Challenges in preparing contrast media for videofluoroscopy

We would like to congratulate Popa Nita and colleagues [1] for their article exploring the challenges of matching the rheological (i.e. flow) properties of contrast agents used in videofluoroscopy to thickened liquids used in dysphagia management. This article clearly illustrates the complexities of this challenge; however, there are three additional points that we feel would be clinically relevant and important to bring to the attention of the readers of the Dysphagia journal: The rheological characteristics of barium preparations need to be understood with respect to how they map to clinical categories of liquid consistency; The concentration of barium in commercially available suspensions affects both its visibility on the radiographic image, and the degree to which the suspension leaves a coating on the pharyngeal mucosa; Mixing barium powder into already-thickened liquids may result in further thickening of the liquid. We will provide a brief elaboration on each of these points below.