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

5 Tips to Improve Efficiency With Radiographs

Efficiency can increase a veterinary practice’s income by allowing more patients to be seen or more procedures such as radiographs to be performed.

Additionally, it may lead to an increased average charge per patient—which can improve a practice’s bottom line while delivering excellent patient care.

When it comes to radiographs, here are five ways to increase efficiency…

Start With the Best Equipment for Your Practice’s Needs

Having good, well-functioning equipment can really make life easier for a veterinarian and their team. After all, slower machines and image processors can increase the time per shot. And equipment that’s not operating at its best may lead to frustrating retakes—or even to rescheduling a procedure.

To maximize the usefulness of radiography equipment at a veterinary practice, start by taking an inventory of which equipment is there, including: generator, table, plate or cassette, film processor or digital image software, etc.

Next, evaluate each piece of equipment with the following questions:

• How is the equipment functioning right now?

• If not working well, can repairs or maintenance solve the issue—and what is the cost?

• Is there any routine maintenance due to be performed?

• Does anything need to be replaced—and is it the whole system, or just one specific component?

• Would an upgrade improve efficiency? For example, upgrading from film to digital x-rays can save a lot of time that would otherwise be spent processing films.
  

  Develop Standard Protocols and Techniques

If certain procedures are performed infrequently or don’t have a standard set of protocols to follow, this may lead to confusion, inconsistency, or errors—all of which can waste time and cause frustration.

To make things more efficient, it helps to have standard protocols for team members to follow, which have been properly explained to them. Protocols may include:

• Specific instructions for patient positioning for different radiographic views, such as thorax, hip, spine, etc.

• Guidelines for effective patient restraint while minimizing the staff’s exposure to radiation. For example, be sure the team knows how to properly use positioning aids such as sandbags and tape. 

• If patients are sedated, be sure to have a minimum standard for patient monitoring, with prepared monitoring sheets a team member can easily pick up and use for their monitoring notes.

• Have a standard technique chart, or make sure the team knows how to properly set up an x-ray study using a digital program that automatically sets technique. This includes explaining how to measure a patient in the position in which they will be radiographed.

  Have the Right Resources Available for Radiographic Interpretation

This may include textbooks and other references for what is normal on each radiographic view and what is not. 

Access to a second opinion can also be very valuable. Try to create a collaborative environment where veterinary colleagues within the practice can help each other discuss and interpret radiographs. Consider subscribing to an online forum such as the Veterinary Information Network (VIN), where a vet can post their radiographs for a second opinion. Or, consider using a teleradiology consultation service with veterinary radiologists.

Practice Makes Perfect

Efficiency in taking and interpreting radiographs will improve over time, with practice. So even if fitting more radiographs into a busy schedule feels time-consuming at the beginning, it will get to be second nature over time. 

The same is true with x-ray image interpretation—many vets become faster and more proficient with practice. Also, be sure to study the radiographs of normal patients, to gain a thorough understanding of all the different ways normal anatomy can look in different sizes and breeds of veterinary patients.

Plan for Conversations With Clients

If pet owners are unsure about proceeding with radiographs—especially when sedation is required—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. Also, clients may feel more comfortable if everything is explained in just the right way.

Efficient x-ray conversation techniques may include general principles for good communication (active listening, empathy, non-verbal communication, etc.), as well as proactively discussing the answers to commonly asked questions and concerns. For example, explain how sedation not only makes the radiographs more detailed and accurate—it also makes the procedure less scary and more comfortable for a dog or cat.

Putting all these principles together, a veterinary team may find the whole x-ray 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 over time while providing excellent care for patients. For all these reasons, it’s usually well worth it for a veterinary practice to invest in radiographic efficiency!

Written by: Dr. Tammy Powell, DVM

The Ultimate Guide to Veterinary Dental Cleaning Stations

A comprehensive oral health assessment and treatment (COHAT), also known as a veterinary dental procedure, is an important consideration for any pet’s long-term health.

Keeping the mouth healthy helps protect a dog or cat’s teeth and contributes to a pet’s overall wellbeing. And, it can be a source of revenue for the veterinary practice.

Here are some of the common components of a dental cleaning station, and the roles they play during a COHAT.

The Equipment Needed for Scaling and Polishing

Even for pets who need significant extractions, the dental procedure typically also involves scaling and polishing the remaining teeth, to clean them, keep them in good health for as long as possible, and avoid further tooth loss. 

So, it’s safe to say that scaling and polishing are an important part of any dental procedure.

Dental scaling and polishing are often delegated to skilled veterinary technicians and nurses. So, when it comes time to invest in a new dental cleaning station, it’s a good idea for veterinarians and practice managers to review the equipment available and see what is required to meet their practice’s needs.

These common tools on a dental cleaning unit play a role in scaling and polishing:

• Ultrasonic scaler. Hand scalers are still used, too, especially for tight spots that need extra attention. And curettes are needed for subgingival cleaning. However, it’s hard to beat an ultrasonic scaler for speed and efficiency when removing large amounts of dental calculus above the gumline. Many include a built-in LED light for easy visualization of the area being cleaned.

• Polisher/Low-speed handpiece. This tool is crucial for smoothing over any small defects or microabrasions in the tooth enamel caused during scaling. In other words, polishing should ALWAYS follow scaling. Recent AAHA dental guidelines recommend using disposable prophy angles and individually packaged, fine-grit prophy paste with a polisher.

• Air/Water syringe. This tool is useful for flushing away bits of tartar and other debris as you’re working, for drying a tooth prior to applying a sealant, or for irrigation and inspection of any visible subgingival areas after cleaning.

• Suction tool. Weak suction can be a convenient way to remove excess water and saliva during a procedure.

Equipment for Drilling and Extractions

Many extractions require drilling into alveolar bone to expose the tooth root or divide the tooth into segments. This allows for safe and efficient extractions, with less risk of leaving root tips or fragments behind.

For this reason, a high-speed drill is an essential component of any veterinary dental cleaning station. The drill should have several burs to choose from, too, since veterinarians see patients of all different sizes and since different bur shapes (rounded or tapered, for example) serve different purposes.

In addition to the drill, hand tools—such as elevators, luxators, extraction forceps, and suture kits—will be used. 

Other Factors to Consider In a Dental Cleaning Station

In addition to the tools available on the dental station, here are some considerations that may affect a veterinarian or practice owner’s decision to make a purchase…

• The size of the unit. Practices with small spaces may prefer a compact cleaning station, while others might not have a size restriction.

• Easy storage and access to tools. No matter the size of the station, it should be easy to store and access the tools right when you need to. No veterinary team member wants to fumble while reaching for a tool or accidentally drop something because it’s difficult to put back.

• Water reservoirs. No one wants to run out of water (which is used for many of the tools, including drilling and ultrasonic scaling) during the middle of a procedure, then put things on hold as the reservoir is refilled. For that reason, it may be beneficial to look for a station with a larger distilled water reservoir capacity.

