Rapid Detection of Penetration-Aspiration from Fluoroscopic Videos in Dysphagia Patients

The Videofluoroscopic Swallowing Study (VFSS) is an x-ray imaging modality used as the gold standard for dysphagia assessment, in which clinicians analyze the three stages of swallowing. In dysphagia patients, the invasion of food material to the airway, called penetration or aspiration, can lead to asphyxia or pneumonia risk. The penetration or aspiration risk assessment from the VFSS using the penetration-aspiration scale is known to be subjective, with a high degree of inter-rater and inter-patient variability. We developed a clinical tool called SPAD (Swallowing phase classification coupled Penetration-Aspiration Detection) for classifying the different phases of swallowing from VFSS videos and subsequent identification of penetration-aspiration by assessment of pharyngeal bolus residue, which has a positive correlation with penetration-aspiration risk. SPAD tool demonstrates an Fl Score of 0.75 and 0.79 on phase classification and penetration-aspiration risk detection, respectively. Further-more, the risk detection is interpretably overlaid on VFSS videos using Grad-Cam, helping deglutologists better assess dysphagia.