INTEROBSERVER AGREEMENT ON THE ASSESSABILITY OF STANDARD VENTRODORSAL HIP-EXTENDED RADIOGRAPHS AND ITS EFFECT ON AGREEMENT IN THE DIAGNOSIS OF CANINE HIP DYSPLASIA AND ON ROUTINE FCI SCORING

Insufficient agreement on scoring hip quality might be caused by differences in the assessability of a radiograph (exposure, contrast, positioning, and diagnostic quality). We studied the agreement in assessability of standard ventrodorsal hip-extended radiographs by experienced (nine) and inexperienced (21) observers, using the standard subjective method of quality control, currently applied in screening programs. The effect of assessability on the agreement of scoring hip quality [dysplastic vs. nondysplastic and the final Federation Cinologique International (FCI) score] was also investigated. There was a significant difference ( P <0.0001) in agreement on assessability between the experienced and inexperienced observers. In 68% of evaluations, experienced observers stated that the radiograph was assessable. Inexperienced observers evaluated the radiographs as being assessable in only 46.5% of evaluations. Increased interobserver agreement on assessability of a radiograph did not increase the overall interobserver agreement in the diagnosis of hip dysplasia, nor did it result in consistent scoring of the hip status from that radiograph, despite a significant ( P <0.05) increase in agreement of FCI scoring with an increasing agreement on assessability at a one to five ratio in the experienced group. The inconsistent evaluation of radiographic quality, as well as the inconsistent evaluation of the hip quality, caused differences in diagnosing hip dysplasia and FCI scoring in the same dog ranging from excellent hips to moderate hip dysplasia. Therefore, the credibility of the FCI screening method for canine hip dysplasia, using the standard hip-extended radiographic view, as currently applied in most European countries, is questionable.     

Interobserver agreement in the diagnosis of canine hip dysplasia using the standard ventrodorsal hip-extended radiographic method

OBJECTIVES: To determine the agreement between observers and to investigate the effect of observer experience in diagnosing canine hip dysplasia and providing final scoring of hips using the standard ventrodorsal hip-extended radiographic method. The agreement of the final scoring, with a presumed correct assessment based on the Norberg angle, is also investigated. METHODS: Thirty observers were requested to read 50 ventrodorsal hip-extended radiographs of 25 dogs according to Federation Cynologique International criteria. Groups of experienced (nine members) and inexperienced (21 members) observers were used. RESULTS: For providing the distinction between dysplastic versus non-dysplastic dogs, the average interobserver agreement was 72 per cent and was significantly higher (P<0.0001) than the score that could be expected by chance without any agreement between observers. For providing the final score (A, B, C, D or E), an average interobserver agreement of 43.6 per cent was found. In the experienced group, an agreement score of 76 per cent was found for the distinction between AB versus non-AB and an agreement score of 81 per cent was found for the distinction between C versus non-C. The agreement score was significantly higher (P<0.0001) for the experienced group than for the inexperienced group in all cases. Agreement between the presumed correct assessment based on the Norberg angle and the observer's evaluation was low (P=0.35), irrespective of whether the observers were experienced (71.8 per cent correct assessments) or inexperienced (69 per cent correct assessments). CLINICAL SIGNIFICANCE: Although interobserver agreement is low, observer experience increases agreement.     

THE EFFECT OF DEXMEDETOMIDINE ON RADIOGRAPHIC CARDIAC SILHOUETTE SIZE IN HEALTHY CATS

Dexmedetomidine, an alpha₂‐adrenergic agonist, may be used in companion animals for chemical restraint, including cardiac evaluation. Echocardiographic changes associated with alpha₂‐adrenergic agonists have been described; however reports of radiographic changes in cats were not found at the time of this study. Aims of this observational, prospective, experimental study were to describe the effects of dexmedetomidine on the radiographic appearance of the cardiac silhouette in healthy, adult cats. Fourteen healthy adult cats received dexmedetomidine 40 mcg/kg IM. Right lateral, left lateral, ventrodorsal, and dorsoventral thoracic radiographs were obtained for each cat at three time points: presedation, intrasedation, and postsedation (≥ two hours after reversal with atipamezole). Radiographs were evaluated in a blinded, randomized fashion by two independent observers using the vertebral heart score on all four views, the number of intercostal spaces on lateral projections, and the percent width of thorax on ventrodorsal and dorsoventral projections. Median vertebral heart score on right lateral view was significantly increased intrasedation (median = 7.8; range = 7.25–8.25) compared to presedation (median = 7.5; range = 7–8 [P = 0.001]). Median percentage width was significantly higher intrasedation (70% on VD; range 65–80 [P = 0.001], and 75% on DV; range 65–80 [P = 0.006]) compared to presedation (65%; range 65–75 on both projections). Dexmedetomidine was associated with a small but significant increase in cardiac silhouette size on right lateral (vertebral heart score), ventrodorsal (percentage width), and dorsoventral (percentage width) radiographs in healthy adult cats. This effect should be taken into consideration for future interpretation of thoracic radiographs in dexmedetomidine‐sedated cats.     

