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Radiation Dose During Videofluoroscopic Swallowing Studies and Associated Factors in Pediatric Patients

  • Hyo Won Im
  • Seung Yeun Kim
  • Byung-Mo Oh
  • Tai Ryoon Han
  • Han Gil SeoEmail author
Original Article


Although children are more radio-sensitive than adults, few studies have evaluated radiation dosage during videofluoroscopic swallowing study (VFSS) in children. The aim of the study was to investigate the radiation dosage using dose-area product (DAP) for VFSS in pediatric cases and to identify factors affecting the radiation dose. Patients aged 0–17 years who had undergone VFSS were included. The following data were collected retrospectively: DAP; fluoroscopic time; number of tried diets; and clinical characteristics including sex, age, etiology of dysphagia, and recommended feeding type. In the videofluoroscopic field, use of collimation and appearance of metal object, such as a lead apron or a wheel chair, was checked. A total of 290 VFSSs were included. The mean DAP was 5.78 ± 4.34 Gy cm2 with a mean screening time of 2.69 ± 1.30 min. The factors associated with the DAP included screening time, appearance of metal objects in the field, and use of collimation. In 98 cases with no metal object in the field and with collimation, the mean DAP was decreased to 2.96 ± 2.53 Gy cm2. This study evaluated the radiation dosage during VFSS in children according to age groups and the influencing factors such as screening time, appearance of metal objects in the field, and use of collimation in VFSS. To reduce radiation risk, it is important to identify and control modifiable factors.


Radiation Child Deglutition Deglutition disorders 



We thank the Medical Research Collaborating Center (MRCC) of Seoul National University Hospital for their assistance with statistical analysis.


This study was not supported by any Grant or funding.

Compliance with Ethical Standards

Conflict of interest

The authors report no conflicts of interest. The authors alone are solely responsible for the content and writing of the paper.

Ethical Approval

This study was conducted in conformance with the ethical standards of the Declaration of Helsinki (1964) and was approved by the Institutional Review Board of our institution before study initiation (IRB No. 1605-030-760). The requirement for informed consent was waived because of the retrospective nature of the study.


  1. 1.
    Fung C-W, Khong P-L, To R, Goh W, Wong V. Video-fluoroscopic study of swallowing in children with neurodevelopmental disorders. Pediatr Int. 2004;46:26–30.CrossRefGoogle Scholar
  2. 2.
    Chau KHT, Kung CMA. Patient dose during videofluoroscopy swallowing studies in a Hong Kong public hospital. Dysphagia. 2009;24:387–90.CrossRefGoogle Scholar
  3. 3.
    Kim HM, Choi KH, Kim TW. Patients’ radiation dose during videofluoroscopic swallowing studies according to underlying characteristics. Dysphagia. 2013;28:153–8.CrossRefGoogle Scholar
  4. 4.
    Bonilha HS, Humphries K, Blair J, Hill EG, McGrattan K, Carnes B, et al. Radiation exposure time during MBSS: influence of swallowing impairment severity, medical diagnosis, clinician experience, and standardized protocol use. Dysphagia. 2013;28:77–85.CrossRefGoogle Scholar
  5. 5.
    Zammit-Maempel I, Chapple C-L, Leslie P. Radiation dose in videofluoroscopic 198 swallow studies. Dysphagia. 2007;22:13–5.CrossRefGoogle Scholar
  6. 6.
    Hart D, Hillier MC, Wall BF. National reference doses for common radiographic, fluoroscopic and dental X ray examinations in the UK. Br J Radiol. 2009;82:1–12.CrossRefGoogle Scholar
  7. 7.
    Weir KA, McMahon SM, Long G, Bunch JA, Pandeya N, Coakley KS, et al. Radiation doses to children during modified barium swallow studies. Pediatr Radiol. 2007;37:283–90.CrossRefGoogle Scholar
  8. 8.
    Wall BF, Kendall GM, Edwards AA, Bouffler S, Muirhead CR, Meara JR. What are the risks from medical X rays and other low dose radiation? Br J Radiol. 2006;79:285–94.CrossRefGoogle Scholar
  9. 9.
    Hiorns MP, Saini A, Marsden PJ. A review of current local dose–area product levels for paediatric fluoroscopy in a tertiary referral centre compared with national standards. Why are they so different? Br J Radiol. 2014;79:940.Google Scholar
  10. 10.
    Hall EJ. Lessons we have learned from our children: cancer risks from diagnostic radiology. Pediatr Radiol. 2002;32:700–6.CrossRefGoogle Scholar
  11. 11.
    Hiorns MP, Ryan MM. Current practice in paediatric videofluoroscopy. Pediatr Radiol. 2006;36:911–9.CrossRefGoogle Scholar
  12. 12.
    Le Heron JC. Estimation of effective dose to the patient during medical x-ray examinations from measurements of the dose-area product. Phys Med Biol. 1992;37:2117.CrossRefGoogle Scholar
  13. 13.
    Bibbo G, Balman D, Linke R. Diagnostic reference levels for common paediatric fluoroscopic examinations performed at a dedicated paediatric Australian hospital. J Med Imaging Radiat Oncol. 2016;60:469–74.CrossRefGoogle Scholar
  14. 14.
    Peladeau-Pigeon M, Steele CM. Technical aspects of a videofluoroscopic swallowing study. Can J Speech Lang Pathol Audiol. 2013;37:216–26.Google Scholar
  15. 15.
    Mercado-Deane M-G, Burton EM, Harlow SA, Glover AS, Deane DA, Guill MF, et al. Swallowing dysfunction in infants less than 1 year of age. Pediatr Radiol. 2001;31:423–8.CrossRefGoogle Scholar
  16. 16.
    Cohen MD. Can we use pulsed fluoroscopy to decrease the radiation dose during video fluoroscopic feeding studies in children? Clin Radiol. 2009;64:70–3.CrossRefGoogle Scholar
  17. 17.
    Wright RE, Boyd CS, Workman A. Radiation doses to patients during pharyngeal videofluoroscopy. Dysphagia. 1998;13:113–5.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Rehabilitation Medicine, Seoul National University College of MedicineSeoul National University HospitalSeoulRepublic of Korea

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