Modified Barium Swallow Evaluations

What is a Modified Barium Swallow?

A Modified Barium Swallow (MBS), also referred to as a Video Fluoroscopic Swallowing Exam (VFSE), a “speech swallow exam,” or a “cookie swallow”, is an x-ray test that takes pictures of your mouth and throat while you swallow foods and liquids of varying textures and consistencies. This radiologic exam uses a special movie-type x-ray called fluoroscopy, which gives physicians information as to whether foods or liquids are entering the trachea or windpipe when swallowing. It also helps to determine what foods or liquids you cannot eat or drink due to risk of choking.

An MBS/VFSE may be performed as an independent test to look at the swallowing mechanism, or together with an esophagram (sometimes called a barium swallow exam), which evaluates the structure and function of the esophagus to the level of the stomach. The names of these two exams are similar, which can sometimes cause confusion when test orders are being entered. Therefore, please be sure to clarify with your physician which exam your doctor intended to prescribe.

Why would a person need a Modified Barium Swallow?

There are several reasons that a person may need a MBS, which may include coughing and/or choking when eating or drinking, wet sounding voice when eating or drinking, or frequent respiratory infections.

How is the evaluation performed?

The speech pathologist will first gather any relevant medical history or concerns regarding your swallowing problems, and answer any questions about the test. The MBS is done in the Radiology Department in a fluoroscopy room with a radiologist who takes the pictures and x-ray technician who helps the doctor. This exam is also often performed with a speech-language pathologist present.

• An x-ray (radiograph) is a noninvasive medical test that helps physicians diagnose and treat medical conditions. Imaging with x-rays involves exposing a part of the body to a small dose of ionizing radiation to produce pictures of the inside of the body. X-rays are the oldest and most frequently used form of medical imaging.
• Fluoroscopy allows imaging of anatomical structures in real-time and allows the interpreting physician to observe structure and limited function.

What happens during the test?

You will be asked to drink food or liquids mixed with barium to make the foods and liquids visible on the x-ray while you swallow. The radiologist will move the x-ray camera next to you. Different strategies will be given by the speech pathologist to help you swallow foods and liquids safely and better, if deficits are demonstrated.