How Much Does Veterinary Fluoroscopy Equipment Cost

For many years, when it came to diagnostic imaging modalities in general practice, many veterinarians were limited to film or digital radiographs. Some general practitioners may have had ultrasound available, but for more advanced imaging modalities, patients were referred to specialty hospitals.

Nowadays, general practitioners may have noticed that imaging technology is becoming more widely available. Even looking at digital radiography, machine prices have come down significantly in the last 10 years.

And it’s not unusual for a practice to offer an additional imaging modality such as fluoroscopy or cone-beam CT, along with interventional radiology procedures, in addition to radiography and ultrasound. 

Today, we’ll discuss the availability of fluoroscopy, cost considerations, and other factors to consider when investing in a veterinary fluoroscopy unit.

How to Choose a Fluoroscopy System

When shopping for a fluoroscopy unit, veterinarians will find that there are some veterinary-specific machines available, while others were designed for human medicine. Either option could potentially be useful depending on the specific needs of the practice. 

It’s important to consider the specific features of the equipment you are purchasing, as there are big differences between some of the machines. It’s not always an “apples to apples” comparison when price shopping.

Some of the factors to consider include…

• Which type of fluoroscopy unit is best? A C-arm is what comes to mind for most vets, as that was the primary system available for many years. And C-arms still have their place, especially when used in the surgery suite. But the downsides are that they can be expensive and very bulky. A table unit is another option. Small, mobile units are also available, especially for large animal practitioners, although they may not carry all the capabilities of larger units.

• X-ray output/generator. Fluoroscopy generators can be continuous (constant x-ray output during a study) or pulsed (short bursts of x-rays, similar to the frames of a movie reel). As you can probably imagine, pulsed generators tend to have a lower overall output, which is important for radiation safety. However, exposures can still add up over time, so it’s important to practice radiation safety no matter which unit is being used.

• What will your practice use fluoroscopy for? If there is a specific need such as fluoroscopy guidance during major surgeries, that may determine the type of unit your practice purchases. 

• Where in the practice will the unit be used? Consider whether the power supply in the room needs to be redone or if the room itself needs modifications to meet radiation safety guidelines. Also, does the unit physically fit into the room in which it’s intended to be used? A combination unit, such as one that combines fluoroscopy with digital x-ray or CT functions, could help with space savings in the hospital.

• Ease of use and technical support. Efficiency in the hospital is important, even more so during busy times. Machines that are difficult or confusing to use could create challenges with effectively schedule fluoroscopy studies. This could lead to less frequent use of the machine, and therefore less of a return on investment. 

• Cost considerations. Of course, look at the actual purchase cost. But also consider factors such as financing/payment plan options for cash flow, warranty and maintenance (a warranty or service plan might not be an option when purchasing used equipment), and calculating the return on your financial investment. A practice consultant or financial expert can help with these financial projections and decisions.

How Much Do Veterinary Fluoroscopy Machines Cost?

Once a veterinary practice has evaluated their needs, it’s time to start comparing machines that would be a great fit for the practice. So, how much can a veterinarian expect to pay for a fluoroscopy unit?

The price is incredibly variable depending on the type of unit a vet practice is looking for. 

Used or refurbished mini C-arm units are available through resellers starting at around $15,000. On the other hand, some new fluoroscopy units can cost well over $100,000. 

There are used and new options sold between these price ranges, too.

How Can a Veterinary Practice Maximize the Return on Their Equipment Investment?

No matter which type of equipment a veterinary practice purchases, it’s important to make sure the equipment actually gets used! 

Some of the factors above will help ensure the best ROI. For example, ease of use/efficiency and keeping the machine in good working order are both important. 

Staff training, appropriate pricing strategies for fluoroscopy studies, and client education on the value of the service can also contribute to ROI.

Keeping all these factors in mind will help promote regular use of the machine—which carries benefits to patient care and practice profitability alike.

Written by: Dr. Tammy Powell, DVM

the Price of a Portable Veterinary Ultrasound Machine?

Ultrasound is a great imaging modality that can add value to a veterinary practice, allowing them to offer new services in-house. But for some practices, a mobile ultrasound may be the best choice. 

This includes mobile small animal practitioners, equine and large animal vets, and even some veterinary practices that may want to move their equipment between rooms or cage sides.

If you’re looking to purchase a portable veterinary ultrasound machine, here are some things to consider…

Which Components and Features Do You Need?

Before comparing the purchase price of different manufacturers and vendors, it’s important to make sure you’re comparing apples to apples.

So, make a list of the things you must have with your ultrasound machine, as well as a list of ‘nice-to-haves’. Here are some possibilities…

• Transducers. Which type of transducer(s) are included with the machine? Ultrasound probes or transducers come in different shapes and frequencies, which are used for different purposes and different species/sizes of patients. So, it’s important to make sure you’re getting the options you need, based on your practice type, the patients you see, and the services you plan to offer.

• Functions and features. Does the machine offer all the operating functions that you need for your studies? And what about features like color Doppler, or the ability to make measurements and annotations on the screen? Doppler technology can be indispensable for certain types of ultrasound studies. Color Doppler provides a look at blood flow, which is crucial when evaluating the heart and helpful for identifying vascular landmarks for certain abdominal structures.

• Durability. For vets who make farm calls, it’s important to purchase a unit that can handle being out in dust, humidity, and temperature fluctuations, as well as something that travels well. 

• Power and connectivity. Do you always have reliable power outlets available, or are there some cases when a battery-powered machine would be needed? And how will your images and videos be stored or added to your practice management software?

