# Excess Radiation Exposure in Infants and Children From Videofluoroscopic Swallow Studies

> **NIH NIH R01** · MEDICAL UNIVERSITY OF SOUTH CAROLINA · 2022 · $401,255

## Abstract

ABSTRACT
The Videofluoroscopic Swallow Study (VFSS) is the primary diagnostic test used to identify abnormalities in
oropharyngeal swallowing function, detect the presence and etiology of aspiration, and test the effects of diet
modifications and therapeutic interventions. While VFSSs are important diagnostic tests, they expose patients
to ionizing radiation, which should be kept “as low as reasonably achievable” due to the associated cancer
risks. We currently do not know the excess cancer risks associated with this diagnostic test in children. This
lack of knowledge is the cause of variable / erroneous clinical practice patterns ranging from not using this
valuable exam to acquire important diagnostic information to using the exam but in a diminished manner (with
reduced diagnostic accuracy) or potentially overusing the exam and possibly greatly increasing cancer risks. It
is imperative that we understand the cancer risks so that clinicians, hospital safety boards, patients and
caregivers can make informed decisions about the use of the Videofluoroscopic Swallow Studies in children.
Due to concerns regarding radiation exposure and associated cancer risks, using an x-ray beam pulse rate
(pps) of 15pps or a lower has become a widespread practice pattern despite the high likelihood that this
compromises diagnostic accuracy, exposing patients to radiation and increasing cancer risks without providing
useful diagnostic information. We found that, in adults, decreasing the pulse rate from 30 to 15pps significantly
reduced diagnostic accuracy and changed treatment strategies. A young child's swallow occurs in about a third
of the time of an adult swallow. When a reduced pulse rate of 15pps is used for a young child's VFSS, the
diagnostic accuracy would be less than that of an adult's VFSS performed at 7.5pps, a rate that we know
substantially decreases diagnostic accuracy. Despite this expected reduction in diagnostic accuracy,
approximately 47% of hospitals use pulse rates of 15pps or lower to decrease children's radiation exposure.
Clear evidence of the impact of using a pulse rate of 15pps or lower on diagnostic accuracy is needed to
convince clinicians to change their practice.
The information gained from the proposed experiments is desperately needed to guide the use of VFSSs in
children, including the timing of and use of repeat VFSSs, and to facilitate accurate counseling of caregivers
regarding the risks of the test. Once we know the radiation-related cancer risks for children from VFSSs, we
can evaluate whether the benefit of reducing radiation exposure by using pulse rates of 15pps or less
outweighs the risk associated with reduced diagnostic accuracy. Thus, the specific aims of this proposal are:
Aim 1. Establish the standard radiation doses from VFSSs in children. Aim 2. Quantify patient cancer risks
from VFSSs in children. Aim 3. Determine the impact of pulse rate on the assessment of swallowing
impairment severity and treatment recommend...

## Key facts

- **NIH application ID:** 10355491
- **Project number:** 5R01DK122975-03
- **Recipient organization:** MEDICAL UNIVERSITY OF SOUTH CAROLINA
- **Principal Investigator:** Heather Shaw Bonilha
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $401,255
- **Award type:** 5
- **Project period:** 2020-03-04 → 2022-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10355491

## Citation

> US National Institutes of Health, RePORTER application 10355491, Excess Radiation Exposure in Infants and Children From Videofluoroscopic Swallow Studies (5R01DK122975-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10355491. Licensed CC0.

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