Effect of various thoracic radiographic projections on the appearance of selected thoracic viscera

OBJECTIVES: To assess the effect of different radiographic projections on thoracic width, as well as position and visibility of the trachea, principal bronchi, cardiac silhouette, aorta, caudal vena cava (CVC) and oesophagus. METHODS: Right lateral recumbency (RLR), left lateral recumbency (LLR), dorsoventral (DV) and ventrodorsal (VD) thoracic radiographs of 42 dogs were reviewed retrospectively. RESULTS: In 78 per cent of cases the thoracic width was significantly larger on the VD projection than on the DV projection. The angle of divergence formed by the principal bronchi was significantly larger on the VD projection than on the DV projection in 80 per cent of dogs. A cardiac silhouette bulge at 1 to 2 o'clock was apparent on the VD projection in 22 per cent of dogs but was never seen on DV projections. The descending aorta was more visible at the 4 to 5 o'clock cardiac silhouette level on the DV projection and laterally at the T8 level on LLR projections. The CVC was better seen on VD and LLR projections. The oesophagus was visible as a soft tissue opacity in LLR in large dogs with normal thoracic conformation in 35 per cent of cases. CLINICAL SIGNIFICANCE: The DV projection appears to be more reliable for assessing the cardiac silhouette, the descending aorta and the angle of divergence of the principal bronchi. The VD projection should be considered for evaluating the CVC. LLR should be used for assessing the descending aorta and CVC.     

Radiographic measurement of vertebral heart size in healthy stray cats

The aims of this study were to determine vertebral heart size (VHS) in stray cats and to compare different radiographic views. This study was performed on 50 adult stray cats. All cats were short-haired and non-obese and were considered to be healthy based on physical examination and electrocardiography. Left and right lateral, dorsoventral and ventrodorsal radiographs were taken. The long and short axes of the heart were measured in millimetres. The thoracic vertebral length spanned by each dimension was measured caudally from the fourth thoracic vertebra. Mean+/-SD and the correlation coefficient between the measurements were calculated with standard statistical software. The sum of the long and short axes of the heart expressed as VHS was 7.3+/-0.49 vertebrae in right lateral, 7.3+/-0.55 vertebrae in left lateral, 7.5+/-0.68 vertebrae in dorsoventral and 7.5+/-0.53 vertebrae in ventrodorsal. The differences between right and left lateral as well as dorsoventral and ventrodorsal views were not significant (P>0.05). Absolute measurements and vertebral heart scale values were slightly smaller than those reported in the literature for mixed population of cats. It is, therefore, important to take the breed in to account.     

A VALENTINE‐SHAPED CARDIAC SILHOUETTE IN FELINE THORACIC RADIOGRAPHS IS PRIMARILY DUE TO LEFT ATRIAL ENLARGEMENT

Conflicting information has been published regarding the cause of a valentine‐shaped cardiac silhouette in dorsoventral or ventrodorsal thoracic radiographs in cats. The purpose of this retrospective, cross‐sectional study was to test the hypothesis that the valentine shape is primarily due to left atrial enlargement. Images for cats with a radiographic valentine‐shaped cardiac silhouette and full echocardiography examination were retrieved and independently reviewed. A subjective scoring system was used to record severity of radiographic valentine shape. Subjective radiographic evidence of left atrial enlargement in a radiographic lateral projection and a final diagnosis based on medical records were also recorded. A total of 81 cats met inclusion criteria. There was a strong positive correlation (P < 0.001) between echocardiographic left atrial size and severity of radiographic valentine shape. There was no effect of echocardiographic right atrial size on the severity of valentine shape, except when concurrent with severe left atrial enlargement. In this situation, right atrial enlargement increased the likelihood of observing a severe valentine shape. There was no effect of right atrial enlargement on the shape of the cardiac silhouette when left atrial enlargement was absent or only mild to moderate. There was no correlation between the category of final diagnosis of cardiac disease and the severity of valentine shape. Findings from this study supported the hypothesis that a valentine‐shaped cardiac silhouette in radiographs is due primarily to left atrial enlargement in cats, with right atrial enlargement only impacting the shape if concurrent with severe left atrial enlargement.     

