DSA study on evaluation of the aspiration prevention posture in dysphagic patients

本研究的目的是确定吞咽困难患者的测量参考线，特别是姿势改变技术的使用。影像透视是吞咽困难患者最常用的检查方法。设备的两个主要组成部分是x射线管和图像增强器（I.I.）。由于I.I.有失真本质上称为线轴失真，校正I.I.失真是必要的。我们开发了一种对I.I.进行畸变补偿的程序，对畸变进行了满意的校正。应用该程序对对照组（74例）、患者组（150例）和应用颏钉组（40例）进行研究。利用这些影像，我们检查了参考线。在喉部拉长的患者组中，腭平面作为水平指标不能确定42%。如果用鼻底代替腭面，不能确定水平指数的病例减少到29%。测定颈椎线为垂直线，尽管几乎所有病例均能看到第4 < 1 >椎体，但约有10%的病例未见第5椎体，因为它位于暴露场外。利用这些水平和垂直指标，我们研究了吞咽姿势改变的影响。下颌下拉前后的角度变化平均为13度。习惯体位与收下巴体位比较，舌面与咽部表面的T2-P2、T3-P3距离比分别从0.82、0.76增加到0.81。这意味着把下巴往下拉会使咽的宽度变窄。综上所述，本研究建议1。在确定颈椎线时，连接C2和C4下端可能优于C2和C5。2.可以用鼻腔代替腭面。

The purpose of this study was to determine the reference lines for measurement of dyphagic patients, especially the usage of posture change technique. Videofluorography is most popular examination for dysphagic patients. The two main components of the equipment is X-ray tube and Image Intensifier (I.I.). Since the I.I. has distortion essentially called spool distortion, the correction of the I.I. distortion is necessary. We developed the program for distortion compensation of I.I. which corrected the distortion satisfactory.Using this program we studied Control group (74 cases), Patient group (150 cases), and Chin tack application patient group (40 cases). Using these videofluorographic images, we examined reference lines. The palatal plane as a horizontal index was not able to determine 42 % in patient group when their larynx have elongated. If we used nasal floor instead of the palatal plane, the cases cannot determine the horizontal index were reduced to 29 %. Determining the cervical vertebral line as a vertical, although, almost all the cases of the 4^<th> vertebra could be seen although the 5th cervical vertebra was not seen about 10 % because it located in outside the exposure field.Using these horizontal and vertical indices, we studied the effect of swallowing posture change. The angle change before and after pulling down the jaw was measured mean 13 degrees. Comparing the habitual position and the chin tuck position, T2-P2 and T3-P3 distance ratio between the tongue surface and the surface of the pharynx from Ment on increased from 0.82 to 0.86 and 0.76 to 0.81.respectively. That means pulling down the chin makes the width of the pharynx narrow.In conclusion, this study suggests 1. when determining the cervical vertebral line to connect the lower ends of C2 and C4 may be better than C2 and C5. 2.nasal cavity may be used instead of palatal plane.