• Support. Is there a technical support line available 24/7? And is the company stable—meaning, are support and replacement parts expected to be available in the next few years?

How Much Do Portable Veterinary Ultrasound Machines Cost?

Veterinary ultrasounds are highly variable in price, depending on the quality of the machine itself and what’s included. But the average price of a portable veterinary ultrasound is about $10,000 to $25,000.

Some units can cost significantly more, especially if they come with multiple probes and extended service plans, and warranties.

To the other extreme, there are some units that only cost between $1,000 to $5,000. Typically, these inexpensive units are handheld and compact, and they may be able to hook up to a smartphone. They typically don’t offer the capability of seeing everything in fine detail. But they may be a good option for vets who only plan to do things like ultrasound-guided cystocenteses or quick checks for free fluid in the chest or abdomen.

Financial Considerations

In addition to the purchase price, plan for long-term expenses. This could include routine service and maintenance costs, renewing a warranty, updating software, unexpected repairs, and anything else that could come up over time.

Also, investigate your financing options. Will you purchase the equipment outright using saved business funds? Or does it make more sense to do monthly payments via financing from the vendor or a bank?

Don’t forget to factor in tax savings, too.

Talking to a financial professional, especially one who is familiar with the veterinary industry, can help. This advisor or consultant can also help you determine how much to charge for the new ultrasound services your practice will offer.

Maximize the Return on Your Investment

Many veterinary patients can benefit from ultrasound studies. But in order to schedule a lot of studies and earn a profit with the new equipment, a vet must be able to perform an ultrasound study with confidence and in a timely manner.

Ultrasound is not covered in most veterinary schools to nearly the same extent as x-rays. And the use of the probe and interpretation of what’s on the screen are not always intuitive. Therefore, many vets require in-depth training and a lot of practice before becoming comfortable performing ultrasound studies.

For all these reasons, if a practice is investing in a new ultrasound machine, it also makes sense to invest in training. That way, the machine can be used with confidence and efficiency. 

A vet doesn’t have to have these skills mastered at the time a machine is purchased. But at least one vet at the practice should have a commitment to learning how to use the ultrasound.

The right portable ultrasound purchase will vary from practice to practice, depending on the practice type, budget, and other factors. 

But by carefully considering all these things ahead of time, it will be easier to determine which machine suits your practice’s needs and to ensure your equipment investment pays off.

Written by: Dr. Tammy Powell, DVM

Digital Radiography vs. Film X-Ray: A Veterinary Comparison

What is Veterinary Digital Radiography, and How Does It Compare to Film X-Ray Systems?

Nowadays, veterinarians have a lot of options when it comes to their x-ray system—so how does a veterinary practice choose between film and the various digital x-ray modalities that are available?

It helps to compare price, efficiency, and other factors that will affect the daily use and value of your investment. Here are some considerations…

What Is Digital Radiography Versus Film?

First, it’s helpful to define the different x-ray options that are used in veterinary medicine.

The first choice is to decide between film or digital radiography. Film is exactly what it sounds like: X-ray images are captured on physical films. To produce an image, those films are then developed using processing chemicals in a dark room.

Digital radiography, on the other hand, produces a digital image. However, there is more than one method available for obtaining this image, including CCD, CR, and DR.

CCD (charge-coupled devices) have been compared to digital cameras in the way that they work. However, they have some disadvantages, including edge distortion when collimation is wider. While this older technology is still used in some capacities, most vets would be choosing between CR or DR.

CR (computed radiography) uses phosphor plates to capture an image. That image is obtained when a plate is put through a plate reader.

DR (direct radiography) doesn’t have any type of “middleman” (film developer or plate reader). Instead, digital images are captured on a special type of x-ray sensor that directly or indirectly converts x-rays into an electrical signal. The image is produced almost instantaneously.

Costs of Digital Radiography Versus Film

As with many other technological advances, there tends to be an increase in price for newer generations of technology—at least initially, because newer technology eventually does come down in price and becomes more accessible. Compare it to smartphones and digital cameras—two type of technology that have become much more widely accessible in recent years.

X-ray technology has followed a similar pattern. Digital technology does generally cost more to purchase than a film system. And DR generally costs more than CR.

That being said, prices have come down significantly in the last decade or so, making digital technology much more affordable to many veterinary practices. 

While it’s great that newer technology is becoming more affordable, that doesn’t mean the latest tech is right for every veterinary practice. For practices with a slower pace that don’t perform a lot of x-ray studies, a film or CR system may meet their needs just fine and be a smarter investment than DR.

It’s also important to consider long-term maintenance and repair costs, in addition to the purchase price of the x-ray system. 

For example, is there a warranty, and what does it cover?

If a component of the machine or plate/sensor breaks down, are replacement parts available (that’s not always the case for older equipment)?

Also, for film, the cost of supplies (film purchase and disposal, processing chemicals, and developer maintenance) must also be factored in.

Efficiency of Digital Radiography Versus Film

There’s not doubt that, used to its maximum potential, DR technology is fast and efficient. That’s because, rather than waiting on a developer or plate reader, images are created in just a few seconds.

This efficiency can make x-ray studies go much faster, with fewer retakes. Also, for digital systems in general, it’s usually faster to set up the study, since there are automatic technique settings for different patient sizes and areas of the body being studies.

All of this means a faster, simpler workflow, less time for the patient to be on the x-ray table, and the potential to schedule more x-ray studies. Many practices have reported increasing their x-ray revenue after upgrading to DR. This can certainly increase the financial return on the equipment investment.

But there is one important consideration when it comes to efficiency. The machine is only efficient if team members feel confident using it. So, it’s ideal to invest in something that’s user friendly and that has tech support available. 

