Combining X-Rays / Ultrasound for Cat Orthopedic Assessment

X-Rays are a very commonly used diagnostic technique in veterinary clinics.

Feline patients are notoriously reticent when it comes to overt signs of pain and illness, and therefore diagnostic imaging plays a vital role in the assessment of cats in veterinary clinics.

Despite the inherent radiation risks, radiographs are a non-invasive tool with fewer complications or unwanted sequellae than more invasive diagnostic modalities, but a higher sensitivity and specificity for many conditions than most less invasive techniques. 

In many ways, we can consider radiographs to be the optimal middle ground in imaging technology for the diagnosis of a remarkable variety of conditions. 

Why use radiographs?

X-rays are a common imaging modality used in veterinary clinics due to their ability to penetrate tissue, and so reveal internal structures.

They are therefore used to assess solid structures and are particularly useful in areas with contrasting densities, such as in the thorax.

Radiographs can be an important part of a diagnostic pathway and should be used alongside a full clinical history, physical examination, and other diagnostic tools such as bloodwork and other imaging modalities. 

Why not use radiographs?

X-rays are usually considered non-invasive for patients in a veterinary setting, as they are unlikely to alter or exacerbate any underlying pathology.

However, it should be remembered that X-ray exposure can be harmful at certain levels, and positioning cats for X-rays may cause stress and discomfort. For this reason, chemical restraint is always preferred, when clinically possible.

Why are radiographs particularly useful in cats?

Cats are notorious for their ability to mask clinical indicators of pain, illness, and disease. Their tendency to withdraw at times of physiological, physical, and behavioral stress can lead to both owners and veterinarians missing clinical signs, and make a comprehensive physical assessment more difficult.

This means that objective measures of disease are important, with accurate diagnostic methods beyond physical assessment needed.  

Indications for X-rays in cats 

Radiographs have a role in the diagnosis of many conditions, but they are of particular value in disease processes affecting:

The thorax

One of the most commonly imaged areas in cats is the thorax. Due to the pleural potential space providing mechanical coupling between the chest wall and lung, invasive imaging techniques – such as thoracoscopy – are very high risk. In the acutely dyspnoeic patient, ultrasonography may be more rewarding and lower risk, but in most cases, radiography gives more useful information due to the radiolucent air-filled spaces preventing ultrasound penetration.

X-ray imaging of the thorax may be used for the determination of respiratory, cardiovascular, oncological, and traumatic conditions.

The standard radiographic projections should include left and right lateral and a VD or DV view; although the VD should be avoided in patients with severe pulmonary or cardiac disease, as the resulting V/Q mismatch may prove rapidly fatal in a brittle dyspnoeic cat. 

Fortunately, the range of densities from gas-filled lungs to solid bone provides high contrast, meaning that a resting “cat-o-gram" will often prove diagnostically useful, if the patient’s medical status precludes a more correctly positioned radiographic series.

However, findings can be non-specific and require further investigation, in particular, if there is profuse pulmonary, pleural, or pericardial fluid or solid lesions in the lungs. 

The abdomen

Abdominal radiographs have many diagnostic uses, including changes to the size, shape, or architecture of organs, foreign bodies, fluid or gas accumulations, and trauma.

Common views taken are the left and right lateral and a DV or VD. However, radiographic interpretation is not always straightforward, as the mass of overlapping soft tissue structures produces a complex palimpsest where three-dimensional relationships are obscured.

Moreover, while different fat: water ratios in different tissues do give subtly different radiographic density (and thus shade), these subtle variations are difficult to appreciate. In many cases, only the major organs are visible on a plain film radiograph. Remember too that obese patients can be more difficult to assess, due to the accumulation of fat around organs. 

However, even a simple survey radiograph has its advantages, as being relatively quick and easy, while an ultrasound scan can give different information, it is not possible to visualize the entire abdomen in a single view, unlike with a radiograph.

And while an exploratory laparotomy or even laparoscopy would indeed allow the surgeons to access and examine every structure in the cavity, these are invasive procedures with a relatively high complication rate.

The essence of obtaining – and interpreting – a diagnostic abdominal radiograph is in understanding the contrast. For example, intestinal gas – especially in the colon – shows a clear contrast to the soft tissue around it, as do radio-opaque foreign bodies.

For a more detailed examination of the intestinal or urinary tracts, contrast radiography is an under-utilized and powerful technique that bypasses the fundamental problem of poor tissue differentiation and should always be considered, especially if a structural or functional bowel obstruction is suspected.

Bones and joints

Fractures, deformities, and injuries of bony structures can all be assessed in cats using X-rays. Joint and soft tissue imaging can be more challenging, as the density of ligaments and tendons is extremely similar.

Orthopedic imaging is classically considered to revolve around radiography; however, if soft tissue lesions are suspected (or no bony lesions are detected), the parallel use of radiography and ultrasonography is an exceptionally powerful combination.

