How to Buy Veterinary Digital X-ray Equipment without Experiencing Buyer's Remorse

Have you ever bought something and regretted the purchase?

I think I have at one time or another. However, it’s one thing to regret ordering a cheeseburger and fries, but quite another when I regret buying a $50,000 car or truck.

When I make a big purchase, I want to feel good about my decision. I want to make sure that I made the right choice.

I want you to feel great about buying from me! I understand it is no small thing for a Veterinarian to spend $20,000 or $30,000 on digital x-ray equipment, and I want you to feel great about buying from us.

So, here is my “purchase without buyer's remorse” plan:

The 30-day satisfaction guarantee, or your money-back offer. When you make a digital x-ray system purchase, I will give you 30 days so that you feel comfortable and confident that you made the right choice.

And if you are not satisfied, return your digital x-ray equipment for a full refund.

Yes, that is correct! A FULL refund!!

I know that after the vet digital x-ray equipment is installed in your clinic, and once you learn how to use the software, you will be very happy with the results you get.

I can offer this guarantee because I am very confident with the quality of the digital x-ray equipment we sell, and I want you to be completely satisfied.

Here is the fine print:

• Equipment must be returned in original packaging.

• Equipment cannot be returned if damaged by the user during your 30 days.

• The buyer pays the cost of shipping/packing/insurance of all returned equipment.

• You must give us a reasonable chance to correct any dissatisfaction.

The main reason I am offering this “30-day satisfaction guarantee or your money back” is to give you peace of mind.

I understand I’m not as big as Idexx, Cuattro, or Sound-Eklin. Perhaps that makes you think twice about trying us out.

But I am confident that our equipment is as good, if not better, and now we have a “30-day satisfaction guarantee or your money back” - which the big boys do not offer!

The bottom line is simple:

• I am offering quality digital x-ray equipment for the veterinary industry at an amazing price, with a great warranty, and now a 30-day guarantee.

• I want to do the right thing, treat you with respect, and help you be successful in your veterinary practice.

Call or text me - Brad Haven, Jr. - 530-355-5886

Essential Factors for Picking the Perfect Small Animal Ultrasound Probe

Small Animal Veterinary Ultrasound Probes: What To Look For

Ultrasound imaging has become an indispensable tool in modern veterinary medicine. Offering real-time, non-invasive visualization of internal organs and tissues, it aids in diagnosing a wide range of conditions, from abdominal pathologies to cardiac malformations. However, for optimal image quality and diagnostic accuracy, the right veterinary ultrasound probe is crucial. This blog delves into the key considerations when choosing probes for your small animal practice.

Understanding Probe Types:

Veterinary ultrasound probes come in various shapes and sizes, each tailored to specific anatomical regions and applications. Here are the most common ones:

• Micro-convex Probes: The workhorses of small animal abdominal ultrasonography, offer a good balance between image resolution and penetration depth. Their small footprint allows access to tight spaces like intercostal gaps, making them ideal for visualizing organs like the liver, kidneys, and bladder.

• Linear Probes: With a flat footprint and high-frequency range, linear probes excel at providing high-resolution images of superficial structures like muscles, tendons, and joints. They are also valuable for cardiac examinations and evaluating delicate structures like the eyes.

• Phased-array Probes: Offering electronic beam steering, phased-array probes enable detailed visualization of deeper structures like the heart and blood vessels without requiring probe manipulation. Additionally, some models enable 3D reconstruction, enhancing diagnostic capabilities.

• Endocavity Probes: For internal examinations of the female reproductive tract or urinary bladder, specialized endocavity probes are available. These miniature probes feature sterile sheaths for safe insertion and provide clear visuals of organs within body cavities.

Frequency Matters:

Frequency refers to the number of sound waves emitted by the probe per second, directly impacting image resolution and penetration depth. Higher frequencies (5-12 MHz) generate sharper images but struggle to penetrate deeper tissues. Conversely, lower frequencies (2-5 MHz) offer deeper penetration but with less detail. The ideal frequency range depends on the target organ and patient size. Consult your ultrasound manufacturer's recommendations for specific applications.

Image Quality and Advanced Features:

Beyond probe type and frequency, several features influence image quality and diagnostic utility:

• Field of View: Indicates the area covered by the ultrasound beam, impacting the number of organ sections captured in a single image. Wider fields of view are helpful for general surveys, while narrower fields provide a more focused examination of specific structures.

• Tissue Harmonic Imaging (THI): Reduces image noise generated by tissue interfaces, resulting in sharper and clearer visualization of organ borders and internal structures.

• Doppler Modes: Enables evaluation of blood flow within vessels, aiding in diagnoses related to cardiovascular and circulatory disorders.

• Ergonomics and Handling: Probe weight, grip design, and cable length can significantly impact user comfort and scanning efficiency. Choose probes that feel comfortable in your hand and minimize fatigue during prolonged examinations.

Considerations for Your Practice:

When selecting probes for your practice, consider the following factors:

• Patient Population: The typical size and species of animals you see will influence the appropriate probe sizes and frequencies.

• Common Examination Types: Regularly performed procedures like abdominal scans, echocardiography, or musculoskeletal assessments will guide your probe selection.

• Budget: Probe prices vary widely, depending on technology, features, and brand. Determine your budget constraints and prioritize must-have features versus optional ones.

• Compatibility: Ensure the chosen probes are compatible with your existing ultrasound machine.

Conclusion:

Selecting the right veterinary ultrasound probes is vital for accurate diagnoses and effective patient care. By understanding probe types, frequencies, and advanced features, you can tailor your equipment to your practice's specific needs and optimize your diagnostic capabilities. Investing in high-quality probes not only enhances your clinical acumen but also improves workflow efficiency and patient comfort.

Remember, consulting with your ultrasound equipment provider and colleagues can offer valuable insights during the selection process.

By making informed choices, you can equip your practice with the best tools to provide exceptional veterinary care for all your furry (and feathered) patients.

Small Animal Veterinary Ultrasound Probes: What to Look For

Ultrasound probes, or transducers, are a necessary part of any veterinary ultrasound system. Without a good quality probe, veterinarians would have difficulty producing high-resolution images with their ultrasound machine. 

But since probes can also be a big financial investment, it’s important to select one that’s a good fit for your practice.

How Do Veterinary Ultrasound Probes Work?

These devices have piezoelectric crystals built into the probe’s working surface, which convert electrical energy into sound waves. These sound waves interact with tissues at different depths within an animal’s body, reflecting back to be picked up by those same crystals. The information is transmitted back to the ultrasound machine to produce an image for interpretation. 

However, not all probes are created equally. Different probes work better than others for different patients or types of studies.

Goals for Your Veterinary Ultrasound System

What will the doctors, specialists, technicians, or other team members be using the ultrasound for? 

If specialty ultrasounds, like echocardiograms and detailed abdominal studies, are performed frequently, it probably makes sense to invest in high-quality probes. On the other hand, if the ultrasound is used primarily for cystocentesis, the fanciest probe on the market might not be a great investment.

Some practices might want to invest in handheld or portable veterinary ultrasound units that connect to a smartphone or tablet. This is probably best in scenarios like triage with a focused check for fluids (A-FAST or T-FAST).

Of course, another important consideration is the type of patients your practice sees. A feline-only practice might have different needs than a practice that sees large dogs.

Goals may change over time and with additional experience. It’s not necessary to buy all the probes upfront, before practitioners are ready to use them. But it might make sense to select an ultrasound machine with additional functionalities that offer room to grow, so more probes can be added in the future when they are needed. 