• Service, maintenance, and warranty. It’s important to protect any equipment investment and to make sure it’s easy to keep the machine running so a veterinary practice can avoid canceling procedures due to equipment issues.

Also, remember to invest in high-quality complementary equipment. In addition to the dental cleaning station and other dental tools, a complete dental procedure also involves dental x-rays, appropriate anesthetic protocols and equipment, personal protection equipment, and anything else needed to perform a COHAT safely and effectively.

Veterinary dentistry can be a rewarding way to provide excellent patient care and generate income for a veterinary practice—a win-win scenario. To make sure these procedures run as smoothly as possible, it’s important to choose the equipment that’s the best fit for your practice’s needs.

Additional resources:

2019 AAHA Dental Care Guidelines for Dogs and Cats: https://www.aaha.org/globalassets/02-guidelines/dental/aaha_dental_guidelines.pdf 

Editor’s Note:

Currently, we offer a complete veterinary dental cleaning station at an affordable price including shipping, delivery, and a 3-year warranty. 

The space-saving machine is designed for high-volume use. 

It features key tools that are crucial to any veterinary dental procedure—plus, a few exciting special features like advanced cooling for the high-speed drill, a scaler with an endodontics feature, an LED light on the polisher, and more!

Learn more, and contact us with any questions, here: https://newvetequipment.com/cleaning-station 

Written by: Dr. Tammy Powell, DVM

Mastering Small Mammal X-Rays: Techniques and Tips

Small mammals can be rewarding to work with, although they can also present some unique challenges.

When radiographing these pets, it’s important to understand species differences and plan accordingly. 

Here are some tips and starting points for radiographing these unique pets…

Considerations for Small Mammal X-Ray Studies

While often lumped together as one group—commonly called “small mammals,” “exotic small mammals,” or even “pocket pets” for smaller species—this group of pets actually covers a range of diverse species. 

This can include everything from ferrets to guinea pigs and rabbits to small rodents like hamsters and mice—and even marsupials like sugar gliders.

It’s important to understand what’s normal and what’s not for each species. For example, hindgut fermenters (rabbits, guinea pigs, and chinchillas) often have notable gas in their GI tract, whereas that amount of gas would be abnormal for a ferret.

To gain an understanding as to what’s normal for each species, it helps to not only study texts and references but also to practice looking at radiographs of healthy pets for comparison.

In addition to understanding species differences in anatomy, it’s also important to consider each patient’s needs when preparing for an x-ray study. For example, certain small mammals may face health consequences with fasting prior to x-rays. For others, a short period of fasting (especially if anesthesia is used) might be appropriate.

Due to the small size of most patients, highly detailed images are needed. Many experts recommend using mammography films for this reason, with tabletop technique. For very small patients, or for extremity views, dental x-ray machines and films may provide good results.

Positioning and Restraint of Small Mammals

Since many small mammals are prey species, they may be prone to excess stress with strong manual restraint, especially if they are already ill. For critical, dyspneic, and otherwise in poor condition patients, it’s usually best to stabilize them prior to pursuing diagnostics.

For patients who are stable, it may make sense to use manual restraint for short studies. Chemical restraint is often favored over manual restraint, though, for reducing patient stress and patient movement. Chemical restraint may include injectable sedative drugs, or inhalant anesthetic delivered via intubation. If intubation isn’t possible, inhalant delivery via mask may also be an option for some patients. Check for appropriate drug doses for each species.

The use of positioning aids and props depends on the size of the patient. Due to their small size, heavy sandbags are not typically used for these patients. Taping a patient’s limbs to the cassette may be a better strategy. And a small trough may be helpful for obtaining a VD view.

Key Radiographic Views

As with any other species, it’s important to obtain a minimum of two orthogonal views (a lateral and VD/DV) with proper patient positioning. Then, additional views such as obliques can be added if relevant. 

Because most of these patients are small in size, whole-body radiographs are common. Then, additional close-up views of areas of interest (like limbs or the skull, for example) can be included, too. For patients who are large enough, it may be ideal to do separate thoracic and abdominal studies.

If needed, standard contrast agents such as barium and iodinated contrasts may be used. Keep in mind that GI transit time is variable depending on the species. In general, carnivores (like ferrets) have the fastest transit times, while hindgut fermenters have the slowest.

Skull radiographs are common in small mammals for evaluating dental issues. A complete set of skull radiographs usually includes DV/VD, lateral, right and left oblique, and “skyline” (rostrocaudal) views.

Conclusion

With the right knowledge, practice, and a few adaptations, radiographs can be used to help diagnose and treat small mammals. Owners of these unique pets often appreciate finding a veterinarian who is able to perform such procedures and deliver a high quality of care to these small patients. 

Written by: Dr. Tammy Powell, DVM

Radiographing Reptiles: Helpful Key Tips and Techniques

If you work with lizards, snakes, tortoises, or other reptiles, x-rays are an important diagnostic tool for these patients.

So, how does the process of radiographing reptiles differ from dogs and cats? Here are some helpful tips for reptile x-rays…

Considerations for Reptile Radiographs

Many reptiles are small in size compared to the average dog or cat. Thus, good quality radiographs with sufficient detail are required for images to be diagnostic. High detail films such as those used for mammography can be beneficial here.

At the same time, many reptiles have highly keratinized scales, or, in the case of chelonians (turtles and tortoises), a shell. These coverings can mean a higher power beam is required, which can also mean loss of detail for internal body structures. Fortunately, motion blur is not a common issue, though.

As with other species of pets, good general rules of radiography apply. This means taking a minimum of two orthogonal views to get a complete picture of the part(s) of the body being radiographed.

Indications for Reptile Radiography 

With reptiles, clinical symptoms are often subtle, and exam findings are often non-specific. So, diagnostic tools such as radiographs are important for figuring out what’s going on and providing the best treatment.

With this in mind, full-body radiographs are beneficial for any reptile who is showing symptoms of illness.

Additional common indications may include evaluating…

• Bone lesions, such as osteomyelitis, traumatic injuries, or metabolic bone disease such as nutritional secondary hyperparathyroidism.

• The digestive tract, including looking for ingested foreign bodies or other digestive ailments.

• Reproductive issues, such as dystocia, egg binding, or yolk coelomitis.

• Abscesses and other soft tissue swellings.

• Lung disease.

• Urinary issues such as bladder stones.

• Problems with other organs such as the heart or liver, although these organs may be difficult to evaluate in detail for many types of reptiles.

• Assessing if intraosseous catheters are placed correctly.

Restraint for Reptile X-Rays

Fortunately, many reptiles hold still without restraint, or with limited restraint, for certain x-ray views. But it’s still important to have a plan in place to ensure quality, diagnostic images are obtained.

A few examples of restraint for different reptile species may include…

• For snakes, allowing them to crawl inside a plastic tube. This also prevents coiling (which may interfere with radiographic interpretation) and ensures the snake is evenly extended for their radiographs.

• Cardboard boxes or other radiolucent containers for smaller species, especially small lizards. Note that this may result in a minor reduction in details/image quality.

