspectives on swallowing physiology. J Texture Stud. 2015;46:122-137.

9. 9. Bonilha HS, Reedy EL, Wilmskoetter J, et al. Impact of reducing fluoroscopy pulse rate on adult modified barium swallow studies. Dysphagia. 2024;39:632-641.
10. 10. Mahesh M. Fluoroscopy: patient radiation exposure issues. Radiographics. 2001;21:1033-1045.
11. 11. Palmer PM, Padilla AH, Murray SC, et al. The impact of videofluoroscopic pulse rate on duration and kinematic measures in infants and adults with feeding and swallowing disorders. Dysphagia. 2025;40:118-131.
12. 12. Layly J, Marmouset F, Chassagnon G, et al. Can we reduce frame rate to 15 images per second in pediatric videofluoroscopic swallow studies? Dysphagia. 2020;35:296-300.
13. 13. Arslan SS, Demir N, Kılınç HE, et al. The ability of the Eating Assessment Tool-10 to detect aspiration in patients with neurological disorders. J Neurogastroenterol Motil. 2017;23:550.
14. 14. Demir N, Serel Arslan S, İnal Ö, et al. Reliability and validity of the Turkish eating assessment tool (T-EAT-10). Dysphagia. 2016;31:644-649.
15. 15. Lee WH, Chun C, Seo HG, et al. STAMPS: development and verification of swallowing kinematic analysis software. Biomed Eng Online. 2017;16:120.
16. 16. Lee WH, Lim MH, Nam HS, et al. Differential kinematic features of the hyoid bone during swallowing in patients with Parkinson’s disease. J Electromyogr Kinesiol. 2019;47:57-64.
17. 17. Sia I, Carvajal P, Carnaby-Mann GD, et al. Measurement of hyoid and laryngeal displacement in videofluoroscopic swallowing studies: variability, reliability, and measurement error. Dysphagia. 2012;27:192-197.
18. 18. Kim Y, McCullough GH. Maximum hyoid displacement in normal swallowing. Dysphagia. 2008;23:274-279.
19. 19. Molfenter SM, Steele CM. Use of an anatomical scalar to control for sex-based size differences in measures of hyoid excursion during swallowing. J Speech Lang Hear Res. 2014;57:768-778.
20. 20. Kim HY. Statistical notes for clinical researchers: assessing normal distribution (2) using skewness and kurtosis. Restor Dent Endod. 2013;38:52.
21. 21. Bonilha HS, Blair J, Carnes B, et al. Preliminary investigation of the effect of pulse rate on judgments of swallowing impairment and treatment recommendations. Dysphagia. 2013;28:528-538.
22. 22. Mettler FA Jr, Huda W, Yoshizumi TT, et al. Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology. 2008;248:254-263.
23. 23. Galgano S, Gauntt D, Boyd M, et al. Trade-off between pulse rate and radiation dose during modified barium swallow examination: what is the reality? Clin Radiol. 2019;74:736.e9-12.
24. 24. Molfenter SM, Steele CM. Physiological variability in the deglutition literature: hyoid and laryngeal kinematics. Dysphagia. 2011;26:67-74.
25. 25. Nagy A, Molfenter SM, Péladeau-Pigeon M, et al. The effect of bolus volume on hyoid kinematics in healthy swallowing. Biomed Res Int. 2014;2014:738971.
26. 26. Zhang Z, Perera S, Donohue C, et al. The prediction of risk of penetration–aspiration via hyoid bone displacement features. Dysphagia. 2020;35:66-72.
27. 27. Ishida R, Palmer JB, Hiiemae KM. Hyoid motion during swallowing: factors affecting forward and upward displacement. Dysphagia. 2002;17:262-272.
28. 28. Lee YS, Lee KE, Kang Y, Im Yi T, Kim JS. Usefulness of submental ultrasonographic evaluation for dysphagia patients. Ann of Rehabil Med. 2016;40:197-205.
29. 29. Everton LF, Benfield JK, Michou E, et al. Reliability of the Penetration–Aspiration Scale and temporal and clearance measures in poststroke dysphagia: videofluoroscopic analysis from the swallowing treatment using electrical pharyngeal stimulation trial. J Speech Lang Hear Res. 2022;65:858-868.
30. 30. Ellerston JK, Heller AC, Houtz DR, et al. Quantitative measures of swallowing deficits in patients with Parkinson’s disease. Ann Otol Rhinol Laryngol. 2016;125:385-392.
31. 31. Di Pede C, Mantovani M, Del Felice A, et al. Dysphagia in the elderly: focus on rehabilitation strategies. Aging Clin Exp Res. 2016;28:607-617.