ArticleFolia phoniatrica et logopaedica : official organ of the International Association of Logopedics and Phoniatrics (IALP)2026
Quantifying Pharyngeal Residue during Videofluoroscopic Swallow Studies (VFSS/MBS): Validation of Percentage-Based Visual-Perceptual Residue Ratings.
Article in Folia phoniatrica et logopaedica : official organ of the International Association of Logopedics and Phoniatrics (IALP), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
<p>Introduction: Computerized, percentage-based assessments of pharyngeal residue (e.g., % filling of the valleculae) during videofluoroscopic swallow studies (VFSSs) offer a high level of precision, validity, and reliability compared to more frequently used visual-perceptual categorical-based rating methods (e.g., mild, moderate, severe). Despite these advantages, clinical practice largely relies on visual-perceptual methods, given their ease, speed, and lack of need for specialized software or training. Percentage-based visual-perceptual residue ratings could represent a scalable and clinically feasible alternative to computerized techniques; however, their accuracy and reliability have not been systematically investigated. Therefore, this study aimed to: evaluate the accuracy of visual-perceptual percentage-based ratings of pharyngeal residue during VFSS compared to pixel-based ground-truth measurements; characterize the inter- and intra-rater reliability of these ratings; and explore whether clinician characteristics are associated with rating accuracy.
methodsAn anonymous international survey was distributed to speech-language pathologists (SLPs). Respondents were asked to provide visual-perceptual ratings of pharyngeal residue for 40 pairs of unique fluoroscopic images. Digital tracings were superimposed onto each image to guide percentage-based ratings. SLP respondents provided two types of residue ratings: Bolus Clearance Ratio (BCR; n = 20) and Residue Ratio Scale for the valleculae (RRS
results129 SLP respondents participated in the survey, yielding an analysis of 6,569 visual-perceptual percentage-based residue ratings. Residue ratings showed moderate-to-substantial agreement with ground-truth values for both BCR (ρ
conclusionVisual-perceptual percentage-based residue ratings during VFSS demonstrate a high level of accuracy and inter- and intra-rater reliability. Clinician experience and practice patterns influence rating accuracy. These findings support the potential clinical utility of percentage-based visual-perceptual methods as a valid and accessible alternative to traditional ordinal residue scales. </p>.
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