Canine hip dyslasia: the significance of the Norberg angle for healthy breeding

Objectives : To assess the reproducibility of the Fédération Cynologique Internationale (FCI) classification over time, and between assessors and to evaluate the benefit of computer‐assisted measurement of the Norberg angle and of its percentile ranking by breed for the diagnosis of canine hip dysplasia, and for the selection of couples for breeding. Methods : During the time period of 2006 to 2010, 5094 hip radiographs were evaluated according to the FCI rules, and 4400 have been submitted for statistical analysis. A system of computer‐assisted image analysis (Digimizer^®, MedCalc Software Ltd, Mariakerke, Belgium) was used to measure the Norberg angle. The Norberg angle value of individual dogs was expressed as percentile rank by breed. Results : The agreement between individual assessors was highly significant (P<0·001), but there were important variations over time of the ratio of classes A or B. The Norberg angle and the percentile rank accurately discriminated between dogs with or without canine hip dysplasia, with positive and negative likelihood ratios of 6·31 and 0·21, respectively, for the Norberg angle at criterion value of 102·2°, and 4·21 and 0·18 for the percentile rank at criterion value of the 25th percentile. Clinical Significance : The percentile rank of the Norberg angle may be a valuable tool for breeding selection.     

The intra‐ and intertester repeatability of radiographic elbow incongruity grading is high in chondrodystrophic dog breeds

Elbow incongruity is a form of elbow dysplasia that causes osteoarthritis, pain, and lameness, and it is common in chondrodystrophic dog breeds. The objective of this retrospective secondary analysis study was to evaluate the intra‐ and interobserver repeatability of a novel radiographic incongruity grading system for assessing elbow incongruity in three chondrodystrophic dog breeds—the dachshund, Skye Terrier, and Glen of Imaal Terrier. We conducted an observer agreement study that included 220 mediolateral antebrachial radiographs from 110 dogs with the elbow in 90° flexion. The radiographs were independently assessed by three observers at three time points, using a four‐stepped grading scale. The proportion of agreement and Kappa coefficient were calculated. Both the intra‐ and interobserver proportions of agreement were substantial when three grades were required to be identical (.705‐.777 and .609, respectively), and almost perfect for two identical grades (.991‐1.000 and .991, respectively). Some differences in repeatability between breeds were noted; specifically, the intraobserver repeatability was higher in the dachshund, and the interobserver repeatability was lower in the Glen of Imaal Terrier. Our study showed that the radiographic imaging protocol and incongruity grading system have high repeatability when assessing elbow incongruity in chondrodystrophic dog breeds.     

Reliability of radiological assessment of ulnar trochlear notch sclerosis in dysplastic canine elbows

Objectives : The objectives of this study were to quantify the sensitivity and specificity of visual assessment of radiographs of the canine elbow in detecting ulnar trochlear notch sclerosis, to establish interobserver and intra‐observer variation for the presence and grade of sclerosis and to quantify the effect of radiographic exposure on observer grading. Methods : Mediolateral elbow radiographs were obtained from Labrador retrievers (n=34) aged between six and 18 months. Radiographs from dogs with an arthroscopic diagnosis of fragmented medial coronoid process (n=17) and those from a control population (n=17) were subjected to observer grading for the presence or absence of and the grade of ulnar trochlear notch sclerosis. Interobserver and intra‐observer variation and observer sensitivity and specificity were calculated. Digital data from the ulnar trochlear notch were correlated with mean observer grade to quantify the effect of radiographic exposure on observer grade. Results : Interobserver agreement was “fair” (kappa=0·251 to 0·369) and intra‐observer agreement was “moderate” to “substantial” (kappa=0·462 to 0·667). The sensitivity of observer assessment was 72 per cent with a specificity of 22 per cent. Mean observer grade was not significantly correlated with the degree of radiographic exposure (P=0·70). Clinical Significance : Ulnar trochlear notch sclerosis is a phenomenon associated with fragmented medial coronoid process. However, interobserver agreement in grading this feature is only fair, being identified by observers with moderate sensitivity but with relatively poor specificity. This low specificity may predispose to overdiagnosis in clinical cases. Intra‐observer agreement is moderate to substantial, suggesting that individuals can reliably quantify this radiological feature on multiple occasions. The ability of observers to assess the degree of sclerotic change is not significantly affected by radiographic exposure.     

