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Diagnostic Radiology
Very similar to small animals Principles are the same as in small animals Large animal radiology is very unique due to the
conformation of the patient and the fact that most radiographs are performed on a standing, awake patient.
The temperament of the animal can hinder the ability to position a patient for ideal film studies.
Safety: “Fear Factors”
Injured horses-painful Strange noises Strange things touching the horses; for
example, ideally the film cassette should be placed to contact the patient’s skin.
Personnel and equipment are in vulnerable positions with a patient that is often suspicious of the situation.
Safety: Personnel Involved
Move slowly and speak in a low calm voice
Do not make loud crashing noises Let the horse know that you are getting
ready to do something to him/her. Gently rub the area of interest-touch it lightly if it is not injured.
PPE-Wear these items! What are they?
Just how many people does it take to take a radiograph?
One person to tend to the horse’s head-your restrainer
One person to operate the radiograph machine
One person to hold/position the film cassette
That’s right-this equals 3
The five Routine views
Lateromedial (Lateral)--Extended Lateromedial (Flexed lateral)--Flexed Dorsopalmar (DP) Dorsolateral-palmaromedial oblique (DLPMO) Dorsomedial-palmarolateral oblique (DMPLO)
Radiograph labeling
Standard convention Marker is placed
Cranial / Dorsal Lateral
Be sure to “flash” the cassette Permanently identifies film as belonging to a
certain patient Owners name Patient name / number Name of clinic / Location Date of exam Limb examined (RF, LF, RH, LH)
The Equipment: Radiograph machine Caliper Radiograph cassette holder Cassette/film Play-doh or putty Positioning blocks Processor to develop the film Chemical Sedation/Restraint devices PPE Time and patience!
Packing of the grooves of the sole to prevent artifacts
created by the air pockets of the hoof.
These artifacts can sometimes mimic fracture
lines and may obscure true lesions. Do not over pack.
Always be sure to clean the hoof wall, sole and recesses
of the frog.Hoof picks, soap, water and a
brush may be needed.
Removal of the shoe is recommended but is expensive to remove and place back on the horse. Many owners will object to this. Always obtain owner consent before removing shoes!
Lateral
• Horse is weight bearing
• Cassette holder is used
• X-ray beam is perpendicular to the middle carpal joint
Flexed Lateral
• Foot is elevated• Carpus held in flexion• X-ray beam is centered
at middle carpal joint• Tendency to shift
carpus toward midline• Hands are close enough
for scatter radiation--use gloves!
Dorsopalmar
• Weight bearing
• X-ray beam centered at middle carpal joint
• Cassette parallel to the palmar aspect of the limb
DLPMO
• Weight bearing• Foot of interest
placed slightly cranial
• Centered at middle carpal joint
• Beam is 60 degrees lateral off a straight dorsal-palmar
DMPLO
• Same as previous, BUT, beam comes from 60° MEDIAL from a straight DP
• Since beam comes across the front of the horse, have a cooperative horse
Sedation if needed
CT or CAT Scan
Computed tomography has just recently become available for large animal patients.
This equipment is very expensive and limited to specialized facilities.
Use is restricted in adult horses to the examination of the head, cranial cervical spine and distal limbs.
Patient must be under anesthesia. Must be injected with radioisotope and is absorbed
by bony areas Used as a last resort in diagnosing.
This is the CT control room. The animal patient must be anesthetized because you can not remain in the room with them.
There can be no motion or movement involved.
“By scanning foals as they mature, one is able to directly quantify the rateof bone development in the distal limb. At this stage the foal mustbe anesthetized for a short time so there is no movement artifact.”
MRI Magnetic Resonance Imaging; the area being
imaged is placed within a strong magnetic field and stimulated by radio-frequency pulses. These radio-frequency signals are collected and analyzed by computers to form the image.
Very, very costly and not widely available Anesthesia is required MRI tend to be superior to CT for soft tissue
imaging The head, cervical spinal cord and lower legs
can be imaged in an adult animal Precise and focal imaging tool that produces
images of all tissue types; bone, tendons, ligaments, and fluid. Mainly utilized in equine lameness.
Thermography
Uses a heat camera to scan the body surface temperature of the patient.
Very popular because it is non-invasive, equipment is affordable and portable.
Primarily used to locate “hot spots” which may indicate inflammation near the body surface. Deeper locations can not be detected, such as within the thorax or abdomen.
Ultrasound
Operates on high frequency sound waves beyond our hearing.
Uses sound waves to detect differences in tissue density
Generally superior to standard radiographs for visualizing soft tissues.
Radiographs are superior for imaging bony structures.
Common uses of Ultrasound
Visualize kidneys and capable of ultrasound guided biopsy Lungs for pneumonia diagnosis and treatment GI for colics - small intestinal distension, large colon wall
thickness, peritoneal fluid, diagnosis of abcesses and tumors
Foals - GI disease, umbilical structures (diagnose umbilical infections), ruptured bladder
Liver - ultrasound guided biopsy Assist with lameness diagnosis, including the extent of
tendon and ligament damage Eyes
Common uses of Ultrasound cont… Monitor the mare's reproductive tract and
optimize the time for breeding The genital tract in stallions Early detection of pregnancy Early detection of problem pregnancies,
including fetal abnormalities Cardiovascular Ultrasound can be used to image the heart,
lungs, kidneys, liver, spleen, and intestines, even during colic episodes.
Brief Introduction to Ultrasound
• Transducer produces sound waves and also receives reflected sound waves.
• Sound waves travel in a plane through tissue.• Sound waves are transmitted, absorbed or reflected by tissues.• Computer forms image – in shades of gray.• Bone appears white, fluids appear black
From: Zagzebski, JA; Essentials of Ultrasound Physics, Mosby, © 1996
MusculoskeletalPalmar distal extremity
ReproductionUterine cysts
AbdomenLiver - cholelithiasis
Infected umbilicus EchocardiographyPericardial effusion
ThoraxPleuropneumonia
Imaging technique
Systematic organized approach – must be familiar with normal
Scan from proximal to distal
Evaluate structures individually
Transducer perpendicular to structure
Limb should be weight bearing
Imaging Techniques
Label images - patient info, directions and location
Two methods for location1. Zones2. Reference points
- cm distal to standard pointaccessory carpal bonepoint of hockpoint of ergot
Endoscopy
Endoscopes come in two basic varieties; rigid and flexible.
A thin tube that contains a fiberoptic camera and a tool at the end allowing samples to be taken from various locations in the body. It is passed through virtually any open cavity on the body.
Usually takes 2-3 people to operate
Maintenance of the Equipment
You will be utilizing some if not all of the previously mentioned equipment.
Take care of the equipment and it will take care of you in the long run.
Please follow ALL procedures in your hospital/clinical pertaining maintenance and trouble shooting equipment.
Follow ALL cleaning procedures as well. Read, read, and read! Ask questions!