Fluoroscopic Analysis of the Pathophysiologic Mechanisms of Swallowing

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:

Radiography: 3.00
Procedures: 3.00
Thorax and Abdomen Procedures: 3.00

Registered Radiologist Assistant: 3.00
Procedures: 3.00
Abdominal Section: 3.00

Outline

1. Introduction
2. Anatomy for Radiographic Interpretation
3. Phases of Swallowing
   1. Oral Preparatory Phase
   2. Oral Propulsory Phase
   3. Initiation of Pharyngeal Swallow
   4. Pharyngeal Phase
   5. PES Opening Phase
   6. Esophageal Phase
4. Indications for Fluoroscopic Swallowing Examinations
5. Fluoroscopic Swallowing Examination Technique
6. Functional Abnormalities
   1. Abnormalities of Oral Preparatory phase
   2. Premature Spillage from Mouth into Pharynx
   3. Delayed or Slow Oral Propulsory Phase
   4. Delayed Initiation of Pharyngeal Swallow
   5. Nasal Regurgitation
   6. Slow or Incomplete Displacement of HLC
   7. Weakness of Tongue and Pharyngeal Contraction
   8. Lack of Synchronization of Pharyngeal Contractions
   9. Limited tilt of Epiglottis
   10. Delayed or Incomplete Laryngeal Closure
   11. Incomplete Opening of PES
   12. Delayed Opening of PES
   13. Early Closure of PES
   14. Residue in Valleculae and Pyriform Sinuses after Swallowing
       1. Penetration
       2. Aspiration
7. Anatomic Abnormalities
   1. Radiography of the Neck
   2. Pharyngeal Strictures
   3. Zenker Diverticula
   4. Killian-Jamieson Diverticula
8. Complications of Total Laryngectomy
   1. Surgical Technique
   2. Anastomotic Leakage
   3. Pseudoepiglottis
   4. Anterior Pharyngeal Pouches
   5. Neopharyngeal Dysmotilities
   6. Dysfunctions of PES
   7. Benign Strictures
   8. Complications of Tracheoesophageal Fistula and Prosthesis
9. Conclusion

Objectives

Upon completion of this course, students will:

1. state the prevalence of oropharyngeal dysphagia in the United States
2. choose the most used technique for evaluation of deglutition disorders
3. list the healthcare professionals that take part in modified barium swallow procedures
4. describe how the oral cavity is bounded
5. give the alternate name for the laryngopharynx
6. describe the oral preparatory phase
7. understand when a bolus is “swallowable”
8. describe the oral propulsory phase of swallowing
9. list the steps in the initiation of the pharyngeal swallow
10. list the steps in the pharyngeal phase of swallowing
11. know the process of laryngeal closure
12. describe the steps in the pharyngoesophageal segment opening phase
13. note the swallowing phase in which esophageal peristalsis takes place
14. list the common indications for fluoroscopically guided swallowing examinations
15. list the equipment capabilities needed for fluoroscopic swallowing examinations
16. describe the patient position for fluoroscopic swallowing examinations
17. describe the views utilized during fluoroscopic swallowing examinations
18. choose the proper technical settings for fluoroscopic swallowing examinations
19. list the types of contrast agents used for fluoroscopic swallowing examinations
20. explain the personnel required to perform a modified barium swallow examination
21. explain the role of the speech-language pathologist for modified barium swallow examinations
22. describe the importance of the tongue during the oral preparatory phasel
23. ist the causes of tongue failure during the oral preparatory phase
24. choose the anatomy that forms the glossopalatal seal
25. understand what diseases may cause repetitive unsuccessful attempts to swallow a bolus
26. list the causes of delayed swallowing initiation
27. describe the function of the hyolaryngeal complex
28. describe what is required to increase intrabolus pressure and propel the bolus into the esophagus
29. discuss risks of improper pharyngeal contraction
30. describe the role of the epiglottis during swallowing
31. explain why the pharyngoesophageal segment is normally closed
32. list the necessary actions for opening of the pharyngoesophageal segment
33. describe how radiologists should evaluate the function of the pharyngoesophageal segment
34. recall how much contrast material should remain in the pharyngeal lumen after swallowing
35. describe the complications of aspiration
36. explain why external-beam radiation affects swallowing
37. define radiation strictures
38. define cervical esophageal tumors
39. describe Zenker diverticula
40. explain the development of Zenker diverticula
41. list the risk factors for anastomotic leakage
42. define pseudoepiglottis
43. describe how dysfunctions of the pharyngoesophageal
44. segment should be evaluated