Objective radiographic assessment of abdominal sand accumulation in horses.

Gastrointestinal sand accumulation is a common cause of equine colic. Subjective assessment of sand accumulation on abdominal radiographs has been used as a diagnostic aid; however, there is poor correlation between clinical, diagnostic, and surgical findings. The purpose of this study was to develop an objective method of assessing radiographic sand accumulation in order to improve the diagnostic utility of radiography for sand colic. Fifty-one equine abdominal radiographic examinations were reviewed, with approximately half of the imaged patients having a clinical diagnosis of sand colic. Initially, four observers independently reviewed these radiographic studies to subjectively decide whether or not sand accumulation was sufficient to cause colic. Subsequently, an objective scoring system was developed using various radiographic parameters that yielded a score ranging from one to 12 for quantity and apparent density of sand accumulation. Inter- and intraobserver results using the subjective scoring method had significant differences among all observers. Subjective assessment was also deemed to be inaccurate for colic prediction. Using the objective scoring system, there were no significant differences between or within the observers' results. A score of seven out of 12 was found to have an 83% likelihood of being associated with a positive diagnosis of sand colic. The designed objective scoring method creates a more uniform and accurate method to assess the sand accumulation.     

Intra‐ and interobserver agreement in the interpretation of navicular bones on radiographs and computed tomography scans

Reasons for performing study: Criteria for the radiographic evaluation of navicular bones in horses have been published to standardise classification of radiographic signs. However, intra‐ and interobserver agreement have not been established. Objective: To determine intra‐ and interobserver agreement in the evaluation of radiographic and computed tomographic (CT) navicular changes. It was hypothesised that: 1) intraobserver agreement would be better than interobserver agreement; 2) agreement would be better for CT than for radiography; and 3) pathological changes would be recognised with greater certainty with CT. Methods: Radiographs and CT scans of 60 cadaver navicular bones were evaluated by 3 observers using published criteria. A subset of 30 studies was evaluated twice by one observer. Agreement was tested using the kappa statistic. Certainty about pathological changes was evaluated by giving the observers the option to choose ‘not sure’. Results: Agreement varied from poor to almost perfect for radiographic evaluation and from poor to substantial for CT evaluation. For radiographic evaluation mean interobserver agreement was fair, as it was for CT evaluation. For radiographic evaluation mean intraobserver agreement was moderate as it was for CT evaluation. Pathological changes were evaluated with greater certainty on CT scans compared to radiographs; however, this was not associated with improved agreement. Conclusions: Variations in classification of navicular lesions in radiographic and CT studies were considerable between and within observers and challenge the use of such studies for diagnostic and prognostic purposes. Potential relevance: The results of this study allowed the identification of evaluation criteria with sufficient precision to be useful for navicular bone evaluation.     

ACCURACY OF RADIOGRAPHIC DETECTION OF THE CRANIAL MARGIN OF THE DORSAL LAMINA OF THE CANINE SACRUM

An elongated sacral lamina has been described as one of the contributing factors for dogs with cauda equina syndrome due to degenerative lumbosacral stenosis (DLSS); however, published evidence is lacking on the accuracy of radiographic screening for the presence of this lesion. Objectives of this prospective, cross‐sectional cadaver study were to describe the accuracy and repeatability of detection of the cranial sacral lamina margin on plain lateral radiographs of the lumbosacral junction in dogs. Twenty‐five medium and large breed canine cadavers were radiographed before and after placement of a radiopaque hook in the cranial margin of the sacral lamina. Three independent evaluators placed digital markers at the perceived margin on preinterventional radiographs. The distance from perceived location to the true location on postinterventional radiographs was recorded for each dog and observer. A discordance threshold (distance between perceived and actual margin) of 1.5 mm was subjectively defined as clinically relevant. The three evaluators demonstrated good repeatability, although the accuracy for margin detection was only fair (mean discordance 1.7 mm). Evaluators demonstrated greater accuracy in identifying the landmark in juveniles (1.4 mm) vs. adults (1.8 mm; P < 0.01). Results of this study indicated that observer repeatability is good and accuracy is fair for correctly identifying the radiographic cranial margin of the sacral lamina in dogs. This should be taken into consideration when interpreting elongation of the sacral lamina in radiographs of dogs with suspected DLSS, especially adults.     

