 Dysphagia affects up to 22% of adults in the primary care setting and is more common in older adults [3,4]. Adults over 65 years of age account for up to two-thirds of all people with dysphagia [3]. Although the aging process is associated with neuromuscular changes, aging itself does not typically cause clinically significant dysphagia. Aging is associated with an increased prevalence of neuromuscular and degenerative disorders that can cause dysphagia; therefore, the presence of dysphagia should prompt evaluation [3,5]. It is also important to recognize that a person may have an asymptomatic swallowing disorder. In one study of 2,000 patients evaluated with videofluoroscopic examinations, 51% of patients were found to aspirate; however, of those who were aspirated, 55% demonstrated silent aspiration with an absent protective cough reflex [6]. Reprint requests to: publications@acr.org Pharynx Dynamic and Static Imaging Biphasic examination of the pharynx is performed by acquiring static and dynamic images of the pharynx. Double-contrast and single-contrast images of the pharynx and videofluoroscopy of swallowing are obtained. Pharyngeal function, structure, and motility are also assessed. The structural evaluation of the pharynx is superior to that obtained with a modified barium swallow because fluoroscopic spot images are obtained. Therapeutic maneuvers are not typically performed or assessed in this examination. Biphasic Esophagram A biphasic fluoroscopic evaluation of the esophagus includes single- and double-contrast techniques, including full-column, mucosal relief, and double-contrast views of the esophagus [11]. Esophageal function and motility are evaluated at fluoroscopy. Double-contrast technique provides more mucosal detail compared with the single- contrast technique. However, patient cooperation and mobility are required.
Dysphagia.  Dysphagia affects up to 22% of adults in the primary care setting and is more common in older adults [3,4]. Adults over 65 years of age account for up to two-thirds of all people with dysphagia [3]. Although the aging process is associated with neuromuscular changes, aging itself does not typically cause clinically significant dysphagia. Aging is associated with an increased prevalence of neuromuscular and degenerative disorders that can cause dysphagia; therefore, the presence of dysphagia should prompt evaluation [3,5]. It is also important to recognize that a person may have an asymptomatic swallowing disorder. In one study of 2,000 patients evaluated with videofluoroscopic examinations, 51% of patients were found to aspirate; however, of those who were aspirated, 55% demonstrated silent aspiration with an absent protective cough reflex [6]. Reprint requests to: publications@acr.org Pharynx Dynamic and Static Imaging Biphasic examination of the pharynx is performed by acquiring static and dynamic images of the pharynx. Double-contrast and single-contrast images of the pharynx and videofluoroscopy of swallowing are obtained. Pharyngeal function, structure, and motility are also assessed. The structural evaluation of the pharynx is superior to that obtained with a modified barium swallow because fluoroscopic spot images are obtained. Therapeutic maneuvers are not typically performed or assessed in this examination. Biphasic Esophagram A biphasic fluoroscopic evaluation of the esophagus includes single- and double-contrast techniques, including full-column, mucosal relief, and double-contrast views of the esophagus [11]. Esophageal function and motility are evaluated at fluoroscopy. Double-contrast technique provides more mucosal detail compared with the single- contrast technique. However, patient cooperation and mobility are required.