It’s smart to invest time to train everybody on the new equipment, since many employees will be used to different systems and need a little help learning all the features and functions of the new equipment.

Quality of Digital Radiography Versus Film

While many vet professionals believe digital radiography is always better quality than film, that’s not necessarily true. 

Quality depends on the system itself, as well as on the ability of team members to use the equipment proficiently to obtain high-quality, diagnostic images. Performed with skill, film studies can be perfectly diagnostic and of high quality.

That being said, digital does allow some room for error. A lot of practitioners like it for that reason. The software automates much of the image processing, and the digital image can be manually manipulated if something needs to be seen in more detail.

Which Is Best—Digital Radiography or Film?

Digital x-ray technology, particularly DR, certainly offers many advantages. And it may make sense to invest in the latest technology that a veterinary business can reasonably afford, so that replacement parts and tech support are available for as many years as possible.

However, each veterinary practice must evaluate their unique needs and see what works best for them.

Written by: Dr. Tammy Powell, DVM

How Much Do Today’s Veterinary Digital X-ray Systems Cost?

What Price Range Is to be Expected?

The average price for a DR digital x-ray system in the veterinarian industry ranges from $21,000 to $35,000.

Examples:

• DR Plate and system - $21,995

• A complete DR system with table, generator, and DR digital x-ray is $29,995

• A wireless system for equine or mobile vets - $28,995.

Equipment purchases are one of the most important investments a veterinary practice will make, so it’s important to ensure that the price makes sense for the business.

This doesn’t necessarily mean that the cheapest equipment is always the best deal. Instead, it’s important to consider a number of factors in terms of how you can maximize your investment and meet all the goals you had in mind for your new equipment.

The Price of Veterinary X-Ray Equipment Has Decreased Dramatically

Fortunately, this is much more affordable than machines were as recently as 10 years ago. That being said, it’s still a significant financial investment.

You may find equipment outside of this range, depending on which deals the manufacturer/seller is able to offer or which features the equipment offers. But this is a pretty common range to budget for.

Once you see the initial offer price, also be sure to ask about any deals. Don’t be afraid to shop around and tell sellers what other offers you have, in order to receive their best price. 

And if you are buying from a company from which you plan to use other services (for example, using lab work services and buying an x-ray machine from the same company), ask about discounts or bundled deals. 

What Additional Costs Can Be Expected?

In addition to the actual purchase price, it’s important to factor in the ongoing costs of maintaining your equipment in working order. 

After all, if the new digital x-ray system can’t be used, it won’t bring in any income and it would go from a smart investment to just an expense!

Some long-term or ongoing costs to consider, for both new and used equipment alike, include…

• Warranties, including when any initial warranties will expire, whether they can be renewed, and how much it will cost to renew.

• Ongoing maintenance and repairs. Ask about routine recommended maintenance, as well as costs of the most common types of repairs. If any of this isn’t fully covered by a warranty or service plan, set aside savings each month into a sinking fund earmarked for future repairs.

• Software upgrades. Timely upgrades are crucial to keeping your image processing and storage in working order, efficient, and secure.

• Ask about technical support, if there is a free 24/7 support line you can call for smaller issues.

Speaking of repairs, also check how it works if you need repairs in the future—how long your equipment would be down, and whether replacement equipment (such as another sensor or plate) is available in the meantime.

Which Financing Option Is Best for Your Practice?

Once you’ve calculated all the costs of purchasing and owning your new equipment, it’s also important to consider how you will finance the purchase. This can make or break your monthly cash flow.

If your practice is well-established and has a business savings account to fully cover the cost of the purchase, that may be a good option. But then again, a monthly payment plan may be better, since you can pay as you go (and perhaps earn a profit on your investment right away) rather than depleting the liquid funds you have on hand.

Of course, when financing on a monthly payment plan, interest rates must be factored in. Interest will increase your total cost of purchase—perhaps very significantly if it’s a high-interest rate.

But a reasonable interest rate may be worth it.

The equipment manufacturer or seller may offer monthly payment plans, so be sure to ask about this. Also, many banks offer business loans for equipment purchases, an option known as a “capital lease.”

There are even some options to rent equipment rather than purchasing if this is a good fit for your practice.

Also, remember to factor in tax savings—most commonly through Section 179 of the IRS Tax Code—which can make a huge difference on overall practice revenue.

All of this can get complicated, so it’s a good idea to seek advice from a financial professional for large purchases.

How Can a Veterinary Practice Maximize the Return on Their Equipment Investment?

Here’s the fun part—getting to use your shiny new equipment!

This is why you bought the x-ray equipment in the first place. In addition to financial gains for your practice, you wanted to provide excellent care to your patients.

Maximizing the use of your equipment starts BEFORE the purchase.

Make sure you’re investing in something that is user-friendly and efficient, as well as something that produces high-quality images on all the different sizes of patients your practice sees. 

That way, you can ensure it actually gets used (and produces diagnostic quality images) to its maximum potential rather than being cumbersome to use.

Also, plan ahead for how much you will charge for x-ray studies or other services. And talk to the team about communicating the value of these services to clients.

This improves client compliance to maximize patient care and ROI on your new x-ray machine.

With all these factors in mind, remember that a big discount on the purchase price isn’t always the best deal. Of course, you should always do your research and get the best deal you can.

But also remember the other factors that will affect the use (and profitability) of your equipment in the long term.

Written by: Dr. Tammy Powell, DVM

When and How to Perform Equine Neck X-Rays

Radiographs of the cervical spine in horses can be challenging, but developing a system and becoming familiar with interpretation of these views can be very useful.

Here are some common guidelines to follow for cervical x-ray studies in horses…

When Are X-Rays of the Neck Indicated in Horses?

X-ray studies of the cervical spine are used to evaluate for a number of different conditions, such as cervical vertebral malformations, congenital malformations, trauma such as fractures, subluxations, osteoarthritis, or neoplasia.

Some of the symptoms that might lead a veterinarian to suspect an issue with a horse’s cervical spine include pain on palpation, stiffness or a reduced range of motion in the neck, neurological signs (ataxia, proprioceptive deficits), swellings or asymmetry of the neck, or even lameness or decreased competitive performance.

Advanced imaging, such as CT and nuclear scintigraphy, is becoming more common. A myelogram is sometimes indicated as well, for more information.

However, plain radiographs are usually the first line for diagnostic imaging. Plain radiographs can provide a lot of information, can be used to guide the next step of treatment or diagnostics, and may be performed with sedation, whereas other imaging modalities require general anesthesia.

An ultrasound study may also accompany neck radiographs, especially for evaluating the joints and soft tissues such as ligaments.

Performing Radiographs of the Cervical Spine in a Horse

Here are a few things that will help with smooth and efficient x-ray studies of the neck…

• Make sure the generator is powerful enough for cervical radiographs, especially for the caudal cervical spine, which is a very thick region to shoot through due to surrounding musculature.

• Know which views are needed (more on this below).

• Carry all appropriate PPE, including cassette holders, lead aprons, gloves, etc.

• Use appropriate technique for this region. This is typically a kVp of 70-90, while mAs can vary greatly between the cranial to caudal portions of the neck due to thickness.

• The horse is typically sedated unless contraindicated and standing for the x-rays.

• Markers should be used to clearly differentiate the different regions of the neck, so a vet knows which vertebrae they are looking at. Some vets find it’s easier to use tape on the cassette to mark the views.

Which Radiographic Views of the Equine Neck Should be Taken?

Lateral views are typically the first ones taken. The standard lateral-to-lateral view (which can be taken from either the right or the left side) can provide a good screening of the entire area. 

The region is usually broken down into three overlapping shots: cranial, middle, and caudal. One disadvantage of a lateral-to-lateral view is that bilateral structures are superimposed.

Oblique views can help with the problem of superimposition and allow the vet to take a closer look at the side where a lesion is located. To provide a basis for comparison, both a right and a left oblique are taken for each region of the cervical spine (cranial, middle, and caudal). 

Obliques are usually performed at an angle of 45-50 degrees from lateral—for example, dorsal-right-lateral to ventral-left-lateral oblique. A ventral to dorsal oblique technique has also been described. Either way, the direction of the shot should be clearly noted and compared to a reference of the same direction and angle, for accurate interpretation.

Additional views may be obtained if needed, especially if more focal shots are indicated to isolate an area in question. 

VD views are typically not performed due to impracticality, because of the thickness of a horse’s neck, although it may be possible in smaller breeds or foals.

Interpreting Radiographs of the Equine Neck 

Practice, good reference images for comparison, and familiarity with the anatomy of the region can all help with the interpretation of x-ray images.

A consultation with a radiologist can also be helpful.

Evaluate each radiograph in its entirety. Asymmetry, variations of normal anatomy, changes associated with degenerative joint disease, lytic lesions, stair-stepping between vertebrae, compression of the vertebral canal, or any other abnormalities should be noted.

Measurements of the vertebral canal can also be made and compared with standards, which can help with diagnosing more subtle compressive lesions.

By having a system for neck radiographs, knowing which views to take, and becoming familiar with the interpretation of these x-ray studies, a vet can determine the next step for a horse showing symptoms of a problem localized to the cervical spine. 

Written by: Dr. Tammy Powell, DVM

When and How to Perform Equine Skull X-Ray

Radiographs of the head are useful when evaluating for injuries or disease processes of the skull, jaws, teeth, nasal cavity, and paranasal sinuses in horses.

Examples include, but are not limited to, dental or periodontal disease of the cheek teeth, head trauma, sinusitis, and neoplasia.

Common clinical signs for which skull radiographs may be indicated include nasal discharge or epistaxis (especially unilateral), swellings of the face, odor or draining tracts, bony changes, or difficulty eating.

When skull radiographs are indicated, here are some common guidelines to follow for procedures, views, and interpretation.

Performing Radiographs of the Head in a Horse

A systemic approach to an x-ray study can help improve efficiency and ensure nothing is missed. This should include…

• All necessary equipment, including a generator with enough power for skull radiographs, a large sensor (while intraoral plates are available for dental evaluation, here we’ll discuss extraoral views), and any props that may be needed to aid with views or positioning.

• Knowing which views are needed (more on this below).

• Having a technique chart or reference for settings. While the numbers can vary depending on the machine/equipment, commonly kVp is set between 70-100 and mA between 3-20.

• Sedation is generally recommended unless there is a medical contraindication.

• If possible, remove the horse’s halter or anything else on the head that could create an artifact or cover-up details in the x-ray image.

In some cases, it may be worthwhile for radiographs to be accompanied by (or followed up with) additional diagnostic tests, such as ultrasound or endoscopy.

Which Radiographic Views of the Equine Skull Should be Taken?

These are the most common views that are typically used for an equine skull study…

• Lateral: This is a good screening shot to look for abnormalities (such as fluid or opacity) in the nasal cavity and paranasal sinuses. Bony and dental structures will be superimposed, but obvious abnormalities (such as tooth root abnormalities) might also be noted here. The cassette is centered over the 4th upper cheek tooth or rostral aspect of the facial crest, and a horizontal beam is used. 