When performing orthopedic radiographs, orthogonal views are critical, as the X-ray produced is a two-dimensional image of a three-dimensional anatomic site, requiring the opposing view to fully visualize the area.3 In essence, with the exception of some of the more specialized glenohumeral and coxofemoral views, any limb radiograph can be considered to comprise a dorsopalmar/dorsoplantar view and a mediolateral view. 

It is usually important to image limbs from medial to lateral, as the limb being imaged should be as close to the imaging plate as possible. Imaging the upper, rather than lower, limb will result in excessive magnification due to an elongated object-film distance; in addition, due to the resultant angularity of the limb, variable magnification along its length may be seen. In both cases, it is impossible to accurately measure lesions or bones for the selection and fitting of plates.

In some cases, with subtle or highly focal pathology, additional oblique views may also be necessary to skyline the lesions.

These should be selected based on the location, size, and any suspicions based on simple DP and ML views.

However, in the majority of cats, the bone opacity is low enough that most lesions can be appraised from a simple paired view.

Dental X-rays

Dental disease is extremely common in cats, and management can be complex. Radiography allows for a thorough assessment of oral structures, including those below the gingival margin.

Using dental X-rays in cats allows for success in both treatment planning and evaluation.

Radiographs can provide a rapid, non-invasive, and clinically useful assessment of many internal structures in the cat.

However, X-rays should be used alongside other clinical options such as a physical exam, bloodwork, and other imaging. It is important to remember the limitations of a plain film radiograph (the reduction of three-dimensional structures into a flat palimpsest, and the limited differentiation between soft tissue structures).

As a result, a good knowledge of feline-specific anatomy and a good radiographic atlas are invaluable aids in interpreting the images. However, no other imaging modality is as versatile and as quick and easy to perform in the clinic, and with cats frequently presenting late into the course of a range of pathologies due to their masking behaviors, this makes radiography an excellent first choice for imaging most body systems. 

References

1. del Regato JA: Wilhelm Conrad Röntgen, in Radiological Physicists. American Institute of Physics, 1985. 

2. Larson, M. Feline Diagnostic Imaging. Published 2020 John Wiley. Ed. Holland & Hudson.  ISBN:9781118840948

3. Lavin L: Small animal soft tissue, in Lavin L (ed): Radiology in Veterinary Technology, ed 3. Philadelphia, WB Saunders, 2003

4. DuPont, G. & DeBowes, L. Atlast of Dental Radiography in dogs and cats. Saunders Elsevier Missouri, 2009

5. Ismael Hernandez-Avalos, Daniel Mota-Rojas, Patricia Mora-Medina, Julio Martínez-Burnes, Alejandro Casas Alvarado, Antonio Verduzco-Mendoza, Karina Lezama-García & Adriana Olmos-Hernandez (2019) Review of different methods used for clinical recognition and assessment of pain in dogs and cats, International Journal of Veterinary Science and Medicine, 7:1, 43-54

6. Borgeat, K. and Pack, M. (2021), Approach to the acutely dyspnoeic cat. In Practice, 43: 60-70. https://doi.org/10.1002/inpr.15

Old X-ray Table and Generator Be Used with a New Digital X-ray System?

Can My Old Universal Easymatic X-ray Table and Generator Be Used with a New Digital X-ray System?

Some of the Universal Easymatic systems look like this

Some veterinarians purchased their x-ray table and generator 25+ years ago and they still work perfectly!

Through care and good maintenance, they have been able to produce diagnostic images over the years using film.

For some veterinarians, 2017 is the year they would like to stop using chemicals and standard film.

However, they do not want to spend the 17k-25k on a new table and generator when their old system is producing excellent mas/kvp options for each case.

The good news is your existing system can work well with proper installation with your new digital x-ray equipment. For computed radiography or CR it is a simple calibration that will enable the old table and generator be ready for use the day of the installation.

This installation should be carried out by the installer on the day of installation and prior to the training session with the veterinary staff.

For direct radiography or DR, the plate may be wired into the foot switch as a prep switch. The old universal Easymatic x ray table and generator send out a 120-volt prep and expose signal.

A conversion box is brought by our onsite installers so that the cesium technology can convert the voltage down to a high of 5 volts and a low of 0 volts.

Another item that we include with our system is a new foot pedal switch. Often times the old switch can be worn out and the wiring loose.

A new foot pedal switch ensures a smooth transition from prep to exposure. In some instances, we also include a hand switch which can be mounted on the wall.

This secondary option is nice especially if the foot switch was to go out you always have another backup to take a high-quality digital x-ray.

You do not always need to buy a new table and generators to enjoy the speed, safety, and quality of digital x-rays.

Contact us today.

We can help you upgrade your system to digital.

