Clinician accuracy in identifying essential laryngeal landmarks on swallowing fluoroscopy - PubMed (original) (raw)
. 2023 Jul 29;8(5):1265-1271.
doi: 10.1002/lio2.1127. eCollection 2023 Oct.
Affiliations
- PMID: 37899869
- PMCID: PMC10601579
- DOI: 10.1002/lio2.1127
Clinician accuracy in identifying essential laryngeal landmarks on swallowing fluoroscopy
Nina W Zhao et al. Laryngoscope Investig Otolaryngol. 2023.
Abstract
Objective: Identification of anatomical landmarks is essential for interpretation of video fluoroscopic swallow studies (VFSS). This investigation sought to confirm the location of essential laryngeal landmarks and determine clinician accuracy in structure identification on VFSS.
Methods: A single human cadaver was used to generate unmarked standard lateral and anterior-posterior (AP) fluoroscopic images. Essential laryngeal structures (e.g., true vocal fold, arytenoid) were directly identified using a guidewire placed through an endoscope while obtaining corresponding marked fluoroscopic images. Licensed clinicians (speech-language pathologists [SLP], laryngologists) and trainees (otolaryngology residents, SLP clinical fellows [CF]) identified 18 structures (9 lateral, 9 AP) on unmarked images. Answers were compared to corresponding marked images. The percentage of accurate identification was calculated for each clinician and then compared between groups using _t_-tests.
Results: Twenty-four individuals (10 SLPs, 1 CF, 9 residents, 4 laryngologists) from six institutions completed structure identification. Mean overall accuracy was 41.7 ± 13.0% (range 18.8-68.8%). There were no significant differences in mean overall accuracy between trainees (41.9 ± 12.9%) and clinicians (42.0 ± 13.1%), p = .97, or between SLPs (45.5 ± 12.8%) and physicians (38.9 ± 12.3%), p = .22. On average, participants were significantly more accurate identifying structures on lateral view (53.1 ± 16.1%) than AP (27.3 ± 22.8%), p < .001. Less than half of participants accurately identified the laryngeal ventricle, cricoid, epiglottic petiole, and the anterior commissure on lateral view.
Conclusions: The ability of certified clinicians and trainees to correctly identify essential anatomic landmarks on swallowing fluoroscopy may be poor. Future work is needed to identify how we can train clinicians on more accurate identification of essential anatomic structures on swallowing fluoroscopy.Level of Evidence: NA.
Keywords: fluoroscopy; laryngeal anatomy; modified barium swallow study; videofluoroscopic swallow study.
© 2023 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.
Conflict of interest statement
Clark A. Rosen reports the following disclosures and financial relationships: Olympus America Inc., consultant; Instrumentarium, royalties; Freudenberg Medical, consultant; Reflux Gourmet LCC, shareholder. Peter C. Belafsky reports the following disclosures and financial relationships: Reflux Gourmet, LLC, co‐founder; Hope Medical, co‐founder; California Institute of Regenerative Medicine, grant support; Innovio, grant support. The other authors have no financial relationships or conflicts of interest to disclose.
Figures
FIGURE 1
Simultaneous digital laryngoscopic and fluoroscopic images of the left true vocal fold in lateral (A and B) and anterior–posterior (C and D) captured during structure identification.
FIGURE 2
Sample survey questions in (A) lateral and (B) anterior–posterior views. Participants were asked to identify the indicated structure (in white box) by placing an open 0.5 cm diameter circle (0.63 cm when calibrated to image size) on the location on the image that they felt best represented the structure of interest. Participants were not asked to distinguish laterality for paired structures on lateral view.
FIGURE 3
Representative answers classified as correct and incorrect in lateral and anterior–posterior (AP) views. The participants' circle was overlaid onto images with the endoscopically marked structures for comparison. (A) Correct versus (B) incorrect identification of the true vocal fold on lateral view. (C) Correct versus (D) incorrect identification of the left true vocal fold on AP view.