Modified Monday: Not According to Plan

Our patient for this Modified Monday had decreased PO intake and severe weight loss. His cognitive function was poor causing him to be unable to communicate why he was not eating. Midway through the test, he had redirection of barium to the pyriform sinuses and had retention of barium in the upper esophagus. When we noticed this, rather than continuing with our protocol, the patient was repositioned to an AP view. In this view, there were apparent esophageal abnormalities, and the barium was not passing through the thoracic esophagus. Continuing to give additional PO presentations would have been contraindicated because it would have resulted in further build-up, backflow, and increased risk of aspiration. A recommendation was made to refer the patient to GI for further medical workup and diagnosis.

When doing an MBSS, some might be stuck in the rut of continuing with a protocol despite what is identified early in the study. Today’s Modified Monday is a perfect example of the importance of knowing when you need to change your image perspective. At times, you might need to go to an AP view to identify if you should continue with the lateral view. Had we noted that the barium cleared on the AP view, going back to the lateral and proceeding with our general protocol would have been appropriate. If you get pushback on varying the procedure, it is important to be able to explain your rationale.