Here is a video showing the conversion from film to digital using the old table and generator.

Feline Radiograph Techniques for Sedation-Free Imaging

X-rays are a commonly used diagnostic tool in many veterinary clinics for our feline patients. Radiographs can provide a wealth of diagnostic information, as long as they are of good quality and well-positioned.

However, cats aren’t known for their trainability, or their propensity to lie perfectly still for periods of time in a veterinary hospital, to allow veterinarians and technicians to work around them! So how do you get an X-ray of good diagnostic quality in a cat without sedation?

Do you need X-rays without sedation?

The first question to be asked is if the radiographs really need to be taken without sedation or anesthesia. Safety is paramount – for both patients and veterinary staff.

Taking X-rays conscious is not worthwhile if the process ends up having to be repeated multiple times due to poor positioning or movement blur, increasing both stress and levels of radiographic exposure to the patient and staff alike.

In many cases, a short-acting sedation or anaesthesia is the safest option to gain radiographs.1 There are many protocols now in use for a variety of situations, including drugs which are more cardiac-safe, those which avoid either renal or hepatic metabolism, and those with short half-lives for those quick X-ray procedures.

However, there are scenarios in which a veterinarian may prefer to attempt a conscious X-ray. These may include:

• Cats with advanced cardiac disease

• Cats with severe renal or hepatic impairment 

• If a cat has eaten recently and there is concern for aspiration, but needs urgent X-rays

• A known previous reaction to sedation or anesthesia

• A moribund patient who requires urgent assessment but is clinically unstable

Techniques for conscious radiographs in cats

If you have a feline patient requiring X-rays in your veterinary hospital, there are a few ways to make the procedure safer and less stressful for all involved.

The welfare of the cat, and the safety of all involved, should always be at the forefront of decision making in a veterinary clinic.

Preparation

When taking X-rays conscious, it’s hugely important to be prepared – time is of the essence. Use an exposure chart to predict your kV and mA settings,1 have restraint equipment ready to go and veterinary staff primed as to their roles. Have a plan of which order the radiographs will be taken in, and how positioning is going to be achieved. 

The process with be smoother if both staff and patient are relaxed. Practice feline-centric protocols: calm voices, quiet areas, pheromone diffusers, and minimal handling. Speed is helpful, but not to the detriment of calm handling and a low-stress environment.

Positioning

Firstly, keep the X-ray area secure by closing or locking doors: as well as being a distraction, doors opening suddenly can be an escape route for a stressed cat!

Positioning aids will be required

These may include:

1. Perspex box – if it is not possible to restrain the cat in a specific position, or the cat is very sick and/or recumbent, a clear Perspex box can be used to gain rapid radiographic assessment. Specific positioning will not be achieved, but a radiographic overview of a certain area – or even a full ‘catogram’ – can be achieved very quickly without the need for chemical or more aggressive physical restraint. Some boxes also allow oxygen to be piped in for those cats with respiratory concerns.  

2. Sandbags, troughs, and foam wedges – cats who are mobile will require physical restraint. Wedges can be used to elevate anatomic areas, or to ensure correct alignment. Sandbags are useful mostly for limb restraint – they are heavy, so avoid placing them across the thorax as this can affect respiration. Always try and ensure positioning is comfortable for the patient, as this will aid them to lie still and not panic. 

Be aware that “less is more” when restraining cats; and that cats with dyspnoea are brittle and require minimal restraint. In these patients, initial stabilization, thoracic ultrasonography, and general anesthesia for radiography (if cardiac failure can be excluded) is often the most appropriate approach.3

Taking the radiographs

A veterinary team member can stay with the cat until the machine is ready to go and the positioning is perfect, providing reassurance and extra restraint. Once the area is safe, personnel can exit and take the radiograph. The ‘beep’ or ‘click’ of the X-ray machine can cause cats to move, so you may need some background music or white noise to distract from this. 

Allow the cat to rest and hide in a covered box in between X-rays. Provide reassurance, and reward (if clinically appropriate). If the patient is becoming distressed, consider moving to chemical restraint or postponing the radiographs. 

There are many potential pitfalls when taking conscious radiographs, and it is more likely that these X-rays will be affected by poor positioning, movement blur or sub-optimal exposure. Wherever possible, sedation or anesthesia is preferable to achieve radiographs safely. 

References

1. Larson, M. Feline Diagnostic Imaging. Published 2020 John Wiley. Ed. Holland & Hudson. ISBN:9781118840948

2. Lavin L: Small animal soft tissue, in Lavin L (ed): Radiology in Veterinary Technology, ed 3. Philadelphia, WB Saunders, 2003

3. Borgeat, K. and Pack, M. (2021), Approach to the acutely dyspnoeic cat. In Practice, 43: 60-70. https://doi.org/10.1002/inpr.15

The Art of Cat X-ray Imaging: Techniques and Interpretation

Introduction to Cat X-ray Imaging: Importance and Basics

Radiography is one of the most common diagnostic tools utilized in veterinary clinics. It can provide vital information about structures inside the body and can be used to identify pathologies in both bone and soft tissues.

