Imaging Vets

10/07/2024

Why is feline pulmonary cardiogenic oedema difficult to assess on radiographs?
Well…. it can have a quite a variable appearance and this complicates its radiographic diagnosis.

• In a study, by Benigni et al in 23 cats, cariogenic pulmonary oedema was characterised radiographically by an increased pulmonary radiopacity associated with a range of patterns and variable distribution (Journal of Small Animal Practice (2009) 50, 9–14.DOI: 10.1111/j.1748-5827.2008.00655).

What they found:
•Increased Opacity:
Radiographically, there was a notable increase in lung opacity, often presenting with a reticular or granular interstitial pattern. This opacity can also include alveolar patterns, sometimes with air bronchograms, and an enlarged diameter of pulmonary vessels.
•Distribution VariabilityThe distribution of pulmonary oedema varies significantly:
>It was diffuse/non-uniform in about 61% of cases.
>Diffuse/uniform in approximately 17% of cases.
> Multi-focal in 17% of cases, and focal in the remaining 4%.
•Regional Differences: About 39% of cats exhibited regional distribution, with examples like ventral, caudal, or hilar distributions.
•Symmetry: Bilateral symmetry of pulmonary opacities was noted in only 22% of cats.

Cardiogenic pulmonary oedema cases are the cases that you don’t want to stress at all, and echocardiographic LA: Ao ratio may be used to confirm cardiac aetiology. Depending on your degree of suspicion, some clinicians may start a treatment trial with frusemide and repeat the thoracic radiographs in 24 hours to assess the lungs again.

Happier Imaging
Dr Hoff

19/07/2023

Just a quick note from IVRA Dublin 2023

You probably already know that transitional lumbosacral vertebrae (TV) of the dog are classified into 4 types:
Type 0 - normal;
Type 1 - absent fusion of sacral spinal processes;
Type 2 - isolated lumbar vertebra within the pelvic girdle;
Type 3 - partial fusion of one or both transverse processes with iliac bones.

At IVRA 2023 an abstract presented by Prüllage, Folertsma and Kneissl from Vetmeduni, Vienna, Austria looked at ….
DO DOGS WITH LUMBOSACRAL TRANSITIONAL VERTEBRA HAVE A HIGHER INCIDENCE OF LUMBOSACRAL STENOSIS?
It was a retrospective study to describe potential differences in the incidence of lumbosacral disc herniation or foraminal stenosis in dogs with different types of TV.

Over 100 dogs were reviewed and more than half had TV most commonly at L8 vertebra
They found that dogs with a TV type 3 are more likely to have lumbosacral stenosis, either in the shape of lumbosacral disc herniation or foraminal stenosis.

Happy Imaging.

21/03/2022

14/02/2022

Happy Valentine's Day to everyone.......

Heart shapes can appear in the strangest places 😍 even in the cauda equina

24/10/2021

Neoplasia of the musculoskeletal system is rare in horses.
Let's think about the cervical region. Rare but reported neoplasia includes undifferentiated sarcomas, haemangiosarcoma vertebral angiosarcoma, fibrosarcoma and melanoma. Osteochondromas are benign slowly progressive masses most commonly recognised in the caudal distal radius of horses but have also been reported in the cervical region (Dixon and Anderson (2019)

https://doi-org.ezproxy.library.sydney.edu.au/10.1111/eve.13183

Happy imaging
Dr Hoff

24/07/2021

Do you see pocket pets? ...

Dilated cardiomyopathy is common in rats.
Thoracic radiographs are easier to perform than echocardiography and are also more cost-effective.

In a recent study in VRUS by Dias et al. (2021), the vertebral heart score in rats was performed on 124 adult rats.

The normal range for each view was .....
Right Lateral - VHS mean was 7.7 and range 7.0–8.5,
Ventrodorsal - VHS mean was 7.5 and range 6.6–8.6
Dorsoventral - VHS mean was 7.9 and range 6.9–9.0

And VHS values were greater in males than in females.

This may come in handy for some of you

Happy Imaging
Dr Hoff.

09/06/2021

What is the difference between a Radiographer and a Radiologist in the Veterinary sphere?

In the veterinary field there is some confusion about who does what, so from the point of Diagnostic Imaging here are some of the basics.

Radiographers are usually science-trained professionals who take medical images (Radiographs, NM, CT, or MRI) to assist veterinarians in diagnosing diseases and injuries. They are also known as medical imagers.

What is the difference between a Radiographer and a Radiologist in the Veterinary sphere? Generally, a radiographer is a person who can perform the study or who works with the radiologist to get perfect images and optimise the positioning and settings to help get the best image. They do not interpret the images.

