Classification of high-resolution manometry data according to videofluoroscopic parameters using pattern recognition
Open accessAbstract
OBJECTIVE: To determine if pattern recognition techniques applied to high-resolution manometry (HRM) spatiotemporal plots of the pharyngeal swallow can identify features of disordered swallowing reported on the Modified Barium Swallow Impairment Profile (MBSImP). STUDY DESIGN: Case series evaluating new method of data analysis. SETTING: University hospital. SUBJECTS AND METHODS: Simultaneous HRM and videofluoroscopy was performed on 30 subjects (335 swallows) with dysphagia. Videofluoroscopic studies were scored according to the MBSImP guidelines while HRM plots were analyzed using a novel program. Pattern recognition using a multilayer perceptron artificial neural network (ANN) was performed to determine if 7 pharyngeal components of the MBSImP as well as penetration/aspiration status could be identified from the HRM plot alone. Receiver operating characteristic (ROC) analysis was also performed. RESULTS: MBSImP parameters were identified correctly as normal or disordered at an average rate of approximately 91% (area under the ROC curve ranged from 0.902 to 0.981). Classifications incorporating two MBSImP parameters resulted in classification accuracies over 93% (area under the ROC curve ranged from 0.963 to 0.989). CONCLUSION: Pattern recognition coupled with multiparameter quantitative analysis of HRM spatiotemporal plots can be used to identify swallowing abnormalities, which are currently assessed using videofluoroscopy. The ability to provide quantitative, functional data at the bedside while avoiding radiation exposure makes HRM an appealing tool to supplement and, at times, replace traditional videofluoroscopic studies.
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Claims the paper makes
0 of 22 cited sources checked · 0 supported · 0 flagged
- Findingown data
None of the classification schemes achieved 100% agreement with videofluoroscopy.
“While values reported in this study were fairly high, none achieved 100% agreement with videofluoroscopy.”
Quote in the paperSubstantial claim - Findingown data
Among 213 swallows with disordered hyoid excursion, 135 had normal PES opening.
“Interestingly, of the 213 swallows in our dataset exhibiting disordered hyoid excursion, 135 had normal PES opening.”
Quote in the paperSubstantial claim - Findingown data
MBSImP parameters were classified as normal or disordered with an average accuracy of approximately 91%.
“MBSImP parameters were identified correctly as normal or disordered at an average rate of approximately 91% (area under the ROC curve ranged from 0.902 to 0.981).”
Quote in the paperSubstantial claim - Findingown data
Classification of PES opening in the presence of abnormal hyoid excursion achieved 92.6±4.2% accuracy (AUC=0.971).
“92.6±4.2% (AUC=0.971) when evaluating PES opening in the presence of abnormal hyoid excursion”
Quote in the paperSubstantial claim - Findingown data
Classification of anterior hyoid excursion given delayed pharyngeal swallow initiation achieved 92.6% accuracy.
“This analysis produced a classification accuracy of 92.6%; such a method could be used to determine if patients with a delayed swallow are at risk for dysphagia or if it is merely a normal variant.”
Quote in the paperSubstantial claim
- Findingown data
Classification of hyoid excursion in the presence of delayed pharyngeal swallow initiation achieved 95.2±1.7% accuracy (AUC=0.989).
“95.2±1.7% (AUC=0.989) when evaluating hyoid excursion in the presence of delayed pharyngeal swallow initiation”
Quote in the paperSubstantial claim - Findingown data
Across individual MBSImP parameters, total classification accuracy ranged from 86.5±6.2% for pharyngeal swallow initiation to 94.0±2.4% for anterior hyoid excursion.
“Total classification accuracy for individual MBSImP parameters ranged from 86.5±6.2% for pharyngeal swallow initiation to 94.0±2.4% for anterior hyoid excursion (table 4).”
Quote in the paperSubstantial claim - Findingown data
Classification of tongue base retraction in the presence of abnormal PES opening achieved 91.6±8.4% accuracy (AUC=0.963).