Veterinary Ultrasound Probe Types and What They’re Used For

Here are some important factors to consider when choosing a transducer…

• Frequency and depth. Frequency is measured in MHz. Higher frequency probes offer better image resolution. 

Depth refers to how deeply the sound waves penetrate into tissue.

While each of these factors are important in their own right, they are often grouped together because they are inversely related: a higher frequency probe has shallower penetration, and vice versa.

Thankfully, newer technology means many probes offer an adjustable range of frequencies and depths, so a single probe can be used on a variety of patients. There are even some that auto-adjust when viewing different depths.

• Size. Probe size generally refers to the “footprint,” or the area of the probe in contact with a patient. For cats and small dogs, a smaller probe is more easily placed under the ribs, which offers an advantage for seeing certain organs. Footprint is also relevant for cardiac studies since the probe must be placed between ribs.

• Shape. This refers to the shape of the footprint of the probe, and properties that tend to be associated with that category. The most commonly used probes in small animal medicine typically fall into one of these categories…

  • Linear. A linear probe has a footprint in a straight line. This creates a square or rectangular image with less distortion at the edges. Typically, these probes are higher frequency and low depth. Ideal for surface structures (like muscles, joints, and ligaments), some practitioners prefer linear probes for abdominal studies in cats and small dogs. A smaller, hockey stick-shaped version is also available, which may be a good fit for exotics or small structures like the eyes.

  • Convex and microconvex. Convex probes have a curved footprint. They vary in frequency and can be used for a variety of studies. They create a more triangular image, with some distortion at the edges.

Microconvex probes, which have a smaller footprint, are probably the most commonly used, versatile probe in small animal medicine. They’re often a good fit for those who want to invest in a good “all around” probe for cats and most dogs, for abdominal and basic cardiac exams.

However, a standard convex probe might be needed to see deep structures in very large dogs. 

• Phased array. This is considered a more “advanced” probe. It’s a common choice for echocardiography. It facilitates easier passage of the beam between ribs, while still generating high-quality images. Phased array probes also offer a higher frame count, for documenting small changes with the heart’s movements. They typically have several functions, including Doppler. 

Additional Considerations

As with any equipment investment, it’s important to research the equipment itself and consider factors like financing, tax advantages, warranties, and service plans. 

Talk to veterinary ultrasound suppliers. Ask to try out the machine you’re considering. Many offer a sample or demo machine that you can keep in the clinic for a short period of time, or at least can offer a demo in your office. Speak to colleagues or check veterinary forums for recommendations, too.

And of course, remember to protect your investment. Dropping a probe can cause permanent damage. Have a system to prevent this, including proper storage, as well as a tie or leash to hold the probe to the operator’s arm in case of accidental drops, so it won’t hit the floor.

All things considered, an ultrasound probe can be a great investment in patient care and generating income for the practice. But since they can be pricey, it’s important to choose wisely and find a probe that’s a good fit for your practice’s needs.

Written by: Dr. Tammy Powell, DVM

Veterinary Ultrasound Tables: Are They Needed, and How to Choose One

What’s the best type of veterinary ultrasound table to purchase? Are ultrasound-specific tables even necessary?

It all depends on the specific needs of your veterinary practice. Here are some factors to consider…

Which Types of Ultrasound Studies Are Performed—And How Frequently?

The first thing to think about is whether a separate ultrasound table is truly needed, or if ultrasounds can be performed cage-side or on a regular exam or surgical table. 

This can be answered by thinking about which types of ultrasounds your veterinary team performs (or plans to perform in the near future, if anyone is seeking additional training and planning to expand services). 

Many general practices have limited ultrasound capabilities. There’s nothing wrong with that if it works for your practice and your clients’ needs. For example, maybe a small animal general practice simply performs A-FAST and T-FAST cage-side or in the exam room for triage—or uses their ultrasound primarily for performing a cystocentesis. In these cases, investing in an ultrasound-dedicated table might not be high priority or necessary at all.

The next stage of ultrasound usage would probably include practices where a team member (or possibly a mobile ultrasonographer) performs occasional abdominal or cardiac studies in select patients who could benefit from one. In these cases, it might make sense to “borrow” a procedure table for an ultrasound rather than purchasing a new table.

Finally, for busy or specialty practices where in-depth ultrasound studies are frequently performed, it might make sense to invest in a dedicated ultrasound table for veterinary patients—especially one that facilitates echocardiograms.

Are Clients Present for Patient Ultrasounds?

This question goes beyond sheer table functionality and instead focuses on client experience and perception. 

At the time of this writing, veterinary practices are busier than they’ve been in many years. According to market research, younger generations of pet owners are seeking high-quality pet care, and their experience as a consumer matters in terms of where they choose to bring pets.

While individual client preferences may vary, it’s probably safe to say that having the right equipment, organized in a clean and efficient way, can make a good impression. It can convey that a veterinary practice is professional and proficient and that they care about the patient’s comfort. 

One example would be a proper echocardiography table. These have at least one hole or cutout for placement of the ultrasound probe on the recumbent side of the patient’s thorax. They might also be padded so the patient can lie comfortably.

Another option that some practices use is to build a make-shift echocardiogram examination station, such as a cardboard box with a hole cut in the side. Some clients won’t mind this, but for others, it might make a negative impression.

A good in-between option for cardiac evaluation might be a portable, padded add-on that sits on top of an exam table, essentially converting a regular procedure table into one that can be used for echocardiography studies. Some can be folded for storage when not in use.

Which Features Are Most Important in a Veterinary Ultrasound Table?

Here are some table characteristics that might aid a veterinarian in performing ultrasounds…

• Height Adjustability. Ergonomics are being recognized more and more as a crucial factor for long-term veterinary careers. Not only do better ergonomics help protect team members’ health, they can also facilitate better care in each procedure by reducing operator fatigue and pain. Proper table height is an important component, whether using an ultrasound-specific table or not. Height adjustments can also make for easier patient transfers to the table. 

• Portability. Mobile tables are important for practices that plan to perform evaluations in more than one room or location, who want a table to transport patients with reduced mobility, or who want to store their ultrasound table out of the way when not in use.

• V-Top. A V-top table, especially one that allows for tilting, could potentially help facilitate abdominal scans. But it’s important to add padding for patient comfort.

• Equipment Storage. In addition to the ultrasound table itself, think about where your ultrasound machine will go. This could be on an attached “arm” of the table designed to hold equipment, or it could be a separate countertop or cart. Set it up in such a way that your arms don’t get tangled trying to view the machine, change settings, and hold the probe to the patient all at once.

• Patient Facilitation. This is a combination of ease-of-use, practical considerations, and patient comfort to help ensure they don’t wiggle around during examinations. Consider factors like waterproof padding, table size, and weight limit, and how many cutouts you want in the table and where they should be placed. 

Whether you purchase an ultrasound table or convert a regular exam or surgery table, there are ways to boost client experience. Add comfy non-slip mats with pretty (not torn up or bleached) blankets on top. Set up the room with soothing lighting, white noise or soothing music, or other things to help keep everyone (patient and client alike) calmer during the experience. Add pet-friendly items like DAP or Feliway.

As with any piece of veterinary equipment, do your research and seek reviews from colleagues. Consider factors such as maintenance and repair costs, and ease of cleaning. 

These purchasing considerations, along with planning your hospital’s ultrasound service offerings, will help ensure you find the best ultrasound table for your veterinary practice.