• Vagal response in large lizards, which means placing pressure over the eyeballs when the lizard’s eyes are closed. This stimulates the vagus nerve, resulting in a lower heart rate and a calmer lizard. A vagal response could be accomplished with gentle digital pressure, or by placing cotton balls over the eyes and holding them in place with VetWrap wrapped around the head. Dimming the lights and avoiding any noise stimulation will also help.

• Chemical restraint if indicated. This could mean sedation or general anesthesia, depending on how challenging the patient is to work with, what information needs to be obtained from radiographs, and the health status of the patient. Be sure to check the best sedative drugs and doses for the particular reptile species you are working with.

Common Radiographic Views for Reptiles

As mentioned above, it’s important to obtain orthogonal x-ray views. Often, due to the smaller size of many reptiles, this means orthogonal views (a lateral and a DV) of the entire body. 

It’s important to remember that reptiles don’t have a diaphragm. They have a coelomic cavity, rather than separate abdominal and thoracic cavities like mammals have. Because of this difference, placing a reptile (except for snakes) in lateral recumbency may result in coelomic contents shifting, which can confound radiographic interpretation.

To prevent this issue and view organs in their natural position, many veterinarians obtain lateral radiographs of reptiles using a horizontal beam while the animal is standing. 

For chelonians, it helps to place them on some type of stand by balancing the plastron on a block, overturned bucket, etc. This facilitates the horizontal beam view and encourages the patient to hold still and extend their limbs and head from their shell.

Additionally, the horizontal beam can be used to obtain a craniocaudal view in chelonians. This allows comparison of the right and left lung fields.

Contrast agents, such as barium or iodine-based contrast, may be used, especially when evaluating the GI tract. However, it’s important to keep in mind that digestive transit times are highly variable (within a day at the shortest, and weeks at the longest) depending on the species, their nutritional status, and environmental conditions such as temperature and season.

If more detailed radiographs of the skull or extremities must be obtained, it’s important to collimate. For some species, veterinary dental films may provide better detail. Anesthesia may be needed for chelonians to fully view the skull or extremities outside of the shell.

Conclusion

Radiographs are a key tool when assessing reptiles for disease or injuries. But it’s important to understand the wide range of species variations in anatomy and become familiar with what’s normal and what’s not for each type of patient. This could mean having a good reference text, obtaining additional CE, or radiographing a healthy patient of the same species for comparison.

Once the best strategies and techniques are incorporated, diagnostic images can help a practitioner evaluate these unique pets and form an appropriate treatment plan. 

Written by: Dr. Tammy Powell, DVM

Radiographing Exotic Pets: avian patients

When it comes to avian patients, many general principles of radiology still apply, just as they would for a dog or a cat.

For example, proper technique and a systemic method for looking at the entire image are important.

However, birds also present unique challenges. For example, their small size means that fine details must be visible on radiographic images. And a bird’s rapid breathing rate can create motion artifact and blurriness, which can compromise radiographic details.

Here are a few strategies and tips for radiographing an avian patient…

Restraint of Birds for Radiographs

Appropriate positioning and stillness of the patient are both crucial for obtaining x-ray images with enough detail to be diagnostic. Because of this, sedation or anesthesia are usually necessary, with appropriate patient monitoring.

Of course, the decision to administer anesthesia depends on the stability of the patient and whether they can handle anesthesia. But even with ill birds, light sedation may still be beneficial to reduce stress, discomfort, or injuries that could be caused by physical restraint. 

When administering sedation or anesthesia, be sure to check the best medications and doses for birds, as these may vary from those used for dogs and cats.

Radiographic Technique for Avian Patients

It’s ideal to use the shortest possible exposure time. This helps minimize motion blur due to a bird’s fast respiration rate.

For small patients, tabletop technique is used. A grid is not needed, thanks to a bird’s air sacs which don’t cause significant x-ray beam attenuation or scatter radiation. However, a grid may be considered when radiographing an area wider than 10 cm.

Also, appropriate collimation should be used.

Positioning Avian Patients for Radiographs

Whether a patient is canine, feline, or avian, orthogonal x-ray images are more useful and accurate than single-view x-ray studies. So, whenever possible, try to obtain both a lateral and VD view.

A common view for studies is a “whole bird” radiograph for small or medium-sized birds, which means a head-to-tail view including the coelom, pectoral limbs, and pelvic limbs. However, it’s beneficial to focus on areas of interest, too—whether that’s examining organs in the coelom, evaluating a fractured limb, etc.

To visualize the coelom, it’s best to pull the wings and legs away from the body. That way, there’s nothing overlying the coelomic cavity that could complicate interpretation or cover up important details.

When positioning, it’s best to be gentle, especially with small birds that can be fragile. Pulling the wings too much can cause pain or injury, or lead to over-rotation and improper patient alignment. Tape may be used, but it should have minimal adhesive in order to avoid pulling feathers. Other positioning aids made from clear plastic can also be very useful.

For patients in poor condition, it may make sense to first do a “screening” x-ray via a horizontal beam. For this shot, the bird could be standing on a perch on the x-ray table. Sometimes, this gives enough information to rule out certain conditions (such as egg binding or heavy metal ingestion) and develop a preliminary treatment plan. Then, if needed, more detailed imaging could be pursued once the patient is more stable.

A Few Tips for Bird X-Rays

Here are a few more things to keep in mind when it comes to bird radiographs…

• If possible, it’s helpful to fast a patient prior to radiographs of the GI tract. This allows better visualization, and it reduces the risk of regurgitation and aspiration pneumonia. However, keep in mind a bird’s fast metabolism. For very small patients, fasting beyond two hours may be detrimental.

• Have a good reference guide available to use as a point of comparison for your patient’s images. This will help not only with distinguishing what’s normal and what’s not for an individual bird, but also for anatomic variations between species.

• Consider a referral or consult as needed. There’s nothing wrong with referring a patient to an avian and exotics specialist. Or, if you take the radiographs yourself, consider sending the images for a teleradiology consult.

X-rays can be a very important part of the diagnostic plan for birds. With knowledge and some practice, bird radiographs may become faster and easier for the team, leading to prompt diagnosis and treatment of ailments and excellent avian care. 

Written by: Dr. Tammy Powell, DVM

Dental Disease and Heart Disease: What’s the Correlation?

Dental disease is one of the most common health conditions affecting dogs and cats, even though much of it is preventable.

Estimates of dental disease prevalence vary, but many experts say that most (more than half of) dogs and cats over three years of age have some form of periodontal disease.

How Dental Disease Progresses to Periodontal Disease

The process begins with plaque, a thin, bacteria-containing film that forms on the teeth. Plaque can be removed by brushing. But if plaque is not removed, minerals in the saliva harden the plaque, which creates tartar (calculus). Tartar is much more difficult to remove, and it can build up to look like “concrete” deposits on the side of a dog or cat’s tooth.

