The use of low-osmolar water-soluble contrast in videofluoroscopic swallowing exams.

The selection of the contrast agent used during fluoroscopic exams is an important clinical decision. The purpose of this article is to document the usage of a nonionic, water-soluble contrast (iohexol) and barium contrast in adult patients undergoing fluoroscopic exams of the pharynx and/or esophagus and provide clinical indications for the use of each. For 1 year, data were collected on the use of iohexol and barium during fluoroscopic exams. The contrast agent used was selected by the speech language pathologist (SLP) or the radiologist based on the exam's indications. A total of 1,978 fluoroscopic exams were completed in the 12-month period of documentation. Of these exams, 60.6 % were completed for medical reasons and 39.4 % for surgical reasons. Fifty-five percent of the exams were performed jointly by a SLP and a radiologist and 45 % were performed by a radiologist alone. Aspiration was present in 22 % of the exams, vestibular penetration occurred in 38 %, extraluminal leakage of contrast was observed in 4.6 %, and both aspiration and leakage were seen in 1 % of the exams. In cases with aspiration, iohexol was used alone in 8 %, iohexol and barium were both used in 45 %, and barium was used alone in 47 %. In cases with extraluminal leakage, iohexol was used alone in 58 %, iohexol and barium were both used in 31 %, and barium was used alone in 11 %. No adverse effects were seen with the use of iohexol. When barium was used in cases of aspiration and extraluminal leakage, the amount of aspirated barium was small and the extraluminal barium in the instances of leakage was small. Iohexol is a useful screening contrast agent and can safely provide information, and its use reduces the risk of aspiration and the chance of leakage of large amounts of barium.

Radiation safety for the speech-language pathologist.

It is the responsibility of the medical Speech-Language Pathologist (SLP) who performs video-assisted fluoroscopy of swallowing (VFSS) to be aware of guidelines, recommendations, and preventive measures to reduce radiation to oneself and the patient. Established parameters to reduce radiation during videofluoroscopy include keeping the exposure time brief, using lead aprons and other shielding, and maximizing the distance from the source of radiation. The purpose of this study was to measure radiation exposure to SLPs in the clinical setting and to provide practical recommendations to keep radiation exposure as low as reasonably achievable. Our study measured radiation exposure to six SLPs practicing in an acute-care university hospital. We monitored the radiation received during 130 examinations, 102 of which were of the pharynx only and the other 28 included pharynx and intrathoracic viscera. Individual times were documented, and average doses per exam were calculated from dosimetry badges worn on the lead apron of the SLP doing inpatient exams. Average fluoroscopy time per procedure was 165 s. Average radiation to the dosimeter worn on the front of the lead apron at chest level was 0.15 mR (0.0015 mGy) per procedure. SLPs stood behind the lead shield during fluoroscopy when feasible. Our measurements document the practical importance of reducing radiation exposure to health-care personnel by increasing the distance from the source of radiation and by shielding. While recommendations are not new, details of the findings may help guide and reinforce good radiation safety practice.

Conversion of FDG PET activity of fibrous dysplasia of the skull late in life mimicking metastatic disease.

Fibrous dysplasia (FD) accounts for 7% of benign bone tumors. It is a developmental disorder of unclear etiology. The lamellar cancellous bone of the medullary cavity is replaced with immature fibroosseous tissue. We describe a case of FD of the skull in a patient of advanced age (69 years) with recent diagnosis of colon cancer, which changed its FDG activity and CT appearance within 10 months of follow-up. Surgical biopsy confirmed FD. Several case reports describe FDG-avid FD, but conversion of metabolic activity late in life is probably unusual.