{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T16:58:31Z","timestamp":1780937911983,"version":"3.54.1"},"reference-count":29,"publisher":"S. Karger AG","issue":"3","license":[{"start":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T00:00:00Z","timestamp":1754956800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T00:00:00Z","timestamp":1754956800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Folia Phoniatr Logop"],"abstract":"<jats:p>&lt;p&gt;Introduction: Computerized, percentage-based assessments of pharyngeal residue (e.g., % filling of the valleculae) during videofluoroscopic swallow studies (VFSSs) offer a high level of precision, validity, and reliability compared to more frequently used visual-perceptual categorical-based rating methods (e.g., mild, moderate, severe). Despite these advantages, clinical practice largely relies on visual-perceptual methods, given their ease, speed, and lack of need for specialized software or training. Percentage-based visual-perceptual residue ratings could represent a scalable and clinically feasible alternative to computerized techniques; however, their accuracy and reliability have not been systematically investigated. Therefore, this study aimed to: evaluate the accuracy of visual-perceptual percentage-based ratings of pharyngeal residue during VFSS compared to pixel-based ground-truth measurements; characterize the inter- and intra-rater reliability of these ratings; and explore whether clinician characteristics are associated with rating accuracy. Methods: An anonymous international survey was distributed to speech-language pathologists (SLPs). Respondents were asked to provide visual-perceptual ratings of pharyngeal residue for 40 pairs of unique fluoroscopic images. Digital tracings were superimposed onto each image to guide percentage-based ratings. SLP respondents provided two types of residue ratings: Bolus Clearance Ratio (BCR; n = 20) and Residue Ratio Scale for the valleculae (RRS&lt;sub&gt;V&lt;\/sub&gt;; n = 20). 50% of the images were randomly repeated to assess intra-rater reliability. Ratings were compared to ground-truth values. Statistical analyses were used to characterize rater accuracy and reliability. Results: 129 SLP respondents participated in the survey, yielding an analysis of 6,569 visual-perceptual percentage-based residue ratings. Residue ratings showed moderate-to-substantial agreement with ground-truth values for both BCR (\u03c1&lt;sub&gt;c&lt;\/sub&gt; = 0.92) and RRS&lt;sub&gt;V&lt;\/sub&gt; (\u03c1&lt;sub&gt;c&lt;\/sub&gt; = 0.94). Group-level inter-rater reliability was good-to-excellent for BCR (ICC = 0.90) and excellent for RRS&lt;sub&gt;V&lt;\/sub&gt; (ICC = 0.93). Intra-rater reliability was also excellent (BCR ICC = 0.92; RRS&lt;sub&gt;V&lt;\/sub&gt; ICC = 0.97). Greater accuracy was associated with clinicians with fewer years of clinical experience (r = 0.35, p = 0.006), clinicians who used frame-by-frame analysis more frequently in their clinical practice (\u03c4 = 0.228, p = 0.002), and clinicians who used standardized residue rating tools such as DIGEST and MBSImP more frequently in their clinical practice. Conclusion: Visual-perceptual percentage-based residue ratings during VFSS demonstrate a high level of accuracy and inter- and intra-rater reliability. Clinician experience and practice patterns influence rating accuracy. These findings support the potential clinical utility of percentage-based visual-perceptual methods as a valid and accessible alternative to traditional ordinal residue scales. &lt;\/p&gt;<\/jats:p>","DOI":"10.1159\/000547346","type":"journal-article","created":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:00:29Z","timestamp":1756310429000},"page":"212-223","source":"Crossref","is-referenced-by-count":0,"title":["Quantifying Pharyngeal Residue during Videofluoroscopic Swallow Studies (VFSS\/MBS): Validation of Percentage-Based Visual-Perceptual Residue Ratings"],"prefix":"10.1159","volume":"78","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5677-6364","authenticated-orcid":false,"given":"James","family":"Curtis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8323-7068","authenticated-orcid":false,"given":"Valentina","family":"Mocchetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon","family":"Jagdhar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1543-2634","authenticated-orcid":false,"given":"Ana\u00efs","family":"Rameau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine M.","family":"Clark","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mel","family":"Grasso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"127","published-online":{"date-parts":[[2025,8,12]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1007\/s12603-016-0754-6"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-011-9337-1"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-008-9185-9"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-012-9426-9"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1044\/2022_AJSLP-22-00199"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcm.2016.02.012"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1007\/PL00009559"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1044\/2020_JSLHR-19-00314"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-017-9838-7"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-021-10293-5"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-013-9459-8"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-019-10014-z"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1044\/2020_AJSLP-20-00042"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.178.2.1780393"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-002-0085-0"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1044\/2018_JSLHR-S-17-0212"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-018-9918-3"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1044\/2022_JSLHR-21-00659"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2013.05.009"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1080\/17549507.2024.2420606"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-015-9631-4"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.30283"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-019-10089-8"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1044\/2020_persp-20-00087"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.2307\/2532051"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1044\/2023_JSLHR-23-00132"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-023-10635-5"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-018-9883-x"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1007\/PL00021291"}],"container-title":["Folia Phoniatrica et Logopaedica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/karger.com\/article-pdf\/doi\/10.1159\/000547346","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T16:04:16Z","timestamp":1780934656000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000547346"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,12]]},"references-count":29,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,6,8]]},"published-print":{"date-parts":[[2026,6,10]]}},"URL":"https:\/\/doi.org\/10.1159\/000547346","archive":["Portico"],"relation":{},"ISSN":["1021-7762","1421-9972"],"issn-type":[{"value":"1021-7762","type":"print"},{"value":"1421-9972","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,12]]}}}