Cats differ from dogs and other pets in many ways, including their propensity to hide pain and illness. As a result, radiographs can be an excellent method of collecting vital diagnostic information for these patients in a non-invasive manner. 

Techniques

Safety for both patient and veterinary staff should be paramount when using X-rays. Veterinary clinics and hospitals should have effective radiation safety protocols in place and clinical staff should wear monitoring equipment.

Radiographs also need to be of good diagnostic quality to allow for accurate interpretation of injury and disease for cats presented to the veterinary clinic. 

When a feline patient requires X-rays, certain procedures should be followed.

Be cat-friendly!

Taking X-rays of a fractious cat is no veterinarian’s idea of a good time! Keep these feline-centric principles in mind to reduce stress for all involved:

• Quiet areas

• Calm handling

• Pheromone sprays/diffusers
  
  
  

  Restraint

Cats must be adequately restrained for radiographs, to ensure correct positioning and to minimize motion blur. Even small movements can cause unacceptable blurring in the X-ray.

This can be minimized by adjustments to the exposure time and mA settings, but sufficient restraint is still the most desirable. 

Sedation or brief anesthesia is usually required, but physical restraint using equipment such as sandbags and tape is also possible if necessary.

There are various sedation and anesthesia protocols that are suitable for cats, including cardiac-friendly combinations and short-acting sedatives.

Wherever possible, chemical restraint is preferred to physical in fractious animals.

Positioning

Depending on the body area requiring radiographic examination, the cat will need to be carefully positioned. Proper positioning is necessary to achieve X-rays of diagnostic quality in your veterinary clinic. 

Take more than one radiograph

Multiple views are always necessary for radiography! A good example of this is in thoracic radiographs in cats: when in lateral recumbency, fluid accumulates in the down-side lung, and there is a degree of atelectasis (lung collapse).

This leads to an increased opacity of this lower lung field, which can obscure soft tissue nodules. Orthogonal views are also needed, as X-rays are two-dimensional images of a three-dimensional patient, therefore opposing views are needed to visualize the patient as a whole. 

Interpretation

Radiographs require expertise and attention to detail for accurate interpretation. In a veterinary hospital, veterinarians should be encouraged to view X-rays in a quiet, darkened room and should not be rushed for a diagnosis. 

When interpreting feline X-rays, it is best to proceed in a logical and step-wise manner, to avoid anything being missed.

Assess positioning and exposure

Before leaping to any diagnostic conclusions, first, evaluate the basics. 

Is the X-ray:

• Of the correct patient?

• Clearly marked as to the positioning of the animal and the area exposed (i.e., left vs right markers)?

• Is the X-ray well positioned and collimated correctly, and is the exposure adequate? A cat X-ray that is improperly positioned or exposed is difficult to interpret and reduces the amount of available information.

• Are there orthogonal views available? X-ray images are two-dimensional representations of a three-dimensional subject (the patient), requiring some mental reconstruction of an anatomical image, using two radiographs taken at right angles to each other.

• Are any exposure, positioning, or rendering artifacts visible? If so, note them at this point so as not to be distracted by pseudopathological changes later.

Assess the X-ray

A logical and systematic approach should be used to evaluate X-rays in a veterinary clinic. Clinicians should choose an approach that works for them – for example, evaluate from outside in, or from left to right, or whatever system suits them and allows a thorough assessment of the whole radiographic area. 

All organs and structures should be assessed, and findings should be categorized by radiologic (or Roentgen) signs:

• Number

• Size

• Shape

• Position

• Opacity/architecture

• Margination

If possible, normal function can also be assessed, for example through contrast studies or through the use of physiological changes such as inspiratory vs expiratory thoracic radiographs. 

Evaluate the X-ray

Once the radiograph has been thoroughly assessed and described, the findings can be evaluated for abnormalities and a radiographic diagnosis.

There is a wide range of ‘normal’, which can make this assessment of pathologies more difficult, and X-rays should be used alongside other clinical findings when making a list of differential diagnoses. 

Radiography is a commonly utilized tool in veterinary clinics and has a wide range of indications in cats. However, taking good radiographs – and interpreting them correctly – is indeed an art form, requiring practical skills, study, and experience. 

Radiographs for CCL Injuries and TPLO Surgery

When it comes to cranial cruciate ligament (CCL) injuries in your patients, x-rays play a key role in your diagnosis, treatment, and follow-up.

So whether you’re the surgeon performing the procedure or a GP referring your patient to a specialist, having a good understanding of what to look for on your radiographic images can help you provide great patient care.