VERTEBRAL HEART SIZE RANGES SPECIFIC FOR WHIPPETS

To assess the influence of breed, breeding lines, and training on heart size, the vertebral heart size (VHS) was evaluated on left-to-right lateral, right-to-left lateral, dorsoventral, and ventrodorsal thoracic radiographs from 44 whippets free from cardiac and pulmonary disease. In lateral views, the VHS was 11.0 +/- 0.5 vertebrae (mean +/- SD) on right-to-left lateral and 11.3 +/- 0.5 vertebrae on left-to-right lateral radiographs, being larger than the 9.7 +/- 0.5 vertebrae proposed by Buchanan (P<0.0001). The VHS on left-to-right lateral views was larger than on right-to-left lateral views (P<0.0001). The VHS was 10.5 +/- 0.6 vertebrae on dorsoventral radiographs and 11.1 +/- 0.6 vertebrae on ventrodorsal radiographs. Both values were larger than the 10.2 +/- 1.5 vertebrae (dorsoventral) (P<0.0082) or 10.2 +/- 0.8 vertebrae (ventrodorsal) (P<0.0001) proposed by Buchanan. In addition, the VHS on ventrodorsal views was larger than on dorsoventral views (P<0.0001). Dogs out of racing pedigree lines had a significantly larger VHS than those out of show pedigree lines, and trained dogs had a significantly larger VHS than nontrained dogs. Because most trained dogs came out of racing pedigree lines, and all nontrained dogs came out of show pedigree lines, however, it is difficult to determine whether the higher VHS for trained dogs is due to genetic influences or training, or both. In conclusion, it is important to take into account the breed and the radiographic view when evaluating heart size in thoracic radiographs of whippets to avoid overinterpretation of cardiac enlargement in these dogs.     

Radiographic evaluation of cardiac size in flying fox species (Pteropus rodricensis, P. hypomelanus, and P. vampyrus).

Dilated cardiomyopathy is a relatively common pathology in captive flying foxes (Pteropus spp.). The goal of this study was to establish quantitative reference range measurements that could be used to support a diagnosis of cardiac disease in these animals. Lateral and ventrodorsal thoracic radiographs from apparently healthy flying foxes (n = 66) of three species (Rodriguez island flying fox, P. rodricensis, n = 18; small island flying fox, P. hypomelanus, n = 16; and Malaysian flying fox, P. vampyrus, n = 32) were evaluated objectively to describe the cardiac appearance. Absolute and relative cardiac dimensions also were measured. The same methods were used to evaluate radiographs from flying foxes (n = 9) with known dilated or acute cardiomyopathy. The following ratios were most appropriate for categorizing normal cardiac silhouette size. In the ventrodorsal projection, heart width to thoracic width and heart width to clavicle length were the preferred measurements. In the lateral projection, heart width compared with thoracic height was the preferred measurement. From radiographs of the bats with known dilated and acute cardiomyopathy, the apicobasilar heart length compared with thoracic height and heart width compared with thoracic height on lateral films were the most sensitive ratios for diagnosing cardiomegaly.     

Vertebral heart size in healthy Australian cattle dog

The vertebral heart score or size (VHS) measurement is routinely used to provide a more objective measurement of cardiomegaly in dogs. However, breed or body conformation can influence the VHS. To assess the specific VHS for the Australian Cattle Dog, left‐to‐right lateral, right‐to‐left lateral, dorsoventral and ventrodorsal thoracic radiographs from 20 individuals free from cardiac and pulmonary disease were obtained. The mean VHS was significantly higher in Australian Cattle Dog (10.5 ± 0.4 vertebrae), when compared with the average VHS for 100 normal dogs of different breeds that had been initially published (9.7 ± 0.5 vertebrae). This emphasizes the importance of breed‐specific VHS ranges. In our study group of normal Australian Cattle Dogs, the mean VHS was 10.5 ± 0.5 vertebrae (mean ±SD) on right lateral and 10.3 ± 0.5 vertebrae on left lateral radiographs. The VHS on right lateral views was significantly larger than on left lateral views. The VHS was 10.5 ± 0.6 vertebrae on dorsoventral and 11.1 ± 0.6 vertebrae on ventrodorsal radiographs. The VHS on ventrodorsal views was significantly larger than on dorsoventral views.     

