[NCH]

I read a thread about whether or not to do a swallow study and that prompted me to start this thread.

If you do repeated swallow studies, have the professionals involved ever mentioned the risks (if any) of repeated radiation exposure? A swallow study is more time exposure say than for shots for a broken bone because the radiation is streaming during the whole swallow process. Times solid, thin liquids, thickened liquids (for instance).

You are exposing the salivary glands and thyroid gland to radiation in this process.

So at what point is it too much? 3, 5, 10 swallow studies? Is the exposure so miniml the body processes it out in a year? (I doubt this).

The reason I ask is that my daughter just turned 6. She's has 5-7 swallow studies in her life. First would be a solid or puree or both depending on which study. Then thin liquids then thicker liquids, usually with 2 trials to find the right thickness. So minimum 3 "rounds" possibly 4-6 rounds per swallow study.

My problem now is my daughter's sublingual salivary gland is profoundly enlarged on one side (to the point of pushing her tongue up a little) and slightly enlarged on the other side.

CT scan showed no stones (ranula) or cysts. They did a biopsy that showed no cancer.

But when I told the ENT my theory that the swallow studies may have done this, he agreed that salivary glands are very sensitive and easily disrupted. He was going to investigate the exposure levels and said don't do any more swallow studies.

Now I'm worried about the long-term ramifications to these salivary glands, the others and the thyroid.

She still produces enough saliva, but had 4 cavities in 6 months when normally she has none. So it is possible the make-up of the saliva is not right. Different sets of glands contribute different substances so if one set is not functioning, the other set may produce more to compensate, but it doesn't produce the same "ingredient". This is the current theory with my daughter.

Nancy

 

[MotherWhimsey]

our SLP that does ours is really careful of the time limit. I think we've had about 9 swallow studies so far and since the first couple were super short because they were so dangerous, they might have equaled the time of maybe one study total. Our SLP will be asking the person who turns on and off the machine what time they're up to. There is a normal limit, but since Linden was going to have to do a lot of studies they made his limit shorter.

I talked to the SLP two weeks ago and told her that one of our dr's wanted to do another one. She flat out said it's not worth it, in 9 studies it's gotten worse not better, so she said not to do it. So I think we're pretty done with swallow studies unless he suddenly miraculously gets a lot better over all and that's not likely.

 

[Steve's Wife]

Wow, my ped wants my DD to get a swallow test after we see several other specialists. I wasn't really hot to do it right now, and I had no idea the tests involved radiation. I definitely don't want to do this now. DD had xrays a a week old (lung) and I didn't feel great about that.

 

[queencarr]

I don't know the exact dose of radiation, but a typical single swallow study is equivalent to several x-rays. My teachers (SLP graduate program) suggest no more than 1 every 6m-1 yr unless absolutely necessary. A good therapist and rad tech can get the exposure level way down by being prepared and turning the machine off and on between swallows--often there is only 2 minutes of exposure during a 30-45 minute test. I haven't heard of any problems with salivary glands like you describe, but intuitively it makes sense that there could be a corrolation. There is a name for the enlarged glands that I am supposed to know

that I am drawing a blank on. I just looked it up in my notes...is it by chance Ludwig's Angina? My notes from class say "tissue cellulitis in the floor of the mouth; mucosal, submucosal cells inflamed, endemetous--space between floor of the mouth and tongue no longer there" and that it can impact ability to swallow as a result.

ALso, looked up the radiation info in my text: "Guidelines of Radiation Safety issued by the National Institutes of Health (NIH) recommend 5 rem/year for all diagnostic procedures after age 18 years and 3 rem to any tissue in a 13-week time period. Swallow studies are limited to a dosage of between 270 to 660 mrad/study, with a 10% reduction in that level recommended for children less than 18 years of age" Pediatric Swallowing and Feeding: Assessment and Management, 2nd Ed pg 361. It didn't list a recommendation from NIH for under 18y.

As far as rem vs. rad, etc., here is a simplified explanation:

"When talking about x-ray exposures, 1 rad is equal to 1 rem and 1 mrad is equal to 1 mrem. Similarly, 1,000 mrad or mrem equals 1 rad or rem, respectively."

Not sure if any of that helps, but maybe it points you in the right direction.