Refining measurement of swallowing safety in the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) criteria: Validation of DIGEST version 2
Background Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) is a validated method to grade the severity of pharyngeal swallowing impairment as a toxicity of cancer based on the degree and patterns of penetration/aspiration and pharyngeal residue over a standardly acquired radiographic modified...
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| Veröffentlicht in: | Cancer Jg. 128; H. 7; S. 1458 - 1466 |
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| Hauptverfasser: | , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
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United States
Wiley Subscription Services, Inc
01.04.2022
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| ISSN: | 0008-543X, 1097-0142, 1097-0142 |
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| Abstract | Background
Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) is a validated method to grade the severity of pharyngeal swallowing impairment as a toxicity of cancer based on the degree and patterns of penetration/aspiration and pharyngeal residue over a standardly acquired radiographic modified barium swallow (MBS) study. Since its implementation in 2016, areas for the refinement of grading mild safety impairments have been identified by clinical and research users. The objective of this study was to assess the performance and validity of refined DIGESTsafety grading criteria (per DIGEST version 2 [DIGESTv2]).
Methods
Refined safety criteria were developed and vetted with clinical and research users. DIGESTv2 included 2 changes to the safety criteria. All MBSs with blinded DIGEST version 1 grading were sampled from a registry database (1331 patients underwent MBS over the period of December 2005 to July 2019). New criteria were applied to derive DIGESTsafety grading version 2. Measures of criterion validity, including the MD Anderson Dysphagia Inventory [MDADI] composite score, the Modified Barium Swallow Impairment Profile (MBSImP) pharyngeal total, the MBSImP hyolaryngeal components (items 8‐11), and the Performance Status Scale for Head and Neck Cancer Patients [PSS‐HN] diet, were correlated with DIGESTsafety and overall DIGEST grades from versions 1 and 2 and were compared pairwise between reassigned grades.
Results
With the application of version 2 safety criteria, 112 of 1331 examinations (8.4%) and 79 of 1331 examinations (5.9%) changed in their DIGESTsafety and overall grades, respectively. The safety and overall DIGEST grades (versions 1 and 2) significantly correlated with criterion measures, including the MBSImP pharyngeal total, laryngeal MBSImP parameters of interest, MDADI, and PSS‐HN (P < .0001); correlations maintained a similar magnitude between versions 1 and 2. Forty‐six upgraded examinations (reassigned from safety grade 1 per version 1 to grade 2 per version 2) performed similarly to other safety grade 2 examinations (version 1), and this was likewise true for 66 downgraded examinations (reassigned from safety grade 1 per version 1 to grade 0 per version 2).
Conclusions
Refined criteria defining mild safety impairments with the DIGEST methodology changed grades in small numbers of examinations. DIGESTv2 criteria maintained criterion validity, demonstrated ordinality, and improved the performance of the method in these rare scenarios.
Lay Summary
Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) is a method developed and validated by the investigators in 2016 to grade the severity of pharyngeal swallowing dysfunction (dysphagia) with a decision tree or flowsheet to guide the clinician's review of a standard radiographic modified barium swallow study.
This work reports on the validity of updated DIGEST criteria (version 2) that incorporate 2 modifications to the decision tree.
