Background Information:

What are the other Names for the Procedure?

• Cookie Swallow/Video Fluoroscopic Swallowing Exam
• MBS (Modified Barium Swallow)
• Modified Barium Swallow (MBS)

What is Video Fluoroscopic Swallowing Exam radiology procedure? (General Explanation)

• A Video Fluoroscopic Swallowing Exam (VFSE) is a radiology exam of ‘swallowing’ that uses a special type of movie x-ray, called a fluoroscopy
• The patient’s ability to swallow is evaluated as they swallow various types of food substances, coated with barium or liquid barium
• A VFSE  can be combined with esophagram to evaluate the function of the esophagus

What part of the Body does the Procedure involve?

A Video Fluoroscopic Swallowing Exam involves the throat area.

Why is the Video Fluoroscopic Swallowing Exam radiology procedure Performed?

A Video Fluoroscopic Swallowing Exam is used for the following reasons:

• To diagnose patients having difficulty swallowing (dysphagia) due to choking, presence of masses, muscle weakness, or any neurological disorder
• To evaluate functions of swallowing, respiratory infections, or wet-sounding voice
• To check the presence of aspiration (food getting into the airway, instead of the pharynx and esophagus)

What is the Equipment used? (Description of Equipment)

The following equipment is used for a Video Fluoroscopic Swallowing Exam:

• An X-ray machine
• An examination table
• A monitor to view the examination in real time
• A fluoroscope converts the X-rays into video images and provides real-time images, as the exam progresses.

What are the Recent Advances in the Procedure?

There have been no recent advances to replace the VFSE procedure.

What is the Cost of performing the Video Fluoroscopic Swallowing Exam radiology procedure?

The cost of a Video Fluoroscopic Swallowing Exam procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding a Video Fluoroscopic Swallowing Exam procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.radiologyinfo.org/en/info.cfm?pg=modbariumswallow#part_six (accessed on May 7, 2015)

Prior to Video Fluoroscopic Swallowing Exam radiology procedure:

How does the Video Fluoroscopic Swallowing Exam radiology procedure work?

• X-rays are passed through the patient’s body and recorded on a recording plate on the other side of the body
• Fluoroscopy uses a contrast material along with the x-ray machine, to produce real-time images of the organs or joints in motion

How is the Video Fluoroscopic Swallowing Exam radiology procedure Performed?

• The radiologist is present during the exam
• The patient is either made to stand or sit on a chair
• The patient is instructed to eat or drink a variety of food items coated with barium
• As the patient is swallowing the substance, the swallowing motion is analyzed using a fluoroscope

Where is the Procedure Performed?

A Video Fluoroscopic Swallowing Exam is performed as an outpatient procedure at a hospital.

Who Performs the Procedure?

A radiologic technologist under the supervision of a radiologist will guide you through the Video Fluoroscopic Swallowing Exam.

How long will the Procedure take?

The actual procedure of the Video Fluoroscopic Swallowing Exam takes about 15 minutes. However, there may be some waiting time or preparation time involved.

Who interprets the Result?

• A radiologist interprets the results of the Video Fluoroscopic Swallowing Exam
• A follow-up exam may be necessary for further analysis or to monitor the abnormality over time
• A full report of the study will be given to your healthcare provider within a few days
• A team of physicians may then determine the best nutrition plan for you, based on the results obtained

What Preparations are needed, prior to the Procedure?

The following preparations may be needed prior to a Video Fluoroscopic Swallowing Exam:

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are currently being taken
• Do inform the medical professional if you have a history of any medical conditions, such as a heart disease, asthma, diabetes, or kidney disease
• Do inform the medical professional about any allergies, especially related to barium or iodinated contrast material, which may be used in the procedure
• It is advisable to wear comfortable and loose clothes. Avoid wearing any metal objects or jewelry, as it may interfere with the x-ray
• It is highly recommended to inform your healthcare professional if you are pregnant or breastfeeding
• The patient may be asked to avoid eating or drinking, several hours before the test
• In case of children or infants, parents may be asked to bring all the food and liquids that children are having difficulty swallowing. These foods may be then mixed with barium for the children to swallow during the exam

What is the Consent Process before the Procedure?