Written by: Dr. Tammy Powell, DVM

What to Know About the Mindray Vetus E7 Ultrasound

Purchasing a new veterinary ultrasound machine is an exciting, yet complex, decision. A veterinarian may feel overwhelmed by choices. There are many systems available at all different price points, with different features—many of which are hard to compare side by side for vets who are new to performing ultrasounds.

In this article, we’ll look at some of the features of the Mindray Vetus E7 Ultrasound, a veterinary-specific model, to see if it might be a fit for your practice.

What Is the Mindray Vetus E7 Ultrasound?

The Vetus E7 is a laptop-type portable ultrasound unit made specifically for veterinary practitioners. It’s designed for use on both small and large animals, for abdominal studies, cardiology, musculoskeletal and small parts studies, and even some reproductive applications.

This 2022 model features a lot of new and advanced technology. Some of the key features that might appeal to a veterinarian are discussed below.

Features of the Vetus E7

While every practice has unique needs, these features may be beneficial to veterinarians in many clinical settings…

• Small size and portability. The Vetus E7 is a laptop design, so it can be transported as needed. There is a 15.6-inch, high-resolution color LED monitor. The unit is 1.7 inches thick and weighs 3.0 kg (6.6 lbs) without the battery and 3.5 kg (7.7 lbs) with the battery. Battery life is about 1.5 hours on the laptop alone, or up to 8 hours with the included U-bank battery.

• Durability and ease of cleaning. The unit is basically “sealed” in, making it more difficult for liquids and stray hairs to get inside the unit or under the buttons. This includes an anti-liquid touchpad that replaces the standard rollerball, and seamless keys/buttons. Materials are said to be durable and chemical resistant. It stands to reason that the seamless design might also be helpful for protecting the unit from dust and humidity when out in the field.

• ZONE Sonography Technology+ (ZST+). This is the first laptop-based system to use the technology, which is supposed to provide excellent image clarity and quality. A simplified way to describe this technology would be to say that it uses software to process acoustic data in large “zones” at a fast speed. This large amount of acoustic data creates a detailed image and can help reduce tissue motion artifacts. Dynamic pixel focusing means good special resolution and the ability to focus at various depths without the user needing to manually adjust the focal point. 

• Dedicated veterinary presets and user-friendly workflow. Presets are available according to species (canine, feline, equine, bovine, ovine, and customizable), and further subdivided by body size (including dog ranges of <5 kg, 5-15 kg, and >15 kg). The iWorks feature offers smart scanning protocols that standardize the workflow and allow automatic addition of annotations, marks, and measurements. The company claims this can reduce exam time by 50% and reduce keystrokes by 80%, for faster and more efficient studies. 

• iScanhelper, a built-in learning tool that provides tips on how to scan, as well as anatomical illustrations, patient positioning and probe placement pictures, and ultrasound images for comparison with real-time scanning. 

Additionally, the Vetus E7 system includes many standard features such as Doppler and compatibility with image storage software. 

Conclusion

Is the Vetus E7 right for your veterinary practice? It depends on exactly what you’re looking for, what your practice plans to budget, and what you plan to use the machine for, i.e., what’s the return on investment based on the expected number and types of studies that would be performed at your practice.

Also, it’s important to ask your supplier questions to ensure you know exactly what you are purchasing. Check how many probes are included (and which types), whether there’s a warranty and what it covers, and anything else you might want to know. See if it’s possible to get a demo, too.

All that being said, the Mindray Vetus E7 does offer some exciting features for veterinarians. In addition to the practical considerations that make it easier to keep the machine clean, many vets would appreciate the features that may make it easier to learn and use this ultrasound unit, such as intuitive workflows and processing capabilities for high-quality images at multiple depths. 

It’s common knowledge that ultrasound can require a lot of training and practice before a vet feels confident in the modality. So, anything that makes the process a little easier or more intuitive, and helps with obtaining high-quality images, can certainly be a plus. 

Written by: Dr. Tammy Powell, DVM

Can Veterinary Technicians Perform Ultrasounds?

With the growing demand for veterinary services—and many vet hospitals being fully booked—many vets are delegating tasks to skilled veterinary technicians when possible. But is an ultrasound something that can be delegated to vet techs?

Here, we’ll cover what separates the duties of a veterinarian and a veterinary technician, and how that applies to performing ultrasounds on companion animals.

Which Duties Can a Vet Tech Legally Perform?

Credentialing, as well as the laws and rules governing what veterinary technicians can or cannot do, vary widely from state to state. So, it’s important to check your state’s rules and regulations for specifics.

However, as a general overview, trained technicians are allowed to perform many of the same duties that veterinarians perform. But they must operate under the supervision of a licensed veterinarian.

There are a few things that vet techs aren’t legally able to do, though. This includes making a diagnosis, prescribing treatments and diagnostic tests, performing surgery, and giving a prognosis.

How Do a Vet Tech’s Training and Legal Restrictions Apply to Performing an Ultrasound?

With the above rules in mind, think about what’s involved in an ultrasound study.

The person performing the study must be familiar with the ultrasound machine and how to use the controls to operate it. They must know how to find the organs/anatomic structures of interest and take the correct views (images and videos) of those structures, along with any relevant measurements. 

So far, all of these tasks are something a vet tech could learn how to do. 

Although it can take time to learn and practice ultrasound technique, vet techs are smart and educated, and capable of doing many of the challenging tasks a veterinary hospital requires on a daily basis. 

So, given the right training and opportunities to hone their skills, it stands to reason that many vet techs could be taught to perform ultrasound studies.

What About Interpreting the Images?

The tricky part comes in when it’s time to interpret the images or videos that were captured during an ultrasound study. 

Even though a highly trained and experienced vet tech will probably understand the significance of what they are seeing on an ultrasound study, there are legal limitations to what a vet tech can do with that information.

Interpreting the images would involve making a diagnosis (or at least a diagnostic rule out list) and possibly giving a prognosis. Plus, based on that information, prescribing treatments or additional diagnostic tests (such as performing an FNA or obtaining a biopsy) could be the next step. 

Those things would fall into the realm of services limited to a licensed veterinarian.

So, a vet tech could perform the ultrasound study and capture images. But it would be up to a veterinarian to interpret the study.

In many ways, this is very similar to how x-ray studies are already performed in veterinary medicine. It’s also similar to the way ultrasound techs operate in human medicine. 

So, it’s not a stretch to imagine a similar system could work for ultrasound studies in vet med.

Potential Pitfalls to Consider

With ultrasound studies, there is value in someone being able to interpret the studies in real-time.

For example, if a mass is noted in the liver, a veterinarian might recommend an FNA of the mass. However, a vet tech wouldn’t necessarily be able to prescribe this next step.

Also, certain findings may require veterinary knowledge to put into context and alter the course of the scan. One example is finding a splenic mass, which might prompt a veterinarian to also look and see if a right atrial mass is present. 

One solution is to have veterinarians present (or at least be accessible for questions) during the study. That way, additional views, and procedures could be performed as needed. 

However, even veterinarians who are new to ultrasound themselves may run into shortcomings with image interpretation. So, there may be limitations no matter who is performing the study, until a person gains years of practice.

A good place to start is to have whoever is performing the study—whether it’s a vet or a vet tech—use a standardized list of views to obtain. Then those views can be sent to a specialist for interpretation, which will help everyone learn.

Training and hands-on practice are also crucial. Skills will need to improve over time.

Does It Make Sense for Veterinary Technicians to Perform Ultrasounds?

With veterinary practices being so busy since the pandemic, it makes sense to utilize staff (veterinarians, techs, CSRs, and the rest of the team) to their full potential.

This is one reason why the discussion of a mid-level practitioner (veterinary nurse practitioner) role has become more prominent.

