Taking, Measuring, & Interpreting Rads of the Equine Foot

Subtle changes within a horse’s foot can be indicative of pathology that affects the horse’s performance and quality of life, so it’s important to know how to take and interpret radiographs of the equine foot.

While extensive study and experience are needed to accurately evaluate foot radiographs, this article will cover some of the main principles behind taking and interpreting x-rays of the equine foot.

When Are Radiographs of a Horse’s Foot Indicated?

Common indications include lameness localized to the foot, suspected laminitis, navicular disease, trauma, infection, conformation or balance problems, or any other issues of the foot.

Additionally, radiographs can serve a preventive and management function, to help prevent some issues before they arise. This can be done during a pre-purchase examination, as part of a consultation with a farrier, etc.

Setting Up for and Obtaining Diagnostic Quality Radiographs

Since some of the abnormalities that indicate/lead to pathology can be subtle, it’s important to set up an x-ray study very precisely. Otherwise, interpretation can be inaccurate.

For example, a horse that is not distributing its weight equally between its right and left sides may slightly hold up one of its feet. This can result in a false diagnosis of an abnormal angle of part of the hoof when measurements are made.

Here are some tips that can help a veterinarian obtain the best possible radiographs of a horse’s feet…

• Be very familiar with the anatomical structures, and have a good reference image for comparison.

• Radiograph all of the feet (or at least take bilateral views), even if not all are showing symptoms of a problem. This may help uncover pathology that is radiographically evident but not yet clinically evident. At the very least, if no abnormalities are detected in the other feet, the views of the unaffected feet can serve as a great reference for comparison to normal within that individual horse. 

• Ensure that equipment is good quality and well-maintained/undamaged.

• Have a systematic approach each time, to ensure nothing is forgotten. Know which views need to be obtained and which technique should be used for each.

• Do the study on level ground, so that the horse can stand in a normal position. Make sure the horse bears weight equally between the right and left foot and keeps its neck and head straight so that the foot being radiographed is at a standard, weight-bearing angle that can be effectively compared to reference images and measurements. Wooden blocks are typically used to align the beam to about the level of the bottom of the coffin bone.

Common Radiographic Views of the Equine Foot

Orthogonal lateromedial and dorsopalmar/plantar horizontal views are the most commonly obtained radiographic views of the foot, and a good starting point.

Depending on which pathology is suspected, additional views may include various oblique or angled shots. 

Tips for success include cleaning the foot to remove any foreign material that could obstruct visualization of normal anatomy or create an artifact. 

After cleaning, it is recommended to pack the sulci with a pliable material such as Play-Doh, to eliminate gas artifacts.

Many experts also recommend placing radiopaque markers (such as Barium paste) at certain positions on the hoof, to serve as a point of reference for measurements.

Describing the technique and positioning for all of these views is beyond the scope of this article, but more detailed instructions on setting up and taking views are described in reference texts.  

Measurements of Radiographs of the Equine Foot

In addition to what can be seen with the eye qualitatively, there are standard measurements of various parts of the equine foot that can greatly aid in radiographic interpretation. Some of those measurements are covered here.

For example, asymmetry or deviation of the distal interphalangeal joint space on the DP view is considered abnormal in terms of the medial-lateral balance of the foot.

Also, dorsal hoof wall thickness measurements can help identify laminitis. Rotation of the distal phalanx (P3 or coffin bone) may be noted if the lines are drawn along the hoof wall and dorsal cortex of P3 are no longer parallel to one another. 

Or, laminitis may be noted as “sinking” of P3, when the lines along the hoof wall and the dorsal cortex of P3 are still parallel to one another but are displaced lower than they should be (noted as an increased distance between the coronary band and the proximal edge of the extensor process of P3). 

These measurements can be made by hand, but some digital systems and software allow for measurements made right on the images on-screen, with automatic calculations. 

Either way, a good reference text should be used to be sure measurements are made comprehensively and accurately, and to compare the measurements to standard reference ranges. 

Having a good understanding of the anatomy of a horse’s foot, a systematic process for obtaining diagnostic quality radiographs, and practice with measurements and interpretation of the radiographs will help a vet make the most of their x-ray studies of the equine foot.

Written by: Dr. Tammy Powell, DVM

Obtaining High Quality X-Ray Images of the Equine Stifle

Radiographs of the stifle in horses are a relatively common procedure. They are used to evaluate for developmental and acquired abnormalities of various structures of the knee joint.

Here are some tips for when to obtain these radiographs, and how to obtain great shots of the equine stifle…

When Are Stifle Radiographs Indicated?

Some of the most common indications for stifle radiographs in a horse include a pre-purchase examination or investigation of any swelling of the joints, lameness localized to the stifle, difficulty bending the joint, or traumatic injuries that could affect the knee.

Some of the conditions of the stifle that radiographs may be used to evaluate include osteochondrosis, osteochondritis dissecans (OCD lesions), subchondral bone cysts, trauma, osteoarthritis, joint effusion, infection, or any other suspected abnormalities.

Ultrasound may also prove useful in evaluating the equine stifle, especially for soft tissue structures such as the joint space, meniscus, and ligaments. 

Additional diagnostics—such as joint fluid analysis, arthroscopy, or CT when available—may also provide valuable information. But radiographs are usually a good diagnostic to start with, as they are fairly routine and provide a lot of information.

Planning for Equine Stifle Radiographs

Prior to doing an x-ray study of the stifle, it’s important to thoroughly understand the anatomy of the stifle.

In addition to a working knowledge of stifle anatomy, it’s important to know how this anatomy can change over time. For example, knowing which ages the physes of the joint close can greatly aid in accurate radiographic interpretation.

A vet team should also know how to obtain standard views at appropriate angles, with correct exposure techniques for each view. Due to thick musculature, cranio-caudal views may require significantly longer exposure times than latero-medial views.

Additionally, having a differential diagnosis list will help a vet determine if any additional views are needed to see specific structures of the stifle joint in more detail.

Sedation can help to reduce motion artifact, which can produce x-ray images that are of higher diagnostic quality.

Bilateral views are recommended. This provides an easy basis for comparison in that individual horse, if lesions are unilateral. Also, some lesions (such as OCD) may be bilateral, even if the horse is only showing symptoms on one side at the moment.

Which Views of the Stifle Should be Obtained?

The most commonly obtained views of the stifle include the following…

• Latero-medial. In this view, the x-ray generator is positioned laterally, facing the femorotibial joint, and slightly (10-20 degrees) in a caudo-cranial direction. The beam is directed horizontally, with the detector placed medially and perpendicular to the beam.

• Caudo-cranial. For this shot, the generator is placed caudally to the joint—with the beam centered at the midline—and the detector cranially and perpendicular to the beam. The generator is raised at a 10 to 20-degree, proximo-distal angle. 

• Caudo-lateral to Cranio-medial Oblique. For this view, also known simply as a “lateral oblique,” the beam is centered over the lateral aspect of the femorotibial joint and then angled at a 30 to 60-degree caudo-lateral to cranio-medial orientation. It is directed horizontally across the joint, or at a slight proximo-distal angle. The detector is placed on the opposing side and perpendicular to the beam. 

These three views make up the majority of routine x-ray studies of the stifle. But additional views may be included if more information is needed, such as the patellar skyline or flexed lateromedial views.

For additional information on obtaining views of the stifle in a horse—including detailed pictures of the anatomy in common x-ray views—this article is highly recommended: RadiographWilson.pdf (aaep.org)

Conclusion

As with any aspect of practicing medicine, having a good reference and proper equipment, and gaining practice/experience over time, will help a veterinarian develop confidence in taking and interpreting radiographs of the equine stifle.

Written by: Dr. Tammy Powell, DVM

Upgrade Your Surgery Room with Burton Veterinary LED Light

The Burton Veterinary LED Surgery Light is designed for surgical procedures in small and large animals. This is an ideal alternative to incandescent or halogen surgery lights and has a long life span of over 50 times the average lifespan of these lights.

What is the best use for the Burton LED surgery light?

