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.”


HubSpot Video

TIMS 1Extremely detailed MBS studies
While speech pathologists are well-trained in gross assessment of swallow disorders, Ms Stone says the TIMS system enables sophisticated and detailed instrumental assessments.

“Using the TIMS unit, we can assess the structures and biomechanics of the swallow in detail, measuring change in millimetres; we can score it, and measure pre and post-rehabilitation measures. This allows us to pick up on very subtle improvements in the biomechanics, so that we’re not just relying on patient self-report, for example a functional change such as a change in what they eat.

“The image quality is excellent, and we can slow it down and re-analyse it after the live study and go back again and again … You can be looking at a millisecond’s worth of movement.”

Targeted treatment
Ms Stone says precision MBSS helps speech pathologists formulate targeted rehabilitation programs.

“This is because we have the ability to review in more detail so we can appreciate the deficits.”

And, she adds, it is easy to share MBS study outcomes with colleagues via the TIMS DICOM feature which sends files with the click of a button.

Telestration and slow-motion tools
Ms Stone says her favourite TIMS Review tools are slow-motion review and the telestration feature, which allows users to annotate directly on an image and send it to the referral source, enhancing collaboration.

Ms Stone can save her query as a small AVI file to send to a doctor, or she can send a speech pathology colleague a DICOM file so they can review the entire MBSS.

“This is really great because the file will come up on the speech pathologist’s computer – even without TIMS being installed – with a mini TIMS reviewer, so they can actually manipulate the images and review it screen by screen.”

A valuable teaching and research tool
At RNSH, the TIMS system is also used as an education tool to train junior speech pathologists in the use of measurement tools, as well as how to conduct and analyse video fluoroscopy.

“With TIMS, we can actually slow down the flow of the bolus. We can watch the liquid going through all the different structures really, really slowly because we can move the cursor as slowly as we want to.”

Ms Stone also uses TIMS to conduct patient research as part of her PhD, which is examining whether swallow disorders are potentially under recognised after whiplash injury.

“TIMS comes in very handy in research because you’re really getting down to the nuts and bolts of swallow biomechanics, which informs our knowledge of swallowing. Without it, we’d only be getting the gross picture.”

Inline service
From installation to customisation that accommodates workflow and clinical requirements, Ms Stone says Inline’s customer support team has helped the RNSH speech pathology department get the most out of its TIMS system.

Inline provides regular staff training and a phone-support service for day-to-day queries.

“Having that close relationship with Inline has been really appreciated because technology is not necessarily a speech pathologist’s strength – we’re good at other things, like communicating with people.

“So, when we have a good relationship with the reps who teach us the ‘techy side’, it really makes the whole system less intimidating and very user friendly.”

The overall verdict

“What would I say to my colleagues? You won’t know yourselves when you get a TIMS. It makes a huge difference.”

Product features and benefits

  • Record studies in High Definition at 30fps
  • Send studies immediately to your speech office, for collaborative review
  • Full editing suite and capacity to send all or part of the study to PACS
  • Teaching hospital friendly: De-identify studies, telestrate, and save to video clips
  • Objective quantitative measures: Includes timer, length, angle measurements for reporting
  • Conversion of any digital image or stream (JPG, BMP, PNG, AVI) to DICOM
  • Export of any study, series, or image as DICOM, AVI and JPG for integration with reports and presentations
  • Integration of any medical video and image into PACS
  • Significantly less storage space on PACS required due to review and edit function
  • Improved workflow and economy of time

For further information about the TMS MVP and TIMS Review, or to arrange a demonstration, call or email us.

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