Giving additional roles and responsibilities to educated, trained vet techs could carry a lot of benefits. One would be to take some of the time-consuming duties off the doctors.

This could improve the overall efficiency and profitability of the practice by freeing up more time for the vets and allowing them to see more patients or perform more medical procedures.

Additionally, new roles and skills for vet techs could provide much-needed pay increases, job satisfaction, and career advancement opportunities.

While performing ultrasound studies isn’t a full solution to these industry-wide concerns, it’s one example of a skill set that could contribute to the expanding role of technicians in the profession.

Each vet practice must decide what will work best in their individual practice and adhere to the laws of their state. But there are many reasons to believe that vet techs learning to perform ultrasounds could be beneficial to the whole practice. 

Written by: Dr. Tammy Powell, DVM

What Does Veterinary Ultrasound Training Include

Purchasing a new ultrasound machine is very exciting—but in addition to buying the equipment, it’s important to invest time and resources into training vets to use the machine. 

This is crucial to ensure accurate ultrasound studies, and to maximize the return on investment by ensuring the machine gets used to its full potential. Here are some ways to do that…

Determine Your Goals

Some veterinarians want to become ultrasound experts—proficient in full abdominal studies and echocardiograms. 

Others may simply want to examine certain organs (such as the urinary bladder) or perform FAST exams. And many vets fall somewhere in the middle.

There’s no right or wrong answer. Each veterinarian and their practice must determine what is the best use of their new ultrasound machine. Knowing these details—such as the species and size of patients you will be performing studies on, and the types of studies you will be doing—can help a veterinary practice choose the best type of ultrasound machine to purchase.

This information can also help veterinarians determine which type of training program, course, or resource is best for learning to use the ultrasound.

Practice, Practice, Practice

There’s no denying that repeated, consistent practice is probably the best way to become very proficient at ultrasound studies.

This means scanning as many pets as possible. This could be done by scanning healthy patients (for example, before routine spays/neuters is often a convenient way to do this), taking a quick peek at other abdominal structures when doing a cystocentesis, offering lower-cost ultrasound examinations on client-owned pets while you are learning, or practicing on the pets of colleagues and friends.

Practice is the best way to gain an intuitive knowledge of all the variations of normal—so a vet can confidently diagnose any abnormalities.

Regular practice is also crucial for developing hand-eye coordination. This means being able to adjust the probe while keeping their eyes on the screen. Like any other new skill, it can take time to get comfortable with this.

While practice is central to learning, in many cases, formal instruction is also immensely helpful.

Why Seek Ultrasound Training?

Training programs can help a veterinarian get a jump start on learning. While practice is crucial, a course could accelerate the learning process by helping a vet know what they are looking at.

It’s also helpful to learn the technical stuff like “knobology.” This means knowing how to work the different knobs and functions on the ultrasound machine—such as gain, time-gain compensation, depth, focal zone, and transducer frequency. 

These functions are necessary to help a vet obtain good quality, clear images. But they’re usually not intuitive without guidance.

Ultrasound Training Programs, Opportunities, and Resources

Fortunately, there are several high-quality ultrasound training programs available to veterinarians. These can be an extension of major conferences/educational organizations like the NAVC Institute or veterinary universities. 

Also, courses are offered by vendors such as Sound who sell ultrasounds and want to help veterinarians maximize the return on their investment.

Training doesn’t have to be a completely formal course, though. It’s possible a veterinarian may find a mentorship opportunity at their practice or with a nearby colleague.

Remote opportunities also exist for learning. This includes online or virtual courses and consultations. Sometimes, manufacturers or vendors offer consultations with radiologists as a benefit of an ultrasound purchase. 

Collaborative communities such as VIN also offer opportunities for consulting with specialists.

It’s important to have a good reference source for images and video clips. Ask colleagues who perform ultrasounds which textbooks or other resources they prefer. 

Texts and reference images are especially helpful for comparison to standardized measurements, such as expected intestinal wall thickness in different species.

Keep Going!

Ultrasound techniques and interpretation can be challenging to learn. However, for a vet who is committed to learning, it’s worth the time because it means such a great diagnostic tool for patient care (plus a new income source for the practice).

Since ultrasound can take time to learn (and to practice!), it’s not possible to rush the process. Also, remember it doesn’t have to be all-or-nothing…

In other words, a vet doesn’t have to be an expert at all types of studies before starting to offer the benefits of this valuable service to clients. 

For example, maybe a vet has difficulty finding the adrenal glands. But they can do a quick and accurate study of the urinary bladder—a very valuable service to offer to pet owners! 

Then, in the near future, the vet can seek additional training to boost their skills even more and offer additional/more comprehensive ultrasound studies.

Keep at it, and ultrasound will likely be a very rewarding tool that helps a practice offer excellent care to its patients.

Written by: Dr. Tammy Powell, DVM

5 Tips to Improve Proficiency With Ultrasound

By becoming proficient at ultrasound studies, a veterinarian can elevate patient care at their practice while also boosting profits.

Whether you’re evaluating the abdomen, the heart, or something else, an ultrasound study can be a very valuable tool.

Here are five ways for a practitioner to improve their ultrasound skills and offer more of this valuable service to pet owners…

The Right Equipment Can Make a Vet’s Job Easier

Having good, well-functioning equipment can really make life easier for a veterinarian and their team. 

This could include a variety of factors, such as…

• Does all of the ultrasound equipment—probe, machine and monitor, and any programs for saving videos and information—work? Does any component (or the whole system) need to be repaired or replaced?

• Is the equipment of a good quality? Maybe it’s technically working, but do the images you produce have enough detail and clarity to see what you need to see? Is any part of the process cumbersome, which can make it less likely that the ultrasound will be used to its full capacity and potential?

• Would routine maintenance or an upgrade improve efficiency and make it easier to offer this service to clients and their pets?

This is all-important because even as you learn, practice, and improve your skills, inefficient or subpar equipment may make it challenging to fully implement your new training and may lead to frustration.

Standard Protocols and Techniques Can Improve Efficiency

If an ultrasound is only performed once in a while, it may feel like a hassle or lead to confusion or inefficiency when trying to schedule and perform an ultrasound study.

To improve efficiency and make it easier to offer ultrasound services at your practice, consider all stages of the process, including…

• Has the veterinary team been trained and empowered in all aspects of scheduling an ultrasound study? For example, is there a specific day of the week, especially if there is only one doctor at the practice who performs ultrasounds? Has enough time been scheduled, especially if sedation is needed? Having a standard set of instructions or protocols can help the team and make things run smoother for everyone.

• If the patient needs any special instructions to prepare for their ultrasound study (such as fasting from the previous evening), is there a clear process for communicating this to the client?

• Does the veterinary team know all the tools you would prefer to have available during an ultrasound study? This may include everything from a v-trough, towel, and clippers, to syringes and microscope slides in case an FNA is indicated. Having a kit or list prepared ahead of time will help save time so no one has to run to the other room and grab supplies mid-study.

• If a patient is sedated or under anesthesia, is there a standard format/form for monitoring?

• Is there a report prepared for the client? Can video clips or still images be saved as part of the medical record? Will the client be present during the ultrasound in some cases? Make sure the whole team knows what should be done.

Take Advantage of All the Resources You Find Helpful

This may include textbooks and other references for what is normal on each ultrasound study and what is not. 

Access to a second opinion can also be helpful. Consider discussing your findings with colleagues within the practice, subscribing to an online forum such as the Veterinary Information Network (VIN), or even using a specialist consultation service for an expert, second set of eyes on your ultrasound images or videos.

