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MBS PROTOCOL:
All MBS studies must follow a standard protocol as outlined below.
Bolus trials (lateral view) outlined below MUST be administered first before any additional
consistencies are given or swallowing strategies/postures are tested. Additional bolus presentations or
swallowing strategies may be tested after completing bolus trials in the study protocol, at the discretion of
the clinician conducting the MBS study.
Studies will be done in lateral and AP views with focus fixed on the soft palate superiorly,
cricopharyngeus inferiorly, lips anteriorly, and cervical spine posteriorly.
Video-recordings will require time code imprints accurate to 0.01 seconds (30 frames/second).
Studies must be recorded in AVI or MPEG format with audio and uploaded to the RTOG coordinating
center website for review at (INSERT HYPERLINK). All centers must use the Kay Digital Swallowing
Workstation for the studies; or alternatively, have the ability to convert files to AVI of MPEG format.
Centers must use Varibar products. Consistencies and quantities are listed below. Liquids must be
administered first to avoid confounding the results from remaining residue in the pharynx after solid
consistencies.
A dime must be taped to the subject’s chin during the swallowing study. The circular shape of the dime
minimizes the impact of head rotation and the known diameter of the dime allows for calibration of pixels
per cm and thus calculation of distances and areas on the lateral view of the x-ray.
A-P view:
10mL thin (1 trial). Instruction: slightly raise your chin (neutral position, not tucked or extended), hold this
in your mouth until asked to
RATING RULES: Rate MBS outcomes below ONLY on the basis of the 5 bolus trials presented in
the lateral view of RTOG protocol (specified above): 5mL Varibar thin liquid (2 trials), 20 mL Varibar
MBS Modified Barium Swallow Study Form
RTOG 1221: Randomized Phase II Trial of Transoral Endoscopic Head And Neck Surgery followed by Risk-
Based IMRT and Weekly Cisplatin versus IMRT and Weekly Cisplatin for HPV Negative Oropharynx Cancer
thin liquid, 5mL Varibar pudding, and ½ cookie or cracker coated in 3mL Varibar pudding. Do not rate
based on additional bolus trials that are administered outside of the protocol or based on bolus trials in
which a swallow strategy/posture was tested. Please select a SUMMARY RATING based on the highest
level of impairment you observe on any bolus trial in the protocol.