Pet owners may or may not notice tartar on the crown of their pet’s teeth. But the biggest problem comes from the part they can’t see—the tartar that grows below the gumline.

This leads to periodontal disease, a condition that affects the structures that hold teeth in place. 

Consequences of Periodontal Disease

The early stage of periodontal disease is gingivitis, inflammation or infection of the gums that is often noticeable as red, swollen, or bleeding gingiva. Gingivitis is reversible if treated in a timely fashion. 

After that, further damages from periodontal disease are NOT reversible. This may include damage to the periodontal ligament, cementum, and alveolar bone. These three structures, together with the gingiva, are collectively called the ‘periodontium’.

As periodontal disease progresses, a pet may suffer from gingival recession, tooth loss, alveolar bone loss, and even jaw fractures in severe cases. And one ‘bad’ tooth may affect neighboring teeth, thanks to infection and damage to bone and other surrounding structures.

Bacteremia From Periodontal Disease

Tartar harbors a lot of bacteria, and a mouth affected by periodontal disease carries infections.

These bacteria may enter the bloodstream via areas of the mouth affected by periodontal disease, which may lead to negative health consequences for an affected pet. 

Studies demonstrate conflicting conclusions, so the association between bacteremia from periodontal disease and pathology of certain organs (especially the heart, liver, and kidneys) is not as clear-cut as it was once thought to be. 

For example, the common condition of MMVD (myxomatous mitral valve degeneration) in small dogs is no longer thought to be caused by periodontal disease. Instead, both are conditions that occur commonly in older, small breed dogs. 

The link between periodontal disease and heart disease is more firmly established in human beings. And in pets, there have been associations noted between periodontal disease and pathologic changes to the heart, liver, and kidneys on necropsy. 

Because of these associations with organ disease in other parts of the body, and since bacteremia can and does happen in dogs with periodontal disease, it makes sense to take extra precautions for pets with a condition that would make them more at risk from bacteremia. 

For example, immunocompromised patients, or patients with certain types of heart conditions may benefit from an injectable dose of prophylactic antibiotics during a dental procedure, whereas it might not be necessary for an otherwise healthy pet.

There’s some speculation that chronic inflammation is responsible for pathology to other organs just as much as (or more than) bacteremia. Maintaining good oral health is the best way to decrease the risks of both infections and inflammation from periodontal disease.

Preventing Dental Issues Is Good for a Pet’s Overall Health

So, what’s the conclusion to draw from all of this information, some of which is conflicting?

Of course, that’s up to each practitioner. But in general, maintaining a healthy mouth will always be a good thing. 

Having a chronic disease (such as periodontal disease) anywhere in the body can be a strain on a pet’s health. So appropriate dental care can only serve to improve the overall health of the pet and reduce any risks associated with bacteremia and chronic inflammation.

Additionally, good dental care can also improve quality of life by decreasing oral pain, preventing tooth loss, and decreasing halitosis that could interfere with the human-animal bond. So, preventive dental care is an important part of any pet’s health plan.

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

How Much Is a DR Digital X-Ray System for a Veterinary Hospital?

When choosing equipment such as an X-ray system for your veterinary practice, how do you know how much to spend?

Radiographs are used often—even daily—in many veterinary practices. Also, equipment is one of the largest investments a veterinary practice owner will make.

So, maybe a practice owner feels some pressure when trying to select the best equipment for their hospital but also stay within their budget.

Whether you’re opening a new practice or looking to update your current X-ray system, here are some things that may help with the decisions of what to purchase and how much to spend…

How Much Does a Veterinary X-Ray Machine Cost?

See our price here

The equipment itself can be a big investment, but it doesn’t paint the whole picture. When calculating the total investment, here are some things to consider…

• Which equipment do you actually need? For x-rays, do you require an entirely new system, or do you already have a table and generator that could be retrofitted for DR technology?

• How will images be acquired? While physical film is used less commonly in recent years if you do use film be sure to calculate the costs of purchasing and disposing of films and supplies for the processor. On the other hand, when calculating how much a digital X-ray machine costs, you’ll need to factor in the software and acquisition computer for viewing and storing images. 

• Are there shipping and installation costs?

• Is a warranty included, and for how long? If it’s possible to renew a warranty, how much does that cost? Or, is there a maintenance plan available after the warranty expires? What is and isn’t covered under these plans (i.e. drops and accidents, loaner equipment if repairs are needed, etc.)?

• What’s the expected lifespan of the equipment? Get input from colleagues if you can. Decide if it’s worth paying more upfront for something that will last longer, and which has an affordable warranty or maintenance plan.

How Much Can a Practice Afford to Spend?

Even experienced, savvy business owners can benefit from consulting a CPA or other financial professional when it comes to working out the budget and figuring out the best way to invest in a large equipment purchase.

When deciding how much your practice can spend on new equipment, it’s important to think about the return on investment, or ROI. Basically, this means using the equipment often enough (and charging enough for these services) to pay off the equipment AND earn a profit.

Calculations and questions to ask may include…

• Should you rent or buy the equipment? Many experts recommend buying if at all possible, although the recommendation may vary from practice to practice.

• If buying the equipment, will you pay everything up front, or use monthly payments over time? Monthly payments may be offered directly from the seller, or via bank financing. If using monthly payments, what is the interest rate?

• How often do you expect to use the equipment? Speak to your veterinarians, vet techs, and other team members to get input on the expected demand for the service—as well as what’s involved with communicating the value of this new service to pet owners.

• How much will you charge? Multiply your profit on each procedure (i.e. each x-ray study) by how often you expect to use your new equipment, to see if this fee covers the equipment cost and provides you with additional income.

• What sort of staff training is involved, to get everyone up to speed on how to use the new equipment? And is the software, equipment, etc. user friendly? This is important, because these factors may impact how easy it is to integrate the new equipment into your daily practice flow, and whether or not the equipment will actually be used the way you planned.

• Are there any tax benefits, such as a Section 179 deduction? These tax savings may help to offset some of your equipment costs.

All in all, a large equipment purchase is a big decision for any practice owner. But by analyzing each factor in the decision process one at a time, knowing your practice style and budget, and consulting with a financial professional, you can make the best decision for your hospital—and hopefully see a great return on investment, all while improving patient care!

Written by: Dr. Tammy Powell, DVM

Choosing an X-Ray System for Shelters and Non-Profits

X-ray equipment is an important purchasing decision for animal rescues, state and county-run shelters, and 501(c)(3) organizations. 

Animal shelters and non-profits have a mission to help as many pets as possible, including those pets who have nowhere else to turn.

As a veterinarian working for a non-profit or rescue organization, you know that every dollar counts. The more you can save on expenses, the more money can be used to care for pets. 

With that in mind, here are some considerations for purchasing x-ray equipment…

What Radiographic Equipment Does Your Shelter or Non-Profit Need?