It all starts when the patient first comes in to see you…

The initial visit

More than likely, you’ll be seeing a middle-aged, medium or large breed dog who suddenly started limping on one of their hind limbs.

During the exam, you determine that the pain is in the stifle. Then, using sedation, you perform more thorough palpation, followed by radiographs.

Your detailed exam of the knee reveals some swelling and a positive drawer sign, and you take x-rays to confirm your suspicion of a CCL tear.

Considering this is one of the most common orthopedic injuries in dogs, you’re probably correct. However, occasionally there may be a surprise—such as a fracture near the stifle, or even an osteosarcoma lesion for older patients.

Radiographs will help you correctly diagnose and document the problem, and rule out concurrent conditions.

With a recent CCL injury, you might not see a lot of obvious evidence on your views—that’s because it can take more time for radiographic evidence of a CCL problem to show up.

However, you will likely see compression of the infrapatellar fat pad—which indicates joint effusion.

If the condition is chronic, you may notice arthritis and other signs of long-term inflammation.

Planning for a TPLO surgery

If your patient is a good candidate for surgery, then it’s time to discuss options with the owner. A tibial plateau leveling osteotomy is a good option for many otherwise-healthy dogs, but of course, the recommendation may vary for each individual pet.

Now’s the time when pre-op radiographs come in, by helping you to measure the tibial plateau angle and determine the saw blade size and position of the bone plate and screws.

The importance of post-op radiographs

After a surgery such as a TPLO, it’s important to document that everything went well—that all implants are in place, the tibial plateau has been repositioned as planned, and that there were no complications such as bone splintering.

This will be very reassuring to a worried pet parent, and will also be a valuable part of your medical record.

These post-op radiographs can also provide more information if a problem or complication comes up later, by using these initial images as a frame of reference for comparison.

Radiographs are useful if complications arise

More than likely, your patient is doing great. In that case, follow-up x-rays will help you confirm and document that the bone has healed as expected.

However, if they do run into any problems—such as an infection or a fracture—an additional set of radiographs can help you diagnose the issue and treat it ASAP. And follow-up rads will allow you to monitor the patient’s healing progress and their response to treatment.

Basically, radiographs give you an “inside view” throughout the whole process of diagnosing and treating a CCL injury, and are useful for common surgical options such as a TPLO.

Digital radiographs are especially helpful in terms of sensitivity for soft tissues such as a joint space, and also for providing rapid results within seconds.

But no matter which radiology equipment you choose, your X-ray images will provide valuable information for diagnosis and treatment of CCL—for happy patients and clients.

Disclaimer: This article is for general informational purposes only, and not intended as a guide to the medical treatment of any specific animal.

Written by: Dr. Tammy Powell, DVM

How to X-Ray a Cat Safely Without Sedation or Anesthesia

If you’ve ever tried to radiograph a fractious cat without sedation or anesthesia, then you know what a difficult challenge it can be.

In addition to blurry, crooked, non-diagnostic images, maybe you or your team members received some scratches and scars to show for the experience.

So, it’s understandable you might not want to try that again—both for your safety and for the cat’s safety.

However, there are some situations where you may want to avoid sedation or anesthesia—or, if it can’t be avoided entirely, to use the lowest dose possible to get the results you need—during an x-ray study on a feline patient. For example…

• Cats with advanced heart disease or other conditions that could make sedatives and anesthetic drugs dangerous.

• Patients with kidney disease or other conditions that cause less predictable metabolism of anesthetic drugs—possibly resulting in a cat that’s excessively drowsy for a whole day, and an unhappy client.

• A patient who’s otherwise friendly and great to work with, just very wiggly for their x-ray shots. A few tweaks may make the experience more comfortable for them and make sedation unnecessary.

• Contrast studies such as a barium GI study, where the patient has to be awake to avoid aspiration of the barium.

Of course, sometimes sedation or anesthesia may be safer, decreasing the kitty’s stress and risk of injury.

Only you know what’s best, using your clinical judgment. However, if you do have a situation where it’s worthwhile to try the radiographs WITHOUT sedation or anesthesia, here are a few tips…

Tips to get diagnostic radiographs on an awake cat

• Practice feline-centered protocols from the beginning.

• Have team members use quiet voices throughout the clinic, especially near the x-ray room or area.

• Use pheromone products, including diffusers or spraying the products directly on towels your patient will be in contact with.

• Lock the door to the x-ray room or area if possible. That way, no one will walk in by surprise and cause your patient to suddenly look in the direction of a swinging door.

• Give the cat a place to hide between views and try to complete the views as quickly as possible. Less time is usually better when it comes to felines. Try a test view to confirm your settings, and then either use digital radiographs or if using film shoot all views at once and then develop them while the cat is resting comfortably in a kennel or carrier. 

