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Modified Monday: It's a fine line


Obtaining a quality image is a crucial part to a good instrumental assessment. Positioning and making sure the contrast and dosage is safe, but still adequate, are important first steps in gathering the needed data about a patient's physiology and swallowing anatomy. Critical to getting this image is the scout, or baseline image. Grabbing this initial shot and then critiquing the "held" image on the screen to ensure we can see what we need to before proceeding with the study should be the foundation of every MBS study. The other benefit to this scout image is taking a moment or two to become really familiar with the patient's particular anatomy and the appearance of any darker or lighter areas before the introduction of barium.

Calcification of the laryngeal cartilages is very common and is considered a normal part of the aging process. We have looked here at other videos with laryngeal calcification and this week's patient is another great example of why familiarity with the patient's baseline appearance is so important.

This patient from our Michigan team had quite a bit of calcification, and it happened to follow the line of the anterior and posterior airway to almost perfectly mimic the appearance of aspiration. Our team SLP noticed it right away and mentioned it during the first image (which we use for positioning and adjusting the dosage if needed). Throughout the study, she also asked the patient to clear their throat occasionally, just to double check the calcification appearance and ensure that what she was seeing wasn't aspiration popping through.

It's also interesting to note that this patient had an MBS in the hospital that did, in fact, cite aspiration with all consistencies, which may have definitely occurred. BUT it is worth considering that the MBS could have been overinterpreted, since the calcification was not noted in the documentation anywhere. The point here-even though calcification is normal and benign, it's still a good idea to document its presence, so that any SLP completing a follow up MBS can be aware and make sure they are taking that into account when assessing.

Differentiation between aspiration and calcification can be difficult sometimes, but it is necessary-and made a whole lot easier by obtaining that quality image-and then taking a moment to study that image.

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