EVALUATION OF TRADITIONAL AND NOVEL RADIOGRAPHIC VERTEBRAL RATIOS IN GREAT DANES WITH VERSUS WITHOUT CERVICAL SPONDYLOMYELOPATHY

Great Danes are predisposed to osseous‐associated cervical spondylomyelopathy (Wobbler syndrome). The first aim of this prospective study was to compare values measured using previously published intravertebral and intervertebral ratio methods and a novel ventrodorsal ratio method in radiographs of clinically normal and affected Great Danes. The second aim was to determine whether these ratios could be used as predictors of sites of spinal cord compression based on magnetic resonance imaging (MRI). Thirty dogs (15 normal, 15 affected) were prospectively enrolled. Lateral and ventrodorsal radiographs were obtained and six measurements were recorded from C3‐T1. For each vertebral location, intravertebral ratios and intervertebral ratios were calculated from lateral views, and the ratio of the distance between the articular process joints vs. vertebral body width (novel ventrodorsal ratio) was calculated from ventrodorsal views. Values for these three ratios were compared, by vertebral location and dog group. Intravertebral and intervertebral ratios did not differ between dog groups. The ventrodorsal ratio was significantly smaller in affected Great Danes at C5–6 (P = 0.005) and C6–7 (P < 0.001). The ventrodorsal ratio was significantly associated with MRI presence of spinal cord compression. For each 0.1 unit increase in this ratio value, there was a 65% decrease in the odds of spinal cord compression being present at that site, independent of vertebral location (P = 0.002). Findings from this study supported use of the novel ventrodorsal ratio as an initial radiographic screening method for Great Danes with suspected cervical spondylomyelopathy.     

RADIOGRAPHIC MEASUREMENT OF CARDIAC SIZE IN NORMAL FERRETS

Right lateral, left lateral and ventrodorsal radiographs were obtained in 20 normal ferrets (11 male). Three independent observers recorded measurements of the cardiac silhouette and results for each parameter were averaged. Long axis (length), short axis (width) and total of length plus width (L+W) were recorded in each view. Comparative measurements were calculated, including the ratio of L+W/length of thoracic vertebrae 5-8, and a modified vertebral heart score (VHS) method, measuring the heart in vertebral units. Measurements made in ventrodorsal views were usually larger than corresponding measurements in lateral views. Weight and most absolute measurements differed significantly between male and female ferret (P<0.05), but the differences in absolute measurements were not apparent when related to measures of body size (Ratio and modified VHS methods). Given the variability in body weight and size in ferrets, measurements of the cardiac silhouette normalized for body size may be more universally applicable than absolute measurements.     

Measurement of the cardiac silhouette in psittacines

OBJECTIVE: To determine reference values for size of the radiographic cardiac silhouette in healthy adult medium-sized psittacines. DESIGN: Prospective case series. ANIMALS: 46 African grey parrots (Psittacus erythacus), 7 Senegal parrots (Poicephalus senegalis), and 6 orange-winged Amazon parrots (Amazona amazonica). PROCEDURE: Birds were anesthetized, and ventrodorsal radiographic projections were obtained. Maximum width of the cardiac silhouette, width of the thorax at the level of the maximum width of the cardiac silhouette, and width of the coracoid were measured on the radiographs. Sternum length was directly measured on individual birds. Results of physical examination, electrocardiography, and echocardiography were normal in all birds. RESULTS: Mean cardiac silhouette width-to-sternum length ratio was 38%, mean cardiac silhouette width-to-thorax width ratio was 55%, and mean cardiac silhouette width-to-coracoid width ratio was 600%. Width of the cardiac silhouette was strongly correlated with length of the sternum, width of the coracoid, and width of the thorax. No significant differences between species were detected. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that in healthy adult medium-sized psittacines, the cardiac silhouette on a ventrodorsal radiographic projection should be 35 to 41 % of the length of the sternum, 51 to 61 % of the width of the thorax, and 545 to 672% of the width of the coracoid.     