• If the patient is just too stressed that day and it’s not an urgent matter, consider rescheduling. Sometimes starting fresh—having the kitty return first thing in the morning and completing the radiographs quickly—is better for you and the patient (and the client may feel better about it when they see the decreased stress level in their pet).

• Make the cat as comfortable as possible during radiographs. For example, use a trough for VD views—it’s a lot more comfortable for them than having their spine right up against the x-ray table.

• Remember the machine’s noise. Many cats are fine during positioning, but then panic, wriggle and squirm once they hear the whirring and “beep” that happen when you push the button to take the shot. To avoid this problem, try talking to the cat in soothing tones, or have another background noise such as a white noise machine or calm music. That way, the sudden noise from the machine won’t stand out so much compared to the other background noises.

Remember, making the whole experience less stressful for the cat can also make everything less stressful for you and your staff.

So if possible, making a little extra effort to accommodate a feline patient can help you get diagnostic views more quickly, with a better time for everyone.

Written by: Dr. Tammy Powell, DVM 

Identifying Trauma in X-Rays of Hit-By-Car Patients

It’s been a slow day, and you just got back from lunch. Your first-afternoon appointment is waiting, and you look through their chart, preparing to go into the room… 

All of a sudden, the clinic doors burst open. You hear a big commotion upfront…

You walk up to see what happened and discover a distraught pair of pet owners holding carrying their Border Collie, who’s just been hit by a car.

How to avoid further surprises…

Of course, as a veterinarian, you’re probably used to something like this happening from time to time—panicked pet parents arriving at your clinic with a dog or cat in need. And you’re probably well-prepared to triage and decide what to do next…

However, you’ll want to avoid unpleasant surprises down the line—liked missed diagnoses—by ensuring that you find and plan for unexpected injuries.

For example, maybe that Border Collie has an obviously broken leg and some nasty road rash.

You’ll address those injuries, but first, you’ll explain to the owners that there are other conditions you need to check if their fur kid has just been hit by a car—conditions that could be life-threatening.

What to look for on the x-rays

Your physical exam will help direct you on what to look for. For example, if you feel a painful joint with crepitus, or hear crackles or decreased lung sounds when you auscult the chest, those will be areas you want to explore with radiographs. 

But, even if the lungs sound fine and you don’t find any other obvious abnormalities, it’s always good to evaluate the thorax and abdomen radiographically.

Sometimes, x-rays will need to wait…

For example, if the pet is in critical condition, they need stabilization first. And, you’ll use your judgment on whether sedation is needed and safe, for clearer and more diagnostic x-ray images, as well as for relief from pain and stress.

Then, when you read the radiographs, it’s important to evaluate EVERYTHING on your set of x-ray images. 

The impact of being hit by a car can cause trauma to many different parts of the body all at once, including serious internal injuries.

Here are a few things to check for on your radiographs…

• Pulmonary contusions. A strong trauma to the thorax can cause dangerous bleeding in the lungs, often visible on radiographs as alveolar or interstitial opacities.

• A ruptured bladder and uroabdomen. Look for signs of fluid in the abdomen, especially if you notice bloody urine. Try to visualize the bladder.

• Internal bleeding or damaged organs. If an organ such as the spleen has been injured, you may notice a hemoabdomen (although radiographically, this would be difficult to distinguish from a uroabdomen). In the case of ruptured intestines, you may notice spots of free air in the abdominal cavity.

• Broken bones, including the ribs and vertebrae. Visually trace along the bones one-by-one to be sure no lesions are missed. 

• Dislocations, such as a dislocated hip. Also, check for tail-pull injuries, especially in cats who may get their tail caught under a car’s wheels.

• Diaphragmatic hernia. Look for evidence of intestines or other abdominal organs in the thorax.

• Air or fluid in the pleural space. Seen as gas opacity, or fluid opacity.

• Skull and jaw radiographs if needed—in case of suspected head trauma.

Of course, other abnormalities are possible, too. As you know, pets don’t always “read the book” and clinical practice can be full of surprises! If you’re unsure of something on the films or digital images, it may be good to recheck it down the line to be sure no problems are brewing internally.

The number of views you take will vary depending on the size of the pet.

For emergency situations such as this, it may be worth having digital radiographs, for faster results without waiting for films to develop.

Also, it’s important to take orthogonal views. That way, you get the full pictures and lesions are less likely to be missed.

Re-evaluate and repeat radiographs as needed

This will depend on what you see on the first set of images, in addition to how the pet is doing in real life. Use your best clinical judgment to determine if and when repeat radiographs are needed, and keep the pet under close observation.

If there’s any doubt, consider using contrast studies to obtain more information, too.

By developing a plan for radiographs—and remembering to check everything on the images—you’ll increase the chances of finding unexpected injuries and addressing them earlier. Or, in case the radiographs are normal, you may be able to give more peace of mind to the worried pet owners.