Practice Makes Perfect

Any new skill can be challenging at the beginning. But ultrasound proficiency will improve over time, with practice. So even if fitting more ultrasounds into a busy schedule feels time-consuming at first, it will probably get to be second nature over time. 

In addition to training and courses, it may help to ultrasound healthy patients for practice, to gain a thorough understanding of all the different ways normal anatomy can look in different sizes and breeds of veterinary patients. This could be done with the pets of veterinary team members, or possibly offered to clients at a discounted price in the early stages.

Communicate Effectively With Clients

If pet owners are unsure about proceeding with ultrasound for any reason or experiencing sticker shock, the conversation can take up a lot of time for veterinarians and their team members. By planning what to say and gaining comfort with these conversations, time can be saved while providing patients with the care they need. 

Efficient conversations about pet ultrasounds may include general principles for good communication (active listening, empathy, non-verbal communication, etc.), as well as explaining the excellent value that clients are receiving for the cost. For example, explain just how much information can be gathered from an abdominal ultrasound study. In addition to looking at suspected abnormalities, it’s a thorough look at many important organs. Occasionally, unexpected issues are caught early, or if the dog or cat is normal then the owner can have peace of mind.

Putting all these principles together, a veterinary team may find the whole ultrasound process becomes more efficient. This is good for team morale, as it helps to keep the day running as smoothly as possible. It can also increase a practice’s bottom line while providing excellent care for patients.

For all these reasons, it may be well worth it for a veterinary team to invest time and effort in adding ultrasound to their practice!

Written by: Dr. Tammy Powell, DVM

Ultrasound of the Duodenum and Jejunum in Dogs and Cats

There are many reasons why a veterinarian may perform an ultrasound of the duodenum and jejunum sections of the small intestines in a dog or a cat.

For example, the vet may suspect a GI foreign body, inflammatory disease, or neoplasia. 

Here are a few key checkpoints to remember when scanning the duodenum and jejunum.

Setting Up the Gastrointestinal Ultrasound Study

If a patient can be fasted, that’s ideal.

An empty gastrointestinal tract may be easier to visualize, whereas food or digestive content may cause artifacts such as beam attenuation. However, this won’t be possible for all patients, especially in an emergency situation.

Patients are often placed in dorsal recumbency, although lateral recumbency may also be used. The patient can also be repositioned mid-study if needed for better visualization. 

Performing a Thorough Evaluation

Often, a GI ultrasound study is part of an entire abdominal study. In some cases, the GI tract may be visualized on its own. Either way, to ensure nothing is missed, it’s important to perform the study the same way each time. Many experts recommend keeping it simple by following the GI tract in its normal order of digestion, i.e. starting with the stomach, then moving on to the small intestines (duodenum, jejunum, ileum), cecum, and colon. Examine each segment in both longitudinal and transverse views.

Evaluation should include wall thickness (and whether that thickness remains uniform within each GI section), wall layers, luminal contents, signs of obstruction, the presence of a GI mass or multiple masses, infiltrative disease, and whether there’s normal motility/peristalsis.

The Duodenum

The duodenum is located along the right lateral abdominal wall in dogs. It can be found near (ventral to or ventrolateral to) the right kidney. The cranial portion may be challenging to see and may require viewing via an intercostal approach.

In cats, the duodenum may be closer to midline, or just right of midline.

The wall of the duodenum is up to 5mm thick in dogs, and 2-2.5mm thick in cats.

Jejunum

It’s often difficult to trace the long jejunum loop by loop. So, most veterinarians evaluate the jejunum by sweeping the transducer from side to side across the abdomen, in a cranial to caudal direction. Slightly overlapping each sweep will ensure that nothing is missed.

The wall of the jejunum is 2-5mm in dogs, and 2-2.5mm in cats. 

Evaluating the Layers of the Intestinal Walls

The walls of the intestinal tract have 5 specific layers, in this order: the luminal-mucosal interface (most interior layer), mucosa, submucosa, muscularis, and serosa (outermost layer). 

In longitudinal view, these layers are easily distinguished from one another (in a normal patient), thanks to their alternating pattern of hyper- and hypoechogenicity. The inner and outermost layers, and the submucosa, are hyperechoic. The mucosa and muscularis are hypoechoic. 

If these 5 layers are not distinctly visible throughout the intestines, it could indicate a problem. For example, focal wall thickening with obliteration of the layers could indicate focal neoplasia.

Make notes of any wall thickenings, whether they’re focal or diffuse, and whether the 5 layers are still distinguishable or not.

One normal finding that could be mistaken for abnormal is Peyer’s patches (pseudoulcers) in dogs, which appear as focal, hyperechoic indentations within the hypoechoic mucosal layer.

Signs of Obstruction

Sometimes, the obstructing foreign body may be visualized directly. However, this is often not possible. So, a foreign body obstruction may be detected due to differences in intestinal dilation proximal and distal to the point of obstruction. The intestinal tract proximal to the obstruction would tend to be dilated with fluid and gas, while the distal intestinal tract is normal or even empty.

With a linear foreign body, plication of the intestines may be seen via ultrasound. The foreign body itself may or may not be well visualized.

In case of an intussusception, the affected section of intestines will have a characteristic “bullseye” appearance in transverse view. If this is noted in an older pet, be sure to search for signs of neoplasia that could explain why the intussusception occurred.

Intestines may be hypermotile with a recent obstruction, but possibly hypomotile with a more chronic condition.

GI Neoplasia and Inflammatory Conditions

Neoplasia in the digestive tract may occur as a solitary mass, multiple masses, or diffusely as an infiltrative disease.

As mentioned above, discreet masses are often identified because of their focal thickness relative to the rest of the intestines and disruption of the wall layers.

Infiltrative disease, however, can be more difficult to pinpoint. There may be wall thickening with or without disruption of the wall layers. In particular, it can be challenging or impossible to differentiate between small cell lymphoma and inflammatory bowel disease in cats without further testing.

Regional lymph nodes should be evaluated, too.

Conclusion

The duodenum and jejunum are an important part of any GI evaluation. It’s helpful to get an idea of what’s normal and what’s not for these sections of the small intestines, as they’re commonly evaluated for a variety of conditions, including those listed above. 

Written by: Dr. Tammy Powell, DVM

Evaluating the Urinary Bladder on Ultrasound

An ultrasound of the urinary bladder can be recommended for a number of reasons, including suspected uroliths, cystitis, and neoplasia—to name a few.

Often, the evaluation includes the entire abdomen and any other parts of the urinary tract that can be visualized.

Given all the conditions that can affect the bladder, as well as important information from an ultrasound study to help guide the treatment plan, it’s beneficial to gain proficiency in evaluating the bladder via ultrasound.

Use a Systemic Approach to Evaluating the Bladder

A systemic approach to the whole abdomen is good, and a bladder evaluation is usually just one part of an abdominal ultrasound study. So while it may be tempting to jump to the bladder right away if the patient is having urinary symptoms, it’s best to complete your abdominal ultrasound study in the same order that you usually do it.

Once you reach the urinary bladder, a systemic approach is again useful, to ensure nothing is missed. Here is one method for a stepwise evaluation…

• Is the overall bladder shape normal and as expected? Through practice, a veterinarian can get a good feel for what shape is normal for canine and feline patients, and how it may change if the bladder is full versus empty or nearly empty.

• How does the lumen of the bladder look? If urine is present, is the urine is anechoic? Is there sludge, sediment, crystalline material, a polyp, or anything else that is abnormal?