The Burton Veterinary LED Surgery Light is ideal for veterinary specialists in small animal practices and equine veterinarians who prefer to perform surgery under local anesthesia. The Burton Veterinary LED Equine and small animal practitioners also use surgery Lights for examinations and procedures. LED surgery lights are a cost-effective alternative to conventional halogen, Xenon, or fluorescent surgical lighting systems.

Why choose Burton Veterinary

Burton Veterinary manufactures an extensive line of premium quality surgical instrumentation, flexible endoscopes, accessories, and specialty devices explicitly designed with the needs of the high-performance professional in mind. The products are developed, focusing on innovation, quality, and performance. Every product is made by hand to ensure that customers receive medical devices that are safe, effective, and durable.

The Burton light has the following features.

Safe operating temperature - The light can endure temperatures up to 70ºC (158ºF) without affecting its performance. It also has a wide range of power settings that can be adjusted according to your needs and a thermal sensor to protect it from overheating.

LED lifetime

With each light using only 1/10th the power required by other lights, the Burton LED light can last up to 50 times longer than different types of lights do. Also, due to its high CRI rating of 95, this LED provides clear, bright illumination without being too harsh on your eyes.

With the Burton Veterinary LED Surgery Light, you have the operating power you need for your next surgical procedure.

Surgically precise and brighter than ever before, it delivers 70,000 lux at 1 m and a broad 4300 K color temperature. It's easy to adjust the light output to suit your needs with a 3-step dimmer (100%, 75%, 50%).

Adjustable angling head

The flexible head allows you to adjust the direction of the light as needed so that you can work on different angles with no problems.

With a larger adjustable light pattern and limitless arm rotation, this light is ideal to provide participants in surgical procedures with a clear view of their work area.

Featuring multiple LED technology, this surgery light minimizes shadowing and provides uniform illumination. Its sleek modern design is smooth and easy to clean, plus it comes backed by a 5-year limited warranty.

The light's cutting mode has a wide beam angle that illuminates the entire operating area. The viewing mode has a narrow beam angle to focus on small areas. The light is equipped with three lenses that can be quickly interchanged. Full-spectrum light is also available if the surgeon needs to perform surgery during daylight hours.

The Burton Veterinary LED Surgery Light is the most powerful, durable, and flexible surgical light available. This premier surgical light was designed to meet the demanding needs of today's veterinary practitioners.

Written by: Rachel Best

Fluoroscopy / DR Digital X-Ray Veterinary All In One System

Fluoroscopy And DR Digital XRay, veterinary, All In One System

DynaVue is a very popular digital image and radiographic workflow platform used in digital radiography. It offers a complete fluoroscopy and X-Ray system, which comprises an x-ray generator, x-ray imaging table, software platform, and a large capacity Exam Pacs server for storing all the images.

DynaVue Overview

The DynaVue fluoroscopic and digital X-Ray system is based on the principles of noninvasive imaging, which utilizes ionizing radiation for medical diagnosis.

With the help of advanced processing algorithms, the system delivers high-quality images at a very low dose. The system can provide real-time cross-sectional images at a resolution of 400 microns and a speed of 30 frames per second.

The fluoroscopic imaging system is mainly used in minimally invasive surgeries and procedures such as interventional radiology, computed tomography angiography, musculoskeletal procedures, endoscopy, vascular procedures, and intraluminal stenting in veterinary medicine.

DynaVue will prove to be an advantage to veterinary practitioners as it reduces patient exposure to radiation while delivering high-quality images that can be used for various diagnostic purposes. The company offers a wide range of services for customers planning to buy DynaVue, including consultation with specialists and technical support from trained and experienced professionals.

Efficiency Requirements of a Fluoroscopy System

A sound fluoroscopy system will be able to take x-rays from multiple angles. This helps ensure doctors get the best possible images of their patients' internal problems.

The ideal system will take x-rays from three different positions: horizontal, vertical, and angled. In many cases, this is colloquially referred to as 3D imaging because of its appearance on the screen. 

A good fluoroscopy system should have several modes built-in that can be used for different types of procedures. For example, an image set that can be used for knee replacement surgery is not appropriate for heart monitoring; therefore, having several different settings is crucial. 

DynaVue is the Future Of Portable Fluoroscopy System

DynaVue all in one fluoroscopy and digital X-Ray system meets the exacting demands of modern veterinary and is built to provide precise, high-quality images that can be easily captured and shared with other clinicians.

The system is reliable enough to withstand the high levels of stress during a typical day in a busy veterinary facility. Yet, it is simple enough to be operated by anyone with minimal training.

The system has many features that will help enhance your practice's capability and save money in the long run. These include:

• Advanced focusing - This allows for better image control.

• Multiple radiography modes - Provides different functionality from one device.

• Real-time image processing (8 FPS for fluoroscopy) - Supports remote monitoring.

• Minimally invasive fluoroscopy - Helps lower radiation risks for the X-Ray test subjects.

• DynaVue combines high-quality X-ray images with superb image quality and a wide range of therapeutic applications to perform real-time minimally invasive procedures under digital control.

It provides superior diagnostic performance to help veterinarians find early-stage diagnostics of diseases and reduce costs associated with long-term treatment.

Efficiency Requirements of a DR Digital XRay System 

There are many types of digital radiography systems, and you can find them in various places. Consider the following when choosing your digital radiography system:

Technology

X-ray systems that use computer technology are almost always going to be the most advantageous. These systems will give you the greatest flexibility, such as adjusting the screen brightness or contrast levels or freezing and zooming into your images.

Installation

Your DR digital x-ray system should be easy to install and be able to be set up by 1 or 2 people. It is best if you can connect it to your computers with an Ethernet connection, but at the very least, they should have a direct USB port connection available.

Basic

Advanced x-ray machines offer all kinds of features that can be confusing and sometimes not even used by dentists. It is best to find an x-ray system with all of the basic features such as Auto Exposure, Automatic Battery Charger, Auto Focus, Automatic Film Advance, Automatic Film 

Identification and Automatic Film Orientation.

Resolution

You want a minimum screen resolution of 1024x768 pixels to allow you to get sharp images on your screen. You will also need a good amount of contrast on your screen to view your images clearly. 

DynaVue provides superior image quality by combining two technologies: True Waveform™ and a photodiode sensor array (PSA). 

The PSA provides high-quality images with low noise levels, even at higher frame rates. The True Waveform™ feature enables superior imaging performance during cardiac gating procedures by synchronizing the image acquisition to the patient's heart rate.

For large facilities, the DynaVue system is easily scalable to meet your requirements by adding modules and accessories.

DynaVue excels in small diameter access applications because of its unique True Waveform™ technology, which provides superior imaging performance for soft tissue applications such as small blood vessels, nerve bundles, and lymph nodes.

DynaVue Features Guarantee High Efficiency

2-in-1 (DR and Fluoroscopy:

DynaVue is a 2-in-1 system that works for soft tissue and fluoro imaging. It is a state-of-the-art imaging solution that enables healthcare professionals to simultaneously see fluoro and soft tissue anatomical structures.

Flexible movement with 4-way floating table: DynaVue DR and Fluoroscopy system is one of the few systems that provides a 4-way floating table. This enables the physician greater freedom of movement, which creates a better visualization of the anatomy.

23" touchscreen display: The large display and high-quality resolution make it easy to conduct your examinations. This device ensures high-quality imaging and an intuitive user experience.

10 kW monoblock type; 15 kW inverter-based system: DynaVue DR and Fluoroscopy systems are developed for advanced diagnostic applications. Up the image quality, up the efficiency, and up the flexibility. Up the power with the Fluoroscopy system and enjoy a full range of possibilities with a single system.

Pulsed fluoroscopy offers reduced dose: The DynaVue DR system uses a backscatter method that reduces patient radiation exposure by up to 50 percent. This system also offers greater visibility throughout the exam. What's most important is that the system can still produce excellent diagnostic images comparable to existing diagnostic imaging procedures.

DynaVue uses ExamVue, a straightforward, easy-to-use, and highly customizable digital radiography software.

ExamVue is the most advanced DICOM 3.0 compliant software for X-ray imaging and reporting. More than 1,000 hospitals worldwide trust it for their daily clinical activities. 

The intuitive interface offers seamless frame rate control, imaging and annotation, post imaging processing, and connection to DICOM 3 to allow your team to focus on their work instead of dealing with technology.

