Diagnosing Barriers to Radiation Safety Knowledge and Practice Among Speech-Language Pathologists Performing Videofluoroscopic Swallowing Studies: A Single-Center Quality Improvement Initiative

Abstract

The videofluoroscopic swallowing study (VFSS) is used by speech-language pathologists (SLPs) to assess swallowing under fluoroscopy, introducing radiation risk to patients and SLPs. Challenges with routine practice, work-as-prescribed (WAP), are not well-studied among SLPs. We aimed to identify barriers in safe radiation practices among SLPs performing VFSS and suggest methods to reduce radiation exposure. We conducted a single-center study of SLP-led VFSS (January 2024–May 2025). Data collection included surveys, observations, an educational intervention, a focus group, and dosimetry. Assisting patients directly in the fluoroscopy field-of-view (FOV) resulted in increased reliance on personal protective equipment (PPE) and dosimetry. Badge compliance was inconsistent, and ancillary PPE (e.g., lead glasses, gloves) was often ill-fitting or absent. The safety of SLPs was dependent on the availability of better-fitting PPE and administrative and engineered controls: distancing, dosimetry compliance, and appropriate lead shielding. These recommendations should be explored to improve radiation safety among SLPs during VFSS.