Version 2 of Dynamic Imaging Grade of Swallowing Toxicity (DIGESTv2) incorporates 2 modifications to the decision tree used by clinicians to grade mild (grade 1) safety impairments based on patterns of laryngeal penetration/aspiration on a radiographic modified barium swallow study. Key findings of this work include 1) the criterion validity of DIGESTv2 with respect to reference measures of clinician‐graded pharyngeal swallowing impairment and patient‐reported dysphagia and 2) the ordinality of DIGESTv2. |
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| AbstractList | BackgroundDynamic Imaging Grade of Swallowing Toxicity (DIGEST) is a validated method to grade the severity of pharyngeal swallowing impairment as a toxicity of cancer based on the degree and patterns of penetration/aspiration and pharyngeal residue over a standardly acquired radiographic modified barium swallow (MBS) study. Since its implementation in 2016, areas for the refinement of grading mild safety impairments have been identified by clinical and research users. The objective of this study was to assess the performance and validity of refined DIGESTsafety grading criteria (per DIGEST version 2 [DIGESTv2]).MethodsRefined safety criteria were developed and vetted with clinical and research users. DIGESTv2 included 2 changes to the safety criteria. All MBSs with blinded DIGEST version 1 grading were sampled from a registry database (1331 patients underwent MBS over the period of December 2005 to July 2019). New criteria were applied to derive DIGESTsafety grading version 2. Measures of criterion validity, including the MD Anderson Dysphagia Inventory [MDADI] composite score, the Modified Barium Swallow Impairment Profile (MBSImP) pharyngeal total, the MBSImP hyolaryngeal components (items 8‐11), and the Performance Status Scale for Head and Neck Cancer Patients [PSS‐HN] diet, were correlated with DIGESTsafety and overall DIGEST grades from versions 1 and 2 and were compared pairwise between reassigned grades.ResultsWith the application of version 2 safety criteria, 112 of 1331 examinations (8.4%) and 79 of 1331 examinations (5.9%) changed in their DIGESTsafety and overall grades, respectively. The safety and overall DIGEST grades (versions 1 and 2) significantly correlated with criterion measures, including the MBSImP pharyngeal total, laryngeal MBSImP parameters of interest, MDADI, and PSS‐HN (P < .0001); correlations maintained a similar magnitude between versions 1 and 2. Forty‐six upgraded examinations (reassigned from safety grade 1 per version 1 to grade 2 per version 2) performed similarly to other safety grade 2 examinations (version 1), and this was likewise true for 66 downgraded examinations (reassigned from safety grade 1 per version 1 to grade 0 per version 2).ConclusionsRefined criteria defining mild safety impairments with the DIGEST methodology changed grades in small numbers of examinations. DIGESTv2 criteria maintained criterion validity, demonstrated ordinality, and improved the performance of the method in these rare scenarios.Lay SummaryDynamic Imaging Grade of Swallowing Toxicity (DIGEST) is a method developed and validated by the investigators in 2016 to grade the severity of pharyngeal swallowing dysfunction (dysphagia) with a decision tree or flowsheet to guide the clinician's review of a standard radiographic modified barium swallow study.This work reports on the validity of updated DIGEST criteria (version 2) that incorporate 2 modifications to the decision tree. Background Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) is a validated method to grade the severity of pharyngeal swallowing impairment as a toxicity of cancer based on the degree and patterns of penetration/aspiration and pharyngeal residue over a standardly acquired radiographic modified barium swallow (MBS) study. Since its implementation in 2016, areas for the refinement of grading mild safety impairments have been identified by clinical and research users. The objective of this study was to assess the performance and validity of refined DIGESTsafety grading criteria (per DIGEST version 2 [DIGESTv2]). Methods Refined safety criteria were developed and vetted with clinical and research users. DIGESTv2 included 2 changes to the safety criteria. All MBSs with blinded DIGEST version 1 grading were sampled from a registry database (1331 patients underwent MBS over the period of December 2005 to July 2019). New criteria were applied to derive DIGESTsafety grading