Takeaway: The brand new DynaVue is the perfect solution for busy animal hospitals looking to optimize their diagnostic capital while minimizing radiation exposure with a minimal investment in terms of space and equipment.

Written by: Rachel Best

Sources

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7653184/

https://www.researchgate.net/topic/Minimally-Invasive-Surgery~Diagnostic-Imaging/publications

https://www.dicomstandard.org/

https://www.jpihealthcare.com/examvue-pacs/

https://www.medicalexpo.com/prod/jpi-healthcare-solutions/product-100612-915091.html 

Enhance Veterinary Care with Cutting-Edge Dental Equipment

Cutting-Edge Dental X-Ray Equipment for Animal Clinics

Just like human beings, animals are susceptible to various physical ailments and maladies. Practitioners of veterinary medicine are trained to handle all these situations, with animal dentistry being one of these fields of practice. Dental health plays a vital role in the general wellbeing of pets and animals, and veterinarians need various tools and instruments to carry out their role effectively.

One of the essential pieces of equipment is veterinary dental x-ray equipment. This allows the vet to look at the problem areas and make the appropriate diagnoses that will enable them to carry out the corrective procedures required. In this piece, we'll be taking a look at the dental x-ray package provided by New Vet Equipment.

We'll be exploring the qualities of each piece of equipment in the setup, highlighting how they might positively impact the overall performance of a veterinary practice.

Let's dive right in.

Digital Intraoral Sensors

A digital intraoral sensor is a piece of x-ray imaging equipment that makes it possible to get high-resolution images of the inside of a patient's mouth without the need for the bulky, frightening, radiation-leaking x-ray machines of old.

Some people wonder whether these new devices are as effective as the traditional x-ray machines, and the answer is yes, they are.

They not only offer higher-resolution results, but they do it much faster than conventional machines. This means that veterinarians will be able to make their diagnoses much quicker and with more accuracy, leading to better patient outcomes without the need for multiple visits to the vet. This saves the client time and money.

These sensors come with smooth edges, rounded corners and are available in two sizes, making them very comfortable for the patient. For extra comfort, they have a removable outer covering of soft silicon.

These are the specifications on the latest digital intraoral sensors:

• Less than a quarter of an inch in thickness

• Highly durable polyamide housing

• CSI Scintillator

• CMOS Image Sensor Chip

• Shielding Foils

• Shock Absorbers

• Polyurethane USB Cable

E-Z Dent Software and Laptop

This software is designed to make your veterinary dental operations as efficient and straightforward as possible, making the entire process easier for the vet, the patient, and the client.

It is a user-friendly platform that aims to eliminate redundancies, streamline your file keeping, and provide marketing tools and management reports that will combine to optimize the efficiency and effectiveness of your practice.

A typical practice may experience a reduction of up to 75 % in the time it takes for image posting and a 90 % reduction in the time taken for other radiography functions. E-Z Dent was explicitly designed for dental operations and has been rigorously tested and optimized to make it an excellent fit for any practice it may be employed in across the United States.

The Principal Functions of E-Z Dent Software:

• Electronic dental record-keeping

• Referrals tracking

• Electronic dental records

• Patient scheduling

• Word processing

• Treatment planning as well as follow-ups

• Practice management reports

• Recalls

• Electronic and paper billing

Benefits of Using E-Z Dent Software

This software can tangibly improve revenue collections, patient tracking, and information gathering for your practice by:

• Assigning finance charges

• Tracking late payments owed by insurance companies and patients

• Printing out of financial statements and reports

• Providing informative and timely reports

• Highlighting new patient percentages

• Providing collections data

• Referral tracking as well as follow-ups

• Giving flexible reports determined by your chosen criteria on selected patients

• Showing patients who have not shown up for recalls

• Printing of timely, accurate electronic claims and insurance forms

• Estimating the amount insurance should pay and what should be collected from the client at the time of their visit

NOTE: This software will come with a laptop chosen for its ability to handle the memory and processor requirements of the equipment. This will typically be running on a Windows platform (Usually Windows 10) and can be linked to other workstations on the office network.

Portable Dental Generator

Clients will have a choice of generators. These are all effective, reliable generators selling at the flat rate of $6000, but depending on their preferences, they may choose from among the following:

1. Wall/Cart Mounted E-Z Ray Dental Generator

This comes with a detachable control panel, easily moved anti-drift arms and a lightweight tube head. It also features an easily gripped ergonomic handle. You may opt for the wall or cart attachment at no extra cost.

2. Hand-Held Nomad Pro-2 Generator

This comes with a backscatter shield that works with its fully-encapsulated x-ray source to minimize the exposure operators and pets endure. It works well with digital sensors, film, and phosphor plates. It is highly portable and lightweight, weighing only 5.5 lbs.

3. XRD Dental Portable X-Ray

This comes with a small 0.4mm focal spot that provides higher definition and superior imaging while minimizing radiation exposure to the operator and pet. It is compact, lightweight, and features long-lasting battery technology that makes hundreds of exposures possible on a single charge. It is compatible with PSP plate systems, film, and dental sensors.

4. EZ Ray Air Portable Generator

A lightweight, portable device optimized for stable positioning and easy handling. It comes with Internal shielding and external backscatter shielding to ensure operators are not exposed to radiation leakage and backscatter. It utilizes carbon nano-technology to reduce cooling times between shots and thus optimize workflow rates.

5. COCOON Hand-Held Generator

This light-weight, gun-type, portable generator is optimized for battery life and stunning, high-resolution imagery. For added safety, it features a locking trigger and lock mode. It is oil-cooled and has a 0.4 mm focal point size. Its target angle is 12.5 degrees and has a pre-recorded voice guide to assist operators unfamiliar with it.

2-Year Hardware and Software Warranty

Clients who purchase this digital x-ray package will enjoy two-year warranty coverage and support, ensuring that they don't have to worry about any mechanical or software trouble.

Final Thoughts

Regardless of how skilled, experienced, or well-trained a veterinarian might be, they will all acknowledge that poor equipment leads to poor results.

For the optimal welfare of their patients, vets strive to get the best, most accurate, and most reliable instruments to help them play their trade.

The setup we've just reviewed seems to fulfill these requirements.

To acquire it for your practice, visit New Vet Equipment and place your order today. They are always willing to address any questions or concerns you might have, so don't hesitate to make the call.

Written by: Rachel Best

Sources

https://www.vatech.com/software_2d/419

https://newvetequipment.com/dental-xray-equipment

https://ezdent.com/technote/EasyDentManual.pdf

https://videodental.com/digital-intraoral-sensors/

https://imageworkscorporation.com/the-seven-most-common-questions-when-implementing-a-new-dental-intraoral-sensor-system/

https://www.vatechamerica.com/products/ezray-air

https://newvetequipment.com/wall-or-cart-mounted-generator

https://newvetequipment.com/xrd-dental-portable-xray-ray98p-vet

https://newvetequipment.com/nomad-hand-held-generator

https://newvetequipment.com/cocoon

When and How to Perform Equine Neck X-Rays

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

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

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

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

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

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

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

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

Performing Radiographs of the Cervical Spine in a Horse

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

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

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

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

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

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

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

Which Radiographic Views of the Equine Neck Should be Taken?

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

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

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

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

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

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

Interpreting Radiographs of the Equine Neck 

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

A consultation with a radiologist can also be helpful.

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

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

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

Written by: Dr. Tammy Powell, DVM

Upgrade to Digital X-Ray with Your Existing Table/Generator

 Saying Goodbye to Chemicals and Dark Rooms: The Digital X-Ray Advantage

Advantages of upgrading to digital X-ray:

• Faster viewing of X-rays compared to film x-ray.

• Elimination of the need for a dark room, saving 20-30 minutes of processing time.

• Improved environmental conditions and staff health:

  • No more purchasing and handling of chemicals.

  • Elimination of film, storage, toxic chemical fumes, and odors.

• Convenient sharing of X-rays:

  • Sending x-rays to a radiologist via email or PACS.

  • Easy sharing of X-rays with customers through email.

• Enhanced customer service and interaction:

  • Digital technology allows for easier and more efficient viewing of each X-ray.

