Welcome to August!
With the weather really heating up, it seems like a good time to talk about…radiation! When I was a brand new SLP, I once asked the radiology technologist about making sure the fluoro was set for 30 pulses per second, as I had learned was the minimum acceptable pulse rate for Modified Barium Swallow Studies (MBSS) if you’re not using continual fluoro. The tech responded, “Oh don’t worry, we capture at 30 frames per second.”I was kinda confused, so I went with it…but then did a little research afterwards. And what I found was this: pulse rate is the number of individual images that are taken per second during the study, and frame capture rate is how many images are actually recorded per second. Soooooo during a study, if the frame rate is 30, but the pulse rate is 15, that means that only 15 individual pictures are taken per second…so you have what LOOKS good and continual, BUT you just have 15 pictures that are saved twice each!We have multiple experts and research papers1-3 with excellent reasons for us to use 30 pulses per second AND 30 frames per second if not using continual fluoroscopy. While we as SLPs need to be conscious of radiation safety (of course!), there is no point in exposing the patient to radiation at all if we aren’t getting quality data from the MBSS.For more information on radiation dosage and pulse/frame/continual fluoroscopy, see this great paper by Dr. Heather Bonilha et al.1

And for more information on performing an MBSS, check out this consensus paper from an expert panel.2

 

INDICATIONS AND USAGE | IMPORTANT SAFETY INFORMATION

VARIBAR® (barium sulfate)

IMPORTANT SAFETY INFORMATION:

For Oral Administration. This product should not be used in patients with known or suspected perforation of the GI tract, known obstruction of the GI tract, high risk of aspiration, or hypersensitivity to barium sulfate products. Rarely, severe allergic reactions of anaphylactoid nature have been reported following administration of barium sulfate contrast agents. Aspiration may occur during the modified barium swallow examination, monitor the patient for aspiration.

INDICATIONS AND USAGE | IMPORTANT SAFETY INFORMATION

VARIBAR® (barium sulfate)

Indications and Usage:

VARIBAR® THIN HONEY (barium sulfate) oral suspension, VARIBAR® NECTAR (barium sulfate) oral suspension, and VARIBAR® THIN LIQUID (barium sulfate) for oral suspension, are indicated for use in modified barium swallow examinations to evaluate the oral and pharyngeal function and morphology in adult and pediatric patients. VARIBAR® HONEY (barium sulfate) oral suspension and VARIBAR® PUDDING (barium sulfate) oral paste are indicated for use in modified barium swallow examinations to evaluate the oral and pharyngeal function and morphology in adult and pediatric patients 6 months of age and older.

IMPORTANT SAFETY INFORMATION:

For Oral Administration. This product should not be used in patients with known or suspected perforation of the GI tract, known obstruction of the GI tract, high risk of aspiration, or hypersensitivity to barium sulfate products. Rarely, severe allergic reactions of anaphylactoid nature have been reported following administration of barium sulfate contrast agents. Aspiration may occur during the modified barium swallow examination, monitor the patient for aspiration.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1‑800‑FDA‑1088.

Please consult full Prescribing Information for VARIBAR HONEY here, for VARIBAR THIN HONEY here, for VARIBAR PUDDING here, for VARIBAR NECTAR here, and for VARIBAR THIN LIQUID here.

VARIBAR is manufactured by E-Z-EM Canada Inc., for E-Z-EM, Inc., a subsidiary of Bracco Diagnostics Inc., Monroe Twp., NJ 08831.

VARIBAR is a registered trademark of E-Z-EM, Inc.

See you soon,

References:1. Bonilha HS, Blair J, Carnes B, et al. Preliminary investigation of the effect of pulse rate on judgments of swallowing impairment and treatment recommendations. Dysphagia. 2013 Dec;28(4):528-38.2. Martin-Harris B, Bonilha HS, Brodsky MB, et al. The Modified Barium Swallow Study for Oropharyngeal Dysphagia: Recommendations From an Interdisciplinary Expert Panel. Perspect ASHA Spec Interest Groups. 2021 Jun;6(3):610-619.3. Mulheren RW, Azola A, González-Fernández M. Do ratings of swallowing function differ by videofluoroscopic rate? An exploratory analysis in patients after acute stroke. Arch Phys Med Rehabil. 2019 Jun;100(6):1085-1090.

US-VARH-2300010 08/23