The Impact of Videofluoroscopic Pulse Rate on Measures of Swallow Safety in Infants and Adults with Feeding and Swallowing Disorders.

This investigation assessed the impact of videofluoroscopic resolution on measures of swallow safety. Thirty adult and twenty infant swallow studies, all acquired at 30 frames and 30 pulses per second (fps, pps), were obtained from a publicly available repository of swallow studies. All swallow studies were altered to simulate 15 and 5 pulses per second. Safety was assessed using the penetration-aspiration score and a modified DIGEST safety score. Analysis of outcome measures was performed and compared across the three temporal resolutions (30, 15, and 5 pps). Significant differences in measures of safety occurred when lower pulse rates were employed. All 20 infant participants were classified as having safe swallows at 5 pps, despite 11 demonstrating unsafe swallows (PAS > 2) at 30 pps. This pattern was also observed in adult participants to a lesser extent. Reducing pulse rates below 30 pps significantly compromises the accuracy of swallow safety assessment for all age groups. The systematic underestimation of safety violations has direct implications for clinical decision-making and patient risk assessment. These findings support maintaining 30 fps/pps as the standard for videofluoroscopic swallow studies (VFSS) when swallow safety evaluation is paramount and suggest that alternative radiation reduction strategies should be prioritized over pulse rate reduction.