RADIOGRAPHIC AND ECHOCARDIOGRAPHIC MEASUREMENT OF THE HEART IN OBESE CATS

A prospective study was undertaken to reconcile radiographic cardiomegaly and normal echocardiography in obese cats and to test a radiographic technique for better distinguishing between pericardial fat and the heart. Ten obese, but otherwise normal cats and 10 non-obese normal cats were used. A body condition scoring system was used to objectively group obese and non-obese normal cats. Two-dimensional echocardiograms were made to verify that all cats had a normal heart. Thoracic radiographs then were made using standard and altered exposure techniques. The hearts were measured on these radiographs using the metric and a vertebral scale system. Obese cats consistently had excessive fat around the heart especially if they also had a large amount of falciform fat. Altering exposure technique by increasing mAs and decreasing kVp sometimes enhanced the radiographic contrast between fat and myocardium. Enhanced radiographic contrast accentuated the double silhouette identifying the true cardiac silhouette within the fat expanded silhouette. Pericardial fat usually was distinguished more readily in lateral than in VD radiographs. In two cats, pericardial fat had a characteristic prominent square corner to the right cranial margin of the cardiac silhouette in VD radiographs. Obesity caused increased width and depth of the thoracic cage. 2D echocardiograms revealed normal cardiac dimensions in both groups of cats and increased precordial distance in the obese group.     

CARDIAC AND PULMONARY ARTERY MENSURATION IN FELINE HEARTWORM DISEASE

A retrospective study was undertaken to quantify thoracic radiographic changes in cats with heartworm diseases, ( Dirofilaria immitis ). Using a blinded study format, the cardiac silhouette, thoracic cavity and pulmonary arteries were measured from thoracic radiographs of 21 cats with feline heartworm disease and 30 cats without known cardiac or pulmonary vessel pathology. Measured data were normalized to the thoracic cavity or bony structures within the radiographic field of view. The measurements were compared between the two groups of cats using an unpaired, two-tailed Student's t -test, with a p value of < 0.05 being considered significant. Cats with feline heartworm disease had enlargement of the craniocaudal aspect of the cardiac silhouette and normalized cardiac:thoracic ratio (p < 0.05) on the lateral view. Also, there was significant enlargement of the central and peripheral caudal lobar pulmonary arteries and their normalized ratios (p < 0.05) in the heartworm infected cats as visualized on the ventrodorsal projection. Tortuosity of the pulmonary arteries was seen in three of the 21 infected cats. Eleven of the 21 cats with feline heartworm disease had pulmonary parenchymal changes. Based on the present study, central and peripheral pulmonary artery enlargement as viewed on the ventrodorsal radiograph was the single best radiographic indicator of feline heartworm disease.     

Assessment of the value of the vertebral heart scale in the radiographic diagnosis of cardiac disease in dogs

In order to assess the influence of the vertebral heart scale (VHS) on the accuracy of the radiographic diagnosis of cardiac disease, thoracic radiographs of 50 dogs with proven cardiac disease, 26 with other thoracic diseases, and 50 with no clinical signs of cardiovascular or respiratory disease were mixed and examined by three independent, blinded observers chosen to represent a range of radiographic abilities. They first examined all the radiographs without making measurements of VHS and made a diagnosis. They then re-examined the radiographs, and measured VHS on both lateral and dorsoventral or ventrodorsal radiographs before again recording a diagnosis without reference to their original diagnoses. For all the observers, the dogs with cardiac disease had a higher mean VHS than the normal dogs. A VHS over 10.7 on the lateral radiograph was a moderately accurate sign of cardiac disease. The observers' accuracy of diagnosis did not change significantly as a result of using VHS as an adjunct to a subjective assessment of the radiographs.     

