Detecting Airway Invasion in Variable-Length Videofluoroscopic Swallowing Studies: A Vision Transformer Approach for Oropharyngeal Dysphagia.

Background

Dysphagia from aging, neurodegeneration, structural anomalies, or cognitive decline harms quality of life. The videofluoroscopic swallowing study (VFSS) is the diagnostic gold standard but manual interpretation is labor-intensive and costly, motivating automation.

Methods

We introduce a Vision Transformer (ViT) using a temporal sliding window and 3D patch tokenization to capture spatio-temporal dependencies in variable-length VFSS via attention. Training/evaluation used 1154 VFSS sequences from 107 individuals (548 abnormal, 606 normal) with 5-fold cross-validation and comparisons to VGG-16, ResNet-50, EfficientNet-V1/V2, and MobileNet.

Results

The ViT achieved 84.37 ± 1.15% accuracy, 90.81 ± 2.11% sensitivity, 79.49 ± 1.66% specificity, 82.94 ± 2.76% precision, 85.68 ± 1.54% F1-score, and AUC 0.878 (5-fold). It outperformed all CNN baselines across metrics; paired t-tests confirmed significant gains (p < 0.05).

Conclusions

The pure ViT's attention-based spatio-temporal modeling yields robust VFSS classification and is well-suited for screening workflows requiring timely abnormality detection, providing a foundation for clinically deployable VFSS analysis.