• Ventrodorsal (or Dorsoventral) Oblique: Oblique views are valuable for reducing superimposition. A VD or DV technique can be used. 

  • A VD oblique aids in evaluating mandibular structures, as well as in viewing the maxillary sinuses with less superimposition. The cassette is centered at about the same location as the lateral shot, but more dorsally to create obliquity. The x-ray tube is placed ventrolateral to the mandible so that the beam is at approximately a 45-degree angle on the opposite side of the face.

  • A DV oblique is helpful for evaluating sinus structures and maxillary cheek teeth. This view is basically the reverse of the VD, with the cassette positioned below the jaw and the x-ray beam pointing down at approximately a 45-to-60-degree angle on the opposite side of the face.

• Dorsoventral: This view provides a lot of information about the sinuses, nasal passages, and nasal septum, especially for comparing right to left. Teeth and bony structures may also be evaluated, although overlap of these structures is to be expected. For this shot, position the cassette ventral to the head, centered under the mandibles. Then position the beam perpendicular to the cassette.

Additional views may be obtained as needed, especially more focal shots and additional angles to isolate an area in question. 

For more detailed guidance on views for evaluating specific areas of the skull, this article is highly recommended: 101-eve-v25-i12-fm-toc.indd (aaep.org) 

Interpreting Radiographs of the Equine Skull 

Fortunately, the contrast between air (the nasal passages and paranasal sinuses) and bone creates good radiographic contrast. On the other hand, the complex structures of the skull, combined with superimposition of those structures, can make radiographic interpretation challenging.

For the best results, always use markers to identify which side of the head is being evaluated in the shot and differentiate between right and left, especially in oblique views (for example, RDLV—right dorsal to left ventral oblique).

Also, obtaining bilateral views is helpful for lateral and oblique shots, since it allows for comparison between sides. 

Always evaluate the entire radiograph, and be on the lookout for asymmetry.

As with any x-ray study, clinical experience and good radiography reference images can help a vet identify what is normal versus abnormal.

Consultation with a radiologist can be helpful as well.

By having a system for skull radiographs, knowing which views to take, and becoming familiar with the interpretation of these x-ray studies, a vet can determine the next step for a horse showing symptoms of a problem with the head or teeth. 

Written by: Dr. Tammy Powell, DVM

Pre-Purchase Examinations and X-Rays in Horses

Since purchasing a horse can be a large financial investment—both the purchase price itself, as well as any medical bills that arise later due to health or lameness issues—it makes sense for horse owners to do their research prior to buying a new horse.

As such, a pre-purchase examination with a veterinarian is typically performed prior to the sale going through, which includes a physical evaluation and possibly radiographs. 

What Is Included In a Pre-Purchase Examination of a Horse?

At the very least, a pre-purchase check includes the horse’s history (ownership, work, and medical history) and a full physical evaluation.

A horse’s identification should be verified. A vet may also make notes about the horse’s temperament or other non-medical factors.

The horse’s history is important when considering expectations of future performance. 

For example, what is the horse being purchased for, i.e., what will their job be? And how does this level of activity compare to their current level of activity?

Then there’s a standard full physical examination, which looks for abnormalities of the skin, eyes, mouth, cardiovascular, gut, and other body systems. 

This includes evaluating the horse before and after physical exertion and seeing how long it takes them to recover.

The musculoskeletal part of the exam may include more detail while evaluating for lameness. Examples of this part of the exam include (but are not limited to)...

• Observing the horse’s gait at walk, trot, canter, or other tasks, both saddled and unsaddled.

• Palpation of the limbs, neck, and back.

• Hoof evaluation and hoof testers.

• Flexion testing.

• Range of motion.

In addition to the physical examination and lameness evaluation, diagnostic testing may be performed. This might include…

• Bloodwork or labs for general health.

• Drug testing.

• Diagnostic imaging, including radiographs of the joints or ultrasound of tendons.

• Any additional tests (breeding soundness, tests required for interstate travel, endoscopy for respiratory issues, etc.) as needed.

Which Radiographic Views Should Be Included In a Horse Pre-Purchase Exam?

That being said, there is some debate over which/how many views should be included. 

When in doubt, it’s probably best to err on the side of caution and obtain more views rather than less, since these views may potentially be used in litigation if the buyer ends up encountering a problem with the horse.

For this reason, the images also need to be of excellent quality, and it is recommended to use standard views/angles.

Radiographs of the limbs may include views of joints and bones that are more likely to encounter issues, especially the… 

• Stifles (craniocaudal, lateral, +/- obliques).

• Hocks (DP, lateral, +/- obliques). 

• Fetlocks (DP, lateral, +/- obliques)

• Foot/navicular series. 

• Additional views could be added depending on the needs of the situation. This may include additional joints, additional angles or flexed/stressed shots, or even vertebral studies of the neck and back.

A veterinarian would be looking for any abnormalities, such as previous or current injuries, arthritis, or OCD lesions. Of course, all of these findings should be correlated with the horse’s history and clinical evaluation.

Getting a radiologist consultation on pre-purchase radiographs is never a bad idea either.

Conclusions from a Pre-Purchase Examination

The purpose of a pre-purpose examination, including the radiographs, is to uncover any abnormalities which may potentially lead to a problem later, so a buyer has more information about what to expect from that particular horse.

However, it’s important to remember that there aren’t a lot of “perfect” horses out there. Most horses will have some type of lesion or abnormality uncovered. 