“Classifications using a subset of the dataset and incorporating two MBSImP parameters yielded classification accuracies of 91.6±8.4% (AUC=0.963) when evaluating tongue base retraction in the presence of abnormal PES opening”
Quote in the paperSubstantial claim - Findingown data
For individual MBSImP parameters, ROC AUC values ranged from 0.902 for pharyngeal swallow initiation to 0.981 for anterior hyoid excursion and pharyngeal residue.
“ROC analysis yielded AUC values ranging from 0.902 for pharyngeal swallow initiation to 0.981 for anterior hyoid excursion and pharyngeal residue (table 4, figure 3).”
Quote in the paperSubstantial claim - Interpretationown data
Pattern recognition combined with multiparameter quantitative analysis of HRM spatiotemporal plots can identify swallowing abnormalities that are currently assessed using videofluoroscopy.
“Pattern recognition coupled with multiparameter quantitative analysis of HRM spatiotemporal plots can be used to identify swallowing abnormalities which are currently assessed using videofluoroscopy.”
Quote in the paperSubstantial claim - Premisecitation
Swallowing is a pressure-driven process.
“Swallowing is a pressure-driven process;9 accordingly, detailed measurement and analysis of the changes in pressure underlying bolus transit can provide valuable information on swallowing physiology.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [9] source
Not checked in the free run.
- Premisecitation
Abnormalities in PES opening are well-suited to examination with manometry.
“Abnormalities in PES opening are well-suited to examination with manometry19,20 and normal opening is easily identified on the HRM spatiotemporal plot as a decrease in pressure at the UES to or below atmospheric pressure.”
Quote in the paperSubstantial claim0 of 2 sources checked - Interpretationnone given
This is the first study to use pharyngeal HRM to identify specific abnormalities visible on videofluoroscopy beyond penetration or aspiration.
“This is the first study using pharyngeal HRM to identify specific abnormalities visible on videofluoroscopy beyond penetration or aspiration.”
Quote in the paperNot a substantial claim- Rests on an assumption: Simultaneous pharyngeal HRM and videofluoroscopy with MBSImP analysis had not been performed, and it had not been investigated whether HRM alone can identify pharyngeal swallow abnormalities reported using the MBSImP.
- Interpretationcitation
If normal hyoid excursion is preserved, it may allow normal UES opening and bolus passage without risk of penetration or aspiration.
“If normal hyoid excursion is preserved, it may allow for normal UES opening and consequent bolus passage without risk of penetration or aspiration.”
Quote in the paperSubstantial claim - Interpretationreasoning
Pharyngeal swallow initiation and penetration-aspiration, which lack obvious manometric correlates, had the lowest classification scores.
“Parameters which do not have an obvious manometric correlate, such as pharyngeal swallow initiation and penetration-aspiration, had the lowest scores.”
Quote in the paperNot a substantial claim - Premisenone given
The pharyngeal stripping wave can be identified as a traveling pressure wave on the HRM plot.
“Additionally, the pharyngeal stripping wave can be identified as a traveling pressure wave on the HRM plot.”
Quote in the paperSubstantial claim - Premisecitation
Entry of the bolus into the pharynx before hyoid movement alone is not sufficient to cause a swallowing abnormality.
“Martin-Harris et al. performed a videofluoroscopic study of normal subjects across a wide age range and found that entry of the bolus into the pharynx prior to hyoid movement alone was not sufficient to cause a swallowing abnormality.21”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [21]
Not checked in the free run.
- Interpretationown data
Events with direct manometric links had predictably high classification rates and AUC values.
“Events with direct manometric links displayed predictably high classification rates and AUC values.”
Quote in the paperSubstantial claim - Premisecitation
Videofluoroscopy is a relatively poor predictor of aspiration pneumonia.
“Additionally, examination requires the patient be moved to the radiology suite and is a relatively poor predictor of aspiration pneumonia.4,5”
Quote in the paperSubstantial claim0 of 2 sources checked - Interpretationcitation
The lower penetration-aspiration accuracy in this study may be due to the absence of impedance measurement, which is useful for detecting bolus residue.
“This disparity may be due to the absence of impedance measurement, which is useful for detecting bolus residue.6”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [6] source
Not checked in the free run.