Cardiac measurements on thoracic radiographs of cats

Measurements of the heart and thorax were made on lateral and ventrodorsal thoracic radiographs of normal cats. The degree of correlation between selected cardiac and thoracic measurements was determined. Absolute measurements and ratios of measurements in normal cats and in cats with certain cardiac diseases were compared and their diagnostic value was evaluated. It was concluded that on the lateral thoracic radiograph the ratio of the cranio-caudal width of the heart to the distance between the cranial border of the fifth rib and the caudal border of the seventh rib was a highly reliable indicator of cardiac enlargement. On the ventro-dorsal radiograph the ratio of the maxium width of heart to the width of the thorax at the same level was the best indicator of increases in cardiac size.     

INITIAL INFLUENCE OF RIGHT VERSUS LEFT LATERAL RECUMBENCY ON THE RADIOGRAPHIC FINDING OF DUODENAL GAS ON SUBSEQUENT SURVEY VENTRODORSAL PROJECTIONS OF THE CANINE ABDOMEN

Identification of the duodenum and potential abnormalities on survey abdominal radiographs is often difficult unless it contains gas. This study investigated the effect of patient positioning on the presence of duodenal gas in survey abdominal radiographs. One hundred dogs receiving a three‐view survey abdominal radiographic study were enrolled in a prospective, randomized study where all dogs were divided into two groups. Group A (n = 51) dogs had a left lateral projection first, followed by a ventrodorsal projection, ending with a right lateral projection. Group B (n = 49) dogs had a right lateral projection first, followed by a ventrodorsal projection, ending with a left lateral projection. The presence of gas within the duodenum and level of distribution of gas throughout the duodenum were recorded for all three projections. In addition, the presence or absence of duodenal pseudoulcers was evaluated on all three projections for each dog. The results for the two groups were compared using Chi‐square analysis with a P‐value of less than 0.05 being considered significant. Results showed that dogs first placed in left lateral recumbency were significantly more likely to have duodenal gas on the subsequent ventrodorsal and right lateral radiographic projections compared to dogs first placed in right lateral recumbency (P‐value < 0.0001). Pseudoulcers were seen in 11 dogs that had duodenal gas making the visualization of pseudoulcers on survey abdominal radiographs somewhat commonplace. This study emphasizes the benefit of using initial left lateral abdominal projections prior to other views for subsequent evaluation of the duodenum.     

Vertebral scale system to measure heart size in radiographs of cats

OBJECTIVE: To determine absolute and relative heart size in clinically normal cats by correlating heart size and selected skeletal structures. DESIGN: Prospective radiographic study. ANIMALS: 100 cats that did not have thoracic radiographic abnormalities. PROCEDURE: Standardized measurements of the long and short axes of the heart, midthoracic vertebrae, and other structures were made. Measurements were recorded in millimeters and number of thoracic vertebral lengths spanned by each dimension, measured caudally from T4 in a lateral radiograph. The long- and short-axis measurements of the heart, expressed in vertebral lengths, were added to yield vertebral heart size. RESULTS: Mean +/- SD vertebral heart size in lateral radiographs was 7.5 +/- 0.3 vertebrae. The long-axis dimension correlated with the length of 3 sternebrae, measured from S2 to S4. The cardiac short-axis dimension correlated moderately with the length of 3.2 vertebrae, measured from T4 to T6. The cardiac short-axis dimension in ventrodorsal radiographs was 3.4 +/- 0.25 vertebrae. CONCLUSIONS AND CLINICAL RELEVANCE: The vertebral heart-size method is easy to use, allows objective assessment of heart size, and may be helpful in determining cardiomegaly and comparing heart size in sequential radiographs.     

Accuracy of the modified vertebral heart score and the cardio-vertebral ratio for radiographic evaluation of cardiomegaly in ferrets