  • More time can be spent with customers, providing better service.
     

We had one location that had a table/generator which was over 15 years old, and we were able to upgrade to digital, still using his old table and generator.  

Money saved!

The Doctor upgraded to a DR system, and we saved him money by using his old table and generator.

We can do the same for you and it doesn't matter if you want a CR or DR digital x-ray system.

TESTIMONY

Here is what the Doctor had to say in an unsolicited email a few days after the installation...
 

“Image quality is superb! Far better than Sound x-ray we use to have at Bakersfield hospital. We took abdominal X-rays on a 70-pound dog and the x-rays came out great. Thank you! Let me know if anybody wants to visit and see the images...I will be more than happy to show them the images” — Dr. Singh - Family Pet Hospital - Vacaville, CA

Use your current table and generator and go digital - for a CR or a DR system.

Upgrade to Digital X-Ray & Keep Current Table & Generator

DR Digital X-Ray - Easy to Upgrade - Use Your Current Table and Generator

Each veterinary practice relies on various tools and equipment to carry out its services. One of the most important pieces of equipment in treating animals is an X-ray machine.

These machines make it possible to examine the internal structures of an animal to make diagnoses as to the ailments the animals are suffering from.

Broken bones, impacted gastrointestinal tracts, inflammation, and myriad other conditions will all be exposed without the need for invasive surgery with the aid of good x-ray equipment.

In this piece, we'll be taking a look at one of the best x-ray setups designed for use in veterinary practices. This is the DR Digital X-Ray assembly with Plates, Software/Computer, and ExamVue PACS (Server Based) offered by New Vet Equipment.

We'll be taking a step-by-step look at the various components in this assembly, highlighting their positive attributes and how they can positively impact your professional operations. Let's get right into it.

Flat Panel Detector (CareRay Cesium Plate)

Digital Radiography (DR) utilizes x-ray sensitive plates to capture data while the patient examination is going on directly. This data is immediately transferred to a computerized system without needing an intermediate cassette, as happens during Computer Radiography (CR) procedures.

For this reason, DR systems are considered a great choice for those hoping to upgrade from film x-ray techniques. 

Flat Panel Detectors (FPDs) are the essential components of these systems and typically use combinations of amorphous silicon detectors fitted with gadolinium or cesium scintillators.

These are responsible for converting x-rays hitting them into light, which is subsequently translated into digital data by thin-film transistors. This data is represented on the acquisition screen for viewing by the vet.

Various advantages come with using Digital Radiography instead of other methods, including:

• Superior images that exhibit higher resolutions and overall quality, making diagnoses easier and more accurate for veterinary medicine practitioners.

• The ability to enhance images through software tools and algorithms. This capability is not possible when using film x-rays.

• Radiation dosages are significantly reduced because the amount of radiation produced by the x-ray generator does not need to be as high as it is when using other radiography methods.

• Processing chemicals and film will be a thing of the past, making the entire radiography procedure much simpler.

• It's possible to retrofit your equipment to accommodate Digital Radiography equipment without the need to overhaul your entire x-ray setup.

• Processing times will be significantly reduced (by up to 5% in some instances).

• Thanks to increased efficiency and a more streamlined workflow, higher patient throughput can be achieved.

• Digital Radiography systems can be utilized across multiple modalities and systems.

Host Workstation (Desktop/Laptop)

Clients are given the option of choosing between a laptop-based or desktop acquisition computer. These are both sufficiently powerful computers for the tasks they will be called upon to handle, so the choice will largely depend on your particular preferences or space considerations.

The desktop version utilizes an Intel Core i5-6500 with 16GB Ram, 1600Mhz processing speed, and two 1TB hard drives. On the other hand, the laptop version is a ThinkPad E580 running on an Intel Core i7, with 8GB RAM and 500GB hard disk space. It features a 15.6" display. Both these options run on the Windows 10 operating system and come with a 3-year manufacturer's warranty. 

Compatible with Portable X-Ray Generator

Portable medical x-ray units are not much different from fixed digital x-ray units in their method of operation except for their size. Even so, they also have certain unique benefits for practitioners of veterinary medicine, including:

• Portability: Some veterinary practices can be very busy at times, and a portable x-ray unit makes it possible to conduct an x-ray. This convenience causes less stress to the ailing animal and makes things easier for the x-ray technician as well.

• Safer Operation: The use of traditional medical imaging equipment was a source of concern for those exposed to potentially harmful radiation. Portable units come with protective shields mounted on the front of the devices to help prevent patients and operators from exposure to scattered radiation. 

• Increased Speeds: These units eliminate long waits and processing times, leading to quicker diagnosis, treatment, and also recoveries.

ExamVue PAC Software

The ExamVue PAC software is an imaging management solution that will work seamlessly with your hardware while integrating easily with your office workflow. It is designed to facilitate the viewing, storage, sharing, and management of DR images. It offers a variety of benefits and features, including:

• Advanced specialty tools, including Vertebral Heart Score (VHS) and Norberg Angle that make it possible to make quick diagnoses on your x-ray images

• Interactive sharing features that allow for the sharing of diagnostic images with clients and colleagues through their Windows tablets or work desks

• Integration capacity for up to ten Windows stations within a single office setup

• A large variety of annotation tools make it a useful tool for those wishing to share and collaborate with others in the course of their work.

5-Year Warranty

This DR Digital x-ray setup comes with a 5-year warranty to see owners enjoy their use without the worry of system or mechanical failure. These warranties include 5-year drop coverage, five years of remote software support, and five years of hardware support as well.

Shipping and Installation

Depending on your location, you might be eligible for free shipping and installation services. With a quick call or email, you can find out whether or not you qualify for this service.

Final Thoughts

All veterinary professionals know that the success of their efforts relies not only on their personal skill, experience, and training but on the equipment they use. Even the best practitioner of veterinary medicine will perform at less than their best if they are using substandard, inaccurate equipment. To acquire the best digital x-ray assembly for your veterinary practice, visit New Vet Equipment today and place your own order.

Written by: Rachel Best

When and How to Perform Equine Skull X-Ray

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

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

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

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

Performing Radiographs of the Head in a Horse

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

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

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

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

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

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

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

Which Radiographic Views of the Equine Skull Should be Taken?

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

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

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

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

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

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

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

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

Interpreting Radiographs of the Equine Skull 

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

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

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

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

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

Consultation with a radiologist can be helpful as well.

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

Written by: Dr. Tammy Powell, DVM

Reliable Suburban Surgical Operating Table

Suburban Surgical 58 inch V-Style Operating Table With Heated Top and Hydraulic Base

For precise animal positioning, the Suburban Surgical V-style operating table does the job excellently.

With a heated top and hydraulic base, there is a wide range of positions that this operating table can do. A high-quality stainless steel top offers durability and reliability even for several years of use.

The elite hydraulic hand operating table allows you to perform even the most complicated procedures comfortably. Combined with a stainless steel enhanced tilt mechanism, perform your procedures at your desired positions.

The Suburban V-style operating table gives you effective and efficient control of the patient. Achieve the perfect angle while operating on your patients.

Your patient requirements and surgery style are unique and special to your veterinary practice. A good operating table must have excellent features in order to meet the needs of your practice.

The Suburban Surgical 58 inch V-Style Operating Table With Heated Top and Hydraulic Base is specially made for practitioners to meet the demands and requirements they need for their practice.

58 inch V-style stainless steel operating tabletop

The Suburban V-style operating table has one of the strongest operating tables top in the market. If you're looking for a reliable, secure, and durable operating table for your veterinary clinic, this is the best choice.

Stainless steel construction provides strength and convenience as it repels most foreign substances and body fluids. It permits easy cleaning and prevents cross-contamination. For you and your patient's safety, welded smooth radius bends for the corners are designed to avoid accidental injury. 

The table is made with a one-piece die-formed 18-gauge that is designed to last. The top is made with an elegant satin finish.

A large 58-inch top ensures the patient is comfortable no matter how large the patient is. It has a top panel adjusting knob that you can turn counterclockwise to loosen and raise it to a 90-degree angle.