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Disclaimer: This article is for general informational purposes only, and not intended as a guide to the medical treatment of any specific animal.

Written by: Dr. Tammy Powell, DVM

Hands-Free X-Rays: The Next Step in Veterinary Safety

Is it time to put restraints on veterinary radiography?

By Julia Bitan, RVT

When Dr. Debrah Berman, a Thornhill veterinarian with over 30 years of experience felt a lump in her tongue, she didn’t think much of it.

Up until that point, her health had been excellent and she was following all current radiology safety regulations such as monitoring her dosimeter values and using all protective equipment.

The diagnosis of Mucoepidermoid Carcinoma of the salivary gland (a type of cancer often associated with excess radiation exposure) came as a shock and made her start questioning the safety of today’s veterinary radiography.

“Since the 1990s, numerous jurisdictions in North America, and worldwide, have strengthened their regulations and best practice guidelines to actively move away from holding patients, in recognition that exposure to scatter radiation poses a risk.”

Outdated regulations

Although there are several provincial and federal laws in place to protect radiation workers in Ontario, the clauses specifically concerning veterinary workers have not been updated since 1990.

According to a veterinary radiography survey conducted in partnership with the Ontario Association of Veterinary

Technicians (OAVT) in April of 2016, 8 out of 10 RVTs still hold their patients during x-rays most of the time, while 7 out of 10 respondents choose to sometimes forgo the use of gloves and other protective equipment simply due to inconvenience.  

Our human radiology counterparts in Ontario are rarely present in the room when x-rays are taken because regulations state that no person should regularly perform manual restraining for x-rays.

Technicians commonly request parents hold their own children if x- rays are required.

Since the 1990s, numerous jurisdictions in North America and worldwide have strengthened their regulations and best practice guidelines to actively move away from holding patients, in recognition that every x-ray taken increases the overall risk of cancer.

Because we don’t see regular reports of veterinary workers dying of radiation exposure, we may naively assume that modern science has overcome the dangers with newer machine design and intensive research.

In reality, current occupational exposure limits are derived from decades-old research and we know that the risk of getting cancer increases with every exposure.

Recent findings do show that extended exposure to a low level of radiation increases the risk of developing leukemia, while radiation-induced cataracts are observed at a much lower radiation dose than previously believed. In veterinary medicine, the damage caused by ionizing radiation is simply too low to be felt right away and the ALARA principle (As Low As Reasonably Achievable) is much too ambiguous in the context of our profession.

Change is happening

A small number of veterinary clinics in Ontario, including Toronto Veterinary Emergency Hospital and Referral Center (TVEH), began enforcing a strict no-hold, out-of-the-room x-ray policy to keep their veterinarians and RVTs away from ionizing radiation emitted by the x-ray machines.

TVEH started enforcing the 100% -out-of-the- room radiography six years ago.

RVT Ashley Jenner, head of radiology at TVEH, has developed a number of tools and techniques to make out-of-room x-rays possible.  

“Non-manual veterinary radiography is much easier and faster than most people believe,” Jenner says. “All it takes is proper techniques and some extra tools.”

Jenner uses positioning devices alone on 75% of her cases (non-sedated patients), and sedation on the remainder.

Dr. Debrah Berman is now “cancer-free” and back to practicing veterinary medicine. She now endeavors to obtain all her x-rays using positioning/restraining devices or sedation.

“Radiation exposure is cumulative,” says Berman. “You may not realize until 20 or 30 years down the road that you have received too much. It may take a little more effort, but had I known that I would need to have a quarter of my tongue removed because of cancer and that I'd have permanent nerve damage and varying degrees of chronic pain, I wouldn't hesitate. And, I am one of the lucky ones. We need to protect ourselves”.

Transitioning to non-manual radiography is not always an easy task.

Change is rarely welcomed in our profession and as long as the minimum standards are followed, there is little reason or incentive to change.

We do, however, know there are risks involved with radiation, and alternatives do exist.

A program was created to guide clinics through transitioning to non-manual radiography using different tools and techniques.

The Hands-Free X-Rays Initiative aims to promote awareness and encourage change to current veterinary radiography.

For more information about the program, visit our website - www.handsfreexrays.com.

For comments, feedback or help to bring change to your clinic, please contact us at:

email: info@handsfreexrays.com

Phone - +1 (647) 502-4843.

Written by By Julia Bitan, RVT

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Your Warranty and Service Coverage for Veterinary X-Ray

Today, every veterinarian recognizes the importance of incorporating digital X-rays into their animal hospitals.

A considerable number of them plan to transition from traditional film and chemical X-rays to digital systems this year.

While the initial concern typically revolves around the cost of acquiring a digital X-ray system, it is equally crucial to inquire about the warranty and its coverage.

