Case Study: Performing detailed analysis of MBS studies at Sydney’s Royal North Shore Hospital speech pathology
The challenge
Dysphagia, which is the medical term for swallow disorders, is a serious health issue.
To assess patient swallow, a modified barium swallow study (MBSS) is performed using an x-ray process called video fluoroscopy, to record a patient’s swallow of a bolus of varying thicknesses and textures.
In many clinical settings, MBSS review is performed using low quality DVD recorders or fluoroscopy systems with inferior image definition and low acquisition times that only record up to 10 seconds, with no audio recording.
These traditional MBSS systems typically have no clinical capabilities: No slow motion, no editing function, no measuring tools, and only limited connectivity options to archive MBSS sequences to a Picture Archiving and Communication System (PACS), or to save to an Electronic Health Record (EHR).
The product solution
Danielle Stone has almost 20 years’ experience as a speech pathologist and is Clinical Specialist Speech Pathologist at Sydney’s Royal North Shore Hospital (RNSH) where she specialises in head and neck cancer.
MBS studies are a core part of the hospital’s dysphagia patient care.
Until Ms Stone moved to RNSH almost four years ago, she had never used the TIMS MVP 4.0 system before. Now, she says she could never work without it.
“I love the TIMS system, and it has made me a much better clinician,” said Ms Stone.
“I have a much higher standard of assessment and I understand swallow biomechanics a lot more – even though I had been working as a speech pathologist for 15 years before I started using TIMS.
“I thought there was nothing else to learn and then I moved to the Royal North Shore where they have TIMS, and it really changed my way of looking at swallow and assessing swallow and appreciating the detail.
How the TIMS system works
The TIMS MVP 4.0 system and TIMS Review software were designed after extensive consultation with speech pathologists to create an all-in-one MBSS solution that delivers speech pathologists complete control over the swallow study process.
Speech pathologists can use the TIMS MVP 4.0 to record the video fluoroscopy’s high definition (HD) video and audio to the HD monitor in the Fluro room. TIMS captures both still and motion video images (30 frames per second, for up to several minutes of video) with synchronised audio.
The fluoroscopy is automatically saved by the TIMS DICOM System and can be sent to PACS or another network destination within a hospital or external speech pathology clinic. TIMS can also record to CD, DVD and USB device.
The speech pathologist can review the patient fluoroscopy later, at a convenient time and location, via a Windows 10 computer installed with TIMS Review software. Importantly, because TIMS records the full 1024 x 1024 HD fluoroscopy, the speech pathologist will be looking at the same sharp resolution and crisp image in a digital format.
Unique clinical functions
TIMS Review has a full editing suite that slows down the video, frame by frame, to edit out extraneous images or streams.
The system’s objective quantitative measures include timer, length (in millimetres), and angle measurements to assess biomechanical movements of structures, cartilage, and bone, to inform reports.
The telestration tool allows clinicians to highlight, and annotate, areas of interest directly on the image, while study comments can be added on screen.
The full MBS study, or part of the study, can be sent to PACS. The study can be exported as DICOM or AVI (and also JPG for integration with reports and presentations), making it simple to send the MBSS to referring specialists or colleagues for review and collaboration, or as part of a patient medical record.
The benefits
Danielle Stone, Clinical Speech Pathologist at Sydney’s Royal North Shore Hospital, says the TIMS system has transformed her practice.
TIMS improves workflows
“TIMS has made everything streamlined and quick,” said Ms Stone.
At RNSH, MBS studies are performed in the morning and are automatically saved to the speech pathology department’s network, freeing up the fluoroscopy suite for the next patient. Afternoons are set aside to analyse the MBS studies using TIMS Review in the speech pathology clinic.
“Then we score each study using the MBSImP (swallow impairment measurement tool) which helps us write our report, and then we can send that information off to the electronic health record.
“TIMS also allows us to easily send a file to a colleague for a second opinion, or to the referral source.”