Thoracic radiography is commonly used to assess the size of the heart and diagnose cardiac disease in ferrets. Several standardized radiographic heart size indicators have been introduced in this species and values in healthy ferrets have been reported. To date, none of these indicators has been tested in ferrets with cardiac disease. The aim of this prospective and retrospective, analytical observational design study was to assess the accuracy of the modified vertebral heart score (mVHS) and the cardio-vertebral ratio (CVR) in the radiographic detection of cardiomegaly in ferrets. Thoracic radiographs of 24 ferrets with confirmed heart diseases, 22 ferrets with non-cardiac diseases and normal-sized hearts on echocardiogram, and 24 healthy ferrets were mixed and examined by three independent and blinded radiologists who measured mVHS and CVR in right lateral (RL) and ventrodorsal (VD) radiographs. For all readers, ferrets with cardiac disease had significantly higher mVHS and CVR than ferrets without cardiac disease on echocardiography. Optimal cut-points for predicting cardiac enlargement were 6.25 vertebrae and 7.25 vertebrae for RL-mVHS and VD-mVHS, and 1.58 and 1.80 for RL-CVR and VD-CVR, respectively. Using these cut-points, the accuracy was good for indicators measured in RL radiographs (92.9% for RL-mVHS; 91.4% for RL-CVR) and moderate for indicators measured in VD radiographs (88.6% for VD-mVHS; 85.7% for VD-CVR). Findings supported the use of mVHS and CVR for evaluating the size of the heart in diseased ferrets, with caution in values interpretation when pericardial fat prevents precise delineation of the cardiac silhouette contour especially on VD radiographs.     

DETECTION OF PNEUMOTHORAX AND PLEURAL EFFUSION WITH HORIZONTAL BEAM RADIOGRAPHY

Forty‐seven patients with a known history of thoracic trauma or clinical suspicion of pneumothorax were selected for thoracic imaging. The patient population was composed of 42 dogs and five cats. Standard vertical beam (VB) left and right lateral and ventrodorsal/dorsoventral (VD/DV) projections were obtained for each patient, and at least one horizontal beam (HB) projection (VD projection made in lateral recumbency). A total of 240 images were reviewed. Subjective assessment for the presence and degree of pneumothorax and pleural effusion was made more confidently with HB projections. Pneumothorax was identified in at least one projection in 26 patients (26 dogs) and pleural effusion in 21 patients (19 dogs and two cats). Pneumothorax and pleural effusion were present concurrently in 17 dogs. Pneumothorax and pleural effusion were graded for each image as absent, mild, moderate, or severe. Right (P<0.001) and left (P<0.05) lateral HB VD projections and the standard VB left lateral projection (P<0.05) were significantly more likely to detect and grade pneumothorax severely than the VB VD/DV views. The right lateral HB projection had the highest rate of detection and gradation of severity for pneumothorax compared with other views. VD/DV projections had the lowest sensitivity for detection of the pneumothorax and gradation of severity for pneumothorax and pleural effusion. No significant difference in diagnosis (P=0.9149) and grade (P=0.7757) of pleural effusion were seen between views, although the left lateral HB had both the highest rate of detection and grade of severity.     

EFFECTS OF INTRAVENOUS DEXMEDETOMIDINE ON CARDIAC CHARACTERISTICS MEASURED USING RADIOGRAPHY AND ECHOCARDIOGRAPHY IN SIX HEALTHY DOGS

Dexmedetomidine is a highly specific and selective α2‐adrenergic receptor agonist widely used in dogs for sedation or analgesia. We hypothesized that dexmedetomidine may cause significant changes in radiographic and echocardiographic measurements. The objective of this prospective cross‐sectional study was to test this hypothesis in a sample of six healthy dogs. Staff‐owned dogs were recruited and received a single dose of dexmedetomidine 250 μg/m² intravenously. Thoracic radiography and echocardiography were performed 1 h before treatment, and repeated 10 and 30 min after treatment, respectively. One observer recorded cardiac measurements from radiographs and another observer recorded echocardiographic measurements. Vertebral heart score and cardiac size to thorax ratio on the ventrodorsal projection increased from 9.8 ± 0.6 v to 10.3 ± 0.7 v (P = 0.0007) and 0.61 ± 0.04 to 0.68 ± 0.03 (P = 0.0109), respectively. E point‐to‐septal separation and left ventricle internal diameter in diastole and systole increased from 2.4 ± 1.1 to 6.6 ± 1.9 mm, 32.3 ± 8.1 to 35.5 ± 8.8 mm, and 19.4 ± 6 to 27.0 ± 7.2 mm, respectively (P < 0.05). Fractional shortening and sphericity index decreased from 40.7 ± 5.8 to 24.4 ± 2.9%, and 1.81 ± 0.07 to 1.58 ± 0.04, respectively (P < 0.05). Moderate‐to‐severe mitral regurgitation and mild pulmonic regurgitation occurred in all dogs after dexmedetomidine administration. Findings indicated that dexmedetomidine could cause false‐positive diagnoses of valvular regurgitation and cardiomegaly in dogs undergoing thoracic radiography and echocardiography.     

