Spatiotemporal Visualizations for the Measurement of Oropharyngeal Transit Time From Videofluoroscopy

Videofluoroscopy remains one of the mainstay methods for clinical swallowing assessment, yet its interpretation is both complex and subjective. This, in part, reflects the difficulties associated with estimation of bolus transit time through the oral and pharyngeal regions by visual inspection, and problems with consistent repeatability. This paper introduces a software-only framework that automatically determines the time taken for the bolus to cross 1-D anatomical landmarks representing the oral and pharyngeal region boundaries (Fig. 1). The user-steered delineation algorithm live-wire and straight-line annotators are used to demarcate the landmark on a frame prior to the swallow action. The rate of change of intensity of the pixels in each landmark is used as the detection feature for bolus presence that can be visualized on a spatiotemporal plot. Artifacts introduced by head and neck movement are removed by updating the landmark coordinates using affine parameters optimized by a genetic-algorithm-based registration method. Heuristics are applied to the spatiotemporal plot to identify the frames during which the bolus passes the landmark. Correlation coefficients between three observers visually inspecting twenty-four 5-mL single swallow clips did not exceed 0.42. Yet the same measurements taken using this framework on the same clips had correlation coefficients exceeding 0.87.