Therm-o-Matic II Heat Control provides Heated and Unheated modes

The Suburban V-style operating table allows you to operate on animals that require certain temperatures while being operated. The heating feature maintains the body temperature of the patient even during long hours of use. The heating mode is conveniently placed on the side of the table, giving you easy access when desired. Control the temperature via an easy-to-use mounted side panel. 

The Therm-o-Matic II Heat Control shows the temperature using an LCD panel on the side of the table. Once the desired temperature is reached, an indicator light turns on.

The heat control requires 120V AC power. Just select the temperature you want the tabletop to reach, and sensors will automatically regulate the desired temperature. The heating mode can also be turned off when a patient does not require certain temperatures to be operated.

Top-quality stainless steel construction

The Suburban V-style operating table is manufactured and engineered to last. The operating table is made with the latest laser manufacturing and computer numerical control process. Every piece of the table is made with precision and accuracy.

Only high-quality parts are used in the table to give reliability even in the toughest procedures. Engineered and built to last, you can depend on the Suburban V-style operating table for a long time.

Solid stainless steel base with enhanced tilt mechanism and hydraulic hand operation

The stainless steel base is made with high-quality steel that guarantees steady and stable performance even in the toughest procedures. Perform your operations at your desired position with the enhanced tilt mechanism. You can adjust the table to your desired height with the help of the hydraulic mechanism feature.

A pump-action foot pedal is conveniently placed at the side of the base for you to smoothly raise or lower the operating table. The operating table can rise from 35.750" H to 47.500" H. The tilt mechanism is also made with strong stainless steel for enhanced durability and strength.

An adjustable floor leveler feature is also available in this excellent operating table. The floor levelers are located on all four corners to ensure stability during intensive operations.

A positive locking handle is also included so that the top is steady when the desired angle is made. The flat stainless steel base can also b used as a footrest for enhanced comfort, especially in long procedures.

The elite base allows the table to be rotated in full 360 degrees. The mounting brackets are made with high-quality steel for long-lasting strength and durability. The tabletop can be locked in any position from horizontal to near vertical.

Sanitary features

The rigid stainless steel top has a unique raised center to direct and channel fluid to the collection holes at one end. This feature allows a sterile environment for your patient. Avoid having messy procedures with the Suburban V-style operating table.

Access-A-Rail operating table system

The innovative Access-A-Rail feature on this table provides precise positioning for demanding procedures. This feature allows excellent positioning flexibility that is not seen in other operating tables. It has an adjustable height stainless steel with cleats to attach the Access-A-Rail and two Cam Cleat Tie-down for accurate positioning of patients. Keep animals safely positioned and secured during your surgical procedures.

Restraint capability

There are times when patients need greater than necessary control and handling. The Suburban V-style operating table provides a convenient over-the-table restrainer assembly.

The stainless steel supports can attach to the Access-A-Rails and hold a steel rail that spans the width of the operating table. It gives you a reliable upper restraint capability when needed.

This operating table is designed to give you comfort and ease of use even in unique patient situations. The table can have upper rail adjustments to provide excellent flexibility.

Stainless steel rail extensions

Stainless steel extensions allow you to add tie-downs and other accessories for convenience. Your materials and equipment can be placed slightly away from the surgical area for better visibility and ease of access. Make your surgical procedure efficient and fast with this excellent feature.

Warranty

A 3-year warranty on parts is included for the Suburban V-style operating table. Labor is not included in the warranty.

Written by: Leo Heno

Pre-Purchase Examinations and X-Rays in Horses

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

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

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

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

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

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

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

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

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

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

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

• Palpation of the limbs, neck, and back.

• Hoof evaluation and hoof testers.

• Flexion testing.

• Range of motion.

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

• Bloodwork or labs for general health.

• Drug testing.

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

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

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

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

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

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

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

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

• Hocks (DP, lateral, +/- obliques). 

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

• Foot/navicular series. 

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

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

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

Conclusions from a Pre-Purchase Examination

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

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

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

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

Written by: Dr. Tammy Powell, DVM

The Case for Veterinary Nurse Practitioners

We covered what a veterinary nurse practitioner’s role may include, as well as some of the most commonly heard pros and cons of adding this new role to the profession.

This week, we’re covering some additional pros and cons for discussion, as well as practical considerations for when and how this change may occur in vet med.

Read on to learn more…

Veterinary Technician Utilization and Career Growth 

It’s no secret that veterinary technicians are often underutilized and that their pay is often not up to the standards of their professional education and the crucial role that they play at a veterinary practice.

Many technicians note there is a “ceiling” for them in clinical practice—in terms of reaching new levels of professional satisfaction and an income that truly reflects their knowledge and hard work. 

As such, many vet techs leave the clinical side of the work they love in order to pursue management, teaching, or even an entirely new start in human medicine or another field. 

Many argue that a veterinary nurse practitioner option would help more techs stay in the field and be appropriately compensated while continuing to grow professionally.

On the other hand, many have pointed out that it may make more sense to fully utilize vet techs (and pay them a higher compensation) prior to creating a new role. 

In other words, if we don’t fix the current problems vet techs are facing, would those issues just be perpetuated in a new role?

Less of a Role for Veterinary Technicians

Those who don’t support the veterinary nurse practitioner movement point out that once this new role is created, there may be less of a need for traditional vet techs. 

These wonderful staff members may begin to feel underutilized, underappreciated, and underpaid next to their new nurse practitioner coworkers—since nurse practitioners would still be able to perform all the tasks a vet tech could.

Veterinarians Fully Utilizing Their Education versus Daily Routine Appointments

While a nurse practitioner role may help vet techs see their full professional potential, some argue it will carry the same benefit for veterinarians. 

If a vet’s time is freed up from repetitive daily wellness and minor issues appointments, they may be freer to pursue their own professional interests, such as dentistry, surgery, acupuncture, complicated internal medicine cases, or anything else they enjoy. 

Of course, many vets do enjoy daily interactions with clients for more routine appointments, so this may depend on personal preference.

And some worry that the loss of those daily, routine interactions could hurt their relationships with clients in the long-term—that they would only see clients when their pet is seriously ill, without a prior relationship.

Preventing Burnout Within the Profession

Many veterinarians and veterinary professionals have suffered from burnout and mental health concerns related to their careers. 

Some state that a veterinary nurse practitioner role can help the profession as a whole in this regard—by taking some of the extraordinary workloads off of veterinarians and delivering better workflow to the whole practice.

Also, allowing skilled veterinary professionals to receive fair compensation and derive more professional satisfaction could help with job satisfaction for the whole team, not just vets.

Consumer Expectations and Preferences

It’s been pointed out that veterinary medicine, in general, is slow to update to new technology and consumer preferences.

Some argue that veterinary nurse practitioners may be expected by pet owners in the near future, since that’s what people are used to for their own health care.

While many veterinarians and practice owners expect clients to stick to the practice’s way of doing things, history in many other industries has shown us that customers eventually do turn elsewhere when businesses fail to adapt to the times.

Distribution of Veterinary Services

Whether there is a national surplus or shortage of veterinarians, some parts of the country have faced a vet shortage in either climate—especially rural areas.

For this reason, some rural practitioners have voiced their support of the veterinary nurse practitioner, as it may be a way to distribute some of their caseloads even when they can’t find a DVM to hire.

Others argue that while nurse practitioners would be more affordable than a DVM, they would still be too expensive for some rural practices—and that these practices would be hurt in the long run because there would be fewer traditional vet techs overall for them to hire.

Liability

One serious concern to answer is who is legally responsible if a medical error occurs while a patient is under the care of a veterinary nurse practitioner?

If the veterinarian is liable, as is the case when an error occurs by a vet tech, this may make veterinarians reluctant to delegate.

When and How Could the Role of Veterinary Nurse Practitioner Be Created?

While there is much discussion about this topic right now, it could take quite a while for any serious changes to be made toward the creation of this new role.

Some of the roadblocks include the need for major changes to education and credentialing. 

Currently, many vet techs have an associate degree—which is much shorter than the length of time required to become a veterinarian. Supporters of the nurse practitioner role envision the degree being the equivalent of a master’s degree, so the education would be much more extensive.

Additional considerations include accreditation of any educational programs, as well as standardization for credentialing, continuing education, etc.

