BaByVFSSImP© A Novel Measurement Tool for Videofluoroscopic Assessment of Swallowing Impairment in Bottle-Fed Babies: Establishing a Standard.

AIM: This investigation tested the construct validity of the first standardized assessment tool, the BaByVFSS Impairment Profile, (BaByVFSSImP©), developed for the quantification of swallowing observations made from videofluoroscopic swallow studies (VFSS) in bottle-fed babies. METHOD: Construct validity of the measures was tested using descriptive methods and confirmatory factor analysis (CFA) of swallowing scores obtained from a cohort of bottle-fed babies (median age 3 months 1 day, interquartile range 1 month 4 days-7 months 4 days) sequentially referred for VFSS based on clinical signs, symptoms, or risk factors associated with dysphagia and/or aspiration. Main outcome measures were emergence of functional domains derived from swallowing component impairment scores. RESULTS: Confirmatory factor analysis resulted in 21 significant components (factor loadings ≥ 0.5) grouping into five functional domains labeled for common contribution to overall swallowing function. The tool was organized into the BaByVFSSImP. Clinical relevance was explored using correlational analyses between domain scores, maximum penetration/aspiration scores, feeding status, and caregiver burden. INTERPRETATION: Quantification of physiologic swallowing impairment captured by BaByVFSSImP holds promise for identification of physiologically based targets for intervention, clinical decisions regarding enteral feeding, and tracking the trajectory of swallowing impairment throughout development in young children.

Recommendations for the imaging assessment of prosthetic heart valves: a report from the European Association of Cardiovascular Imaging endorsed by the Chinese Society of Echocardiography, the Inter-American Society of Echocardiography, and the Brazilian Department of Cardiovascular Imaging.

Prosthetic heart valve (PHV) dysfunction is rare but potentially life-threatening. Although often challenging, establishing the exact cause of PHV dysfunction is essential to determine the appropriate treatment strategy. In clinical practice, a comprehensive approach that integrates several parameters of valve morphology and function assessed with 2D/3D transthoracic and transoesophageal echocardiography is a key to appropriately detect and quantitate PHV dysfunction. Cinefluoroscopy, multidetector computed tomography, cardiac magnetic resonance imaging, and to a lesser extent, nuclear imaging are complementary tools for the diagnosis and management of PHV complications. The present document provides recommendations for the use of multimodality imaging in the assessment of PHVs.

The use of videofluoroscopy in the assessment of the pharyngeal airway in obstructive sleep apnoea.

This prospective cohort study evaluated the use of videofluoroscopy in assessing changes in both antero-posterior (A-P) and transverse pharyngeal airway dimensions in patients with obstructive sleep apnoea (OSA). Forty patients [32 males and 8 females; mean age of 49.3 (SD = 10.79) years] with confirmed OSA, referred for mandibular advancement appliance (MAA) therapy were recruited. Patients received a customized Herbst MAA, adjusted for maximum comfortable protrusion. A standard lateral cephalogram, supine A-P, and transverse videofluoroscopic investigations were performed. Repeat supine videofluoroscopic investigations were undertaken with the MAA in situ. Parametric tests were used to evaluate the study hypotheses as the data were normally distributed. A paired t-test was employed to determine both the impact of posture on the airway using upright cephalometry and supine videofluoroscopy and the effect of MAA insertion on A-P and transverse pharyngeal airway dimensions. Following a change in posture from upright to supine, highly statistically significant (P < 0.001) changes were observed for all lateral pharyngeal dimensions. Statistically significant increases in minimum lingual airway (P < 0.001) and maximum transverse pharyngeal airway (P < 0.001) were found following MAA insertion. A reduction in soft palate area (P = 0.029) and pharyngeal height (P < 0.001) was also noted. Videofluoroscopy offers a useful dynamic assessment of the pharyngeal airway in both the A-P and transverse planes in patients with OSA.

Three-dimensional quantitative assessment of lung parenchyma in cystic fibrosis: preliminary results.

PURPOSE: The aim of this study was to assess the feasibility of three-dimensional (3D) reconstructions and quantitative analysis of the volume of each component of the lung with cystic fibrosis (CF). MATERIALS AND METHODS: Twenty-two patients with CF (mean age 17+/-8 years) were included in the study. The patients underwent an unenhanced single-slice spiral computed tomography (CT) chest scan with the following parameters: collimation 3 mm, table feed 6 mm x rot(-1), reconstruction interval 1 mm, soft tissue reconstruction kernel. Four image data sets were obtained: native axial slices, cine-mode display, virtual bronchographic volume-rendered images with algorithm for tissue transition display and virtual endoluminal views. The lungs were segmented manually from the hilum to the visceral pleura on the axial images, and the entire lung volume was calculated. A histogram was generated representing the fractional volume of tissues, the density of which was within a preset range. A curve was then obtained from the histogram. RESULTS: Native axial images and cine-mode display allowed complete evaluation of lung volumes. Virtual bronchography allowed a better assessment of the distribution of bronchiectasis. Virtual bronchoscopy was limited by the fact that it visualised only the surface, without differentiating mucus from the bronchial wall. Manual segmentation and generation of density-volume curves required 41+/-7 min for each lung. Three curve patterns were identified depending on disease severity. CONCLUSIONS: Volume-density analysis of lungs with CF is feasible. Its main advantage is that image analysis is not analogical, as the assessment is not performed using scoring systems or similar ordinal scales. This technique cannot differentiate acute from chronic findings, and the predictive value of the curve should be assessed.