version 2. Measures of criterion validity, including the MD Anderson Dysphagia Inventory [MDADI] composite score, the Modified Barium Swallow Impairment Profile (MBSImP) pharyngeal total, the MBSImP hyolaryngeal components (items 8‐11), and the Performance Status Scale for Head and Neck Cancer Patients [PSS‐HN] diet, were correlated with DIGESTsafety and overall DIGEST grades from versions 1 and 2 and were compared pairwise between reassigned grades. Results With the application of version 2 safety criteria, 112 of 1331 examinations (8.4%) and 79 of 1331 examinations (5.9%) changed in their DIGESTsafety and overall grades, respectively. The safety and overall DIGEST grades (versions 1 and 2) significantly correlated with criterion measures, including the MBSImP pharyngeal total, laryngeal MBSImP parameters of interest, MDADI, and PSS‐HN (P < .0001); correlations maintained a similar magnitude between versions 1 and 2. Forty‐six upgraded examinations (reassigned from safety grade 1 per version 1 to grade 2 per version 2) performed similarly to other safety grade 2 examinations (version 1), and this was likewise true for 66 downgraded examinations (reassigned from safety grade 1 per version 1 to grade 0 per version 2). Conclusions Refined criteria defining mild safety impairments with the DIGEST methodology changed grades in small numbers of examinations. DIGESTv2 criteria maintained criterion validity, demonstrated ordinality, and improved the performance of the method in these rare scenarios. Lay Summary Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) is a method developed and validated by the investigators in 2016 to grade the severity of pharyngeal swallowing dysfunction (dysphagia) with a decision tree or flowsheet to guide the clinician's review of a standard radiographic modified barium swallow study. This work reports on the validity of updated DIGEST criteria (version 2) that incorporate 2 modifications to the decision tree. Version 2 of Dynamic Imaging Grade of Swallowing Toxicity (DIGESTv2) incorporates 2 modifications to the decision tree used by clinicians to grade mild (grade 1) safety impairments based on patterns of laryngeal penetration/aspiration on a radiographic modified barium swallow study. Key findings of this work include 1) the criterion validity of DIGESTv2 with respect to reference measures of clinician‐graded pharyngeal swallowing impairment and patient‐reported dysphagia and 2) the ordinality of DIGESTv2. Version 2 of Dynamic Imaging Grade of Swallowing Toxicity (DIGEST v2 ) incorporates 2 modifications to the decision tree used by clinicians to grade mild (grade 1) safety impairments based on patterns of laryngeal penetration/aspiration on a radiographic modified barium swallow study. Key findings of this work include 1) the criterion validity of DIGEST v2 with respect to reference measures of clinician‐graded pharyngeal swallowing impairment and patient‐reported dysphagia and 2) the ordinality of DIGEST v2 . Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) is a validated method to grade the severity of pharyngeal swallowing impairment as a toxicity of cancer based on the degree and patterns of penetration/aspiration and pharyngeal residue over a standardly acquired radiographic modified barium swallow (MBS) study. Since its implementation in 2016, areas for the refinement of grading mild safety impairments have been identified by clinical and research users. The objective of this study was to assess the performance and validity of refined DIGESTsafety grading criteria (per DIGEST version 2 [DIGESTv2 ]).BACKGROUNDDynamic Imaging Grade of Swallowing Toxicity (DIGEST) is a validated method to grade the severity of pharyngeal swallowing impairment as a toxicity of cancer based on the degree and patterns of penetration/aspiration and pharyngeal residue over a standardly acquired radiographic modified barium swallow (MBS) study. Since its implementation in 2016, areas for the refinement of grading mild safety impairments have been identified by clinical and research users. The objective of this study was to assess the performance and validity of refined DIGESTsafety grading criteria (per DIGEST version 2 [DIGESTv2 ]).Refined safety criteria were developed and vetted with clinical and research users. DIGESTv2 included 2 changes to the safety criteria. All MBSs with blinded DIGEST version 1 grading were sampled from a registry database (1331 patients underwent MBS over the period of December 2005 to July 