While some abnormalities may predict a severe issue and lead to cancellation of the sale, other potential issues are not so clearcut. A pre-purchase examination isn’t a guarantee that a horse will never have a problem. And a mild abnormality may be perfectly acceptable to the buyer for the purpose for which they are purchasing the horse.

The goal is to provide information, and to convey that information to the buyer so they can make an informed decision and get the horse that’s right for them.

Written by: Dr. Tammy Powell, DVM

Planning and Measuring for Full-Body X-Rays

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

What Is an Over-Exposed X-Ray, and How to Avoid Over-Exposed

An over-exposed radiograph is one in which the X-ray beam was too powerful, resulting in an excessively dark or “burnt-out” image. 

Unfortunately, this can make it difficult or impossible to interpret the radiograph, which can lead to frustrating retakes or even non-diagnostic images.

Here are some important things to know about over-exposed X-rays and how to avoid them…

Why Are Over-Exposed Radiographs a Bad Thing?

Radiographs are about balance. A veterinary professional may feel like Goldilocks—wanting to avoid too few or too many X-rays passing through the patient and onto the film or sensor/plate, and instead, find the x-ray beam strength that is “just right.”

What happens otherwise?

Too few X-rays (or a beam that’s weaker) means an under-exposed (or whited out) image. Too many X-rays (a beam that’s too powerful) result in an over-exposed image. 

In general, an over-exposed image may be more useful than an under-exposed image when working with physical X-ray films, thanks to the availability of hot light, an extra bright light that may allow a veterinarian to see more details when viewing an over-exposed film.

However, even a hot light can’t save a very over-exposed image. It’s always best to go for high-quality radiographs.

High-quality X-ray images are more diagnostic because they allow for the visualization of fine details that could otherwise be missed. For example, pulmonary vessels and small nodules might not be visible in an over-exposed radiograph.

How to Avoid Over-Exposed Radiographs 

Improving the quality of radiographs involves troubleshooting. By figuring out WHY there is an issue with image quality, a veterinarian can most effectively improve their radiographs.

Here are some possible causes of over-exposed X-rays…

• Machine errors. Sometimes, a generator, developer, or digital plate needs to be serviced in order to correct the problem. 

An equipment issue may be more likely if ALL patient radiographs are showing the same issue, such as an exposure error. Keeping up with routine x-ray equipment maintenance can help to prevent this type of problem.

• Technical errors. This is less common with digital machines that have preprogrammed settings. 

However, it’s still possible, especially if the wrong part of the body has been selected for the study. Or, maybe the clinic has different sensors/plates with slightly differing sensitivities to the same exposure settings. 

For film machines, errors in technique are common. Technique charts can help vet professionals select the best settings and reduce time-consuming retakes. 

Either way, to obtain a lighter image, lower the kVp or mAs for the shot.

• Operator errors. For film and digital studies alike, errors in measuring the patient are common. For example, when performing an abdominal or thoracic study, remember to take the patient’s measurement while they are lying on their side—this number could be surprisingly different from the patient’s width while standing up. 

Also, the X-ray operator should remember to collimate the field. This improves the detail and reduces scatter radiation that could otherwise darken an image.

Training and practice can help veterinary team members master these protocols and obtain high-quality images. 

Also, digital radiographs can help remove some potential human error (such as manually setting the technique) by automating much of the process.

Getting the exposure right the first time will help the whole team save time, reduce stress for patients and staff by avoiding frustrating retakes, and produce images of a higher diagnostic quality for excellent patient care.

Written by: Dr. Tammy Powell, DVM

Equine & Mobile Veterinary DR X-Ray with Wireless Panels

The Benefits Of A Mobile Veterinary X-Ray Service

When you work as a mobile vet, you are often faced with many challenging situations. Having instant access to X-ray technology helps a great deal when you are working in the field. 

It does not matter if you are working with small or large animals, all vets find a mobile veterinary X-ray facility a useful tool. 

For many mobile vets, veterinary digital X-ray technology has been out of reach both from a portability and cost point of view. 

Thanks to advances in mobile X-ray technology, there is now a new player on the market. ExamVue offers mobile vets an opportunity to invest in mobile equine X-ray technology suitable for both field and clinic work. 

What Is Included In The Package?

This easy to transport X-ray solution certainly has a lot to offer. The Wireless Portable DR system features a whole host of functions. It is suitable for both equine and other veterinary work. 

The kit comes complete with a hardshell case specially made for the laptop and plate. 

List of components: 

• Wireless laptop-based capture station

• High-quality Cesium flat panel plate

• A choice of plates - 14 x 17 or 10 x 12

• Dedicated ExamVue Software

• No cable is required between the plate and the laptop

The unique ExamVue PACS makes it easy to evaluate a case quickly. As a client, you will also benefit from a 5-year warranty along with 5-year dedicated phone support. Set up guidance and training as well as shipping and installation are included as part of the package. 

Who Is This X-Ray Set up Suitable For?

This X-ray setup is suitable for both large and small animals. When you work with large barn animals, using X-ray technology as a diagnostic tool is often difficult. It often means transporting the animal to another location. Now you no longer need to do so. 

The system does not need an electricity source. In other words, it works completely independently from the main supply of electricity. The focus is very much on self-sufficiency.

One of the main benefits of the system is that you don't have any cables to worry about when performing an X-ray. That makes entanglement and other hassle factors normally associated with portable X-ray equipment a thing of the past.

You can review your X-rays on site making an immediate clinical decision possible.

What Are The Benefits Of Csl Direct Technology?

