Impact of Pulse Rate on Swallowing Impairment Assessment and Radiation Exposure

描述(申请人提供)：改良的吞钡试验(MBSS)是确定吞咽结构和功能异常的关键诊断试验。MBSS还用于测试饮食调整、代偿策略和练习，以支持临床医生对吞咽困难患者的治疗决定。然而，MBSS是一种使用电离辐射的荧光检查。医学测试的辐射暴露被要求尽可能低到合理的水平。脉率是MBSS设置，它是减少辐射暴露的主要目标。不幸的是，脉率的降低也减少了可用于判断吞咽损伤的信息。由于口咽吞咽仅持续约1秒，当脉率从30降至15时，可用于判断吞咽障碍的独特图像的数量也从30降至15。这种信息减少的影响可能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。错误地评估吞咽障碍的后果是严重的。如果吞咽障碍存在，且未被发现或未被发现，则呼吸道保护和营养可能处于危险之中。不准确的判断也可能偏向过于保守的口服摄入量限制建议，如修改饮食或管喂位置，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对于降低癌症风险是否有意义，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害和辐射暴露的判断的影响，对于权衡误判吞咽损害的风险和辐射减少的益处并做出关于脉率设置的明智决定的能力是重要的。因此，这项研究的目标是量化降低脉率对吞咽损伤和辐射暴露的判断的影响。为了实现这一目标，本方案的具体目标是：目标1.量化脉率对吞咽损害严重程度评估和治疗建议的影响。目的2.量化MBSS过程中的辐射剂量。目的3.根据辐射剂量量化癌症风险。这项研究的结果将提供必要的信息，以权衡在MBSS中使用的不同脉率的风险和好处。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.