• If there are uroliths present, they generally appear as hyperechoic structures inside the lumen of the bladder. There may be acoustic shadowing, and the calculi may move freely depending on how large they are. 

• Is the bladder wall smooth, a normal thickness, and well-defined? Be sure to evaluate the entire bladder. If cystitis is present the wall may be focally or generally thickened or have irregularities in the mucosa, depending on the severity and duration of the cystitis. Keep an eye out for polyps or masses/tumors, too. Also, look for deviations in the wall that could indicate a urinary bladder diverticulum.

• If a mass is present, make note of the size, appearance, and location. Transitional cell carcinoma, the most common neoplasia of the bladder, tends to occur in the bladder wall near the neck and trigone. Commonly, these masses are hyperechoic or mixed echoic and have been compared to cauliflower in appearance. Evaluate nearby blood vessels and regional lymph nodes, too. Avoid cystocentesis or aspiration for samples, because of the risk of seeding the neoplasia into the abdominal cavity when the needle is withdrawn. Sometimes, it’s easy to confuse blood clots with masses, so keep this in mind and re-evaluate as needed.

• Be sure to evaluate other urogenital structures, including the kidneys and ureters (the latter are often not visible unless there’s an abnormality), as well as blood vessels and lymph nodes in the region. Remember to look for the uterus/ovaries in intact females and the prostate in males, although it might not be possible to visualize these structures in all patients, especially if they are normal.

Whenever abnormalities are noticed, describe them in detail and take measurements. Include all of this in the notes. Even if things look normal, it’s still a good idea to take some measurements (such as bladder wall thickness) and describe what you’re seeing, as a baseline for comparison in case anything changes in the future.

A Few Tips

A full bladder can help with visualizing certain lesions (such as hyperechoic uroliths) by providing “contrast” or a backdrop to help make abnormalities stand out. Also, a full bladder smooths out the bladder wall, whereas an empty bladder may lead to false readings of wall thickening or masses. Additionally, a large bladder allows for an easier ultrasound-guided cystocentesis. So whenever possible, try to ultrasound with a full, or at least partly full, bladder. In some cases, it may be appropriate to give the patient water or IV/SQ fluids and wait for the bladder to fill prior to the study.

Pressure from the transducer can alter the bladder’s shape.

So be sure to practice with various pressures and become familiar with how the appearance of the bladder might change.

Repositioning the patient can also be helpful.

This may give you a better viewing angle and position for certain structures. Having the patient stand up may put gravity in your favor by decreasing the distance between the bladder and the probe. Also, patient movement may cause sludge/sediment to move around or disperse so that it’s not mistaken for a urolith.

Have appropriately sized needles, syringes, and collection materials available.

In case an aspiration/cystocentesis is needed, it’s best to have supplies ready to go.

Ultrasound of the urinary bladder is a very valuable skill, and it works well in conjunction with information gained from x-ray studies. Training and practice in ultrasound of the urinary bladder are often well worth it for patient care and for additional income from ultrasound studies. 

Written by: Dr. Tammy Powell, DVM

Finding the Adrenal Glands in Large Dogs using Ultrasound

A thorough abdominal ultrasound includes evaluating the adrenal glands.

Common reasons to look at the adrenals include searching for signs of neoplasia, Cushing’s, or Addison’s disease. And even in animals where adrenal disease isn’t suspected, sometimes growths or other changes to the gland(s) are discovered incidentally.

Unfortunately, sometimes adrenals can play “hide and seek” and be tough to find. That’s true for any dog—but especially for large dogs with deep abdomens, since the abdomen may be too thick for the ultrasound waves to penetrate well. 

Having a repeatable system for where to look can help. Here are some steps for finding those tiny glands inside of a big dog…

Perform an Abdominal Ultrasound in the Same Order Every Time

Just like reading an x-ray or performing a physical exam, a systemic approach helps ensure that nothing is missed. 

Each veterinarian may have their own preference for how to go through a scan in a stepwise fashion. For example, some may scan cranially to caudally. Others may scan clockwise, or have some other system. Any system is fine, so long as it covers everything you need to see and is easy to repeat on each patient. So choose what works best for you.

In addition to revealing unexpected abnormalities of the adrenal gland(s) sometimes, systemically examining the entire abdomen will also help a veterinarian gain experience. Then, when it’s time to locate the glands on a patient with suspected adrenal disease, you’ll have plenty of practice to fall back on and may feel less pressure.

Where to Find the LEFT Adrenal Gland

• To narrow the search, first, find the left kidney by scanning the left dorsal mid-abdomen.

• Next, narrow the search even further by finding the vascular landmarks: the aorta (in long view) and the left renal artery. 

• Look for the spot where the left renal artery branches off from the aorta. The left adrenal gland should be just cranial to this junction.

Where to Find the RIGHT Adrenal Gland

• First, locate the right kidney by scanning the right cranial abdomen.

• Next, locate the vascular landmarks: the caudal vena cava (in long view) and the cranial mesenteric artery.

• Apply some pressure, which will cause compression of the caudal vena cava and allow better visualization of the adrenal gland. The gland is dorsolateral to the vena cava and just cranial to the cranial mesenteric artery.

A Few Tips

It may be tempting to use the kidneys as a primary landmark since the adrenal glands are located near each kidney. However, the kidneys may overshadow the small glands. So while the kidneys are a good starting point, it’s also important to use vascular landmarks.

Color Doppler can be a big help, too. It often makes it easier to find and view vascular landmarks.

Minimize the distance between the probe and the adrenal glands as much as possible. This can be done by moving the probe as needed, and by applying gentle pressure if the patient allows.

What to Include In the Medical Record

Be sure to describe any abnormalities. Additionally, rather than just noting ‘normal’ or ‘abnormal’, it’s good to provide specific details in case a comparison is needed in the future. Here are some things to note, even if the glands look normal…

• Measure and record the size of each gland. Measurements are typically taken from the cranial to caudal pole, as well as a measurement of the thickness of each pole.

• Note if the glands are hypoechoic to surrounding fat or if their appearance is different than expected.

• Classic adrenal gland shape has been compared to a ‘peanut’, or sometimes an ‘arrowhead’ for the right adrenal. Note if the shape is as expected or if it’s abnormal.

• If any abnormalities are noted, list the most likely rule-outs and a recommendation for follow-up/monitoring or further diagnostics if indicated.

With practice, locating the adrenal glands will become second nature. It may still be challenging on some patients, but having a repeatable system and gaining experience will help.

Written by: Dr. Tammy Powell, DVM

Ultrasound-Guided Cystocentesis: Pros and Cons for Your Veterinary Practice

A cystocentesis offers advantages over other urine collection methods

If you work in a small animal veterinary practice, there’s a good chance you’ve performed, assisted with, ordered, or overseen a cystocentesis in many of your patients.

A cystocentesis offers advantages over other urine collection methods in that it provides a sterile sample, as opposed to free catch or even catheter methods that may contain contamination with pathogens or cells from the skin or urethra.

But how does an ultrasound-guided cystocentesis compare to a blind cystocentesis obtained via palpation or anatomical landmarks?

Your preference may depend on your practice style, experience, and patient needs. But here are a few things to consider…

Which Patients Are Good Candidates for Ultrasound-Guided Cystocentesis?

Here are a few factors that may determine if an ultrasound-guided cystocentesis is a good option for any particular patient…

• Large or overweight patients. A blind (or non-ultrasound assisted) cystocentesis may be straightforward on cats, and even small dogs, who are not overweight. In these patients, it is often possible to palpate the urinary bladder and to easily reach the bladder with a standard-length needle. 