As you will know, resolution plays an important part when making a diagnosis. This system offers excellent resolution thanks to its isotropic lateral scattering. You will also benefit from low photon coupling loss which means better quantum efficiency and detector quantum efficiency. 

The Wireless Flat Panel

The wireless flat panel offers you the latest in mobile veterinary X-ray tech including minimal exposure time. High sensitivity and resolution are important for reliable diagnosis and image quality. 

Thanks to the excellent image quality, patients will receive a lower dose of radiation without the need for several X-rays. 

The plates are structured in such a way that they are protected from degradation due to moisture. Good durability thanks to the Csi:TI screen. Your choice of panel is delivered in a flat panel case for easy storage and handling.

Software Performance

The ExamVue DR software is both easy to learn and use. It is one of the few equine X-ray software programs that feature processing, storage, acquisition capture, and the viewing of digital images.

To date, ExamVue has been used in a range of X-ray disciplines including orthopaedic and podiatry. The interface makes the software easy to learn for both experienced and novice vets. 

Other software functions include printing, CD - DVD burn, image stitching, and procedure mapping. You also have a facility that allows you to create worklists. 

Above all, ExamVue offers excellent value both in terms of functionality and cost-effectiveness. 

Other Software Features That Will Impress You

Looking at the software in more detail, you will find that it also offers many other features. 

This is a guide to other features you will find useful: 

• Console Acquisition Software

• Patient registration facility using a manual function of Dicom worklist.

• Complete processing parameters from small to large.

•  Edge enhancement function, histogram and contrast. 

• You can review images by horizontal and vertical flips. 

• The software lets you rotate images both clockwise and counter clockwise.

• Complete zoom and pan along with a magnifying and crop facility.

• The software has a field for annotations and measurements for free text and arrow markers. 

• Backed up by Cobb's and Norberg Angle Measurement.

• Image preview facility

• The emergency mode allows an examination without patient data input.

• Facility for sending Dicom print to a Dicom printer

• Dicom storage along with hard disk capacity notification function.

• Exportable image facility which includes PNG, JPG, BMP, and Dicom to other forms of media. No viewer is required. 

• Database function that allows side by side images and a list of other functions including repeat, delete, and reject. 

• Gridline removal function and stitching software

• Comes complete with AED mode ( Automatic Exposure Detection) which does not require connection to the X-ray generator. 

Laptop Details

The laptop that comes as part of the package is a Dell Wireless 1506. It benefits from a 15.6" HD screen with wide-view anti-glare capability. The operating system is Windows 10 and it features 8 GB of RAM.

The package is backed up by Intel Integrated HD graphics 4400 featuring a 500 GB hard drive. The ExamVue Software is preloaded on delivery of the laptop to you. 

That is good to know when you are thinking about investing in a mobile veterinary X-ray facility. For more information, you can contact the company and further familiarize yourself with their range of other veterinary product lines. 

https://newvetequipment.com/dr-wireless-system

Written by: Annie Wall

Veterinary X-Ray Options: Naomi and CareRay Explained

Comparing X-Ray Panels: Naomi and CareRay

Digital radiography equipment continues to evolve, with several types of x-ray detectors or sensors available to veterinarians.

So, which is right for your practice? Do you need the latest technology to provide the best care, or is it best to get the most mileage you can out of previous generations of technology?

The Evolution of Digital X-Ray Detectors

Just like our cell phones and tablets, maybe it feels like there’s always a new type of x-ray technology available, whether you’re looking for small or large animal x-ray equipment, or for general, mobile, or dental radiography.

When trying to research the technology and all the lingo, maybe the choice feels a bit overwhelming.

To start with the basics, here’s a quick overview of the most common digital radiography plates on the market right now…

• CR (computed radiography). CR cassettes are also known as phosphor plates. In terms of practical application, the biggest difference between CR and DR is probably the fact that CR requires an extra step—rather than the image being transferred directly from the plates to a computer, the sensors must be read by the CR plate reader.

• DR (direct [capture] radiography). DR technology allows images to be read directly from the plate and then show up on a computer screen, which is usually a rapid process. Within DR, there are two main types of plate technologies: 

  • CCD panels. Charge-coupled device (CCD) detectors are generally built into or attached directly to the x-ray table. This technology has been compared to a digital camera in the way it detects and records light. 

  • Flat-panel detectors. Here, the x-rays are converted into an electrical signal (either directly, or indirectly by first converting x-rays into light and then into an electrical signal). The panel is separate from the x-ray table and can be removed in case a horizontal beam is needed. 

The advantages of flat panels include lower x-ray doses and better detail and clarity in the images (although opinions on image quality vary amongst practitioners). On the other hand, flat panels tend to cost more than CCD panels.

Note: The abbreviation DR is also used for “digital radiography” in general, in addition to direct capture panels.

Additional X-Ray Equipment Considerations

In addition to the detector that picks up the x-ray beam, successful radiographs also require…

• An x-ray generator, which produces the x-ray beam. This may be purchased as part of a new digital x-ray system. Or, older generators and tables may be retrofitted to be compatible with a new digital sensor.

• Software. This is what shows the x-ray image that was picked up by the sensor so that a veterinarian can see and read the image. It’s also where images are stored as part of the medical record, or shared electronically with clients, other veterinary clinics, or specialists as needed.

• Wired or wireless technology. So far as the sensor or plate goes, some have wire connections while others are wireless.

In addition to considering which sensor technology is a good fit for your practice, it’s important to think about whether or not any other equipment needs to be upgraded, and how compatible the whole system will be together.

When Is It Time to Upgrade?

This depends a bit on a veterinary practice’s needs. Typically, it’s not necessary to replace equipment for the latest model every time new technology is available, and it may be possible to keep older equipment in good working order for many years.