Also, there’s the matter of what the state laws allow vet techs to do at a veterinary practice. These laws would have to be changed, and that could take years and be very expensive.

What’s Next?

It’s been suggested that more data is needed to know if the nurse practitioner is really sustainable for the long-term (and not just a short-term need during the pandemic), and that it may take many years for this new role to be created.

On the other hand, at least one university is in the process of creating a master’s degree targeted to veterinary technicians.

There is certainly some appeal to the collaborative environment envisioned by supporters, with a healthier workload distribution to all employees while allowing the practice to provide high-quality care to more pets and bring in more revenue.

But while there may be benefits, it’s certainly necessary to continue discussing any potential downsides so that there is a realistic idea of how this new potential role could affect the profession as a whole.

Additional great sources of information include a recent podcast from Dr. Andy Roark

(https://drandyroark.com/vet-nurse-practitioners/ ),

and an article from VIN News Service (https://news.vin.com/default.aspx?pid=210&Id=10484775 ).

Written by: Dr. Tammy Powell, DVM

Does the Profession Need a Veterinary Nurse Practitioner?

A hotly debated topic in veterinary medicine right now is whether there is a need for a midlevel practitioner—a position comparable to a nurse practitioner or physician’s assistant on the human side of medicine. 

So, what are the arguments for and against this potential new veterinary career track? And what would be required for the role of veterinary nurse practitioner to be created?

This is what will discuss today, in the first part of a two-part series on midlevel practitioners in veterinary medicine…

What Is a Veterinary Nurse Practitioner?

A midlevel practitioner is someone whose scope of practice would be beyond that of a veterinary technician or nurse, but less than that of a veterinarian.

This idea has been floating around for at least a decade, if not longer. But the recent veterinarian and vet staff shortage during the pandemic may have spurred to the forefront of many vet professionals’ minds.

Right now, veterinary technicians are able to perform many of the tasks necessary for patient care. The exception is any part of the scope of practice that is limited to vets—diagnosing, prognosing, prescribing, and performing surgeries.

Creating a veterinary nurse practitioner would mean allowing these vet professionals to take on some of these roles that are currently restricted to veterinarians. 

Examples may include taking on wellness visits, diagnosing and prescribing treatment for minor ailments (ear infections, etc.), refilling chronic medications after checking bloodwork or performing minor surgeries such as uncomplicated dental extractions.

Of course, many tasks—including most surgeries and management of more in-depth medical cases—would continue to be reserved for licensed DVMs… 

The goal of this new role would be to take some of the routine daily tasks off the veterinarian’s hands, to free up the veterinarian and allow the practice to provide care to more patients.

What Are the Arguments For and Against Creating Veterinary Nurse Practitioners?

There are strong cases being made both for and against this new position within veterinary medicine. Here are some of the key points of the debate…

Access to Care 

Right now—as demand for veterinary care increased during the pandemic, while a shortage in vets and vet team members has left many practices struggling to keep up with that demand—many pet owners report challenges in receiving care for their pets. 

Clients are having difficulty scheduling appointments, often having to wait weeks to months for a wellness visit. And some practices have limited how many new clients they can see. 

Proponents of the veterinary nurse practitioner envision the role freeing up time for the vet, so that the practice can see more patients and clients. 

On the other hand, some state that a decision that could permanently affect the future of the profession shouldn’t be made because of circumstances that could be short-term.

In other words, is the increased demand for pet care during the pandemic going to stick around? Is it enough to fuel and support the new role of the veterinary nurse practitioners in the long term?

Availability of Jobs for Veterinarians

Right now, there is a veterinarian shortage. But not so many years ago, many complained of a surplus, which made veterinarians’ jobs harder to find with less competitive salaries.

Detractors of the veterinary nurse practitioner movement worry that in another few years, we could again be facing a surplus of vets. After all, ups and downs are natural in any industry.

Should that occur at any point in the future, there is a serious concern that veterinarians could be out of work because practices (especially corporate practices) may prefer to hire lower-salary nurse practitioners rather than DVMs.

Since nurse practitioners in human medicine have the right to open their own practice, there is also a potential concern of competition for veterinarians who are practice owners.

Cost of Care 

Even before staffing shortages occurred, the cost of care has been another hotly debated topic in veterinary medicine for many years. This is another important facet of access to care since many pet owners are unable to afford quality veterinary care. 

Some state that by providing a midlevel practitioner, a veterinary practice can expand its reach to more clients by offering affordable services (since a veterinary nurse practitioner would be paid less than a veterinarian), especially for wellness and minor ailments.

Supporters argue it would be the best of both worlds. In addition to the ability to offer affordable services, the new system would also increase the practice’s bottom line and provide fair compensation to all employees (since having a nurse practitioner would allow a practice to see a lot more patients per day and thus bring in more revenue). 

Also, the availability of nurse practitioners may decrease the need to hire relief vets for too many shifts, decreasing the practice’s overall operating costs. Of course, for relief vets, this would be a disadvantage.

Stay Tuned for More…

To cover this topic more in-depth, we’ll address more pros, cons, and considerations in next week’s article. 

In the meantime, hopefully, this has provided some food for thought. 

Whether the profession moves forward with creating a nurse practitioner role or not, the issue has opened discussions on many important topics currently facing the field of veterinary medicine. And those discussions are important to always improve, adapt, and to find solutions to keep the profession healthy and sustainable.

Written by: Dr. Tammy Powell, DVM

Veterinary Digital DR X-Ray JPI Directvet System

Veterinary Digital DR X-Ray System Package Deal

Regardless of healthcare professionals' skills and experience, the quality of medical care patients receive will only be as good as the equipment used. This applies not only to human beings and their doctors but to animals and veterinary healthcare practitioners. NewVetEquipment is the proud supplier of high-quality veterinary equipment and is pleased to offer the DirectVet Plus full Veterinary Digital X-Ray System.

Here's a closer look at what this system has to offer

DirectVet Plus X-Ray Table

Veterinarians have to handle pets and animals of all sizes, which means that the x-ray table they use needs to withstand the weight of larger animals. This 32x54-inch system can support more than 300 pounds of weight at a time, and the generator arm is designed to move back and forth over the subject. This makes the system capable of handling the x-ray needs of animals as large as ponies with relative ease.

CubeX 28 X-Ray Generator

CubeX is well-known and respected for its high-frequency, portable generators for veterinary and medical use. These x-ray generators are lightweight and compact. Veterinarians will be pleased with the CubeX 28 due to its user-friendly digital displays, simple design, and soft-touch controls. It comes with two-stage, dynamic auto-line compensation, dual integrated laser pointer, and an easy-to-use inverted control panel that makes it compatible for use with a table. 

CareRay Cesium Flat Panel Detector

CareRay Digital Medical Systems is an industry leader in developing, researching, and manufacturing x-ray flat-panel detectors. This system comes with the 17x17-inch cesium flat panel detector that is packed with exceptional performance features, including:

• High-definition filming: The high levels of detail these panels can produce make it possible for veterinarians and radiologists to diagnose tuberculosis, inflammation, tumors, and more. Experts will observe and make judgments regarding the biliary tract, abdomen, and urinary tract. These panels also facilitate skeletal viewing, muscular system observations, foreign body identification, and trauma diagnoses. 

• Image and Video Playback functionality: It comes with a playback function that allows you to save and review videos that highlight the motility and morphology of the organs in the gastrointestinal tract.

• Visual contrast functionality: Barium-based imaging is often necessary for the x-raying and observation of the esophagus, angiographies, enemas, sinus fistulas, and other circumstances where observations need to be made compared to surrounding tissues.

• Large-format perspective functionality: Veterinarians will be able to get a clear view of the pulsation of the heart and respiratory movement of the subject's lungs. This is made possible by the wide format of the flat panel's 17x17-inch layout. These clear and comprehensive radiographic images make the need for multiple imaging and repositioning unnecessary.  

• Easy integration: These flat panel x-ray detectors are easy to configure and integrate with whatever system you're using. This broad system compatibility will make the operator's or technician's life much easier. 

All CareRay Digital flat panels are fully FDA, CFDA, CE, and ISO13485 certified and are widely used in the veterinary, medical, security, and industrial fields in various capacities. They are highly durable pieces of equipment made out of aluminum alloy and carbon fiber housing.