2019). New criteria were applied to derive DIGESTsafety grading version 2. Measures of criterion validity, including the MD Anderson Dysphagia Inventory [MDADI] composite score, the Modified Barium Swallow Impairment Profile (MBSImP) pharyngeal total, the MBSImP hyolaryngeal components (items 8-11), and the Performance Status Scale for Head and Neck Cancer Patients [PSS-HN] diet, were correlated with DIGESTsafety and overall DIGEST grades from versions 1 and 2 and were compared pairwise between reassigned grades.METHODSRefined safety criteria were developed and vetted with clinical and research users. DIGESTv2 included 2 changes to the safety criteria. All MBSs with blinded DIGEST version 1 grading were sampled from a registry database (1331 patients underwent MBS over the period of December 2005 to July 2019). New criteria were applied to derive DIGESTsafety grading version 2. Measures of criterion validity, including the MD Anderson Dysphagia Inventory [MDADI] composite score, the Modified Barium Swallow Impairment Profile (MBSImP) pharyngeal total, the MBSImP hyolaryngeal components (items 8-11), and the Performance Status Scale for Head and Neck Cancer Patients [PSS-HN] diet, were correlated with DIGESTsafety and overall DIGEST grades from versions 1 and 2 and were compared pairwise between reassigned grades.With the application of version 2 safety criteria, 112 of 1331 examinations (8.4%) and 79 of 1331 examinations (5.9%) changed in their DIGESTsafety and overall grades, respectively. The safety and overall DIGEST grades (versions 1 and 2) significantly correlated with criterion measures, including the MBSImP pharyngeal total, laryngeal MBSImP parameters of interest, MDADI, and PSS-HN (P < .0001); correlations maintained a similar magnitude between versions 1 and 2. Forty-six upgraded examinations (reassigned from safety grade 1 per version 1 to grade 2 per version 2) performed similarly to other safety grade 2 examinations (version 1), and this was likewise true for 66 downgraded examinations (reassigned from safety grade 1 per version 1 to grade 0 per version 2).RESULTSWith the application of version 2 safety criteria, 112 of 1331 examinations (8.4%) and 79 of 1331 examinations (5.9%) changed in their DIGESTsafety and overall grades, respectively. The safety and overall DIGEST grades (versions 1 and 2) significantly correlated with criterion measures, including the MBSImP pharyngeal total, laryngeal MBSImP parameters of interest, MDADI, and PSS-HN (P < .0001); correlations maintained a similar magnitude between versions 1 and 2. Forty-six upgraded examinations (reassigned from safety grade 1 per version 1 to grade 2 per version 2) performed similarly to other safety grade 2 examinations (version 1), and this was likewise true for 66 downgraded examinations (reassigned from safety grade 1 per version 1 to grade 0 per version 2).Refined criteria defining mild safety impairments with the DIGEST methodology changed grades in small numbers of examinations. DIGESTv2 criteria maintained criterion validity, demonstrated ordinality, and improved the performance of the method in these rare scenarios.CONCLUSIONSRefined criteria defining mild safety impairments with the DIGEST methodology changed grades in small numbers of examinations. DIGESTv2 criteria maintained criterion validity, demonstrated ordinality, and improved the performance of the method in these rare scenarios.Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) is a method developed and validated by the investigators in 2016 to grade the severity of pharyngeal swallowing dysfunction (dysphagia) with a decision tree or flowsheet to guide the clinician's review of a standard radiographic modified barium swallow study. This work reports on the validity of updated DIGEST criteria (version 2) that incorporate 2 modifications to the decision tree.LAY SUMMARYDynamic Imaging Grade of Swallowing Toxicity (DIGEST) is a method developed and validated by the investigators in 2016 to grade the severity of pharyngeal swallowing dysfunction (dysphagia) with a decision tree or flowsheet to guide the clinician's review of a standard radiographic modified barium swallow study. This work reports on the validity of updated DIGEST criteria (version 2) that incorporate 2 modifications to the decision tree. Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) is a validated method to grade the severity of pharyngeal swallowing impairment as a toxicity of cancer based on the degree and patterns of penetration/aspiration and pharyngeal residue over a standardly acquired radiographic modified barium swallow (MBS) study. Since its implementation in 2016, areas for the refinement of grading mild safety impairments have been identified by clinical and research users. The objective of this study was to assess the performance and validity of refined DIGEST grading criteria (per DIGEST version 2 [DIGEST ]). Refined safety criteria were developed and vetted with clinical and research users. DIGEST included 2 changes to the safety criteria. All MBSs with blinded DIGEST version 1 grading were sampled from a registry database (1331 patients underwent MBS over the period of December 2005 to July 2019). New criteria were applied to derive DIGEST grading version 2. Measures of criterion validity, including the MD Anderson Dysphagia Inventory [MDADI] composite score, the Modified Barium Swallow Impairment Profile (MBSImP) pharyngeal total, the MBSImP hyolaryngeal components (items 8-11), and the Performance Status Scale for Head and Neck Cancer Patients [PSS-HN] diet, were correlated with DIGEST and overall DIGEST grades from versions 1 and 2 and were compared pairwise between reassigned grades. With the application of version 2 safety criteria, 112 of 1331 examinations (8.4%) and 79 of 1331 examinations (5.9%) changed in their DIGEST and overall grades, respectively. The safety and overall DIGEST grades (versions 1 and 2) significantly correlated with criterion measures, including the MBSImP pharyngeal total, laryngeal MBSImP parameters of interest, MDADI, and PSS-HN (P < .0001); correlations maintained a similar magnitude between versions 1 and 2. Forty-six upgraded examinations (reassigned from safety grade 1 per version 1 to grade 2 per version 2) performed similarly to other safety grade 2 examinations (version 1), and this was likewise true for 66 downgraded examinations (reassigned from safety grade 1 per version 1 to grade 0 per version 2). Refined criteria defining mild safety impairments with the DIGEST methodology changed grades in small numbers of examinations. DIGEST criteria maintained criterion validity, demonstrated ordinality, and improved the performance of the method in these rare scenarios. Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) is a method developed and validated by the investigators in 2016 to grade the severity of pharyngeal swallowing dysfunction (dysphagia) with a decision tree or flowsheet to guide the clinician's review of a standard radiographic modified barium swallow study. This work reports on the validity of updated DIGEST criteria (version 2) that incorporate 2 modifications to the decision tree. |
| Author | Alvarez, Clare P. Warneke, Carla L. Barbon, Carly E. A. Hutcheson, Katherine A. |
| Author_xml | – sequence: 1 givenname: Katherine A. orcidid: 0000-0003-3710-5706 surname: Hutcheson fullname: Hutcheson, Katherine A. email: karnold@mdanderson.org organization: The University of Texas MD Anderson Cancer Center – sequence: 2 givenname: Carly E. A. surname: Barbon fullname: Barbon, Carly E. A. organization: The University of Texas MD Anderson Cancer Center – sequence: 3 givenname: Clare P. surname: Alvarez fullname: Alvarez, Clare P. organization: The University of Texas MD Anderson Cancer Center – sequence: 4 givenname: Carla L. surname: Warneke fullname: Warneke, Carla L. organization: The University of Texas MD Anderson Cancer Center |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/34985765$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.1002/lary.26845 10.1001/jamaoto.2019.2725 10.1002/lary.28312 10.1044/2021_JSLHR-21-00014 10.1016/j.apmr.2004.11.049 10.1002/1097-0142(19900801)66:3<564::AID-CNCR2820660326>3.0.CO;2-D 10.1002/hed.25455 10.1177/000348940811701210 10.1007/s00455-008-9185-9 10.3390/cancers11040549 10.1371/journal.pone.0236804 10.1007/s00455-018-09974-5 10.1111/nmo.13251 10.1016/j.apmr.2018.01.012 10.1044/jshr.3702.314 10.1007/s00455-017-9843-x 10.1007/s00455-018-9918-3 10.1002/cncr.30283 10.1002/lio2.203 10.1002/lary.27610 10.1016/j.radonc.2018.06.013 |
| ContentType | Journal Article |
| Copyright | 2021 American Cancer Society 2021 American Cancer Society. 2022 American Cancer Society |
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| Keywords | toxicity dysphagia functional outcome head and neck cancer imaging |