Cinefluoroscopic assessment of mechanical disc prostheses: its value as a complementary method to echocardiography.

BACKGROUND AND AIM OF THE STUDY: Many types of mechanical prostheses are used for heart valve replacement, but it is difficult to distinguish between them using transthoracic echocardiography. Hence, cinefluoroscopy complements the echocardiographic evaluation of cardiac prostheses. The aims of the present study were to: (i) describe the contribution of cinefluoroscopy in identifying different prostheses; (ii) compare gradients obtained by Doppler echocardiography with the opening angle of the discs assessed by cinefluoroscopy; and (iii) assess the ability of cinefluoroscopy to distinguish normal from dysfunctional prostheses. METHODS: A total of 229 mechanical disc prostheses was prospectively evaluated with cinefluoroscopy. Eight prosthetic valves (six aortic, two mitral) were excluded due to the coexistence of severe left ventricular dysfunction. Thus, the final analysis comprised 221 prosthetic valves (146 aortic, 75 mitral). RESULTS: Based on the characteristics of the ring and the discs, cinefluoroscopy identified 87 single-leaflet and 134 bileaflet prostheses. Disc motion allowed distinction to be made between normal and dysfunctional prostheses (opening angle: 74 +/- 13 degrees versus 49 +/- 18 degrees). Fluoroscopy could not define disc profile or the ring in 6% of aortic valves and in 26% of mitral prostheses. The technique could be used to identify the TriTechnologies and HP-Biplus valves, but could not provide data on prosthetic function due to radiolucency of the discs. Among the 146 aortic prostheses, Doppler echocardiography helped to identify 109 normal valves and 37 dysfunctional valves. Among 75 mitral prostheses, 54 normal and 21 dysfunctional prosthetic valves were identified. When both methods were correlated, the sensitivity, specificity and positive and negative predictive values of fluoroscopy to distinguish normal from malfunctioning prostheses were 83%, 80%, 89%, and 71%, respectively. CONCLUSION: Each prosthesis type has radioscopic characteristics that allow its identification. Fluoroscopy permitted rapid and easy evaluation of mechanical prosthetic valve function, and in most cases allowed a distinction to be made between normal and dysfunctional prostheses. The presence of high gradients by Doppler echocardiography, with normal opening angles by fluoroscopy, and without pannus on transesophageal echocardiography, is indicative of patient-prosthesis mismatch. Fluoroscopy was superior to echocardiography in identifying disc motion, whilst Doppler study allowed the measurement of gradients and areas, and semiquantification of regurgitation. Thus, cinefluooscopy rapidly provides valuable information which is complementary to that obtained by echocardiography.

The assessment of left ventricular filling dynamics using an online automatic border detection algorithm: comparison with cineventriculography.

An echocardiographic system has been developed that performs automatic endocardial border detection and instantaneously calculates and displays a waveform of left ventricular cavity area versus time. The purpose of this study was to compare measurements of left ventricular filling dynamics from automatic border detection echocardiography with similar measurements from cineventriculography. Thirty-three patients undergoing cardiac catheterization had automatic border detection echocardiography performed within 45 minutes of cineventriculography. Ten patients had normal catheterization findings and 23 had cardiac disease. The automatic border detection waveforms generated from two echocardiographic views were measured to determine the fraction of filling occurring during the early diastolic rapid filling phase and during the filling phase resulting from atrial contraction. Similar fractions were derived from curves generated from frame-by-frame measurements of cineangiographic volumes. Results were analyzed by correlating echocardiographic and cineventriculographic results, and by a limits of agreement analysis (limits of agreement were +/- 2 standard deviations of the mean difference between echocardiography and cineventriculography). There were significant correlations between echocardiography and cineventriculography for each of the parameters studied. The best results were obtained for the apical four-chamber view (rapid filling fraction r = 0.72, P < 0.0001, atrial filling fraction r = 0.56, P < 0.001). Differences in filling patterns between normal and abnormal patient groups detected by cineventriculography were also detected by automatic border detection echocardiography. However, broad limits of agreement were observed, that may limit the ability of the automatic border detection system to reliably predict cineventriculographic results in an individual patient. Automatic border detection echocardiography can provide information about left ventricular filling dynamics that is similar to that obtained from frame-by-frame analysis of cineventriculograms. However, the variability in the results may limit the application of the technique in individual patients.