- May combine two claims. 14
- Classified as probably not a substantial claim. 11
May combine two claims.
Findingown dataPharyngeal swallow initiation and penetration-aspiration were still classified with greater than 80% accuracy and AUC values greater than 0.9.
“Notably, these parameters were still classified with greater than 80% accuracy and had AUC values greater than 0.9.”
Quote in the paperSubstantial claimMay combine two claims.
FindingcitationPenetration-aspiration classification accuracy was 84.2% under a binary scheme, lower than the previously reported 89.4% under a ternary scheme.
“Secondly, the classification accuracy of 84.2% observed for penetration-aspiration was based on a binary classification scheme (normal versus penetration+aspiration) and was lower than our previously reported value of 89.4% obtained using a ternary scheme (normal versus penetration versus aspiration).13”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [13] source
Not checked in the free run.
May combine two claims.
Findingown dataPES opening was classified correctly nearly 93% of the time, with an AUC of 0.945.
“Accordingly, this parameter was classified correctly nearly 93% of the time and had an AUC value of 0.945.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataClassifications that incorporated two MBSImP parameters achieved accuracies over 93%, with AUC from 0.963 to 0.989.
“Classifications incorporating two MBSImP parameters resulted in classification accuracies over 93% (area under the ROC curve ranged from 0.963 to 0.989).”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataThe pharyngeal stripping wave was classified correctly at a rate of 94.0%, with an AUC of 0.971.
“This parameter was classified correctly at a rate of 94.0% with an AUC value of 0.971.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationThe importance of hyoid excursion in UES opening is well-documented, and impaired hyoid excursion can lead to aspiration.
“The importance of hyoid excursion in UES opening is well-documented27,28 and impaired hyoid excursion can lead to aspiration.29,30”
Quote in the paperNot a substantial claim0 of 4 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenTwenty replicates were performed at each number of hidden nodes to determine classification accuracy and reliability.
“Twenty replicates were performed at each number of hidden nodes to determine classification accuracy and reliability.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductnone givenData were randomly partitioned into a training set (60%), a testing set (20%), and a validation set (20%).
“Data were randomly partitioned into a training set (60%), a testing set (20%), and a validation set (20%).”
Quote in the paperSubstantial claimClassified as probably not a substantial claim. May combine two claims.
Study design and conductown dataEach swallow was rated separately by two trained undergraduate research assistants, and disagreements were resolved by a third licensed speech-language pathologist.
“Each swallow was rated separately by two trained undergraduate research assistants. Disagreements in scores were resolved by a third rater (CAJ), a licensed and certified speech-language pathologist who has completed MBSImP training (Northern Speech Services, Gaylord MI) and also trained the two research assistants on videofluoroscopy analysis.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationVideofluoroscopy examination requires radiation exposure and carries associated risk to patients.
“While videofluoroscopy is certainly valuable, examination requires radiation exposure and associated risk to patients.3”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [3] source
Not checked in the free run.
May combine two claims.
Study design and conductreasoningEach classification analysis included equal numbers of normal and disordered samples, ensuring that chance classification accuracy was always 50%.
“Each classification analysis included equal numbers of samples in each group (normal and disordered).”
- Also stated in: § Data processing · plain
“This ensures that the probability of accurately classifying samples by chance is always 50%.”
Quote in the paperSubstantial claim- Also stated in: § Data processing · plain
Classified as probably not a substantial claim.
PremisecitationAbnormal esophageal clearance is correlated with abnormal findings on esophageal manometry with impedance.
“Subsequent studies determined that the MBSImP protocol does not prolong radiation exposure14 and that abnormal esophageal clearance is correlated with abnormal findings on esophageal manometry with impedance.15”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [15] source
Not checked in the free run.
Classified as probably not a substantial claim.
Study design and conductnone givenTraining and testing data were kept separate to increase generalizability of the classification algorithm.
“Training and testing data are kept separate to increase generalizability of the classification algorithm.”
Quote in the paperSubstantial claimMay combine two claims.
Study design and conductreasoningAll parameters were reduced to a binary normal/disordered classification, which does not yield insight into severity.
