Is there a doctor in the house? Roles and practices in videofluoroscopic swallowing assessment of structural abnormalities

Increasingly, videofluoroscopic swallow studies are being conducted without a radiologist. This study explored current assessment of structural dysphagia in adults during videofluoroscopic swallow studies, both internationally and within the Australian context. A document analysis of available international videofluoroscopic swallow studies guidance regarding the use of videofluoroscopic swallow studies for structural dysphagia was performed, followed by an online survey of Australian speech-language pathologists seeking information regarding roles, practices, training, and self-perceived competence specific to interpreting structural abnormalities. Eleven international guidelines agreed that: a) identification of structural abnormalities is one purpose of videofluoroscopic swallow studies, b) radiologists are responsible for diagnostics, however, c) 55% conceded videofluoroscopic swallow studies takes place without a radiologist if unavailable. Of 139 Australian speech-language pathologists surveyed, only 11% reported constant radiologist presence with 84% requesting radiologists’ input to review images. Fifty eight percent had received training to identify structural abnormalities. Self-perceived competence in identifying structural dysphagia was positively correlated with videofluoroscopic swallow studies experience (<i>r</i> = 0.43, <i>p</i> &lt; 0.05). International guidance varies in its advocacy for speech-language pathologist led videofluoroscopic swallow studies. Speech-langauge pathologists in Australia are often conducting videofluoroscopic swallow studies without a radiologist present and may need to determine when to request radiologist review of potential structural abnormalities. Speech-language pathology training and multidisciplinary clinical pathways are needed to mitigate the risk of missed structural diagnoses.