Here are some pertinent questions to ask the prospective vendor when considering the purchase of a veterinary digital X-ray system:

1. What is the duration of the hardware warranty for my veterinary digital X-ray plate?

2. How long does the software warranty for my veterinary digital X-ray software last?

3. For how long will I receive software upgrades for the X-ray system used in my animal hospital?

4. How long will my veterinarian technicians have access to tech support, enabling them to seek answers to any queries that may arise during the daily implementation of digital X-rays in my animal practice?

5. What are the costs associated with continued phone support, software upgrades, and technical assistance after the warranty period ends?

6. Which entity is responsible for providing software and technical support? Who developed and owns the software?

7. Does the warranty cover labor and shipping expenses, as needed?

8. In the event that my X-ray plate requires repair, will a temporary replacement plate be provided?

It is common for vendors operating in the animal health sector to offer a minimum of a 1-year warranty.

Not all vendors possess ownership of the software that operates their veterinary digital X-ray plate, which holds significant importance. While a digital X-ray plate can remain functional for many years, the software it relies on may become outdated within a short span of time.

An example of this can be observed with Windows XP platforms. Unless companies continually update their software, it becomes incompatible with new computing platforms.

When veterinarians transition from computed radiography (CR) to direct radiography (DR), the predominant issue they encounter is not the failure of the CR system itself but rather the poor performance or lack of support for the software.

This issue is not limited to small companies alone. Renowned brands like Idexx and Sound have discontinued support for their older product lines by ceasing software upgrades.

Our aim is to offer you transparent service and support. Our animal health software has been developed in-house by JPI which has been manufacturing x-ray equipment, writing software, and providing telephone support for these products since 1994.

Here are the responses to the eight frequently asked questions:

1. What is the duration of the hardware warranty for my veterinary digital x-ray plate?

- The hardware warranty lasts for 5 years.

2. How long is the software warranty for my veterinary digital x-ray software?

- The software warranty is also valid for 5 years.

3. For how long will I receive software upgrades for my x-ray system to be used in my animal hospital?

- You will receive software upgrades for 5 years.

4. How long can my veterinarian technicians receive phone support for any questions they may have regarding the daily implementation of digital X-rays in my animal practice?

- Our tech support helpline will be available for your veterinarian technicians for 5 years.

5. What is the cost of continued phone support and software upgrades after the warranty period?

- The cost for continued phone support and software upgrades after the warranty period is $750.00 per year.

6. Who provides the software and tech support? Who developed and owns the software?

- Our Examvue Veterinary software is developed, supported, and owned by JPI. They have been offering industry support since 1994. For technical support, please call 516-513-1330, and select option 2. Our support team is based in New York.

7. Are labor and shipping costs covered under the warranty if needed?

- Yes, labor and shipping costs are included in the warranty as required.

8. Will a loaner plate be provided in case my X-ray plate needs repair?

- Yes, we will provide a loaner plate in the event that your X-ray plate requires repair.

Is the New Digital X-ray System Compatible with Innovet?

Many veterinarians invested in X-ray systems in the ’90s. Most purchased an Innovet Summit table and generator.

They used the table and generator along with cassettes enclosing film to capture X-rays and provide life-saving next steps for their pet patients.

Processing the film in the chemical rinse and developing the images in the darkroom enabled the practicing veterinarian to review the X-ray.

If the X-ray proved complicating or just interesting then the veterinarian would mail the X-ray to a specialist for a review or save the X-ray case for the next ‘radiology rounds’ in upcoming weeks and months.

During these radiology rounds, X-ray cases would be reviewed amongst veterinarian piers and sometimes even veterinary radiologist.

Even if the patient was deceased by the time of the review huge advances in pet medicine were and still are to this day applied.

If you're reading this you use to film with your old X-ray generator and table. You want to impact the neighborhood and village who depend on precise and timely diagnosis to treat their pets.

Digital X-rays can speed up the process not only of image acquisition but also provide clear diagnostic radiology rounds.

Most old tables and generators still can produce excellent X-rays.

Often times these old systems have new light bulb collimators and replaced fuses that enable the old workhorse to continue to provide the power for an X-ray.

Yes, you can use your old table and generator with two types of digital X-rays.

The first is computed radiography or CR which will work today with any generator as the image is captured on an erasable film cassette then scanned into the software where the digital image can now be interrupted, adjusted or emailed to pet owners.

The next is an AED cesium plate. Automatic exposure detection.

This allows the plate to prepare itself for the exposure to capture the image and send in second the inmate to the display monitor.

This is the newest way to capture X-rays.

Not having to wire the old X-ray system to the new digital X-ray system is a confinement advantage.

It removes an element of future failure in hardware by eliminating the interference box!

We can help answer more questions surrounding your old X-ray table and generator.

Reach out today and we would be happy to help.