Detection of joint effusion on radiographs of horses

Joint effusion is one of the classic radiographic signs of osteoarthritis, but no information is available regarding clinicians' ability to detect joint effusion radiographically. This study determined the accuracy and precision of experienced and inexperienced observers in detecting joint effusion of the distal interphalangeal (DIP), metacarpophalangeal (MCP) and midcarpal joints on radiographs. Fresh cadaverous forelimbs were loaded in a material testing machine to mimic a standing horse. The joints were gradually distended and lateromedial and dorsopalmar radiographs were acquired. The images were assessed by three experienced and three inexperienced observers. This study showed that the sensitivity was high for both groups for all joints and projections. Specificity was high for the experienced group but low for the inexperienced group. There was a significant positive correlation between joint distension and severity of joint effusion when reported by experienced observersfor most views (except DIP joint), but only for the MCP joint for inexperienced observers. Interoperator agreement was poor to fair for the experienced group and poor for the inexperienced group. In conclusion, the accuracy and precision of grading joint effusion on radiographs was highly subjective and related to experience.     

VALIDATION OF A NOVEL TECHNIQUE FOR CREATING SIMULATED RADIOGRAPHS USING COMPUTED TOMOGRAPHY DATASETS

Understanding radiographic anatomy and the effects of varying patient and radiographic tube positioning on image quality can be a challenge for students. The purposes of this study were to develop and validate a novel technique for creating simulated radiographs using computed tomography (CT) datasets. A DICOM viewer (ORS Visual) plug‐in was developed with the ability to move and deform cuboidal volumetric CT datasets, and to produce images simulating the effects of tube‐patient‐detector distance and angulation. Computed tomographic datasets were acquired from two dogs, one cat, and one horse. Simulated radiographs of different body parts (n = 9) were produced using different angles to mimic conventional projections, before actual digital radiographs were obtained using the same projections. These studies (n = 18) were then submitted to 10 board‐certified radiologists who were asked to score visualization of anatomical landmarks, depiction of patient positioning, realism of distortion/magnification, and image quality. No significant differences between simulated and actual radiographs were found for anatomic structure visualization and patient positioning in the majority of body parts. For the assessment of radiographic realism, no significant differences were found between simulated and digital radiographs for canine pelvis, equine tarsus, and feline abdomen body parts. Overall, image quality and contrast resolution of simulated radiographs were considered satisfactory. Findings from the current study indicated that radiographs simulated using this new technique are comparable to actual digital radiographs. Further studies are needed to apply this technique in developing interactive tools for teaching radiographic anatomy and the effects of varying patient and tube positioning.     

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.     

Radiographic scoring lacks predictive value in inflammatory airway disease

REASONS FOR PERFORMING STUDY: Diagnosis of inflammatory airway disease (IAD) currently rests upon the results of bronchoalveolar lavage (BAL) cytology, lung function testing and histamine bronchoprovocation (HBP), none of which provides direct information about structural change in the lung. HYPOTHESIS: That thoracic radiography might better portray structural change in the lungs and therefore offer a good clinical assessment of IAD. METHODS: A radiographic scoring system was developed to assess the extent of bronchial and interstitial pattern on thoracic radiographs in the dorsocaudal, dorsocranial and caudoventral regions in 16 control horses and 33 horses with IAD. Mean scores were compared to ascertain whether thoracic radiographs could distinguish between the 2 groups. In order to determine whether independent observers reliably scored radiographs similarly, an inter-rater reliability score was employed for each radiographic observation. Correlations between radiographic scores, BAL cytology, lung function testing using the forced oscillatory technique and HBP were examined. RESULTS: Inter-rater reliability was only moderate. Radiographic scoring demonstrated no differences between the 2 groups. There were no correlations among BAL cytology, lung function testing, HBP and radiographic scores. CONCLUSIONS AND POTENTIAL RELEVANCE: Thoracic radiographs are a low-yield diagnostic modality in horses with a clinical history compatible with IAD. In the absence of clinical evidence of more extensive, infectious disease, thoracic radiographs neither refine nor improve diagnosis of IAD, but increase diagnostic costs.     

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.     