A physician will request your consent for a Video Fluoroscopic Swallowing Exam procedure using an Informed Consent Form.
Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.
You must sign the forms only after you are totally satisfied with the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure. 

What are the Benefits versus Risks, for this Procedure?

Following are the benefits of the Video Fluoroscopic Swallowing Exam procedure:

• The radiation does not remain in the patient’s body after the exam
• VFSE is a noninvasive and safe procedure
• Allergy to barium occurs only in very rare cases

Following are the risks of the Video Fluoroscopic Swallowing Exam procedure:

• Patients with GI obstructions are not advised to go through the exam, as barium may be retained in the body and cause blockage of the digestive system
• There is a rare chance of an allergic reaction due to the barium swallow
• There is a slight chance of cancer from excessive radiation exposure

What are the Limitations of the Video Fluoroscopic Swallowing Exam radiology procedure?

A Video Fluoroscopic Swallowing Exam procedure can only evaluate the area from the back of mouth, through the pharynx, to the top of the chest.

What are some Questions for your Physician?

Some of the basic questions that you might ask your healthcare provider or physician are as follows:

• What is a Video Fluoroscopic Swallowing Exam (VFSE) procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• What are the possible side effects from the procedure? How can I minimize these side effects?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required, after the procedure is performed?
• Are there any follow-up tests or periodic visits to the healthcare facility required after the procedure?
• Is there any medication that needs to be taken for life, after the procedure?
• What are the costs involved?

During the Video Fluoroscopic Swallowing Exam radiology procedure:

What is to be expected during the Video Fluoroscopic Swallowing Exam radiology procedure?

• Following a Video Fluoroscopic Swallowing Exam, individuals may experience constipation or white stools, for a day or two, due to the barium used in the exam
• The individuals are advised to drink more fluids, as it helps in getting rid of the barium faster
• Generally, individuals do not like the taste of barium
• Normal activities may be resumed after the exam

What kind of Anesthesia is given, during the Procedure?

No anesthesia is administered during the Video Fluoroscopic Swallowing Exam.

How much Blood will you lose, during the Procedure?

There is no blood loss during the Video Fluoroscopic Swallowing Exam.

What are the possible Risks and Complications during the Video Fluoroscopic Swallowing Exam radiology procedure?

The risks of the Video Fluoroscopic Swallowing Exam include:

• Patients with GI obstructions are not advised to go through the exam, as barium may be retained in the body and cause blockage of the digestive system
• There is a rare chance of developing an allergic reaction, due to the barium used in the exam
• Over-exposure to radiation in a VFSE procedure may cause cancer; however, such a risk is very low

What Post-Operative Care is needed at the Healthcare Facility after the Video Fluoroscopic Swallowing Exam radiology procedure?

There is no post-operative care necessary at the healthcare facility, after a Video Fluoroscopic Swallowing Exam procedure.

After the Video Fluoroscopic Swallowing Exam radiology procedure:

What is to be expected after the Video Fluoroscopic Swallowing Exam radiology procedure?

Generally, no complications or side effects are observed after the Video Fluoroscopic Swallowing Exam procedure.

When do you need to call your Physician?

If the patient is experiencing an allergic reaction from the barium swallow; then, do contact the physician.

What Post-Operative Care is needed at Home after the Video Fluoroscopic Swallowing Exam radiology procedure?

There is no post-operative care necessary at home, after the Video Fluoroscopic Swallowing Exam. 

How long does it normally take to fully recover, from the Procedure?

The Video Fluoroscopic Swallowing Exam requires no recovery time.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

No tissue sample is taken during a Video Fluoroscopic Swallowing Exam.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Video Fluoroscopic Swallowing Exam radiology procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers. 

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital, where the procedure is performed
• Radiologist or radiologic technologist, performing the procedure
• Healthcare providers, physicians, who is involved in the process

The patient is advised to inquire and confirm the type of billing, before the Video Fluoroscopic Swallowing Exam (VFSE) procedure is performed.