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This study developed and validated a framework artificial intelligence (AI) and image processing to detect penetration, aspiration, and classify residues according to the Yale Pharyngeal Residue Severity Rating Scale (YPR-SRS). The system combines anatomical tracking of the epiglottis, arytenoids, and vocal folds with contrast adjustments, color-based segmentation, and enhancement filters, optimizing the visibility of clinical events. In validation with 60 videos, accuracy was of 0.90 for penetration and 0.87 for aspiration, with sensitivities of 1.00 and 0.90, specificities of 0.80 and 0.85, and Kappa values of 0.80 and 0.75. For residues in the pyriform sinuses, accuracy ranged from 0.91 to 0.95, sensitivity from 0.91 to 1.00, specificity from 0.83 to 1.00, and Kappa\u2009=\u20090.87. In the valleculae, accuracy ranged from 0.95 to 1.00, with sensitivity and specificity of 0.91\u20131.00 and Kappa\u2009=\u20090.91. These findings highlight its assistive potential for FEES analysis and clinical decision-making support in penetration, aspiration, and pharyngeal residue classification, a capability not previously reported.<\/jats:p>","DOI":"10.1038\/s41598-026-44495-4","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T12:17:28Z","timestamp":1775823448000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Artificial intelligence and image processing framework for automated airway invasion detection and residue classification from swallowing endoscopy"],"prefix":"10.1038","volume":"16","author":[{"given":"Luiza","family":"Ara\u00fajo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enzo","family":"Rangel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anibal","family":"Cotrina-Atencio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vit\u00f3ria Gomes","family":"dos Santos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Maria","family":"da Costa dos Santos Reis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hip\u00f3lito","family":"Magalh\u00e3es","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lidiane","family":"Ferreira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9 Felipe Oliveira","family":"de Azevedo Dantas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline Cunha","family":"do Esp\u00edrito-Santo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"key":"44495_CR1","doi-asserted-by":"publisher","first-page":"3067","DOI":"10.1007\/s10072-020-04495-2","volume":"41","author":"M Panebianco","year":"2020","unstructured":"Panebianco, M. et al. 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This study was approved by the Research Ethics Committee of the Santos Dumont Institute (SDI; proponent institution), under the number CAAE 74298723.7.0000.0129. In addition, it was forwarded for approval by Onofre Lopes University Hospital (HUOL) of the Federal University of Rio Grande do Norte (UFRN) (coparticipating institution), under the number CAAE 74298723.7.3001.5292, both committees in Rio Grande do Norte, Brazil. All procedures were in accordance with the Helsinki Declaration of 1975, revised in 2013, and following relevant guidelines and regulations. Given the retrospective nature of the data and impracticability of contacting all participants, the requirement for informed consent was waived by the Research Ethics Committees of the SDI and the HUOL\/UFRN.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}}],"article-number":"16949"}}