Fluoroscopic Analysis of the Pathophysiologic Mechanisms of Swallowing

The anatomy and physiology of swallowing is reviewed, the indications for and techniques of fluoroscopic examinations are explained, and pathophysiologic mechanisms are discussed.

Course ID: Q00708 Category:


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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


  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


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