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Multi-swallow video-fluoroscopic swallow studies (VFSS) combined with high-resolution impedance manometry (HRIM) offer a comprehensive assessment of swallowing function. However, their use in HNC populations is limited by high clinical workload and complexity of data collection and analysis with existing software.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>To address the data collection challenge, we propose a framework for automatic swallow detection in simultaneous VFSS-HRIM examinations. The framework identifies candidate swallow intervals in continuous VFSS videos using an optimized double-sweep optical flow algorithm. Each candidate interval is then classified using a pressure-based swallow template derived from three annotated samples, leveraging features such as normalized peak-to-peak amplitude, mean, and standard deviation from upper esophageal sphincter sensors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The methodology was evaluated on 97 swallows from twelve post-head and neck cancer patients. The detection pipeline achieved 95% Recall and 92% F1-score. Importantly, the number of required HRIM annotations was reduced by 63%, substantially decreasing clinician workload while maintaining high accuracy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This framework overcomes limitations of current software for simultaneous VFSS-HRIM collection by enabling high-accuracy, low-input swallow detection in HNC patients. Validated on a heterogeneous patient cohort, it initiates the groundwork for scalable, objective, and multimodal swallowing assessment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11548-025-03556-1","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T16:41:22Z","timestamp":1765816882000},"page":"1797-1809","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Multimodal framework for swallow detection in video-fluoroscopic swallow studies using manometric pressure distributions from dysphagic patients"],"prefix":"10.1007","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-2108-6905","authenticated-orcid":false,"given":"Manuel Maria Loureiro","family":"da Rocha","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0514-2142","authenticated-orcid":false,"given":"Lisette","family":"van der Molen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1780-3055","authenticated-orcid":false,"given":"Marise","family":"Neijman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3551-6707","authenticated-orcid":false,"given":"Marteen J. 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Cancer 123(1):62\u201370","journal-title":"Cancer"}],"container-title":["International Journal of Computer Assisted Radiology and Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11548-025-03556-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11548-025-03556-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11548-025-03556-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T12:18:30Z","timestamp":1789647510000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11548-025-03556-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,15]]},"references-count":49,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["3556"],"URL":"https:\/\/doi.org\/10.1007\/s11548-025-03556-1","relation":{},"ISSN":["1861-6429"],"issn-type":[{"value":"1861-6429","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,15]]},"assertion":[{"value":"16 May 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 November 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 December 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Manuel Maria Loureiro da Rocha has no relevant financial or non-financial interests to disclose. Lisette van der Molen has no relevant financial or non-financial interests to disclose. Marise Neijman has no relevant financial or non-financial interests to disclose. Maarten J. A. van Alphen has no relevant financial or non-financial interests to disclose. Michiel M. W. M. van den Brekel has no relevant financial or non-financial interests to disclose. Fran\u00e7oise J. Siepel has no relevant financial or non-financial interests to disclose.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All patient data were collected and analyzed under the approval of the Institutional Review Board of the Netherlands Cancer Institute, processes IRBd21\u2013210 and IRBd23\u2013322.","order":2,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}}]}}