Videofluoroscopy is considered one of the gold standard tools for evaluating swallowing disorders. Barium sulfate is the traditional contrast used however due to a nationwide shortage, alternative contrast agents have required exploration. The aim of this project was to investigate whether iohexol was a comparable videofluoroscopy swallowing contrast to barium sulfate from the perspective of 1) Diagnostic visibility and 2) Useability/feasibility. Fifteen clinicians were presented with 294 videofluoroscopy swallow trials of varying food and fluid consistencies and blinded to the contrast used. The clinicians were required to make a judgement regarding satisfaction with contrast visibility using a 5-point Likert scale (1 = very unsatisfied to 5 = very satisfied). A subset of eligible clinicians were also asked to complete a qualitative survey regarding their experience with both contrasts. Data was descriptively analysed to determine if there is a difference in the Likert rankings of satisfaction between the two contrasts based on food/fluid consistency, oral/pharyngeal phase and lateral/anterior-posterior view. The qualitative survey data was analysed thematically. Preliminary analysis indicates that satisfaction with contrast visibility overall between the two contrasts is comparable however there appears to be some within consistency differences. 85% of clinicians were satisfied or very satisfied with the visibility of iohexol when mixed with fluids in comparison to barium (82%); whereas 83% of clinicians were satisfied or very satisfied with the visibility of barium when mixed with solids in comparison to iohexol (63%). The thematic analysis also revealed a contrast preference however this was related to preparation time as a strong deciding factor. These findings will aid in the development of an evidence base for the use of iohexol in videofluoroscopy swallowing studies and guide clinical decision-making regarding contrast choice.

1. Iohexol is a comparable contrast to barium however there are particular situations and scenarios where one is preferenced over another.
2. In light of this we would encourage you to think more broadly regarding contrast use in videofluoroscopy swallowing studies by considering both patient characteristics and the clinical factors that led you to conduct a videofluoroscopy in the first instance and matching these with the contrast.
3. Finally, further development of iohexol recipes would be of benefit as the primary barrier was related to the time required to prepare the food and fluid trials.