Using the Naomi CCD panels and CareRay Cesium (DR) panels as an example, here are some considerations…

• If a clinic is using older Naomi CCD panels that are still producing great, diagnostic images, then it’s typically not necessary to upgrade to a flat panel detector.

The veterinarian is not missing out by hanging onto older technology that still gets the job done.

• What if the plates work fine but there’s a software problem—say, the software is no longer supported? Or, what if there’s no longer any technical support or a warranty available for the plates, which sometimes happens with older technology? 

Here, the decision to upgrade may come down to personal preference, budget, risk tolerance, and how much time and effort it takes to get readable images from the software. 

• Of course, if the panels are no longer producing diagnostic images, then it’s probably time to upgrade. 

You can always check on your warranty if it’s still in place or ask about the cost of repairs, but sometimes veterinarians find that repairs are costly on older technology and their investment may be better spent on an upgrade. But this strategy will vary depending on each individual business and situation.

No matter which equipment you are currently using (or considering purchasing), remember to also think about things such as availability and cost of technical support, whether a loaner plate is available during repairs, and how the software integrates with your practice software.

Also, see if you can sell your used equipment (or make a trade-in, if your vendor allows) to offset the costs of new equipment.

All of these factors will aid in the decision of whether or not it’s time for an upgrade. 

Written by: Dr. Tammy Powell, DVM

5 Tips for Radiation Safety During Uncertain Times

Your x-ray unit is something you use frequently—probably every day, or multiple times per day—in your practice.

You know radiation safety is important. But recently, if you’ve had to reduce the number of team members in the building at any given time, maybe it feels like there aren’t enough hands on deck for patient restraint and positioning.

The good news is, some of the same principles that reduce radiation exposure can also help your team operate more efficiently.

Here are some tips to maintain safety, even when you’re shorthanded…

A.L.A.R.A.: A Brief Reminder

A.L.A.R.A. stands for “As Low As Reasonably Achievable,” and it’s the guiding set of principles that help you reduce radiation exposure to yourself, your staff, and your patients.

This is important because ionizing radiation from x-rays can damage cells, and cumulative exposure can lead to health risks such as cancer and genetic damage to reproductive cells.

To minimize exposure, there are 3 principles to keep in mind:

• Time

• Distance

• Shielding

Decreasing exposure times, increasing the distance between your team and the x-ray source, and using PPE, all can help to decrease radiation exposure.

Tips for Radiography Safety and Efficiency

Hands-Free Restraint

Increasing the distance between your team members and the x-ray source is one of the most effective ways to decrease x-ray exposure.

Think of the inverse square law, which states that doubling your distance away from the x-ray source results in ¼ of the dose of x-ray radiation.

That’s a significant decrease!

Also, scatter radiation comes from the patient—so by not touching the patient, you’re reducing your exposure.

This can be accomplished by using:

• Chemical restraint.

• Positioning aids such as sandbags and tape.

• A combination of both.

In addition to contributing to safety, hands-free restraint also increases staffing efficiency.

Especially for large or wiggly patients, it takes fewer staff members to position the patient when hands-free restraint is used.

Patient Comfort

A patient who wiggles at the last moment can lead to a crooked radiographic image—and thus, the need to retake that view.

The more shots you take, the higher the x-ray exposure to your team members.

Keeping a dog or cat’s comfort in mind can help you get the shot you need the first time—and decrease the need for retakes.

Here’s how you can do this…

• Minimize fear and pain (for example, pain from stretching a sore leg to get the right position) by using chemical restraint. 

• Use a trough or other aid for comfort. Lying with their back on a cold, hard table can cause even the most cooperative of pets to squirm. Giving them a cozy place to settle into can really help.

• Play white noise or background music. This helps make the big buzzing and beeping sounds from the x-ray machine less startling to a dog or cat.

In addition to a better patient experience and less x-ray exposure, these methods help save your staff time by getting your views more quickly.

Getting Things Right the First Time

The fewer images you take, the less radiation exposure there will be.

In addition to the measures listed above, here are some ideas for taking the fewest views possible…

• Good planning. Be sure to know exactly which views you need ahead of time and what position the patient needs to be in for those views. Communicate these expectations clearly with your staff.

• Proper measurement. Measure the patient in the position they will be in during the shot (lying down rather than standing).

• Have a technique chart, or use appropriate settings in your digital unit. Teach team members how to make quick and accurate adjustments in settings, too.

• Use collimation. In addition to producing a higher-quality image, collimation decreases scatter radiation.

A thorough understanding of x-ray positioning and machine settings will save your staff time and headaches—in addition to minimizing radiation exposure.

Who Should Be in the X-Ray Suite?

Only the team members taking the radiographs should be near the machine. Clients shouldn’t be in the x-ray suite, and other team members should be fulfilling other duties—especially when you’re shorthanded.

Rotating the staff you have on x-ray duty can also help minimize their cumulative exposures. 

So, it’s smart to invest in training multiple team members. That way, you’ll also avoid delays if your “go-to” x-ray staff member ever needs to call out sick or otherwise miss a day.

PPE Care and Use

Even though the nature of your daily practice may have changed, it’s still important to keep up with x-ray safety measures, such as making sure your PPE is in good condition.

Experts recommend checking PPE every six months, and this includes radiographing your aprons, gloves, and thyroid shields to check for cracks. Of course, check and replace sooner if there are any notable defects.

Uncertain times may be stressful, but you and your team can continue to help the patients who need you while keeping yourselves safe.

Written by: Dr. Tammy Powell, DVM