Dynamic Imaging Grade of Swallowing Toxicity (DIGEST): Scale development and validation

Katherine A. Hutcheson, Martha P. Barrow, Denise A. Barringer, Jodi K. Knott, Heather Y. Lin, Randal S. Weber, Clifton D. Fuller, Stephen Y. Lai, Clare P. Alvarez, Janhavi Raut, Cathy L. Lazarus, Annette May, Joanne Patterson, Justin W.G. Roe, Heather M. Starmer, Jan S. Lewin

Research output: Contribution to journalArticlepeer-review

63 Scopus citations


BACKGROUND: The National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE) is the universal framework for toxicity reporting in oncology trials. The objective of this study was to develop a CTCAE-compatible modified barium swallow (MBS) grade for the purpose of grading pharyngeal dysphagia as a toxicity endpoint in cooperative-group organ-preservation trials for head and neck cancer (HNC). It was hypothesized that a 5-point, CTCAE-compatible MBS grade (Dynamic Imaging Grade of Swallowing Toxicity [DIGEST]) based on the interaction of pharyngeal residue and laryngeal penetration/aspiration ratings would be feasible and psychometrically sound. METHODS: A modified Delphi exercise was conducted for content validation, expert consensus, and operationalization of DIGEST criteria. Two blinded raters scored 100 MBSs conducted before or after surgical or nonsurgical organ preservation. Intrarater and interrater reliability was tested with weighted κ values.

Original languageEnglish (US)
Pages (from-to)62-70
Number of pages9
Issue number1
StatePublished - Jan 1 2017


  • dysphagia
  • head and neck cancer
  • radiation
  • surgery
  • toxicity

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


Dive into the research topics of 'Dynamic Imaging Grade of Swallowing Toxicity (DIGEST): Scale development and validation'. Together they form a unique fingerprint.

Cite this