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| Notes | We gratefully acknowledge the contributions of all investigators contributing to the development of Dynamic Imaging Grade of Swallowing Toxicity (DIGEST), including Martha P. Barrow, Denise A. Barringer, Jodi K. Knott, Heather Y. Lin, Randal S. Weber, C. David Fuller, Stephen Y. Lai, Janhavi Raut, Cathy L. Lazarus, Annette May, Joanne Patterson, Justin W. G. Roe, Heather M. Starmer, and Jan S. Lewin. We are also grateful for the administrative support of Ms. Angela Kurtz and the regulatory support of the Clinical Research Group in the Department of Head and Neck Surgery. Finally, numerous clinical and research users, particularly those in the Section of Speech Pathology and Audiology at The University of Texas MD Anderson Cancer Center, provided invaluable feedback and collaboration in the refinement of DIGEST. We also appreciate research support from Xiaohui Tang and Ariana Sahli. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 |
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| PublicationDate | April 1, 2022 2022-04-00 2022-Apr-01 20220401 |
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| References | 2018; 3 1990; 66 2021; 64 2018; 128 2020; 130 2019; 41 2019; 11 2021 2019; 34 2008; 23 2020; 15 2005; 86 2008; 117 2018; 30 1994; 37 2019; 129 2017; 123 2018; 33 2018; 99 2019; 145 2001; 127 e_1_2_8_17_1 e_1_2_8_18_1 e_1_2_8_19_1 e_1_2_8_13_1 e_1_2_8_24_1 e_1_2_8_15_1 e_1_2_8_16_1 Chen AY (e_1_2_8_14_1) 2001; 127 e_1_2_8_3_1 e_1_2_8_2_1 e_1_2_8_5_1 e_1_2_8_4_1 e_1_2_8_7_1 e_1_2_8_6_1 e_1_2_8_9_1 e_1_2_8_8_1 e_1_2_8_20_1 e_1_2_8_10_1 e_1_2_8_21_1 e_1_2_8_11_1 e_1_2_8_22_1 e_1_2_8_12_1 e_1_2_8_23_1 |
| References_xml | – volume: 64 start-page: 1802 year: 2021 end-page: 1810 article-title: Adaptation and validation of the Dynamic Imaging Grade of Swallowing Toxicity for Flexible Endoscopic Evaluation of Swallowing: DIGEST‐FEES publication-title: J Speech Lang Hear Res – volume: 37 start-page: 314 year: 1994 end-page: 325 article-title: Oropharyngeal swallow efficiency as a representative measure of swallowing function publication-title: J Speech Hear Res – volume: 30 year: 2018 article-title: Oropharyngeal dysphagia profiles in individuals with oculopharyngeal muscular dystrophy publication-title: Neurogastroenterol Motil – volume: 129 start-page: 2059 year: 2019 end-page: 2064 article-title: Patient‐reported versus physiologic swallowing outcomes in patients with head and neck cancer after chemoradiation publication-title: Laryngoscope – volume: 128 start-page: 442 year: 2018 end-page: 451 article-title: Radiotherapy dose‐volume parameters predict videofluoroscopy‐detected dysphagia per DIGEST after IMRT for oropharyngeal cancer: results of a prospective registry publication-title: Radiother Oncol – volume: 15 year: 2020 article-title: Diagnostic utility of the Amyotrophic Lateral Sclerosis Functional Rating Scale–Revised to detect pharyngeal dysphagia in individuals with amyotrophic lateral sclerosis publication-title: PLoS One – volume: 86 start-page: 1516 year: 2005 end-page: 1520 article-title: Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients publication-title: Arch Phys Med Rehabil – volume: 145 start-page: 1053 year: 2019 end-page: 1063 article-title: Dysphagia after primary transoral robotic surgery with neck dissection vs nonsurgical therapy in patients with low‐ to intermediate‐risk oropharyngeal cancer publication-title: JAMA Otolaryngol Head Neck Surg – volume: 130 start-page: 2153 year: 2020 end-page: 2159 article-title: Gastrostomy utilization by oropharyngeal cancer patients is partially driven by swallowing function publication-title: Laryngoscope – volume: 11 start-page: 549 year: 2019 article-title: Swallowing safety and efficiency after open partial horizontal laryngectomy: a videofluoroscopic study publication-title: Cancers (Basel) – volume: 23 start-page: 392 year: 2008 end-page: 405 article-title: MBS measurement tool for swallow impairment—MBSImP: establishing a standard publication-title: Dysphagia – volume: 117 start-page: 919 year: 2008 end-page: 924 article-title: Validity and reliability of the Eating Assessment Tool (EAT‐10) publication-title: Ann Otol Rhinol Laryngol – volume: 34 start-page: 698 year: 2019 end-page: 707 article-title: Development of a non‐invasive device for swallow screening in patients at risk of oropharyngeal dysphagia: results from a prospective exploratory study publication-title: Dysphagia – year: 2021 – volume: 66 start-page: 564 year: 1990 end-page: 569 article-title: A performance status scale for head and neck cancer patients