Speech-Language Pathologists' Evaluation of Structural Abnormalities on Videofluoroscopic Swallowing Studies

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Purpose: Accurate recognition of structural abnormalities during videofluoroscopic swallowing studies (VFSS) supports timely diagnostic follow-up and informed dysphagia team management. This study examined speech-language pathologists' (SLPs') competency in screening for and interpreting pharyngeal structural abnormalities on VFSS, including related management planning and referral decisions, and the factors influencing agreement. Method: Eighty Australian SLPs ( M = 9.14 years of VFSS experience; range: 1–35 years) completed an online survey and reviewed 12 VFSS clips (single swallows; International Dysphagia Diet Standardisation Initiative Level 0 or 4). Six cases had structural abnormalities (cricopharyngeal bars, Zenker's diverticulum (ZD), and cervical osteophytes), four had none, and two were repeated for reliability. Participants identified structural abnormalities, interpreted bolus flow and biomechanics, and proposed management strategies. Results: Median accuracy for detecting abnormality presence or absence was high (90.0%; interquartile range [IQR]: 80, 100), whereas accurate identification was substantially lower (53.9%; IQR: 31, 77). ZD had the lowest identification accuracy (39.7%–49.4%), while non-obstructive cervical osteophytes were most frequently recognized (86.9%). Biomechanical interpretation was higher in clinicians with 4–10 versus 1–3 years' VFSS experience ( Mdn = 84%; IQR: 80, 88 vs. 79%; IQR: 73, 82; p < .05). Higher VFSS frequency (≥ 5 per month) was associated with better performance; identification 69% (46, 92) versus 1–2 VFSS/month 46% (23, 69), interpretation 86% (73, 85) versus 83% (73, 85); both p < .05. Compensatory strategies were most common for obstructive osteophytes (95.3%) and specialist referral for ZD (98.2%–100%). Conclusions: SLPs can accurately detect the presence of structural abnormalities on VFSS, supporting their screening role, particularly when a radiologist is not present. However, variability in structure-specific identification, biomechanical interpretation, and management planning highlights the need for targeted training and multidisciplinary protocols to support timely medical diagnosis and informed clinical decision making. Supplemental Material: https://doi.org/10.23641/asha.31718536

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