Comparison of multi-view videofluoroscopy and nasopharyngoscopy in the assessment of velopharyngeal insufficiency.

Ratings and drawings of multi-view videofluoroscopy and nasopharyngoscopic studies of the velopharyngeal valve in 25 subjects with velopharyngeal insufficiency (VPI) were compared. The videofluoroscopic projections assessed were lateral, base, and Towne views. The Towne view was visually compared with flexible fiber optic nasopharyngoscopic studies in the same subjects. The Towne view was found to compare well with nasopharyngoscopic examination, and lateral view alone was found to be inadequate for the description of velopharyngeal movements.

New cineradiographic methods for assessment of Bjork-Shiley valve integrity.

The Bjork-Shiley prosthesis has been used extensively for valvular replacement since 1969. Despite its widespread use, it is subject to complications that can be assessed with cineradiography. New methods are presented for assessment of incomplete closing and opening angles that occur with valvular malfunction. Alternative methods of cineradiographic measurement are compared with each other and with the new method. The new method is an appropriate alternative when the conventional double-profile method cannot be used and distributes the burden of performance and complexity between the technologist and radiologist. This new method is shown to be accurate to within 1 degree.

Assessment of the opening angle of implanted Björk-Shiley prosthetic valves.

A method has been developed in which cineradiography is used for the assessment of the opening angle of implanted Bjork-Shiley prosthetic valves. The method is based on the fact that the ring and the disc, which are known to be circular, appear to be elliptical on x-ray films. The spatial position of the valve can be retrieved from the characteristics of these ellipses when vectoranalysis is applied. The method's accuracy does not depend on the position of the patient with respect to the direction of the x-ray beam. The accuracy of the method was demonstrated with the use of a phantom valve. The difference between the measured and the real opening angle was -0.7 +/- 1.8 degrees (mean +/- SD). Results were reproducible in patients to within -0.1 +/- 1.8 degrees. In 18 patients with normally functioning valves it could be demonstrated with frame-by-frame analysis (interval between frames 20 msec) that the valves opened very rapidly up to about 60 degrees. Closing patterns varied. In one of our patients with valvular thrombosis insufficient valvular opening could be demonstrated by our method before the patient's complaints drew attention to the valvular dysfunction.

Global and regional assessment of cardiac performance by ECG-gated radionuclide blood pool imaging.

A non-invasive method for evaluation of regional and global ventricular function by ECG-gated radionuclide blood pool imaging was developed. Cinematic image display is a sensitive method for evaluating wall motion to detect regional ventricular abnormalities and chamber size. A value of r = 0,86 and 0,85 was found for both fixed and variable area radionuclide methods when these ejection fraction values were correlated with cardio-angiographic ejection fraction values in normal subjects and in patients with myocardial infarction. The fixed area method underestimated the ejection fraction in patients with mitra valve stenosis, but this problem can be overcome with the variable area method. The technique developed cannot be used in patients with severe arrhythmias (r = 0,49 and 0,44).

Value of a cinefluoroscopic assessment of the Lillehei-Kaster prosthetic heart valves.

In order to assess the functioning of the pivoting disc of the Lillehei-Kaster prosthetic valve, a cinefluoroscopic technique using multiple angulations was developed. The disc was detected in 240 (99%) of the 242 valves studied (126 aortic, 107 mitral, and nine tricuspid valves). The maximal-opening angle of the disc was measured in 75% of the aortic but only 20% of the mitral valve prostheses in the 182 valve studies in which this was attempted. Prosthetic dysfunctions were suspected clinically in three aortic and three tricuspid valves and confirmed with the cinefluoroscopic technique. This cinefluoroscopic approach constitutes a rapid, noninvasive, and sensitive evaluation of the function of the Lillehei-Kaster prosthetic valve in the aortic position.

Assessment of reliability of cineradiographic recording of temporomandibular joint movements.

As part of a cineradiographic study of temporomandibular joint movements, the reliability of the apparatus and techniques has been assessed. The areas of concern were the radiographic procedure, tracing apparatus and tracing technique. To assess the accuracy of the radiographic procedure, anatomical and radiographic measurements of mandibular condyles were compared. A range of variation of 0-46--0-8 mm was found, which compared favourably to the only previously published investigation. The use of mechanical devices simulating the fundamentals of mandibular movements suggested that the cineradiographic record showed paths of opening and closing separated more widely than occurred in vivo. The reliability of the tracing apparatus was assessed by calculated misalignments and found to be acceptable. The subjective error in tracing cineradiographic films by a regular observer was investigated by a point location error method. The error was found to be small and within acceptable limits.