Radiographers complete a university bachelor's degree in medical imaging medical /radiation science or technology which can take 3 or 4 years. This is the amount of training needed to deeply understand the technology to enable the technologist to perform expert studies for then presenting to the radiologist for diagnostic interpretation.

Many general veterinary practitioners will perform some studies themselves and these understandably may not be able to be performed with the same level of expertise and consistency as those who have been trained over years in the technology. Technologists are always trying to improve their image quality.

For example, see the image below. The left side of the image is an elbow image from a GP clinic and the right image is an elbow image performed by a radiographer/radiologist team. There is some pathology that may not be identified with the first technique eg MCP fissures.

Veterinary Radiologists are veterinarians that are trained to interpret and perform veterinary medical imaging tests. They diagnose pathology using radiographs, ultrasound, CT, MRI, and other imaging technology.

Veterinary Radiologists first had to qualify as veterinarians ( 4-5 year degrees) and then work for years in clinics, then they went back to further education to complete 3-5 years residency training in veterinary diagnostic imaging. When they have reached a level of expertise in veterinary imaging they are externally tested under exam conditions They are sometimes called Diplomates or Fellows of the particular veterinary college that examined them for that qualification. Sometimes specialists may also say they are “boarded in veterinary imaging” meaning that they have passed the veterinary imaging board examinations.

I hope that this helps understand who we are! 🦴

Happy Imaging

Dr Hoff

14/02/2021

Radiologists can have some fun looking for heart shapes everyday.
Today we can share ❤️with you.

Happy Valentines Day
Dr Hoff

27/01/2021

What is carcinomatosis and sarcomatosis?

Carcinomatosis is when there is disseminated spread of malignant epithelial cells within body cavities. And sarcomatosis when there is disseminated spread of malignant mesenchymal cells within body cavities.

Can you tell if it is a sarcomatosis or a carcinomatosis by its imaging characteristics?

In a recent publication in VRUS (2021:1-11), the imaging characteristics of both CT and ultrasound characteristics were evaluated retrospectively in 21 dogs and 10 cats.
There is a large degree of overlap between the appearance of carcinomatosis and sarcomatosis as would be expected.

Although not significantly different, the sarcomatosis was more likely to have defined nodules with strong heterogeneous contrast enhancement and the canine patients has higher body weights.

Whereas, the carcinomas had more poorly defined soft tissue nodules with a more uniform contrast enhancement. Dogs with carcinomatosis are likely to have abdominal pain and cats has clinical signs of inappetence.

Due to the overlapping signs, cytological or histopathological a**lysis remains necessary for a definitive diagnosis of sarcomatosis and carcinomatosis in our patients. And of course there are other causes to exclude such as inflammatory or infectious diseases.

Happy Imaging
Dr Hoff

13/12/2020

A firm bump in the skull base worthy of investigation!

Here is a case with a multilobular tumour of bone in a middle aged Border Collie who presented to their veterinarian after falling over.
The brain compression of some calvarial tumours such as the multilobular tumour of bone can be surprising.

These multilobar tumours of bone…..
🦴arise from flat bones of skull and like occipital bone
🦴 partially mineralised and well delineated mass
🦴 relatively slow growing
🦴 take the path of least resistance
🦴 can destroy bone and the transverse sinus and central sagittal sinus obliterated in some cases
🦴 may require both CT and MRI in cases prior to surgery
🦴 recurrence at the site of surgical excision is common and usually follows incomplete surgical excision.

Early Imaging can be helpful
Dr Hoff

10/11/2020

Do you want to be able to more confidentially identify the complex radiographic anatomy of the equine distal tibia?

Superimposition and radiographic similarities between the different osseous structures of the equine distal tibia can make it difficult for anatomic localization of pathology.
The lateral malleolus is composed of cranial and caudal protuberances, the medial malleolus is a simple rounded protuberance with discrete margins
The intermediate cochlear ridge of the distal tibia extends in a craniolateral to caudomedial direction, with its cranial protuberance largely superimposed with the calcaneus and talus on the dorsoplantar view.
The recent journal article ( Huget et al, Vet Radiol Ultrasound. 2020;61:497–506) will give you a great opportunity to learn and review the anatomy so that you may more readily identified pathology.