Radiographic and electrocardiographic evaluation of cardiac morphology and function in captive cheetahs (Acinonyx jubatus).

In a prospective study, eight (four males and four females) healthy, adult captive cheetahs (Acinonyx jubatus) were immobilized with a combination of tiletamine-zolazepam (4 mg/kg, i.m.), administered with a remote drug delivery system, to define normal cardiac morphology and function. Standard lateral and ventrodorsal (VD) radiographs were then taken to measure heart and thorax using a metric and vertebral scale system. Standard six-lead electrocardiograms were obtained with the animals in right lateral recumbency under isoflurane anesthesia. Mean chest depth and width was 18.7 +/- 1.3 cm and 13.0 +/- 0.6 cm, respectively. The mean lateral cardiac short axis (X) was 9.1 +/- 0.6 cm. the mean cardiac long axis (Y) was 13.6 +/- 0.7 cm, and the mean lateral heart sum (X + Y) was 22.6 +/- 1.2 cm. In the VD projection, mean cardiac short axis (V) was 10.1 +/- 0.7 cm, mean cardiac long axis (W) was 14.9 +/- 1.2 cm, and the heart sum (V + W) was 24.9 +/- 1.8 cm. The vertebral heart size was 8.2 +/- 0.9. All cheetahs had sinus rhythm, and no arrhythmias were noted. Mean heart rate was 126 +/- 15 beats/min, and the mean electrical axis was 82 + 5 degrees. P waves were always positive on lead II and had a width of 0.04 +/- 0.01 sec and a height between 0.1 and 0.3 mV. PR intervals were 0.11 +/- 0.01 sec. The height of the QRS complex was 1.25 +/- 0.24 mV and the width 0.06 +/- 0.01 sec. The ST segment was 0.04 sec, and the T wave (height: 0.25 +/- 0.05 mV) was positive in all cheetahs examined. Although these cardiac and thoracic measurements were larger than those of domestic cats (Felis catus), ratios of cardiac parameters were similar in both species. Electrocardiographic findings were similar to those reported from domestic cats.     

DOES CHANGING THE ORIENTATION OF A THORACIC RADIOGRAPH AID DIAGNOSIS OF RIB FRACTURES?

To test the hypothesis that changing the orientation of a thoracic radiograph aids diagnosis of rib fractures, a case–control study was carried out using 120 radiographs of small animal patients with recent thoracic trauma. Six independent observers representing three levels of experience viewed the radiographs in randomized order in conventional and unconventional orientations at 15‐s intervals in a PowerPoint^® presentation. Sensitivity for rib fractures was 53–69% and specificity was 74–97%, depending on the observer. Radiologists had higher specificity than less experienced observers (P=0.0001), but comparable sensitivity for rib fractures. Radiologists had significantly higher accuracy than residents (P=0.03), and residents had higher accuracy than interns (P=0.02). Accuracy of diagnosis was reduced significantly when based on lateral radiographs compared with dorsoventral (DV)/ventrodorsal (VD) views (P=0.02) mainly because of low sensitivity of lateral radiographs of dogs with rib fractures. Rotating radiographs 90° clockwise was associated with increased specificity of one intern (from 74 to 90%, P=0.03), but had no effect on accuracy of diagnosis by other observers (P>0.16). Turning DV/VD views upside down had no effect on accuracy of diagnosis of any observers (P>0.40). Changing the orientation of a thoracic radiograph may make it easier for some novices to examine the ribs; hence it could be considered a training aid rather than a technique that will benefit an experienced radiologist.