Impact of Pulse Rate on Swallowing Impairment Assessment and Radiation Exposure

描述（由申请人提供）：改良钡吞咽研究（MBSS）是识别吞咽结构和功能异常的关键诊断测试。MBSS还用于测试饮食调整、代偿策略和锻炼，以支持临床医生对吞咽困难患者的治疗决策。然而，MBSS是一种使用电离辐射的荧光检查。医疗测试中的辐射暴露必须尽可能低。脉率是MBSS设置，是减少辐射暴露的主要目标。不幸的是，降低脉率也减少了判断吞咽障碍的可用信息。由于口咽吞咽仅持续约1秒，因此当脉搏率从30降低到15时，可用于判断吞咽障碍的独特图像的数量也从30降低到15。这种信息减少的影响可能会威胁到我们对吞咽障碍判断的准确性，并导致使用不正确的康复策略。错误评估吞咽障碍的后果是严重的。如果吞咽障碍存在并且未被检测到或检测不足，则气道保护和营养可能处于危险之中。不准确的判断也可能错误的一方过于保守的建议，口服摄入量限制，如修改饮食或管喂养的位置，这将不必要地降低吞咽困难患者的健康状况和生活质量。此外，甚至不清楚降低脉率是否是降低癌症风险的有意义的决定，因为我们不知道与MBSS相关的辐射暴露水平和癌症风险。了解降低脉率对吞咽损伤和辐射暴露判断的影响，对于权衡吞咽损伤错误判断风险与辐射降低获益的能力以及做出关于脉率设置的明智决定非常重要。因此，本研究的目的是量化减少脉率对吞咽障碍和辐射暴露判断的影响。为实现这一目标，本提案的具体目标是：目标1。量化脉率对吞咽障碍严重程度评估和治疗建议的影响。目标二。量化MBSS期间的辐射剂量。目标3。根据辐射剂量量化癌症风险。本研究的结果将提供衡量MBSS中使用的不同脉率的风险和受益所需的信息。这些证据将作为语言病理学家、放射科医生和医院安全委员会在评估MBSS程序时的指南，并为患者管理决策提供信息。

DESCRIPTION (provided by applicant): Modified Barium Swallow Studies (MBSSs) are the key diagnostic test to identify abnormalities in the structures and functions of swallowing. MBSSs are also used to test diet modifications, compensatory strategies and exercises to support clinicians' treatment decisions for patients with dysphagia. However, MBSSs are a type of fluoroscopic study that uses ionizing radiation. Radiation exposure from medical tests are mandated to be as low as reasonable achievable. Pulse rate is a MBSS setting that is a main target for reducing radiation exposure. Unfortunately, decreasing pulse rate also decreases the information available from which to judge swallowing impairment. Since the oropharyngeal swallow only lasts approximately 1 second, when pulse rate is decreased from 30 to 15, the number of unique images available to judge swallowing impairment also decreases from 30 to 15. The effect of this reduction of information could threaten the accuracy of our judgments of swallowing impairment and lead to the use of incorrect rehabilitation strategies. The consequences of incorrectly assessing swallowing impairment are serious. If swallowing impairment exists and is un- or under- detected, airway protection and nutrition may be at risk. Inaccurate judgments may also err on the side of overly conservative recommendations of oral intake restriction such as modifications in diet or tube feeding placement and which would unnecessarily decrease a dysphagic patient's health status and quality of life. Furthermore, it is not even clear that decreasing pulse rate is a meaningful decision with respect to reducing cancer risk as we do not know the levels of radiation exposure and cancer risks associated with MBSSs. Knowledge of the effect of reducing pulse rate on judgments of swallowing impairment and radiation exposure is important to the ability to weigh the risk of erroneous judgments of swallowing impairment against the benefit of the radiation reduction and make informed decisions about pulse rate setting. Thus, the goal of this study is to quantify the effect of reducing pulse rate on judgments of swallowing impairment and radiation exposure. Toward this goal, the specific aims of this proposal are: Aim 1. Quantify the impact of pulse rate on swallowing impairment severity assessment and treatment recommendations. Aim 2. Quantify radiation dose during MBSSs. Aim 3. Quantify the cancer risk based on radiation dose. The results of this study will provide the information needed to weight the risks and benefits of the different pulse rates used in MBSSs. This evidence will serve as a guide for speech-language pathologists, radiologists and hospital safety boards when evaluating MBSSs procedures and inform patient management decisions.