ExamVue PAC Software 

The proper software has to be put in place to support the function of this system in an office setting. ExamVue has developed its simple, fast, and user-friendly software, with a very convenient diagnostic function. ExamVue PAC is server-based, and it comes with a series of advanced specialty tools, including line profiles, freehand, rectangle, polygon, and histogram. Image annotation is also made possible via user text, length, cobb angle, angle, and R/L mark.

Smaller practices and more extensive operations are accommodated by the system, with the capability of supporting up to 10 separate viewers. It has unique features and capabilities, including image stitching, importation, comparisons, processing, storage, and communication. It will work well with any DICOM DIR or Q/R compatible devices.

Host Computer Workstation

Buyers have the option of choosing a laptop or desktop computer as the host workstation. Whichever the case, this piece of equipment will have the computing power and processing muscle to handle high volume and high-complexity operations. The desktop host is an i5-6500 processor with 16 GB RAM and 2 Terabytes of storage with a 3-year warranty. The acquisition laptop option is a ThinkPad E580 running on an Intel Core i7 processor with 8GB RAM and 500GB of storage. These specifications, however, might be subject to change. 

5-Year Warranty and Easy Payment Plans

Acquiring the equipment to run a veterinary and radiology service properly is a significant investment. It can be a hurdle for many trying to establish new offices or expand their current operations. To help clients acquire the equipment they need, they may choose between one-time payments or make reasonable monthly payments. 

All the equipment that comes with this system is covered under a 5-year warranty, with 5-year drop coverage and software support included. The DirectVet Plus System offers peace of mind to all who choose to make it a part of their operation.

Take note that you may qualify for a deduction on capital equipment purchases under section 179 of the current Internal Revenue Service (IRS) tax codes. Your potential deduction might allow you to treat the full cost of new equipment and software as a deductible expense whether you purchase cash, capital lease, loan, or an Equipment Finance Agreement (EFA). Further information may be found on the IRS section 179 portal. 

Final Thoughts

The DirectVet Plus Digital X-Ray System is an effective solution for veterinarians looking for a convenient, powerful, and user-friendly way to handle their x-ray needs. It is a system that doesn't need any additional power supplies, construction, or preparations. It is a self-contained veterinary digital x-ray equipment system that will be ready for use as soon as it's delivered, making it an excellent choice for veterinarians in the process of establishing their practice. Visit NewVetEquipment.com to place your order or have any questions or concerns you might have addressed.

Written by: Rachel Best

Treatment for Blocked Cats: The Power of Fluoroscopy

Urinary obstructions in cats are a life-threatening issue that vets see and treat commonly. 

And while most vets have a system for caring for these unfortunate felines, it is exciting to learn about new technology that may provide value during the treatment of these critical patients.

One such development is fluoroscopy technology, which is now more accessible than ever to general practitioners. Here are three ways fluoroscopy may help while unblocking a cat… 

Confirming Placement of the Urinary Catheter

Depending on the type of indwelling catheter used, it may be of value to check the placement of the catheter on radiographs. 

This is especially true for red rubber catheters—which can double back on themselves or even tie into a knot if too much of the catheter is placed into the urinary bladder—or for any catheter long enough to cause additional trauma if passed so far that the tip contacts and irritates the bladder wall.

While traditional x-rays may be used for this purpose, fluoroscopy offers the advantage of being able to adjust the catheter placement in real time. That way, the catheter can be quickly adjusted prior to placing sutures.

Real-Time Contrast Studies of the Bladder and Urethra

Blocked cats with severely distended urinary bladders are at risk for bladder rupture—whether from the condition itself or from manipulation (pressure or cystocentesis) while the bladder is excessively full.

A large bladder rupture is often obvious since a full bladder will suddenly become difficult or impossible to palpate. However, a small tear or leak may be more difficult to detect.

A positive contrast cystourethrogram can help to identify small ruptures, by looking for contrast outside the borders of the urinary bladder on radiographs. 

While traditional radiographs can certainly be used for this purpose, fluoroscopy may prove useful because of the ability to see things moving in real time, and the ability to move the patient and quickly see the abdomen at multiple angles without taking a lot of x-ray shots. 

In addition to the bladder, this can be very useful for tracking the movement of contrast through the urethra (to identify obstructing materials, strictures, etc.), versus only seeing a couple of snapshots in time on traditional x-rays.

Since contrast media can be irritating to tissue that is already compromised, a vet must weigh the pros and cons of doing a contrast study right after unblocking a cat. But this procedure could also be useful after the cat has had time to heal, to ensure the bladder is intact before the urinary catheter is removed and the patient is sent home.

Evaluating for Uroliths and “Sludge” 

In cats, sludge, sand, or gritty material—which may be a combination of crystals, blood clots, mucus, etc.—can accumulate in the urinary bladder. And while less common than in dogs, uroliths are sometimes diagnosed in cats.

On radiographs, sludge may be confused with a bladder mass or even sometimes with uroliths. Fluoroscopy can help with characterizing this material inside the urinary bladder (and distinguishing it from a bladder mass) by seeing how it moves in real time, as the patient is moved. 

Additionally, a vet could use fluoroscopy to track the progress of flushing this material out of the bladder (or urethra) after relieving a blockage. 

Conclusion

For many years, traditional radiographs have been included as part of the workup for blocked cats, and a vet can provide excellent care to feline patients with current protocols.

However, as fluoroscopy technology continues to evolve and become more accessible to general practitioners, it’s exciting to see the ways in which this modality can make a vet’s job easier and provide more information for patient care.

Written by: Dr. Tammy Powell, DVM

Planning and Measuring for Full-Body X-Rays

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

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

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

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

How Many Views Are Required?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Written by: Dr. Tammy Powell, DVM

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

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

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

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

Why Are Over-Exposed Radiographs a Bad Thing?

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

What happens otherwise?

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

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

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

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

How to Avoid Over-Exposed Radiographs 

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

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

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

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

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

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

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

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

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

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

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

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

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

Written by: Dr. Tammy Powell, DVM

Equine & Mobile Veterinary DR X-Ray with Wireless Panels

The Benefits Of A Mobile Veterinary X-Ray Service

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

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

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

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

What Is Included In The Package?

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

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

List of components: 

• Wireless laptop-based capture station

• High-quality Cesium flat panel plate

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

• Dedicated ExamVue Software

• No cable is required between the plate and the laptop

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

Who Is This X-Ray Set up Suitable For?

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

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

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

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

What Are The Benefits Of Csl Direct Technology?

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

The Wireless Flat Panel

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

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

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

Software Performance

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

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

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

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

Other Software Features That Will Impress You

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

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

• Console Acquisition Software

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

• Complete processing parameters from small to large.

•  Edge enhancement function, histogram and contrast. 

• You can review images by horizontal and vertical flips. 

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

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

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

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

• Image preview facility

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

• Facility for sending Dicom print to a Dicom printer

• Dicom storage along with hard disk capacity notification function.

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

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

• Gridline removal function and stitching software

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

Laptop Details

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

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

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

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

Written by: Annie Wall

Diagnosing Dental Disease in Small Mammals: A Vet's Guide

Since dental health can be a serious issue that affects a pet’s ability to eat, it’s important to address dental disease when it arises—even in the smallest of patients, like small mammals or pocket pets. While these tiny mouths can be challenging to work with, it is possible to evaluate and treat dental issues in these species.

In recent articles, we’ve discussed dental care in rabbits and guinea pigs. Today, we’ll focus on small rodents such as hamsters, gerbils, mice, and rats.

Which Dental Issues Do Small Mammals Develop?

These species (gerbils, hamsters, mice, and rats) can develop incisor malocclusions, since their incisors are open-rooted and grow continuously.

Unlike rabbits and guinea pigs, these small rodents have closed-rooted molars that do not grow continuously. Fortunately, that means that dental issues of the cheek teeth, while possible, are much less common.

On the other hand, since their molars have fully developed roots and don’t continuously erupt, small rodents may develop periodontal disease secondary to plaque. They may also develop dental caries if fed a diet heavy in sugar, including excessive use of certain commercial rodent treats.