Happy Imaging
Dr Hoff

25/10/2020

No matter what species you work with you can use high resolution ultrasound to run along rib surfaces to check rib fractures.
This is great when you are out of your clinic looking at horses, foals, farm animals etc and X-rays are not easily performed or available. ... Even when you are in the clinic with dogs and cats it is also a way of double checking any rib(s) that you are not sure about on physical examination or radiographs.
Happy imaging
Dr Hoff

06/10/2020

Do you have trouble remembering the types of growth plate fractures using the SALTER - HARRIS classification ?
Try this ……

S…Straight = Type 1
A…Above = Type 2
L… Lower = Type 3
T…Through = Type 4
E….
R …Rammed or cRushed = Type 5

Happing Imaging
Dr Hoff

27/09/2020

In a recent journal article on the comparison of methods to measure a**l gland neoplasia in dogs in 107 dogs ........
......... a**l gland tumours >2.5 cm (tumour-stage 2) were significantly more likely to present with metastatic disease.

J Small Anim Pract. 2020 Mar;61(3):185-189. doi: 10.1111/jsap.13104. Epub 2020 Jan 20

07/08/2020

As restrictions change across our country, we remind all of our Imaging Vets family not to become complacent and to continue to follow social distancing rules as our new normal even when working.....

In stables we have more room but when using most veterinary imaging rooms we are in close quarters, so what do we do?...

• Both veterinarians and nursing staff are to wear masks and or face shields when we have to work closer than 1.5 meters.
• Sedation of the patient when it is possible to minimise the number of people need to restrain the patient.
• We minimise the number of people in the rooms so we do not have owners or observers in the room.
• Minimise any discussion in close quarters and particularly if there is poor airflow within the rooms

Keep safe,
Happy imaging,
Dr Hoff

23/07/2020

Errors in radiology are inevitable as they are in all human endeavours.
As veterinarians, we are not infallible; we are human and we can all make mistakes.
That is why we work as a team, no result of any tests (even physical examination results), are taken in isolation and everyone one helps each other to get the best results.

The “ average” error rate is radiology is about 30—40%.
Quality of the study, interpretation fatigue, failure to detect, over reading and under reading, inexperience, faulty reasoning, incorrect diagnosis and poor communication are some of the errors.

Rates of lesion detection improve with pertinent clinical data by the primary clinician. As many veterinarians have their technical staff fill in the history to send with the images, layers of information may not be passed on about the case and that can lead to misdirection about a case.

Factors such as fatigue, distraction and bias can contribute to these errors and the increasing volume and complexity of CT and MRI studies increased this type of error.

Most veterinary CT studies have been less < 2,500 Images. A large dataset is considered up to 4,000 images. Recently the study sizes have continued to creep in size and we have seen datasets from some clinics with new CT machines and inexperienced staff that can reach 6-8,000 and even up to 12,000 images. If you spent 2 sec per image on a study of this size would take 6.66 hours to scroll through alone without any dwell time or time for reconstructions. If your radiologist does not know a study of this size is arriving, the time to report on that study will not be anticipated.

By improving the use of imaging protocols and improving consistency in technique by involving skilled radiographers and radiologists in the acquisition of the study, the size of the studies can be optimised, the technical quality of the studies and scheduling for their interpretation while minimising fatigue can improve.

Happier Imaging as a team
Dr Hoff

02/07/2020

What are the non-contrast CT characteristics of melanomas in the equine head?

In non-contrast CT images, all melanomas were HYPERATTENUATING (median; 113.5 HU) compared to masseter musculature (median; 69 HU),

And 25.9% masses were partially mineralized and 19.4% included hypoattenuating areas.

Melanomas were found most frequently in the parotid salivary gland, guttural pouches, surrounding the larynx and pharynx and adjacent to the hyoid apparatus.

Veterinary Radiol Ultrasound, Vol. 57, No. 3, 2016, pp 246–252.

Happy Imaging
Dr Hoff

25/06/2020

RADIOGRAPHY TRAINING TIP:
Improving your images can be as simple as teaching your staff to RESET windowing and level (brightness and contrast) on the radiographs BEFORE saving and ending study and sending it to your server.

It is easy to assume that an adjustment to brightness and contrast prior to sending your images to PACS is doing everyone a favour, but in fact, you may prevent them from seeing anatomical information that was there in the original exposure.

The functionality of your own QC workstation is simply to provide you with an initial quick review, and in the radiologist reading room, there are more image manipulation tools for viewing the images that you sent.

Once you save the altered images to the server you have lost the data from the original image set forever. You don’t want your review of the images to be limited by the previous loss of data

So remember, the more data you save on the original data set, the more you and your radiologist will be able to manipulate the images later.

Happy Imaging
Dr Hoff