Here are some questions to ask to help evaluate your organization’s radiographic needs…

• Which services will you offer that require radiographs? For example, limited-service operations like vaccine or spay/neuter clinics may not have a strong need for radiography. Some rescue organizations will use x-ray equipment moderately—say, for diagnosing bone fractures and creating a plan for stabilization, or for counting the number of puppies in a pregnant dog. And some well-funded non-profits may offer full-service diagnostics and treatment, including dental imaging. Your clinic’s needs will determine which type of equipment is a practical investment.

• Do you need an entirely new system—or do you already own some components such as a table, generator, software, etc. that are still in working order?

• Are you looking for film or digital x-rays—and if digital, CR, or DR technology? Digital offers many advantages such as the speed of obtaining images, while film may be more affordable. Although, by the time the cost of a processor (and maintenance), as well as physical film purchases and disposal, are taken into consideration, the savings might not be as much as expected. So it’s important to factor in all associated costs over the expected lifespan of your equipment.

Where to Obtain X-Ray Equipment for Shelters or Non-Profits

Here are a few options…

• Purchase new equipment. This may be the most expensive option upfront. Although if a warranty for service is offered, it’s possible this may be a cost-effective option for some organizations.

• Purchase used equipment. This option may provide a lower upfront investment for equipment that’s still in pretty good shape. Of course, it’s important to do your research. Ask the seller about the condition of the equipment and whether there is still a warranty in place (and if that warranty can be transferred to a new owner). Figure out what legal rights you have to recoup your money if the equipment doesn’t work as advertised. If it’s from a nearby practice, ask about coming to try out the equipment in person.

• Ask for donations. Sometimes, veterinary practices may be willing to donate their used equipment to a good cause when they want to upgrade. This can be an exciting opportunity that’s difficult to pass up, especially for new rescue and non-profit organizations that don’t have a lot of cash flow yet. Just check the condition of the equipment, and see if excessive maintenance and repairs are expected.

Conclusion

Shelters, rescues, and non-profit organizations can benefit from minimizing expenses whenever possible.

The x-ray equipment needs of each operation are unique.

Factoring in your organization’s services, budget, and available supplies will help with the decision of which equipment is the best fit for your clinic.

Written by: Dr. Tammy Powell, DVM

Editor’s Note:

Our Complete DirectVet X-Ray System is available for $29,995, which includes the table, generator, DR plate, software, and acquisition computer, as well as a 5-year warranty.

Convenient, affordable monthly payments are also available. Learn more and contact us with any questions, Click Here

Looking for used equipment? Be sure to also check out usedvetequipment.com.

Naomi CCD Versus CareRay Cesium Panels: When Is an Upgrade Needed?

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

The EZ Dent Dental X-Ray System by MyVet USA

Dental radiographs are an integral part of dental procedures in small animal medicine

Without x-rays, it’s not possible to see the full extent of periodontal disease or other problems (FORLs, dentigerous cysts, tooth root abscesses, etc.) that happen below the gumline.

As dental radiography has become prevalent in modern veterinary medicine, there are many companies and manufacturers that offer dental x-ray equipment and software for veterinarians. Today, we’ll be examining some of the features and considerations of the EZ Dent dental x-ray system by MyVet USA—including the x-ray generator, intraoral sensor, and software.

MyVet Imaging

In 2018, the US-based MyVet Imaging became a subsidiary of South Korea-based Rayence, a provider of digital x-ray equipment for human medicine. 

Rayence and MyVet Inc. are headquartered in New Jersey for US operations, with veterinary offerings for small and large animal radiography, including digital dental radiography for small animal and equine patients. They advertise innovative dental imaging solutions, including the world’s first veterinary panoramic dental x-ray system and Carbon Nanotube (CNT) technology.

The EzRay VetTM Cart

Despite the intrigue of a panoramic system, many veterinarians prefer the details and consistency of traditional style DR or CR radiographs for small animal dental rads. The EzRay Vet Cart, a mobile intraoral x-ray cart system, is offered by MyVet for this purpose.

Some of the benefits of the EzRay Vet Cart advertised by MyVet include…

• Carbon nanotube (CNT) technology, which they claim reduces maximum exposure time by 75% while still maintaining image quality. The beam has a 0.4mm focal spot, and exposure setting controls are said to automatically adjust the exposure setting to maintain image density.

• Ergonomic design, featuring a non-drift arm and head that is compact, lightweight, and easy to position with one hand.

• Preset technique options.

• No warm-up time or waiting time between shots.

A wall-mounted unit is also available.

The EzRay Air VetTM

The EzRay Air Vet is a handheld generator option. This may suit the needs of veterinarians who require the unit to have ultimate mobility, or who have tight spaces in their clinic. MyVet advertises that the portable generator also features CNT technology, is up to 30% lighter than other handheld units, has no warm-up time (for faster workflow), and features a double scatter shield (with internal and external shielding) to protect from scatter radiation.

EzSensor Vet

The EzSensor Vet is an intraoral sensor for veterinary digital radiography, featuring CMOS technology. Available in sizes 1.0, 1.5, and 2.0, the sensor features rounded corners and a slim design to help with positioning. MyVet advertises superior image quality with low noise, as well as water and dust protection and a reinforced fiber optic cable, which helps with durability.

MyVet DentTM Acquisition Software

The DICOM-compliant MyVet Dent acquisition software is designed to be intuitive and work seamlessly with the EzSensor to quickly acquire, process, and manage images. Since it’s a digital system, there’s no need to process films or plates, so the results are fast. MyVet also advertises that the software features customizable options and tools, and easy integration into an existing clinical network.

Additional Considerations

The EzDent dental x-ray system from MyVet may be an affordable option for small animal veterinarians who perform dental procedures. As with any dental x-ray or other equipment purchase, it’s important to ensure you’re obtaining the best equipment for your needs and to calculate to see if the total costs are as expected and within a budget that makes sense for your practice.

To evaluate the equipment quality and user-friendliness, ask for a demonstration or for referrals to other veterinarians who are using the equipment and can give you honest feedback. 

To calculate total costs, ask about any additional upfront fees (shipping and installation, for example) and ongoing costs (service and maintenance, warranty renewal, software upgrades, etc.). 

By considering all these factors, you’ll know you’re receiving a good value, and you can confidently choose the best option for your dental needs. 

Written by: Dr. Tammy Powell, DVM

Portable Equine X-Ray Generators: What’s Better, Plug In Or Battery Powered?

Plug-In Or Battery Powered?

As an equine practitioner, many of your daily practice needs are different from those of your small animal colleagues. 

Maybe you meet your patients where they are, in a barn or on a farm call. Or, even if you have a facility that allows for equine visits and hospitalization, you may still need portable equipment to bring with you into a stall.

So, which type of portable generator is best for you: plug-in or battery-powered? Here are some things to consider…

Benefits of Battery Powered Portable Equine Generators

One obvious advantage is that a battery-powered generator may be easier to use out in the field, for the simple fact that you’re “wireless” and thus not dependent on a power outlet. This may be especially helpful in situations where power outlets are not immediately accessible, during power outages in inclement weather, or in some barns or other locations where the power supply may be less consistent.

