Who Performs the Modified Barium Swallow Study
The modified barium swallow study (MBSS) is performed as a collaborative effort between a speech-language pathologist (SLP) and a radiologist, with both professionals bringing essential expertise to the examination. 1, 2
Primary Personnel and Their Roles
Speech-Language Pathologist (SLP)
- The SLP is a critical team member who conducts the functional assessment of swallowing during the MBSS, particularly when oropharyngeal dysphagia is suspected. 3
- The SLP determines which bolus consistencies and volumes to administer, tests evidence-based interventions during the exam, and formulates oral intake recommendations based on findings. 2
- SLPs are responsible for evaluating the safety of oral intake and identifying specific swallowing impairments that guide treatment planning. 2
Radiologist
- The radiologist operates the fluoroscopy equipment, controls radiation exposure, and interprets the anatomical and structural findings visible on the imaging study. 1, 2
- Radiologists provide expertise in identifying structural abnormalities such as strictures, tumors, or anatomic variants that may contribute to dysphagia. 3
- The radiologist has direct patient interaction during the exam and can modify examination parameters as clinically indicated. 3
Collaborative Approach
- Current best practice involves both professionals working together during the real-time examination, though traditionally they have dictated separate reports. 1
- Some healthcare systems are moving toward integrated, unified reporting between the SLP and radiologist to improve efficiency and deliver more cohesive patient care. 1
- The combination of the SLP's functional expertise and the radiologist's anatomical imaging interpretation provides higher diagnostic value than either professional working independently. 4
Clinical Context for Referral
- Consultation with an SLP for MBSS is considered when patients exhibit signs and symptoms of swallowing problems including coughing while swallowing, nasal regurgitation, wet vocal quality after swallowing, or feeling of food getting stuck. 3
- Patients with neurologic conditions (stroke, Parkinson's disease, dementia) or those who have undergone head and neck cancer treatment with chemoradiation are at high risk and warrant SLP involvement. 3
- The patient must be able to participate in the assessment and follow recommendations, making the evaluation futile in delirious or severely impaired patients who cannot cooperate. 3
Important Caveats
- Diagnostic procedures involving radiopaque contrast agents should be carried out under the direction of personnel with requisite training and thorough knowledge of the specific procedure being performed. 5
- The MBSS requires facilities and personnel from a radiology suite, a trained speech pathologist, and involves radiation exposure to the patient. 6
- Interdisciplinary engagement between radiologists and SLPs is essential for the clinical validity of the study when conducted using reproducible and validated protocols. 2