Radiologists Not Needed for Barium Swallow Studies

Modified barium swallow studies (MBSS) can be safely and effectively conducted without a radiologist present to oversee the procedure, according to newly presented research.

In a poster presentation during the American Roentgen Ray Society (ARRS) 2021 Virtual Annual Meeting, a team led by Luhe Yang, M.D., CM, from the department of medical imaging at the University of Saskatchewan, showed that MBSS procedures performed by a radiologic technologist performed well against studies where the radiologist was present – and they even did a better job in some circumstances.

For more ARRS 2021 Virtual Annual Meeting conference coverage, click here.

Pivoting away from having a radiologist present, however, would be a significant change to a long-standing practice, the team said.

“Currently, most MBSS are still performed in an environment where both a speech language pathologist and a radiologist are present,” said Yang’s team. “But, many facilities are performing the procedure without the radiologist present during the live study, who then reviews the recorded tape later.”

Despite precedent, there is a growing push for more MBSS procedures to be performed by the technologist, the team said. In many instances, small clinics do not have enough radiologists to effectively supervise these procedures, or the radiologists have a scheduling conflict. It is also possible that radiologists in larger facilities already have numerous responsibilities or lower reimbursement rates could come into play.

To determine whether conducting these procedures without a radiologist present could be an effective option, Yang’s team conducted a pre- and post-observational study with a retrospective review to see how safety and performance compared between radiologist-present (RP) studies and radiologist-absent (RA) studies.

They examined RP study outcomes collected between March 1, 2019, and Aug. 31, 2019, as well as RA study results gathered from Oct. 1, 2019, to March 31, 2020. All total, their investigation included 106 RP exams and 119 RA tests. The average patient age was between 64 and 70 years.

These were their results:

Although the results did show that RA studies had an increased time to finalize a report, their analysis determined that RA studies performed well when compared with RP studies in several areas, including fluoroscopic time, study duration, number of cine loops, and the number of images. And, it actually outperformed RP studies by taking fewer non-diagnostic images and decreasing the number of irradiated non-essential anatomical structures.

Additional work is needed to address the delay in radiology report time, but overall, the team said, this outcome bolsters the growing call to change the current process for conducting MBSS studies.

“Findings of this study support a new practice standard of a technologist-operated MBSS without the presence of a radiologist,” they said. “Future directions include addressing the quality and safety of MBSS performed with and without the presence of a radiologist in a pediatric population parallel study.”

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