DIGEST Measurement and Training
DIGEST™ is an analysis method used to grade the severity of pharyngeal dysphagia based on results of a modified barium swallow (MBS) study or flexible endoscopic evaluation of swallowing (DIGEST-FEES). DIGEST uses a flowsheet and rubric to summarize the patterns of penetration/aspiration and pharyngeal residue as markers of swallowing safety and efficiency. This method provides a reproducible way to achieve a summary grading of dysphagia from the MBS or FEES (i.e., none, mild, moderate, severe or profound/life threatening pharyngeal dysphagia) that aligns to the NCI’s CTCAE framework for clinician-grading of toxicity in oncology.
DIGEST was initially developed for videofluoroscopy or MBS in head and neck cancer in 2016.
Updates:
- Version 2 (for MBS)
- Adaptation of Version 2 for FEES (DIGEST-FEES)
- Mapping DIGEST decision tree to IDDSI (doi pending)
- Translations and validations in new clinical populations
*Reliable and valid application use of DIGEST assumes competency with MBS administration, adherence to a standard MBS acquisition protocol, familiarity with anatomy and physiology of the oropharyngeal swallow and reliable application of Rosenbek’s Penetration-Aspiration Scale.
Contact: DIGEST@MDAnderson.org
DIGEST training
The DIGEST training course aims to help users develop clinical competency to use the DIGEST methodology to grade the results of Modified Barium Swallow studies (MBS) and Flexible Endoscopic Evaluations of Swallowing (FEES). The training course includes access to a written training manual in addition to webinars that step the user through the DIGEST method with ample video examples.
Translations
DIGEST is used internationally, and we are committed to supporting its accessibility across languages. To maintain consistency and fidelity, all translations should be completed in collaboration with our team.
If you are a user who would like to complete a translation of DIGEST or DIGEST-FEES, please complete this form. Our team will:
- Provide translation and back-translation guidelines
- Review and approve procedures to ensure fidelity
- Provide developer review of the translated derivative to ensure fidelity
- Collaborate with you throughout the translation process
Recognized translations (DIGEST for videofluoroscopy, unless otherwise noted)
| Linguistically and psychometrically validated | Linguistically translated; Testing not started | In progress | Planning |
|---|---|---|---|
| German (DIGEST-FEES) Contact: Susanne Bauer |
French-Canadian Contact: Cindy Levesque-Boissonneault |
Dutch-Flemish Contact:Lisette van der Molen |
German Contact: Susanne Bauer |
| Swedish (DIGEST-FEES) Contacts: Kerstin Petersson, Lisa Tuomi |
Italian Contact: Beatrice Manduchi |
Dutch-Flemish (DIGEST-FEES) Contact: Lisette van der Molen |
|
| Portuguese (Brasilian) Contact: Andressa Silva de Freitas |
Mandarin Contact: Theresa Yao |
||
| Portuguese (European; DIGEST-FEES) Contact: Andressa Silva de Freitas |
Spanish Contact: Javier Hurtado Oliva |
||
| Turkish Contacts: Rabia Kum, Numan Demir |
Validations
DIGEST is used in multiple clinical populations, and we are committed to supporting its accessibility across populations. To maintain consistency and fidelity, all population-specific validations should be completed in collaboration with our team.
If you are a user who would like to validate DIGEST or DIGEST-FEES in a new clinical population (e.g. neurological disorders, pediatrics, etc.), please complete this form. Our team will:
- Provide validation guidelines
- Provide developer review and consultation of the validation process to ensure fidelity
Recognized Validations (DIGEST for videofluoroscopy, unless otherwise noted)
| Completed | In progress | Planning |
|---|---|---|
| Acute care Contact: Beatrice Manduchi |
Lung transplant Contact: Kahla Graham |
Dementia Contacts: Joanne Yee, Nicole Rogus-Pulia |
| ALS Contact: Veena Kallambettu |
Lung transplant (DIGEST-FEES) Contact: Kahla Graham) |
Stroke (DIGEST-FEES) Contact: Lisa Everton |
| Anterior cervical discectomy and fusion (ACDF) Contacts: Brynn Jones-Rastelli, Sonja Molfenter |
Oral cavity cancers Contact: Carly Barbon |
|
| Non-HNC oncology Contact: Beatrice Manduchi |
Total laryngectomy Contact: Barbara Ebersole |
|
| Parkinson’s disease Contact: Bendix Labeit |
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| Stroke Contact: Brittany Krekeler |
Research
The Hutcheson Lab is currently funded by the National Cancer Institute to study:
- Dissemination and implementation of DIGEST in cancer care (R01CA271223)
- AI solutions to support DIGEST implementation (P01CA27816)
Research highlights include:
- Clinical implementation of DIGEST
- Clinical utility of DIGEST
- DIGEST training
- Protocol-related publications: