Hands-Free X-Rays: The Next Step in Veterinary Safety
Is it time to put restraints on veterinary radiography?
By Julia Bitan, RVT
When Dr. Debrah Berman, a Thornhill veterinarian with over 30 years of experience felt a lump in her tongue, she didn’t think much of it.
Up until that point, her health had been excellent and she was following all current radiology safety regulations such as monitoring her dosimeter values and using all protective equipment.
The diagnosis of Mucoepidermoid Carcinoma of the salivary gland (a type of cancer often associated with excess radiation exposure) came as a shock and made her start questioning the safety of today’s veterinary radiography.
“Since the 1990s, numerous jurisdictions in North America, and worldwide, have strengthened their regulations and best practice guidelines to actively move away from holding patients, in recognition that exposure to scatter radiation poses a risk.”
Outdated regulations
Although there are several provincial and federal laws in place to protect radiation workers in Ontario, the clauses specifically concerning veterinary workers have not been updated since 1990.
According to a veterinary radiography survey conducted in partnership with the Ontario Association of Veterinary
Technicians (OAVT) in April of 2016, 8 out of 10 RVTs still hold their patients during x-rays most of the time, while 7 out of 10 respondents choose to sometimes forgo the use of gloves and other protective equipment simply due to inconvenience.
Our human radiology counterparts in Ontario are rarely present in the room when x-rays are taken because regulations state that no person should regularly perform manual restraining for x-rays.
Technicians commonly request parents hold their own children if x- rays are required.
Since the 1990s, numerous jurisdictions in North America and worldwide have strengthened their regulations and best practice guidelines to actively move away from holding patients, in recognition that every x-ray taken increases the overall risk of cancer.
Because we don’t see regular reports of veterinary workers dying of radiation exposure, we may naively assume that modern science has overcome the dangers with newer machine design and intensive research.
In reality, current occupational exposure limits are derived from decades-old research and we know that the risk of getting cancer increases with every exposure.
Recent findings do show that extended exposure to a low level of radiation increases the risk of developing leukemia, while radiation-induced cataracts are observed at a much lower radiation dose than previously believed. In veterinary medicine, the damage caused by ionizing radiation is simply too low to be felt right away and the ALARA principle (As Low As Reasonably Achievable) is much too ambiguous in the context of our profession.
Change is happening
A small number of veterinary clinics in Ontario, including Toronto Veterinary Emergency Hospital and Referral Center (TVEH), began enforcing a strict no-hold, out-of-the-room x-ray policy to keep their veterinarians and RVTs away from ionizing radiation emitted by the x-ray machines.
TVEH started enforcing the 100% -out-of-the- room radiography six years ago.
RVT Ashley Jenner, head of radiology at TVEH, has developed a number of tools and techniques to make out-of-room x-rays possible.
“Non-manual veterinary radiography is much easier and faster than most people believe,” Jenner says. “All it takes is proper techniques and some extra tools.”
Jenner uses positioning devices alone on 75% of her cases (non-sedated patients), and sedation on the remainder.
Dr. Debrah Berman is now “cancer-free” and back to practicing veterinary medicine. She now endeavors to obtain all her x-rays using positioning/restraining devices or sedation.
“Radiation exposure is cumulative,” says Berman. “You may not realize until 20 or 30 years down the road that you have received too much. It may take a little more effort, but had I known that I would need to have a quarter of my tongue removed because of cancer and that I'd have permanent nerve damage and varying degrees of chronic pain, I wouldn't hesitate. And, I am one of the lucky ones. We need to protect ourselves”.
Transitioning to non-manual radiography is not always an easy task.
Change is rarely welcomed in our profession and as long as the minimum standards are followed, there is little reason or incentive to change.
We do, however, know there are risks involved with radiation, and alternatives do exist.
A program was created to guide clinics through transitioning to non-manual radiography using different tools and techniques.
The Hands-Free X-Rays Initiative aims to promote awareness and encourage change to current veterinary radiography.
For more information about the program, visit our website - www.handsfreexrays.com.
For comments, feedback or help to bring change to your clinic, please contact us at:
email: info@handsfreexrays.com
Phone - +1 (647) 502-4843.
Written by By Julia Bitan, RVT
Your Warranty and Service Coverage for Veterinary X-Ray
Today, every veterinarian recognizes the importance of incorporating digital X-rays into their animal hospitals.
A considerable number of them plan to transition from traditional film and chemical X-rays to digital systems this year.
While the initial concern typically revolves around the cost of acquiring a digital X-ray system, it is equally crucial to inquire about the warranty and its coverage.
Here are some pertinent questions to ask the prospective vendor when considering the purchase of a veterinary digital X-ray system:
1. What is the duration of the hardware warranty for my veterinary digital X-ray plate?
2. How long does the software warranty for my veterinary digital X-ray software last?
3. For how long will I receive software upgrades for the X-ray system used in my animal hospital?
4. How long will my veterinarian technicians have access to tech support, enabling them to seek answers to any queries that may arise during the daily implementation of digital X-rays in my animal practice?
5. What are the costs associated with continued phone support, software upgrades, and technical assistance after the warranty period ends?
6. Which entity is responsible for providing software and technical support? Who developed and owns the software?
7. Does the warranty cover labor and shipping expenses, as needed?
8. In the event that my X-ray plate requires repair, will a temporary replacement plate be provided?
It is common for vendors operating in the animal health sector to offer a minimum of a 1-year warranty.
Not all vendors possess ownership of the software that operates their veterinary digital X-ray plate, which holds significant importance. While a digital X-ray plate can remain functional for many years, the software it relies on may become outdated within a short span of time.
An example of this can be observed with Windows XP platforms. Unless companies continually update their software, it becomes incompatible with new computing platforms.
When veterinarians transition from computed radiography (CR) to direct radiography (DR), the predominant issue they encounter is not the failure of the CR system itself but rather the poor performance or lack of support for the software.
This issue is not limited to small companies alone. Renowned brands like Idexx and Sound have discontinued support for their older product lines by ceasing software upgrades.
Our aim is to offer you transparent service and support. Our animal health software has been developed in-house by JPI which has been manufacturing x-ray equipment, writing software, and providing telephone support for these products since 1994.
Here are the responses to the eight frequently asked questions:
1. What is the duration of the hardware warranty for my veterinary digital x-ray plate?
- The hardware warranty lasts for 5 years.
2. How long is the software warranty for my veterinary digital x-ray software?
- The software warranty is also valid for 5 years.
3. For how long will I receive software upgrades for my x-ray system to be used in my animal hospital?
- You will receive software upgrades for 5 years.
4. How long can my veterinarian technicians receive phone support for any questions they may have regarding the daily implementation of digital X-rays in my animal practice?
- Our tech support helpline will be available for your veterinarian technicians for 5 years.
5. What is the cost of continued phone support and software upgrades after the warranty period?
- The cost for continued phone support and software upgrades after the warranty period is $750.00 per year.
6. Who provides the software and tech support? Who developed and owns the software?
- Our Examvue Veterinary software is developed, supported, and owned by JPI. They have been offering industry support since 1994. For technical support, please call 516-513-1330, and select option 2. Our support team is based in New York.
7. Are labor and shipping costs covered under the warranty if needed?
- Yes, labor and shipping costs are included in the warranty as required.
8. Will a loaner plate be provided in case my X-ray plate needs repair?
- Yes, we will provide a loaner plate in the event that your X-ray plate requires repair.
Is the New Digital X-ray System Compatible with Innovet?
Many veterinarians invested in X-ray systems in the ’90s. Most purchased an Innovet Summit table and generator.
They used the table and generator along with cassettes enclosing film to capture X-rays and provide life-saving next steps for their pet patients.
Processing the film in the chemical rinse and developing the images in the darkroom enabled the practicing veterinarian to review the X-ray.
If the X-ray proved complicating or just interesting then the veterinarian would mail the X-ray to a specialist for a review or save the X-ray case for the next ‘radiology rounds’ in upcoming weeks and months.
During these radiology rounds, X-ray cases would be reviewed amongst veterinarian piers and sometimes even veterinary radiologist.
Even if the patient was deceased by the time of the review huge advances in pet medicine were and still are to this day applied.
If you're reading this you use to film with your old X-ray generator and table. You want to impact the neighborhood and village who depend on precise and timely diagnosis to treat their pets.
Digital X-rays can speed up the process not only of image acquisition but also provide clear diagnostic radiology rounds.
Most old tables and generators still can produce excellent X-rays.
Often times these old systems have new light bulb collimators and replaced fuses that enable the old workhorse to continue to provide the power for an X-ray.
Yes, you can use your old table and generator with two types of digital X-rays.
The first is computed radiography or CR which will work today with any generator as the image is captured on an erasable film cassette then scanned into the software where the digital image can now be interrupted, adjusted or emailed to pet owners.
The next is an AED cesium plate. Automatic exposure detection.
This allows the plate to prepare itself for the exposure to capture the image and send in second the inmate to the display monitor.
This is the newest way to capture X-rays.
Not having to wire the old X-ray system to the new digital X-ray system is a confinement advantage.
It removes an element of future failure in hardware by eliminating the interference box!
We can help answer more questions surrounding your old X-ray table and generator.
Reach out today and we would be happy to help.