The lack of a cord also allows for simpler mobility during use. There’s no need to untangle a cord and no possibility of tripping over the wire at any point during the procedure.

Benefits of Plug-In Portable Equine Generators

The most common reason for equine practitioners to choose a plug-in generator is probably this: They don’t want the battery to run out!

Nowadays, there are battery-powered generators available that have long battery life. However, depending on how many hours you’re out, a battery may or may not meet your needs. Or, a team member may forget to charge it between shifts. Also, some practitioners note that battery life may decrease over time—and that the batteries of an x-ray generator can be very expensive to replace.

Additional considerations mentioned by some veterinarians are that plug-in generators may weigh less than battery-powered units. Also, plug-in units may cost less on average. There are variations in weight and equipment cost from model to model, though.

Other Considerations

Different brands and models may offer different price points, battery/equipment expected lifespan and other important differences. Doing research before a purchase is crucial.

This includes talking to the company, as well as speaking to colleagues for recommendations (ask companies for referrals to other practitioners in your area who use the equipment or ask around in online forums or in-person events).

In addition to the equipment itself, you’ll also want to consider things like warranty, ongoing costs (repair and service costs, and image storage costs for digital), integration with any of your current equipment (for example, if you already have a plate), ease of use, durability in rugged conditions or temperature extremes, and whether 24/7 live technical support is available.

With all this in mind, different veterinarians may have different preferences—there’s no one size fits all in terms of plug-in versus battery-powered portable equine generators, or in terms of a particular brand and model that are best for everyone.

So be sure to do your research and gather feedback from colleagues, but also think about what will work best for your own preferences and individual practice needs.

Written by: Dr. Tammy Powell, DVM

Midmark Dental X-Ray and Dentalaire Dental X-Ray for Veterinarians

Midmark Dental X-Ray and Dentalaire Dental X-Ray for Veterinarians

Dental radiography is generally considered part of the standard of care for veterinarians who perform dental cleanings, extractions, and other procedures in their practice.

There are many reasons why dental x-rays are important. Just a few examples include: identifying different types of FORLs to determine the best course of treatment, confirming full removal of all root tips during a difficult extraction, discovering and documenting pathology such as the full extent of damage from periodontal disease and whether the location of a missing tooth is hiding a dentigerous cyst under the gumline.

If you’re new to dental x-rays or looking to replace or upgrade your equipment, here are some important considerations, as well as information on two major equipment providers: Midmark dental x-rays and Dentalaire dental x-rays.

Considerations for Purchasing a Dental X-Ray Unit

Here are a few questions to ask yourself (and discuss with sales reps and colleagues) prior to your purchase…

• What equipment do you need? Do you need to purchase EVERYTHING? Or, do you just need a new sensor… a new generator or processer… or new software? If you don’t need an entirely new unit as a whole, purchasing just the pieces you need can save significant money. Just check for compatibility issues if you are purchasing components from a different manufacturer or newer components to pair with older models.

• What’s your dental x-ray space like? Do you need a wall-mounted unit or something on a stand? Or even something handheld?

• What type of service contract or warranty is provided? What are the ongoing and renewal costs? Is bite damage for sensors covered? And is loaner equipment provided while your equipment is being repaired?

• How is the software? Is it user-friendly? Does it provide all the functions you need?

• What type of sensor(s) do you need? Are you interested in film, CR (phosphor plates), or DR? 

Some practitioners like DR for its speed, but dislike the limited size options and rigidity of the sensors. DR is also more expensive to replace. Film and CR, on the other hand, are generally available in sizes ranging from 0-4, to cover small, medium, and large patients. And CR can still be pretty fast. Opinions and preferences vary, so you’ll need to see what works best for you.

• Does your staff know how to take dental x-rays? There’s a learning curve, so ask about training provided by the seller, if available.

Comparing Midmark Dental X-Ray and Dentalaire Dental X-Ray

Midmark and Dentalaire and both excellent providers that offer a wide array of dentistry equipment, including anything you’d need to start doing dental x-rays or update/replace your current equipment.

Here are some of the main selling points advertised by each company:

• Generator settings and usability: Both Midmark and Dentalaire note their dental x-ray generators are user-friendly and simple to operate, with intuitive, easy-to-read displays and veterinary-specific options. Both have options to input your own settings or to use pre-programmed techniques. Additionally, Dentalaire notes that exotics and extremity settings are included. 

• Positioning arm: Both providers claim a well-constructed positioning arm that’s easy to move, with precision braking for preventing drift.

• Image quality: Both Midmark and Dentalaire dental x-ray systems are generally well regarded by veterinarians for image quality. Additionally, they each advertise a focal point of 0.4mm for high-resolution images with sharp, clear details.

• CR equipment: Midmark and Dentalaire both offer CR sensor plates in all sizes, as well as readers.

• DR equipment: DR technology is continuing to evolve! 

In fact, Midmark notes that they have the world’s first bite-resistant sensor, and they stand behind it with a 5-year warranty (including one free sensor replacement in case of catastrophic damage). 

Dentalaire advertises a sensor that is also resistant to bite damage, especially when paired with their protective boot covering, and they offer a 3-year warranty for upgrades. 

For both companies, DR sensors come in both size 1 and size 2.

• Software: Both Dentalaire and Midmark have comprehensive and user-friendly software with DICOM capabilities and compatibility with PACS. Midmark advertises that their software integrates with leading practice management systems and offers the ability to enhance images. Dentalaire notes they have customizable patient reports and advanced image comparison available on-screen.

• Training: Dentalaire offers four hours of on-site training in dental x-ray positioning. Midmark also offers in-clinic training, and their training is RACE approved for CE credits for both veterinarians and technicians.

• Support: Each company offers technical support.

Conclusion

There are several excellent providers of veterinary dental x-ray equipment. Midmark and Dentalaire and two major contenders, and both have great offerings. The one you choose may come down to personal preference. 

Consider asking your sales reps or providers for demos, and for references of other veterinarians who have the equipment and can give you the pros and cons they’ve experienced.

Also, ask about any ongoing or additional costs. By having as much information as possible, you can find the equipment that’s the best fit for your individual practice.

Written by: Dr. Tammy Powell, DVM

Decoding Your Digital Radiography Purchase: Considerations for Sound and Idexx, and Gadox versus Cesium Panels

Comparing Sound and Idexx digital x-ray.

Equipment purchases are a large but important investment for patient care and for the financial success of a veterinary practice.

While diagnostic imaging purchases may seem daunting, it helps to take the process step by step to figure out what’s best for your clinical needs and budget.

As a starting point, here are a few things to consider…

Sound and Idexx Veterinary Equipment Companies

Sound and Idexx are two widely used sources of digital radiography systems in veterinary medicine.

This includes options such as an entire x-ray system (equipment, software, and support), or having flat panel detectors retrofitted into your current equipment.

Sound claims their advantages are:

• Being the #1 provider of veterinary digital radiography, and supporting vets since 1996.