Other oral issues include trauma to the teeth or jaws, food impaction, abscesses and infections, or diseases such as neoplasia. In hamsters, cheek pouch eversions or impactions are especially common.

Normal Dentition in Small Mammals

Mice, rats, gerbils, and hamsters have the dental formula 2(I 1/1, C 0/0, P 0/0, M 3/3), for a total of 16 teeth, with a space called the diastema between the incisors and molars. 

The mandibular incisors are about three times as long as the maxillary incisors. The enamel may be white to yellow or orange, depending on the species.

As mentioned above, their incisors grow continuously, while their molars do not. 

This dentition is consistent with the lifestyle of these small exotic pets. Their diet primarily includes seeds, roots, tubers, and grains—so unlike rabbits and guinea pigs, they don’t ingest a lot of fiber to the point where they require continuously erupting cheek teeth.

Their incisors wear down due to gnawing and burrowing behaviors. Chewing aids—such as wooden blocks or cardboard that is free of print or dyes—can help promote this natural behavior and keep the incisors in good shape.

Diagnosing Dental Disease in Small Mammals

Symptoms may be subtle at first, and it is common for pet owners to miss disease until it becomes more advanced. Symptoms may include anorexia, any change in behavior (such as hiding or hunching if they are in pain), drooling, and swellings or changes to face symmetry.

Hamsters with cheek pouch impactions may present with swollen cheeks. Or the cheek pouches may be seen protruding from the mouth in the case of eversions.

It’s possible for a veterinarian to do an initial, cursory oral exam on an awake pet using an otoscopic cone, and to evaluate the incisors on an awake pet. This method may uncover obvious abnormalities. But it is likely to miss subtle changes and does not allow for a thorough oral exam.

Anesthesia or sedation are best, both for a full oral examination and for dental radiographs.

Additional tools for small rodents, such as mouth gags and cheek retractors, are needed to get the best view of the teeth and oral cavity. Magnification can also be very valuable.

A dental x-ray study is best performed using a dental x-ray unit, with the sensor placed extra-orally due to the small size of these patients. Mammography film can also be used, as it shows fine details.

Treating Dental Disease in Small Mammals

For incisor malocclusions, the goal is to restore the teeth to their normal length and function. An appropriate type of dental drill is recommended. Avoid nail trimmers, rongeurs, and other cutting tools as these carry a risk of fracturing the teeth during trimming.

Molars should NEVER be trimmed since they have true roots and don’t erupt continuously. However, these cheek teeth may require removal of tartar and treatment of periodontal disease or even extraction of severely diseased or abnormal teeth. 

For hamsters with cheek pouch eversions, viable tissue should be put back into normal position and sutured to the cheek. With impactions, the pouch must be emptied out and rinsed with saline.

Antibiotics and pain medications should be prescribed as needed, depending on the pathology.

Any vet treating dental disease in small rodents must have the appropriate sizes and types of dental tools. It’s also possible to use a needle (18 to 25-gauge, depending on the size of the patient) as an elevator during extractions.

Appropriate training is also very important, to ensure these small patients receive the specialized care their need. 

Due to their fast metabolism, nutritional support is usually needed until the animal is recovered and eating on its own.

Owner Education is Important

Many clients buy these small pets for their children and don’t necessarily interact with the pets on a daily basis or have a deep understanding of their husbandry needs.

Promoting regular checkups of these patients can help to catch issues early, as well as educate owners on husbandry and on how to tell if their pet is ill. 

All of this can serve to better the health of these small rodents and help to catch dental disease or other health issues early, when treatment may be simpler and carry a better prognosis.

Written by: Dr. Tammy Powell, DVM

Essential Guide to Guinea Pig Dental Care

Guinea pigs have teeth that grow continuously, and their dental needs are very different from the dental needs of a dog or cat. 

However, dental health is still a vital part of a guinea pig’s wellbeing. Here are some important things to know… 

Which Dental Problems Do Guinea Pigs Develop?

Congenital malocclusions are possible in guinea pigs, although much less common than in rabbits since guinea pigs have not been bred with dwarf or shortened snout variations.

Acquired dental disease accounts for the majority of dental issues in guinea pigs—with dietary factors being a primary cause, due to uneven or inadequate wearing down of the teeth.

A common problem is an inadequate fiber in the diet, which is normally provided via hay. A vitamin C deficiency can also lead to dental issues since it affects the integrity of the connective tissues that hold the teeth in place—leading to loose and misaligned teeth and subsequent tooth overgrowth.

Any other local or systemic issues (trauma to the jaws or teeth, systemic disease, neoplasia, etc.) that affect a guinea pig’s eating habits could also lead to dental problems. 

The uneven or inadequate wearing of the teeth can cause malocclusions, elongated crowns, and sharp edges that can injure or ulcerate the buccal mucosa and cause pain. Overgrowth on the lingual aspect may entrap or irritate the tongue. All of this can make it difficult or impossible for a guinea pig to eat.

Abscesses or infections may also occur, although this is much less common than in rabbits. 

Normal Guinea Pig Dentition

In order to recognize what is abnormal in this species, it’s important to know what’s normal for them.

Guinea pigs have open-rooted teeth that continuously grow, and they wear down their teeth by chewing on fibrous foods. 

Their dentition is the same in all four quadrants: one incisor, followed by one premolar and three molars. Guinea pigs do not have canine teeth, but instead have a space called the diastema between the incisors and the premolars.

The premolars and molars are anatomically identical and collectively known as the cheek teeth.

Since the mandible is wider than the maxilla, the cheek teeth curve (the mandibular teeth inward and the maxillary teeth outward) to occlude with one another on a sloped plane.

Signs of Dental Disease in a Guinea Pig

Since guinea pigs are prey species, they try to hide signs of a problem for as long as possible. But a pet owner may pick up on changes in eating habits, which develop even in the early stages of malocclusions. 

Anorexia is a common symptom of dental problems.

Other symptoms may include weight loss, changes in fecal output (quantity and appearance), dropping food, changes to grooming habits (and subsequent skin issues), salivation, and GI stasis. Facial swellings are possible but less common.

Diagnosing Dental Disease in Guinea Pigs

General anesthesia is best for a thorough dental evaluation. 

Cheek teeth abnormalities are very common, more so than incisor malocclusions. So, if an incisor malocclusion is present, it’s a good indicator that a closer look at the cheek teeth is necessary.

A visual examination with a good light source and an otoscopic cone or speculum may reveal a dental issue. However, small or subtle lesions can be missed this way. 

Use of an endoscope is very helpful for diagnosing dental problems in guinea pigs, with the added bonus of clear images to show clients so they truly understand the issue.

Radiographs are also important for diagnosing dental issues. And if available, CT is an excellent tool for obtaining diagnostic information.

Treating Dental Disease in Guinea Pigs

Supportive therapy is usually needed, since dental problems impact a guinea pig’s ability to eat, and pets may present in poor condition with weight loss and anorexia. Supportive care commonly includes fluid support, dietary support with a critical care formula, and pain relief.

All of this can help stabilize the patient for anesthesia, prevent complications such as GI stasis, and promote a better recovery and return to normal eating habits.

The main goal of dental treatment is to restore the normal length and shape of the teeth as much as possible and to promote normal occlusion in the process.

A high-speed dental drill is generally used while cutting tools are not recommended because they can cause fractures in the teeth. If needed, extractions of diseased teeth or surgical removal of abscesses can be performed, along with appropriate antibiotic therapy.

Prognosis varies, based on the severity of the disease. Severely overgrown teeth may require multiple treatments are done 1-2 months apart, or even chronic palliative treatments.

To perform safe and effective dental procedures for guinea pigs, it’s important for a veterinarian to gain training and experience, and to have the right tools. Referral to a specialist is a good option, too.

Prevention Is the Best Medicine

Since most dental problems in guinea pigs are related to diet, client education can go a long way toward preventing dental issues in guinea pigs.

Providing instruction on a guinea pig’s dietary requirements is a great step at a new pet visit. Additionally, owners should know to look for anorexia or changes in their pet’s eating habits and to report concerns to their vet right away. 

Quick recognition of a problem could help to catch the issue early, resulting in more timely and effective treatment

Written by: Dr. Tammy Powell, DVM