“Importantly, we reduced all parameters to a binary classification scheme (i.e., normal or disordered; table 2).”
- Also stated in: § DISCUSSION · plain
“While this scheme is suitable for identifying persons exhibiting a given abnormality, it does not yield insight into the severity of that finding.”
Quote in the paperSubstantial claim- Also stated in: § DISCUSSION · plain
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductreasoningOnly a subset of the MBSImP components was evaluated.
“Lastly, only a subset of the MBSImP components was evaluated.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationThe authors previously applied ANNs to classify HRM data into normal and disordered swallows and to identify penetration and aspiration.
“We previously applied ANNs to classify HRM data into normal and disordered swallows12 as well as identify penetration and aspiration.13”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [12]
Not checked in the free run.
- cites [13] source
Not checked in the free run.
May combine two claims.
InterpretationreasoningClassification using pattern recognition can be done in seconds and is a more feasible method for analyzing the large amounts of data produced by HRM.
“Classification using pattern recognition, though, can be done in seconds and represents a more feasible method of analyzing the large amounts of data produced by HRM.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
PremisecitationArtificial neural networks are powerful mathematical models that use nonlinear statistical analysis to classify large datasets into groups.
“Pattern recognition techniques such as artificial neural networks (ANNs) are powerful mathematical models which use nonlinear statistical analysis to classify large datasets into groups.10,11”
Quote in the paperSubstantial claim0 of 2 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationThe MBSImP is a standardized method for analyzing videofluoroscopy that can lack inter-rater reliability.
“The MBSImP was presented as a standardized method of analyzing videofluoroscopy, a valuable and frequently used assessment but one that can lack inter-rater reliability.18”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [18] source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationThe tongue plays a critical role in bolus propulsion, and tongue strengthening exercises can improve swallowing function.
“The tongue plays a critical role in bolus propulsion22 and tongue strengthening exercises can be of benefit in improving swallowing function;23”
Quote in the paperNot a substantial claim0 of 2 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe MBSImP protocol does not prolong radiation exposure.
“Subsequent studies determined that the MBSImP protocol does not prolong radiation exposure14 and that abnormal esophageal clearance is correlated with abnormal findings on esophageal manometry with impedance.15”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [14] source
Not checked in the free run.
The paper relies on this without support.
Simultaneous pharyngeal HRM and videofluoroscopy with MBSImP analysis had not been performed, and it had not been investigated whether HRM alone can identify pharyngeal swallow abnormalities reported using the MBSImP.
“Simultaneous pharyngeal HRM and videofluoroscopy with MBSImP analysis has not been performed and, importantly, it has not been investigated whether HRM alone can be used to identify pharyngeal swallow abnormalities reported using the MBSImP.”
The paper relies on this without support.
Videofluoroscopy examination requires moving the patient to the radiology suite.
“Additionally, examination requires the patient be moved to the radiology suite and is a relatively poor predictor of aspiration pneumonia.4,5”
The paper relies on this without support.
An HRM exam is quick, does not require radiation exposure, and can be performed at the bedside.
“An HRM exam, however, is quick, does not require radiation exposure, and can be performed at the bedside.”
The paper relies on this without support.
The eight MBSImP components selected for this study have potential to relate to changes in pressure measured by pharyngeal HRM.
“Eight components (table 1) were chosen for this study based on their potential to relate to changes in pressure measured by pharyngeal HRM.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
VFSS with high-resolution manometry has been considered in the evaluation of pharyngeal and esophageal anatomical structures.
“VFSS, along with high-resolution manometry, has also been considered in the evaluation of pharyngeal and esophageal anatomical structures(27,29-31)”
From Artificial intelligence in the diagnosis and management of dysphagia: a scoping review (2025) · cites this paper as [30]
The Subjects and Methods and Data analysis sections describe simultaneous videofluoroscopy and pharyngeal HRM used to assess swallowing features, including the upper esophageal sphincter. But the Discussion says the study protocol did not allow measurement of esophageal pressure, so the claim overextends the paper’s evaluation to esophageal structures more generally. Page numbers were not available in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredStudies utilizing deep learning and neural network classifiers for esophageal motility have reported sensitivity metrics above 85%.
