Excess Radiation Exposure in Infants and Children From Videofluoroscopic Swallow Studies

摘要 吞咽视频荧光检查（VFSS）是用于识别吞咽异常的主要诊断测试。 口咽吞咽功能，检测误吸的存在和病因，并测试饮食的影响 修改和治疗干预。虽然VFSS是重要的诊断测试， 电离辐射，应保持“尽可能低的合理实现”，由于相关的癌症 风险我们目前还不知道这种诊断测试在儿童中的过度癌症风险。这 知识的缺乏是可变/错误的临床实践模式的原因， 有价值的检查，以获取重要的诊断信息，但以减少的方式使用检查（与 降低诊断准确性）或潜在地过度使用检查并可能大大增加癌症风险。它 我们必须了解癌症风险，以便临床医生，医院安全委员会，患者和 护理人员可以就儿童吞咽视频透视研究的使用做出明智的决定。 由于担心辐射暴露和相关的癌症风险，使用X射线束脉冲率 (pps)15 pps或更低已成为一种普遍的做法模式，尽管这很可能是 损害诊断准确性，使患者暴露于辐射，增加癌症风险，而不提供 有用的诊断信息。我们发现，在成年人中，将脉搏率从30次/秒降低到15次/秒， 降低诊断准确性和改变治疗策略。一个小孩的吞咽发生在大约三分之一的时间里， 一只成年燕子的时间。当将15 pps的降低的脉搏率用于幼儿的VFSS时， 诊断的准确性将低于7.5pps的成人VFSS，我们知道， 大大降低了诊断的准确性。尽管预期诊断准确性会降低， 大约47%的医院使用15 pps或更低的脉冲率来减少儿童的辐射照射。 需要明确的证据证明使用15 pps或更低的脉率对诊断准确性的影响， 说服临床医生改变他们的做法。 迫切需要从拟议的实验中获得的信息来指导VFSS的使用， 儿童，包括重复VFSS的时间和使用，并促进照顾者的准确咨询 关于测试的风险。一旦我们知道了VFSS对儿童的辐射相关癌症风险， 可以评估使用15 pps或更低的脉冲率是否有利于减少辐射暴露 超过了诊断准确性降低的风险。因此，这项建议的具体目标是： 目标1。建立儿童VFSS的标准辐射剂量。目标二。量化患者癌症风险 儿童的VFSSs。目标3：确定脉率对吞咽评估的影响 母乳喂养儿童的损伤严重程度和治疗建议。

ABSTRACT The Videofluoroscopic Swallow Study (VFSS) is the primary diagnostic test used to identify abnormalities in oropharyngeal swallowing function, detect the presence and etiology of aspiration, and test the effects of diet modifications and therapeutic interventions. While VFSSs are important diagnostic tests, they expose patients to ionizing radiation, which should be kept “as low as reasonably achievable” due to the associated cancer risks. We currently do not know the excess cancer risks associated with this diagnostic test in children. This lack of knowledge is the cause of variable / erroneous clinical practice patterns ranging from not using this valuable exam to acquire important diagnostic information to using the exam but in a diminished manner (with reduced diagnostic accuracy) or potentially overusing the exam and possibly greatly increasing cancer risks. It is imperative that we understand the cancer risks so that clinicians, hospital safety boards, patients and caregivers can make informed decisions about the use of the Videofluoroscopic Swallow Studies in children. Due to concerns regarding radiation exposure and associated cancer risks, using an x-ray beam pulse rate (pps) of 15pps or a lower has become a widespread practice pattern despite the high likelihood that this compromises diagnostic accuracy, exposing patients to radiation and increasing cancer risks without providing useful diagnostic information. We found that, in adults, decreasing the pulse rate from 30 to 15pps significantly reduced diagnostic accuracy and changed treatment strategies. A young child's swallow occurs in about a third of the time of an adult swallow. When a reduced pulse rate of 15pps is used for a young child's VFSS, the diagnostic accuracy would be less than that of an adult's VFSS performed at 7.5pps, a rate that we know substantially decreases diagnostic accuracy. Despite this expected reduction in diagnostic accuracy, approximately 47% of hospitals use pulse rates of 15pps or lower to decrease children's radiation exposure. Clear evidence of the impact of using a pulse rate of 15pps or lower on diagnostic accuracy is needed to convince clinicians to change their practice. The information gained from the proposed experiments is desperately needed to guide the use of VFSSs in children, including the timing of and use of repeat VFSSs, and to facilitate accurate counseling of caregivers regarding the risks of the test. Once we know the radiation-related cancer risks for children from VFSSs, we can evaluate whether the benefit of reducing radiation exposure by using pulse rates of 15pps or less outweighs the risk associated with reduced diagnostic accuracy. Thus, the specific aims of this proposal are: Aim 1. Establish the standard radiation doses from VFSSs in children. Aim 2. Quantify patient cancer risks from VFSSs in children. Aim 3. Determine the impact of pulse rate on the assessment of swallowing impairment severity and treatment recommendations in bottle-fed children.