However, difficulties arise in patients who are overweight, which makes it more challenging to feel and reach the bladder. Additionally, an ultrasound can help guide your needle with large dogs.

• Patients with “hard to stick” bladders. Maybe your patient’s bladder is thickened due to chronic cystitis or another condition. Or, maybe the patient’s bladder is small. 

Either way, an ultrasound provides additional direction (and visualization) of partially-full or otherwise difficult-to-obtain-a-sample-from bladders.

• Patients whose bladders could use a visual evaluation. If you’re obtaining a cystocentesis because the patient has urinary symptoms, a quick scan can provide more information about any obvious lesions. 

Use this for your own peace of mind (i.e., there’s no bladder tumor present at the time of the cysto), or create a charge for urinary ultrasound evaluation packaged together with other diagnostics.

Which Patients Are NOT Good Candidates for Ultrasound-Guided Cystocentesis?

• Thin cats with big bladders. Depending on your practice style and preference, you may find it’s easier to do a blind cystocentesis on a cat with an easily palpable bladder, especially for routine health checks. 

Although it may still be worth doing an ultrasound if the cat presented for urinary symptoms, so you can look at the bladder.

• Patients with bladder masses or tumors. If a patient has transitional cell carcinoma, placing a needle into the bladder may “seed” tumor cells into the abdomen as the needle is withdrawn. 

So any time a mass is present or suspected, it’s good to be cautious and skip the cysto (with or without ultrasound).

• Fractious or wiggly patients. These patients may not be good candidates for either ultrasound-guided or blind cystocentesis, since it wouldn’t be good for them to move around while the needle is inserted.

However, sedation may make the procedure possible for these dogs and cats.

PROS of Ultrasound-Guided Cystocentesis Versus Blind Cystocentesis 

Advantages include…

• Quick and easy. If you’re new to ultrasound-guided cystocentesis, it may take some practice. But soon it becomes a habit and may even be faster than a blind cysto.

• Visualization of the bladder. You know exactly where the needle is heading, and therefore you have an improved likelihood of getting a sample from a small or partially-full bladder. 

Plus, you may want to do a quick bladder evaluation to look for things like uroliths, sludge, or bladder masses, as this could change your recommended course of treatment.

• Safety. Supporters of ultrasound-guided cystocentesis point out that if you can see where the needle is going, there’s less risk of accidental puncture of other organs or blood vessels. 

CONS of Ultrasound-Guided Cystocentesis Versus Blind Cystocentesis 

• Training and practice are needed. It may take a little time for your team to become comfortable with this new method. Fortunately, it’s simple and straightforward to learn.

• Creating a charge for the service. This isn’t necessarily a bad thing—after all, you should be paid for your time and expertise when you provide a service.

However, there are differing opinions from practice to practice as to when and how to charge.

• For example, will you charge for all ultrasound-guided cystocentesis?

• Or only charge as part of a package with other diagnostics (urine analysis, urine culture and sensitivity, and quick ultrasound evaluation of the bladder, for example) in patients who are symptomatic?

• And how much will you charge?

• Small risk of side effects. The most common side effect is hematuria, which is mild and transient. Other risks do exist, such as bladder rupture or injury, organ or blood vessel puncture, urine leakage into the abdomen, the spread of bladder cancer, or vagal reactions (retching, panting, hypersalivation, collapse). 

While these effects are quite rare, it’s always worth considering the risks of any procedure before performing it, especially in patients who may be at higher risk due to underlying health conditions.

Investing in Ultrasound Training

In addition to teaching your team members to do an ultrasound-guided cystocentesis, it’s worth considering training in ultrasound examinations for you or one of your DVM associates.

There are plenty of other uses, including but not limited to abdominal evaluation for organs, masses, ascites, or even pregnancy, and cardiac or pericardial evaluations.

By maximizing your ultrasound usage, you can offer more diagnostics to your patients, while also getting the best ROI on your equipment investment—a win-win.

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

Find Those Urinary Bladder Stones

Sometimes, diagnosing urinary bladder stones in dogs and cats is simple: one set of x-rays and the mineral-dense uroliths glow bright white on your viewing screen.

Other times, it’s not so straightforward… especially for small or radiolucent stones.

Here’s how radiographs and ultrasound can be used to help you find pesky, hard-to-view bladder stones.

Are bladder stones on your differential diagnosis list?

Bladder stones may be at the forefront of your mind if you see a dog or cat who’s…

• Having blood in their urine.

• Urinating more frequently, and in short streams.

• Having urinary accidents in the home.

• Straining or experiencing pain during urination.

• Excessively grooming around their genitals.

Usually, a client will bring their pet into you for these concerns, and your physical exam will help to determine that there’s no urinary obstruction.

With urinary bladder stones, you may notice some discomfort on palpation of the caudal abdomen. On a cat or small dog, you may even feel stones or crepitus in the area of the bladder. 

Some patients, on the other hand, may exhibit minimal symptoms and their physical exam may be normal (sometimes bladder stones are an incidental finding).

Either way, most pets will need some type of imaging to confirm that bladder stones are there. Radiographs are a great place to start…

Finding uroliths via radiographs

In addition to any other needed tests—such as a urine analysis or bloodwork—radiographs are often recommended for pets with urinary symptoms, in order to look for uroliths or other abnormalities.

Typically, you’ll start with two simple views of the abdomen—a lateral and a VD. 

Take a close look at the urinary bladder to look for radiopaque stones, which should show up as a white opacity relative to soft tissues thanks to their mineral composition.

Stones can range in size from small sand-like grains to more than two inches across. There may be just one or two stones present… or a small group… or even more than 100.

Remember to check the urethra for small stones that could be stuck—especially if the patient is straining or in pain during urination.

For better visualization of the entire urethra in male dogs, consider taking another lateral view with the hindlimbs pulled forward.

Also, check the kidneys and the areas of the ureters. While much less common in pets than in people, occasionally uroliths may be seen higher up in the urinary tract.

If you see stones now—you have your answer.

If you suspect urinary bladder stones but still don’t see them, a contrast study may allow better visualization.

For finding bladder stones, a double-contrast study is ideal.

This includes using both a positive contrast agent (soluble iodinated contrast medium) and a negative contrast agent (room air, or ideally carbon dioxide to reduce the risk of an air embolus) in the bladder together.

Anesthesia or sedation may be needed for the patient’s safety and comfort since the contrast agents are administered via a urinary catheter.

In addition to radiographs, an ultrasound is a useful tool…

Finding uroliths via ultrasound

An ultrasound study is another great option for finding bladder stones, especially radiolucent ones.

The fluid-filled bladder provides contrast for the ultrasound waves so that stones can be found (and often emphasized by acoustic shadowing). 

Besides radiolucent stones, you may also see…

• Bladder stones (radiopaque or radiolucent) that were too small to visualize radiographically (smaller than 1-3mm).

• Other problematic issues in the bladder, such as ‘sludge’ buildup in cats with crystalluria.

• Damage to the urinary bladder itself, such as inflammation.

• The condition of the upper urinary tract—the kidneys and ureters.

• Unexpected findings, such as tumors or anatomical abnormalities of the bladder.

Because of this, ultrasound imaging is a valuable tool for helping you diagnose and treat problems of the bladder, including urinary stones.

Follow-up

Depending on your findings, you may recommend a diet change for dissolvable stones, or a cystotomy to remove the stones.

For dissolution, follow-up imaging can help to track the patient’s progress and see whether or not the stone is dissolving.