publication-title: Cancer – volume: 128 start-page: 1044 year: 2018 end-page: 1051 article-title: Expiratory muscle strength training for radiation‐associated aspiration after head and neck cancer: a case series publication-title: Laryngoscope – volume: 3 start-page: 377 year: 2018 end-page: 383 article-title: Analysis of pharyngeal edema post‐chemoradiation for head and neck cancer: impact on swallow function publication-title: Laryngoscope Investig Otolaryngol – volume: 34 start-page: 2 year: 2019 end-page: 33 article-title: Psychometric properties of visuoperceptual measures of videofluoroscopic and fibre‐endoscopic evaluations of swallowing: a systematic review publication-title: Dysphagia – volume: 41 start-page: 322 year: 2019 end-page: 328 article-title: Prospective instrumental evaluation of swallowing, tongue function, and QOL measures following transoral robotic surgery alone without adjuvant therapy publication-title: Head Neck – volume: 33 start-page: 185 year: 2018 end-page: 191 article-title: Grading dysphagia as a toxicity of head and neck cancer: differences in severity classification based on MBS DIGEST and clinical CTCAE grades publication-title: Dysphagia – volume: 99 start-page: 934 year: 2018 end-page: 944 article-title: Creation and initial validation of the International Dysphagia Diet Standardisation Initiative Functional Diet Scale publication-title: Arch Phys Med Rehabil – volume: 123 start-page: 62 year: 2017 end-page: 70 article-title: Dynamic Imaging Grade of Swallowing Toxicity (DIGEST): scale development and validation publication-title: Cancer – volume: 127 start-page: 870 year: 2001 end-page: 876 article-title: The development and validation of a dysphagia‐specific quality‐of‐life questionnaire for patients with head and neck cancer: the M. D. Anderson Dysphagia Inventory publication-title: Arch Otolaryngol Head Neck Surg – ident: e_1_2_8_5_1 doi: 10.1002/lary.26845 – ident: e_1_2_8_4_1 doi: 10.1001/jamaoto.2019.2725 – ident: e_1_2_8_7_1 doi: 10.1002/lary.28312 – ident: e_1_2_8_19_1 doi: 10.1044/2021_JSLHR-21-00014 – ident: e_1_2_8_22_1 doi: 10.1016/j.apmr.2004.11.049 – ident: e_1_2_8_15_1 doi: 10.1002/1097-0142(19900801)66:3<564::AID-CNCR2820660326>3.0.CO;2-D – ident: e_1_2_8_10_1 doi: 10.1002/hed.25455 – ident: e_1_2_8_20_1 – ident: e_1_2_8_24_1 doi: 10.1177/000348940811701210 – ident: e_1_2_8_13_1 doi: 10.1007/s00455-008-9185-9 – ident: e_1_2_8_8_1 doi: 10.3390/cancers11040549 – ident: e_1_2_8_21_1 doi: 10.1371/journal.pone.0236804 – ident: e_1_2_8_17_1 doi: 10.1007/s00455-018-09974-5 – ident: e_1_2_8_12_1 doi: 10.1111/nmo.13251 – ident: e_1_2_8_23_1 doi: 10.1016/j.apmr.2018.01.012 – ident: e_1_2_8_6_1 doi: 10.1044/jshr.3702.314 – ident: e_1_2_8_18_1 doi: 10.1007/s00455-017-9843-x – ident: e_1_2_8_16_1 doi: 10.1007/s00455-018-9918-3 – ident: e_1_2_8_2_1 doi: 10.1002/cncr.30283 – ident: e_1_2_8_11_1 doi: 10.1002/lio2.203 – ident: e_1_2_8_9_1 doi: 10.1002/lary.27610 – ident: e_1_2_8_3_1 doi: 10.1016/j.radonc.2018.06.013 – volume: 127 start-page: 870 year: 2001 ident: e_1_2_8_14_1 article-title: The development and validation of a dysphagia‐specific quality‐of‐life questionnaire for patients with head and neck cancer: the M. 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Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) is a validated method to grade the severity of pharyngeal swallowing impairment as a toxicity... Version 2 of Dynamic Imaging Grade of Swallowing Toxicity (DIGEST v2 ) incorporates 2 modifications to the decision tree used by clinicians to grade mild... Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) is a validated method to grade the severity of pharyngeal swallowing impairment as a toxicity of cancer... BackgroundDynamic Imaging Grade of Swallowing Toxicity (DIGEST) is a validated method to grade the severity of pharyngeal swallowing impairment as a toxicity... |
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| SubjectTerms | Barium Cancer Criteria Decision trees Deglutition Deglutition Disorders - diagnostic imaging Dysphagia functional outcome Head & neck cancer head and neck cancer Head and Neck Neoplasms - diagnostic imaging Humans imaging Impairment Lymphoma, Follicular Medical imaging Oncology Patients Pharynx Safety Swallowing Toxicity Validity |
| Title | Refining measurement of swallowing safety in the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) criteria: Validation of DIGEST version 2 |
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