THE EFFECT OF ANESTHESIA ON THE RADIOGRAPHIC APPEARANCE OF THE COXOFEMORAL JOINTS

The effect of anesthesia on the radiographic appearance of the coxofemoral joints was evaluated by taking pelvic radiographs of thirty dogs. Each dog was radiographed twice, once under general anesthesia and once without anesthesia. The radiographs were submitted to the Orthopedic Foundation for Animals independently of one another to be evaluated for signs of hip dysplasia. Results suggest there was no statistical difference between the two groups of dogs. Twenty five dogs received the same reading. Three dogs received readings that were worse by one grade while under anesthesia and two dogs received readings that were one grade better while under anesthesia. This study failed to demonstrate any changes due to anesthesia on the radiographic appearance of the coxofemoral joints. Anesthesia may, however, be beneficial for proper positioning and to decrease unnecessary patient, and personnel exposure to radiation.     

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.     

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.     

RADIOGRAPHIC PROTOCOL AND NORMAL ANATOMY OF THE HIND FEET IN THE WHITE RHINOCEROS (CERATOTHERIUM SIMUM)

Foot pathology is a common and important health concern in captive rhinoceroses worldwide, but osteopathologies are rarely diagnosed, partly because of a lack of radiographic protocols. Here, we aimed to develop the first radiographic protocol for rhinoceros feet and describe the radiographic anatomy of the white rhinoceros (Ceratotherium simum) hind foot (pes). Computed tomographic images were obtained of nine cadaver pedes from seven different white rhinoceroses and assessed for pathology. A single foot deemed free of pathology was radiographed using a range of different projections and exposures to determine the best protocol. 3D models were produced from the CT images and were displayed with the real radiographs to describe the normal radiographic anatomy of the white rhinoceros pes. An optimal radiographic projection was determined for each bone in the rhinoceros pes focusing on highlighting areas where pathology has been previously described. The projections deemed to be most useful were D60Pr‐PlDiO (digit III), D45Pr45M‐PlDiLO (digit II), and D40Pr35L‐PlDiLO (digit IV). The primary beam was centered 5–7 cm proximal to the cuticle on the digit of interest. Articular surfaces, ridges, grooves, tubercles, processes and fossae were identified. The radiographic protocol we have developed along with the normal radiographic anatomy we have described will allow for more accessible and effective diagnosis of white rhinoceros foot osteopathologies.     

Comparison of three distraction methods and conventional radiography for early diagnosis of canine hip dysplasia

Two radiographic distraction techniques (one employing a wooden lath and, the other, a PennHip distractor), an ultrasonographic distraction method and conventional radiographic Fédération Cynologique Internationale (FCI) hip score were evaluated in eight-month-old Labrador retrievers to determine the most reliable method for predicting radiographic FCI hip score at the age of one year. With reference to the FCI hip score, sensitivity and specificity of the PennHip method were 100 per cent and 54 per cent; sensitivity and specificity of the lath technique were 85 per cent and 71 per cent; whereas they were 62 per cent and 67 per cent for the ultrasonographic method. For all distraction methods, the positive predictive value (PPV) was moderate and the negative predictive value (NPV) was high. Sensitivity, specificity, PPV and NPV were 100 per cent for the FCI hip score. It is concluded that, at the age of eight months, FCI hip score is the most reliable method for predicting FCI hip score at the age of one year in the colony of dogs investigated. Both the PennHip and lath method were also clinically reliable techniques in predicting true negatives. The ultrasonographic distraction method was moderately reliable.     

Assessment of low-cost teleradiology for grading elbow dysplasia.

Teleradiology involves the creation of a radiographic image that is then transmitted electronically. It has been shown that low-cost teleradiology has a high level of agreement when comparing the original radiograph to the digital image. However, there has been little investigation of the effect of digitization on the score allocated by a grading scheme. Radiographs of 60 canine elbows were selected, each in three projections (mediolateral flexed, mediolateral neutral, craniocaudal). Each radiograph was photographed at 3 megapixel (3 M) and 6 megapixel (6 M) resolution using a digital camera. The images were placed in groups (radiographs, 3 M and 6 M) and randomized. Each elbow was independently graded by a radiologist and an orthopedic surgeon using the BVA elbow scoring scheme, with the different image sets interpreted separately. Intra and interobserver agreement was compared using a kappa analysis. The radiologist had substantial intraobserver agreement for repeated grading of radiographs, and moderate agreement for the other intraobserver tests (3 M vs. radiographs, 6 M vs. radiographs, 3 vs. 6 M). The surgeon had moderate to substantial agreement for the intraobserver tests. There was reduced interobserver agreement for all image groups. These results suggest that low-cost teleradiology may only allow moderate accuracy when used for grading schemes, and this may affect its use for breed scoring schemes. However, there appears to be an inherent subjectivity present in the elbow-grading scheme, seen in both intra and interobserver analysis. Therefore, further study of teleradiology using a different scoring model (e.g., hip dysplasia) may be indicated.