“studies utilizing deep learning and neural network classifiers for esophageal motility have reported sensitivity metrics above 85%, offering promising diagnostic complements(29,30)”
From Artificial intelligence in the diagnosis and management of dysphagia: a scoping review (2025) · cites this paper as [30]
The Methods describe an artificial neural network classifier, and the Results report classification accuracies above 85% for several swallowing measures. But those figures are accuracies, not sensitivity metrics. The Discussion also says this study’s protocol did not measure esophageal pressure, so its results do not establish performance for esophageal motility. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Two-parameter accuracy claim exceeds two reported results
MinorThe abstract says all two-parameter classifications exceeded 93% accuracy, but the results report accuracies of 91.6% and 92.6% for two of the three classifications.
“Classifications incorporating two MBSImP parameters resulted in classification accuracies over 93%”
“Classifications using a subset of the dataset and incorporating two MBSImP parameters yielded classification accuracies of 91.6±8.4% (AUC=0.963) when evaluating tongue base retraction in the presence of abnormal PES opening, 92.6±4.2% (AUC=0.971) when evaluating PES opening in the presence of abnormal hyoid excursion”
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Flagged first, then by citations
Cited by
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Jones, C. A., Hoffman, M. R., Lin, L., Abdelhalim, S., Jiang, J. J., & McCulloch, T. M. (2018) · Neurogastroenterology & Motility · doi:10.1111/nmo.13236 · Cited by 35 · see citing works
Self-citationArtificial intelligence in the diagnosis and management of dysphagia: a scoping review
Silva, R. D. D., Almeida, S. B., Gonçalves, F. M., Zeigelboim, B. S., Stechman-Neto, J., Schroder, A. G. D., Nascimento, W. V., Santos, R. S., & Araujo, C. M. D. (2025) · CoDAS · doi:10.1590/2317-1782/e20240305en · Cited by 6 · see citing works
“The algorithms used varied within the classification of Machine Learning (2,3,16,20,25-28,30, 32, 35, 37, 39, Despite the considered effective results, all highlighted the need for further studies in the area.”
- Authors
- Hoffman, M. R., Jones, C. A., Geng, Z., Abelhalim, S. M., Walczak, C. C., Mitchell, A. R., Jiang, J. J., & McCulloch, T. M.
- Affiliations
- University of Wisconsin–Madison (US)
- Corresponding author
- McCulloch, Timothy M.
- Venue
- Otolaryngology–Head and Neck Surgery
- Publisher
- Wiley
- Published
- 2013-06
- Volume
- 149
- Issue
- 1
- Pages
- 126-133
- ISSN
- 0161-6439 (ISSN-L)
- 0194-5998
- 1097-6817
- PMC
- PMC3823556
- OpenAlex
- W2093935640
- Cited by
- 45
- References
- 31
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 2 · 2023: 2 · 2022: 1 · 2021: 2 · 2020: 4 · 2019: 3 · 2018: 6 · 2017: 5 · 2016: 9 · 2015: 2 · 2014: 2 · 2013: 1
- FWCI
- 10.69
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Otolaryngology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (R21 DC011130A, F31 DC012495)
- Topics
- Health Sciences › Health Professions › Speech and Hearing › Dysphagia Assessment and Management
- Health Sciences › Medicine › Physiology › Voice and Speech Disorders
- Health Sciences › Health Professions › Health Information Management › Artificial Intelligence in Healthcare
- Keywords
- high-resolution manometry, pharyngeal swallow, dysphagia, Modified Barium Swallow Impairment Profile, artificial neural networks, pattern recognition, penetration-aspiration, videofluoroscopy, radiation-free assessment
- MeSH terms
- Adult, Aged, Aged, 80 and over, Deglutition Disorders, Female, Fluoroscopy, Humans, Image Processing, Computer-Assisted, Male, Manometry, Middle Aged, Pattern Recognition, Automated, ROC Curve, Video Recording, Cohort Studies
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read under definition version 3 (extract-v3) on 2026-09-28.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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