Full-body radiographs are a valuable diagnostic tool for well and sick veterinary patients alike. 

Wellness screening, such as with a senior wellness package, may include full thoracic and abdominal radiographs in addition to bloodwork, as a screening tool to catch disease processes early.

And the use of full-body screening is widely recognized for ill patients—for example, as part of the diagnostic workup for patients with non-specific symptoms, when doing a “met check” to look for metastasis, or when evaluating the patient after a traumatic injury.

But how many views are required, and how are patient measurements performed when screening large portions of the body? These topics will be discussed below…

How Many Views Are Required?

Most experts recommend at least five views: right and left lateral thorax, VD thorax, lateral (usually right lateral) abdomen, and VD abdomen. For both the abdomen and the thorax, a DV view may replace a VD view in some cases, such as if a patient isn’t stable enough to lie in dorsal recumbency.

In general, this is considered the MINIMUM number of views by many veterinary radiologists. With that in mind, sometimes full-body studies require more than five views. 

Here are some examples of additional views that may be needed…

• Some experts recommend including BOTH a VD and DV view of the thorax, for a total of four thoracic views, especially when looking for metastasis or small/localized lesions.

• More and more commonly, veterinarians are increasing their standard abdominal study to three views (adding a left lateral view as the third view), at least for GI studies. A left lateral is especially valuable for evaluating the pylorus.

• For large dogs whose entire thorax or abdomen can’t be captured on the plate or sensor, they would require two of each of these views--a cranial and caudal portion for each view, so that each body cavity can be fully evaluated without any portion being cut off due to the patient’s large size.

• Depending on what a practitioner is looking for, additional views (spine, limbs, skull, contrast studies, etc.) may be needed. This is especially true for blunt trauma, when the patient may have multiple injuries.

Is it possible to do a full-body study with less than five views? 

Sometimes, this does happen. Everyone is probably familiar with the “cat-gram” (a lateral and VD view of a cat’s entire body, for a total of two views) that is commonly used in daily practice. 

A vet will need to use their best clinical judgment for the needs of each individual patient, understanding that if less than the recommended five views are taken, details could be missed.

How to Measure a Patient for Full-Body X-Rays

Once the vet has decided which views are to be included in the study, this allows the vet team to measure the patient for each of these views.

The key is to measure the patient in the SAME POSITION they’ll be in during the study. This is important because the patient’s width may change with their position, thanks to the effects of gravity and the table and any props being used.

So, for lateral views, the patient should be lying on their side, for VD views they should be lying on their back… and so on.

Once the patient is in the appropriate position, a good rule of thumb is to measure them at the widest point for the area within the field of view. This is frequently toward the diaphragm/liver for both thoracic and abdominal studies.

This ensures the beam will be powerful enough to penetrate the part of the body being studied and produce a quality image.

However, there may be times when it makes sense to measure the patient using a different strategy, such as…

• When focusing on a specific organ. For example, to see the most detail on the bladder, it would be helpful to measure that region of the abdomen. For full-body studies, this may be included in addition to the general screening shots.

• If the patient’s body shape is such that measurements are significantly different at the widest and narrowest parts of the body within the field of view. In this case, two shots (at two different settings) may be necessary to see all fields at the right exposure and level of detail needed for diagnostic quality.

Full-body radiographs can be a great diagnostic tool that helps patients receive the care they need. 

By using best practices and strategies, a veterinarian can ensure that these studies deliver the best possible diagnostic value.

Written by: Dr. Tammy Powell, DVM