• Their software, MUSICA, which is highly regarded for excellent quality image processing, optimization, and consistency (across different species, users, and techniques), and includes features such as a 3D position assistant for readily available positioning guides for less common views.

• Excellent quality images and equipment.

• A strong focus on education and training so you can easily use your equipment and get the most out of it. Courses are available through the Sound Academy of Veterinary Imaging via board-certified instructors.

• Long-term relationships with panel manufacturers—which is a good thing when it comes to long-term product support.

• 24/7 live phone support.

• Headquartered in the US (Carlsbad, CA) with in-house production and repairs.

According to Idexx, their advantages include…

• Sharp, high-resolution images obtained in less than 5 seconds.

• Availability of their patented Irradiated Side Sampling on Cesium panels, which raises the detection layer near the top of the scintillator crystals. This means the x-rays have less distance to travel, creating a sharp image at the lowest radiation dose on the market (see below for more information on scintillator layers).

• Idexx Web PACS advanced viewer, powered by AI for faster viewing and easy sharing, and with a reference image library to help clients see abnormal findings compared to a normal image.

• Integration with practice management software.

• 24/7 support.

• Idexx telemedicine consultants.

• An online learning center.

While Idexx and Sound and two major players, there are other companies out there, too.

And of course, each company offers a variety of products, so you can find the technology and a price point that’s a good fit for your needs.

When making a purchase decision, do your research and ask plenty of questions to figure out what’s best for your practice.

The technology and terminology can be a little confusing for new and experienced practitioners alike, especially if this is your first big radiology purchase.

We can’t cover everything in the scope of one article, but here’s some information about common types of DR flat panel detectors…

Cesium, Gadox—What Does It All Mean?

Cesium and Gadox refer to two possible substances that could be used in the scintillator layer of an indirect flat-panel detector.

Now, that’s a mouthful, so here’s what it all means…

A flat panel detector is a panel or plate you use to capture digital images with your x-ray machine.

There are two types of flat-panel detectors: direct and indirect. In a nutshell, direct panels convert x-ray photons into an electric charge, while indirect panels first convert x-rays into light and then into an electric charge. Either way, the final image is read out by a detector layer that contains millions of pixels.

Within an indirect flat panel detector, the scintillator layer is the one that absorbs x-rays and converts them into visible light.

This scintillator layer is most commonly made of either cesium iodide (Cesium) or gadolinium oxysulfide (Gadox).

Gadox is produced by formulating a liquid that hardens into thin sheets.

Cesium, on the other hand, is a bit more complicated to produce in a uniform way because it is “grown.” Cesium is composed of crystals that grow upward (acting as “tubes” for light to pass through) after being formulated and heated.

That means sometimes the composition and quality of Cesium can vary, although reliable manufacturers generally have good quality flat panels whether they use Cesium or Gadox.

What’s Better—Cesium or Gadox?

Each substance is useful and can produce good quality x-ray images.

A major advantage of Cesium is its high sensitivity to the x-ray signal. In addition to producing a clear, detailed image, this also means that images can be produced at a lower x-ray exposure.

Gadox can also produce clear, detailed images—but it requires a slightly higher exposure (within 10% difference) dose.

It’s worth noting that the higher sensitivity of Cesium can also lead to higher noise in the image, but Cesium is generally considered to deliver excellent quality images.

Also important is the fact that the price varies between Cesium and Gadox. Because the process of producing Cesium is more complicated and less consistent than with Gadox (as described above), good quality Cesium flat panels cost more than standard Gadox.

Finally, there is a consideration of how and where the panel will be used. Some veterinarians state that Cesium is less reliable in temperature extremes, and thus they prefer Gadox for their large/equine practices and other mobile practice needs. But this preference may vary between individual veterinarians.

Additional Questions to Ask

As many veterinarians will tell you, your equipment and the initial investment is only part of the story. 

It’s also important to calculate ongoing costs, such as renewing warranties, service costs, software updates, and support, and storage fees for digital images. And, is loaner equipment available if a repair is needed?

Another consideration is the expected lifespan of the equipment, and whether support may eventually be discontinued on older models or parts (asking about where the company obtains their equipment is one way to learn more, so you can research the manufacturer).

Before you buy, it’s also a good idea to look at a variety of images from the equipment you’d like to purchase—at the very least, compare a large dog abdomen and a small cat paw, to view details over a range of sizes.

You can ask for a demo from the equipment company or distributor, or ask for the names of colleagues in your area who have purchased the same equipment who could tell you about their experience.

Keeping all these things in mind will help you choose the best option for your veterinary practice, whether you’re considering Idexx or Sound, Gadox or Cesium panels, or even CR or anything in between. 

Written by: Dr. Tammy Powell, DVM

The Canon Cesium Flat Panel Detector and the Cuattro Flat Panel Detector by Heska: Choosing the Best Option for Your Veterinary Practice

Compare before you buy

If you’re thinking of upgrading your x-ray equipment from films or CR, a DR flat panel detector is a great option.

There are several manufacturers that make these products, with Canon Cesium and Cuattro by Heska being top contenders.

Read on for more information that may help you decide which system is best for you.

What Is a Flat Panel Detector?

A flat panel detector is used for capturing images with digital radiography. There are two types: direct and indirect.

Direct FPDs involve converting x-ray photons into an electric charge, while an indirect FPD converts electrons to light and then to an electric charge. In both systems, a thin film transistor (TFT—a reader that contains millions of pixels, similar to the sensor inside a digital camera) reads out the image.

For indirect FDPs, the scintillator layer (the one that converts x-rays into light) may be made of cesium iodide or gadolinium oxysulfide, with cesium generally considered the superior of the two options.

Why Use a Flat Panel Detector?

One of the primary advantages is the speed of DR systems, which allows you to take radiographs more quickly and efficiently. 

This means greater profits (many clinics report taking MORE radiographs after upgrading to digital) and improved patient comfort/safety.

DR also provides excellent image quality with less retakes and lower radiation doses.

Canon Cesium Flat Panel Detector

Canon is generally regarded by the veterinary community as a manufacturer that makes good quality products for diagnostic imaging.

The Canon CXDI flat panel detector features…

• A cesium iodide scintillator, along with an amorphous silicon detector.

• 6.1 million pixels for a 14”x11” plate, 9.5 million pixels for a 14”x17” plate, and 11.3 million pixels for a 17”x17” plate.

• A/D 16 Bit.

• Carbon fiber design with ergonomic handgrips.

Cuattro Flat Panel Detector by Heska

Heska is also widely regarded as a reliable system that produces high-quality images.

The Heska Cuattro flat panel detector features…

• A cesium iodide scintillator, along with an amorphous silicon detector.

• 15 million pixels for a 14”x17” plate, and 18 million pixels for a 17”x17” plate.

• A/D 16 Bit.

• Automatic exposure detection.

• Carbon fiber housing front and back.

Which Is Better: The Canon Cesium Flat Panel Detector, or the Cuattro Flat Panel Detector By Heska?

