Abstract
Videofluoroscopic imaging of swallowing known as the Modified Barium Study (MBS) is the standard of care for assessing swallowing difficulty. While the clinical purpose of this radiographic imaging is to primarily assess aspiration risk, valuable biomechanical data is embedded in these studies. Computational analysis of swallowing mechanics (CASM) is an established research methodology for assessing multiple interactions of swallowing mechanics based on coordinates mapping muscle function including hyolaryngeal movement, pharyngeal shortening, tongue base retraction, and extension of the head and neck, however coordinates characterizing pharyngeal constriction is undeveloped. The aim of this study was to establish a method for locating the superior and middle pharyngeal constrictors using hard landmarks as guides on MBS videofluoroscopic imaging, and to test the reliability of this new method. Twenty de-identified, normal, MBS videos were randomly selected from a database. Two raters annotated landmarks for the superior and middle pharyngeal constrictors frame-by-frame using a semi-automated MATLAB tracker tool at two time points. Intraclass correlation coefficients were used to assess test-retest reliability between two raters with an ICC = 0.99 or greater for all coordinates for the retest measurement. MorphoJ integrated software was used to perform a discriminate function analysis to visualize how all 12 coordinates interact with each other in normal swallowing. The addition of the superior and middle pharyngeal constrictor coordinates to CASM allows for a robust analysis of the multiple components of swallowing mechanics interacting with a wide range of variables in both patient specific and cohort studies derived from common use imaging data..
Highlights
Swallowing is a complex sensorimotor response involving structures of the upper aerodigestive tract that results in the safe and efficient ingestion of saliva, food and liquids
In this study we describe our approach to annotating the superior and middle pharyngeal constrictors by using an anatomical feature that can be reliably tracked on modified barium swallow (MBS) to locate the position of the muscles
MBS imaging approved by the Medical University of South Carolina (MUSC) Institutional Review Board for Human Research for enrollment at MUSC and the Ralph H
Summary
Swallowing (deglutition) is a complex sensorimotor response involving structures of the upper aerodigestive tract that results in the safe and efficient ingestion of saliva, food and liquids. Disruption of this complex event can lead to dysphagia (swallowing impairment) resulting in malnutrition, dehydration, social isolation, and even death related to aspiration pneumonia. The most commonly used instrumental examination to assess swallowing function is the modified barium swallow (MBS) study that uses real-time x-ray to permit visualization of the rapid physiologic process and allows for analysis of crucial oropharyngeal swallowing mechanics[1]. The Modified Barium Swallow Impairment ProfileTM (MBSImP©) was designed to capture physiologic swallowing impairment using a standardized, Commons Attribution 4.0 International License
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