When a cystotomy is recommended, remember to use imaging on the day of surgery…

Take pre-op radiographs to confirm the stones are still there, and that your urinary catheter is in place.

Include post-op views to confirm and document that all stones were successfully removed.

Since most stones are radiopaque, standard radiographs are a good option for follow-ups—and typically the imaging choice on the day of surgery.

But ultrasound can also be used in conjunction with other diagnostic tests to monitor the health of the urinary system long-term and to look for early signs of a problem such as a reoccurrence of stones.

Catching stones early, when they’re small, may allow less invasive treatment options such as voiding urohydropropulsion.

With the right combination of imaging modalities, you can help your clients stay on top of treating, monitoring, and preventing urinary bladder stones in their pets.

Written by: Dr. Tammy Powell, DVM

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

Pregnancies in Dogs and Cats: Detection and Monitoring with Ultrasound and X-Rays

When it comes to pregnancy in pets, sometimes it’s hard for clients to wait… 

They want to know right away whether there are puppies/kittens present… how many there are… and if the babies are doing OK.

It’s understandable—whether this is a professional breeder or a pet parent who’s decided to proceed with a litter, the arrival of new puppies and kittens is an exciting time.

There are a few ways to check for pregnancy in dogs and cats. Each method has its own pros and cons, which you can explain to your clients to help set up realistic expectations and develop a plan that best suits their pet’s needs.

Early pregnancy checks may include…

Abdominal palpation

• This method of pregnancy detection can yield information as soon as 3-4 weeks into the 9-week pregnancy.

• Abdominal palpation has been used by vets for many years—and can often result in the detection of fetal “bumps.”

• However, this method isn’t always accurate. There are plenty of things that could render palpation inconclusive. For example, in large breeds or overweight dogs, palpation is more difficult. 

Relaxin testing

• Testing for the relaxin hormone—a hormone unique to pregnancy—can be performed as soon as 20 days into gestation. 

• This test gives your client a very important “yes or no” answer—and helps to distinguish between true pregnancy versus pseudopregnancy—but it doesn’t provide information on how many fetuses are present.

The next test to consider is an abdominal ultrasound. 

Canine and Feline Abdominal Ultrasound

The procedure of abdominal ultrasound in veterinary medicine involves examining the internal organs of dogs and cats. To begin the ultrasound study, transverse scanning is performed to locate the urinary bladder and colon, with the uterine body positioned between them.

Once the uterine body is identified, the scan is directed cranially towards each kidney, following the uterine horn towards the ovary. Along this path, each fetus can be identified by its appearance as a round, fluid-filled gestational sac.

Compared to other imaging methods like X-rays, abdominal ultrasound offers several advantages in veterinary practice.

One significant advantage is the ability to confirm pregnancy several weeks earlier than X-rays. Typically, an ultrasound is performed around 30 days into the pregnancy, although it's possible to detect a pregnancy as early as 20 days. At 30 days, it becomes easier to detect fetal heartbeats.

In addition to early pregnancy detection, ultrasound provides other valuable benefits for veterinarians, including:

1. Counting the number of puppies or kittens: The ideal time for this is between 30 and 35 days of pregnancy. After 50 days, the uterine horns may overlap, making it more challenging to accurately count the fetuses.

2. Assessing fetal viability: Ultrasound can confirm the presence of viable fetuses by detecting their heartbeats or movement.

3. Predicting gestation duration: Measurements of fetal size or certain anatomical structures can help estimate the gestation duration.

Another advantage of abdominal ultrasound in veterinary practice is its ability to involve clients in the process. Unlike X-rays, clients can be present during the ultrasound, allowing them to witness the heartbeats of the puppies or kittens.

This experience enhances the bond between the client and their pet, as well as strengthens their connection to the veterinary practice.

However, in the later stages of pregnancy, X-rays also play a valuable role in veterinary medicine. X-rays provide more information when the fetuses have developed significant skeletal structures, usually around 45 to 55 days after breeding.

At this stage, a single set of X-rays is safer for the fetuses compared to earlier in the pregnancy.

Radiographs (X-rays) are particularly useful for:

1. Confirm the fetal count.

2. Assessing the size ratio between the fetal skulls and the pelvic canal. This information helps in planning for potential dystocia and the need for a C-section.

As a veterinary practitioner, you have various diagnostic tools at your disposal to detect and monitor a healthy pregnancy in dogs and cats.

By utilizing the best combination of methods, you can reassure your clients along the way, and increase the chances of a healthy delivery of puppies or kittens!

Written by: Dr. Tammy Powell, DVM

Vertebral Heart Score: How and Why to Calculate One

A vertebral heart score (VHS) is a measurement used to determine if a patient’s heart is enlarged.

The VHS can provide valuable insight to complete your clinical picture, especially at times when you hear a heart murmur, for a general pre-anesthetic check, or to look for cardiac changes on breeds that are predisposed. 

It’s a simple, non-invasive way to get more information and to monitor for changes over time.

How to calculate a vertebral heart score

1. Obtain a high-quality lateral thoracic radiograph. Be sure…

   • To collimate.

   • That the patient is straight and not twisted or at an angle.

   • That you can see enough detail, especially the thoracic vertebrae and the borders of the cardiac silhouette.

2. Make your first measurement along the longest axis of the cardiac silhouette, from the ventral border of the carina of the mainstem bronchus to the apex of the cardiac silhouette.

   • You don’t need to measure this in centimeters or inches—instead, just hold up a sheet of paper to your x-ray viewer and make a mark for your measurement, or use calipers. Or, with your digital x-ray system, use the VHS function to mark the measurement right on your screen.

3. Now, hold the measurement up to the vertebrae, starting with the cranial edge of T4—this is the 4th vertebra to have a rib connected. Count the number of vertebrae (including the vertebral body and the following disc space) that fall into the long axis measurement.

   • Measure to a decimal place of 0.1 (for example, let’s say your first measurement was 5.2 vertebrae).

4. Make your second measurement. This time, you’ll measure along the short axis, which is the widest part of the cardiac silhouette. It should be perpendicular (at a 90-degree angle) to your first measurement.

5. Repeat the process of transferring this measurement to the thoracic vertebrae, starting with the cranial edge of T4. For this example, let’s say your measurement was 4.5 vertebrae.

6. Add these two numbers together.

• In this example, your VHS would be 5.2 + 4.5 = 9.7 

How to interpret the results

For dogs, a normal vertebral heart score is less than 10.7 (with an average range of 8.5 to 10.5). For cats, an average VHS is 7.5 (with a range of 6.8 to 8.1).

Anything larger than that is considered abnormal.

Of course, this doesn’t tell you exactly what’s going on—you’ll need further information such as an echocardiogram to determine whether there is DCM, HCM, or some other issue causing the enlargement of the cardiac silhouette.

However, the VHS is a great screening tool to let you know to investigate further. And, if you have a patient who already has cardiac disease, a VHS can help you monitor their disease progression over time, and provide tangible information to a client who wants to know how their pet is doing on treatment.

Keep in mind that, as with any diagnostic tool, there is some individual variation. Some pets—especially certain breeds such as boxers—may fall outside the normal VHS range even if they’re completely healthy.

So, look at the overall clinical picture when assessing a patient. But with that in mind, a VHS is a quick, easy, valuable addition to your toolkit when it comes to evaluating and monitoring cardiac health.

Vetebral heart score tool video

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

What is the Warranty and Service Coverage if I Buy a Veterinary Digital X-Ray System?

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.

Will a new Digital X-ray System Work with my Old Innovet Summit X-ray Generator?

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.