You really can’t go wrong with either system. Both have received overall positive reviews from veterinarians, and the final decision may come down to personal preference, along with complementary factors and services.

Here are a few things to consider when purchasing…

• Warranty. Ask about warranty type (what it covers, and what it does not cover) and length, as well as cost to renew a warranty once it expires.

• Loaner equipment availability. If you need to use your warranty or have equipment repaired, ask if loaner equipment is available and how quickly it can get to you. After all, you don’t want to be without radiographs for longer than necessary!

• Ongoing expected costs, such as service/maintenance, software upgrades, and cloud-based storage costs.

• Durability/expected lifespan of the equipment. Ask your sales rep and your veterinary colleagues for their experiences.

• Software. You will use the software with each image you take, so be sure you like the accompanying software’s quality and ease of use. Also, check for image formats (jpeg or DICOM, for example) that you may need.

• Compatibility. Will you use your current generator/table, and if so, does the DR system need to be fitted to your current equipment? Does the software integrate with your current practice management system?

• Support availability. 24/7 support is best.

Upgrading to DR is an important decision that may take some research to choose the best system for your needs. 

We recommend choosing a high quality, reputable brand (like Canon or Heska) and evaluating the software, deals, warranty/service, storage, and other factors that will impact your overall investment and satisfaction with your purchase.

Written by: Dr. Tammy Powell, DVM

The MinXray Portable Plug-in Equine Generator: A Perfect Match for Equine Veterinarians

Mobile Generator for Equine Veterinarians

As an equine or large animal veterinarian, you don’t always have the option of practicing under ideal conditions.

Instead, you’re often out in the field—in a variety of weather conditions, and while transporting your equipment with you over long distances.

To make your life easier, and to get the maximum usage out of your equipment investment, it’s important to have equipment that’s lightweight and durable, that delivers high quality while being easy to transport.

That’s why a MinXray portable, plug-in equine x-ray generator is an excellent option for your equine radiology needs.

Why choose a MinXray?

MinXray is considered a “go-to” brand by many equine practitioners. 

The US-based company has been around for more than 50 years (since 1967) and has become a trusted source for quality x-ray equipment that’s easy to carry and use in rugged conditions. In addition to generators for veterinarians and MDs, MinXray also produces x-ray equipment for military use.

That’s why a MinXray generator is great for equine and large animal vets—because of the tried-and-true durability and portability combined with high quality images.

Advantages of the MinXray Portable, Plug-in Equine Generator

• Lightweight and easy to carry and transport. The lightest models weigh less than 15 pounds, for simple transport and positioning. A hard-sided carrying case, tripod, and tripod bag are also provided.

• Durable, for use in rugged conditions. The machine is built for use in a variety of environmental conditions. It’s designed to last and to perform well, even after bumpy rides through pastures, dirt roads, and more, and while working out in the field.

• Excellent image quality. The MinXray generator is high frequency, meaning it can produce a powerful x-ray beam despite the machine’s small size and compact design, and that the beam is consistent for high quality, diagnostic images with fewer retakes and less motion artifact.

• Easy to use. Pre-program up to five exposure techniques, to save time. And use the large, touch-pad control for easy setting adjustments when needed. You also have the option of displaying mAs or exposure time.

• Simple to set up your shots. An adjustable light beam collimator with adjustable dual integrated laser pointers (bright lasers to indicate central x-ray position are easy to see even in sunny conditions) makes the process of focusing and setting up shots simple.

What Else Should I Know About the MinXray Portable Equine Generator?

The DR compatible MinXray generator comes with an 8-foot exposure cord and exposure switch, as well as a 20-foot power cord. A plug-in unit means you’ll never have to worry about batteries running low.

Also, a 5-year, limited warranty is available to protect your investment.

Conclusion

For an equine or large animal veterinary practice, you need durable equipment that can move with you and stand up to a variety of rugged conditions or travel to remote locations.

A high-quality, high-frequency generator like the MinXray is a great option, because it produces consistently superior quality images, while also being lightweight, tough, and easy to transport.

Compare other options

Other options for generators include the Cubex and the Poskum.

Written by: Dr. Tammy Powell, DVM

Perfect for Mobile Veterinarians: Poskom Battery Powered Portable X-ray Generator

Call: 877-545-1202

$135 per month* or $7,995.00

If you want to be able to take an x-ray anywhere, a battery-powered generator is a great option for you.

A Poskom battery-powered portable x-ray generator offers the ultimate portability, making it a popular choice among mobile practitioners.

Capture X-ray Images Anywhere

Since the Poskom VET-20BT is cordless with long battery life, you’re not limited to an external power source during the course of your daily practice or on-call shifts.

That means that as an equine practitioner, you can conveniently use the machine in a barn or out in the field, without a power outlet nearby.

And as a small animal veterinarian, you can easily port your x-ray equipment with you—which is perfect for mobile practitioners.

No Cord, No Fuss

The Poskom battery-powered portable x-ray generator is cordless, which means it takes less time for you to set up for a procedure and then pack everything up again.

No cord also means no chance of anyone tripping over the cord or of patients becoming entangled.

Wireless Technology

In addition to no cord for the power supply, the Poskom VET-20BT also incorporates wireless technology for communication between the generator and the plate.

Radio-frequency (RF) communication means images can be captured without the need for a wire between the generator and the DR interface.

Lightweight and Compact

The generator is only 36 x 20 x 17 cm (approximately 14 x 8 x 7 inches), and weighs merely 6.8 kg (15 pounds). This makes it the lightest, most compact battery-powered generator on the market.

If you’re short on storage space or have to plan for carrying your equipment all day, having a compact, lightweight unit can really make your life easier.

Long Battery Life

With one full charge of the high-capacity lithium-ion battery, you get up to 300 exposures—which means you shouldn’t have to deal with a battery running low right when you need it!

For easy battery monitoring, the Poskom x-ray generator also features an energy balance indicator (so you know the time for battery charging) and an LED indicator for when the battery is fully charged (which usually takes just 2-3 hours).

And should you need to replace the battery (its lifecycle is over 5 years, with no battery maintenance required), you’ll find the process to be simple and easy. 

High-Frequency Technology Means Good Quality

The compact Poskom VET-20BT features advanced, high-frequency technology, with 20mA and 90kV capabilities.

High frequency means a strong power output, with stable/repeatable settings for consistent, high-quality images.

So you receive excellent images, with less need for retakes.

Easy to Use

In addition to being lightweight, compact, and cordless, the Poskom battery-powered portable x-ray generator is simple to use, with the option of programming your favorite settings so you don’t have to adjust the settings every time.

Introducing The Veterinary Saddle Stool

The collimator features a dual laser alignment system and a push-button light with a 30-second timer.

If taking an x-ray anywhere, without the need for electricity or an external power source sounds good to you, click here to learn more.

The Poskom VET-20BT is available for affordable monthly payments (so it can pay for itself and earn a profit right away with use each month), as well as a 3-year warranty.

Written by: Dr. Tammy Powell, DVM