INTRAORAL DENTAL RADIOGRAPHY: EXPERIMENTAL STUDY AND CLINICAL USE IN TWO HORSES AND A LLAMA

A technique for intraoral radiography of the maxillary cheek teeth in large animals using strips of nonscreen and commercial dental x-ray film is described. The method was initially tested using horse cadaver heads and subsequently on three large animal patients with signs of dental disease. Limitations of the described technique include necessity for general anesthesia, special x-ray film and manual developing. Additionally, the need for very accurate adjustment of incident beam angle, beam centering point and depth in the oral cavity provide a major technical challenge. After becoming famillar with the technique, the major limitation was increased time for manual film developing. The images provided by nonscreen technique were subjectively superior. The anatomic detail of the apical and periodontal regions of the teeth was better than on survey radiographs. Nonscreen intraoral technique should be considered for anesthetized large animal patients with signs of dental disease.     

IMAGING: RADIOGRAPHY-11*

In this paper an overview of principles involved in radiographic imaging by tomography, magnification radiography, xeroradiography, and computed tomography is presented. Tomography is a method to selectively blur distracting superimposed shadows while maintaining relative image sharpness in a plane of concern. Magnification radiography is a method to directly enlarge the radiographic image by increasing object-film distance and utilizing a small focal spot. Xeroradiography is an electrostatic imaging process that provides wide latitude and good resolution through enhanced contrast in tissues with poor inherent contrast. Computed tomography involves imaging by computer analysis of x-ray absorption utilizing rotational x-ray projections.     

A 200 CENTIMETER FOCAL SPOT-FILM DISTANCE (FFD) TECHNIQUE FOR EQUINE THORACIC RADIOGRAPHY

The construction of a variable kVp, variable mA radiographic technique chart for the equine thorax using linear regression analysis is described. The independent variables in the analysis were body weight (pounds) and thoracic girth (inches) and the dependent variables were the radiographic exposure techniques (mAs, kV.p). Four areas (lateral views only) of each horse's thorax were radiographed using a focal spot-film distance (FFD) of 200 cm with the animal standing. The four views were craniodorsal, cranioventral, caudodorsal and caudoventral. For comparison, an additional caudodorsal view was made at 100 cm FFD to quantitate the decrease in exposure, the increased magnification and the decreased area of the lung exposed on the x-ray tube side of the horse compared with 200 cm FFD technique. Body weight was a satisfactory means to determine radiographic technique factors for thoracic radiographs in the horse. Thoracic girth (inches) was also measured and used to determine radiographic technique factors but was less exacting and less convenient than body weight.     

PRINCIPLES OF ULTRASOUND APPLICATION IN ANIMALS*†

Diagnostic ultrasound, a non-invasive mode for imaging soft tissues, requires for its use an understanding of sound and sound-tissue interaction physics. Ultrasound frequencies from 1.0 to 10.0 MHz are created by electrical stimulation of piezoelectric crystals. These crystals are housed within transducers, which, when applied to the body surface with a coupling agent will produce sound waves, referred to as the sound beam, which are propagated through the soft tissues of the body. When the sound beam encounters tissue interfaces of differing acoustic impedance, a portion of the sound beam is reflected back to the transducer which also acts as a receiver. Echoes returning from soft tissue acoustic interfaces are converted to electrical impulses and displayed on an oscilloscope screen as a cross section of the tissue. Lower frequency sound beams penetrate further into soft tissue, but have poorer resolving capabilities, than higher frequency sound beams. A, B, and M-modes are the three basic forms of ultrasound used in soft tissue imaging. A-mode ultrasonic imaging is a one-dimensional display of echo amplitudes versus distance. B-mode ultrasonic imaging produces an accurate two-dimensional cross sectional image of soft tissues. M-mode ultrasonic imaging is an adaptation of B-mode to evaluate moving structures of the heart. Fluid-filled cystic structures have characteristic clear (anechoic) central areas with acoustic enhancement of the back wall of the cyst and deeper structures. Solid masses have echoes in their central portion with resultant poor accentuation of deeper structures. Application of ultrasound to animals requires hair removal since trapped air is a barrier to transmission of the sound beam. Gas-filled bowel and bone are effective barriers to ultrasonic imaging because of their large acoustic impedance differences compared to soft tissues. The position of the focal point of a focused transducer relative to tissue interfaces is important to accurately depict tissue character. For example, the focal point of the transducer should be superficial to the back wall when scanning cystic structures. When solid lesions, such as liver metastases, are scanned a focal point that lies deep to the lesion should be selected in order to accentuate sound beam attenuation. Time-gain compensation (TGC) settings are important to produce a balanced scan with equal echo production within like tissues throughout the depth of ultrasound tissue penetration. Initial TGC settings can be made from knowledge of the focal point of the particular transducer, but may have to be adjusted during scanning to produce a balanced image. Ultrasound is an attractive imaging modality in animals since it is noninvasive and presents no known hazard to the operator or patient.     

A NEW AND VERSATILE LARGE ANIMAL DIAGNOSTIC RADIOLOGY UNIT

The plans and technical specifications of a unit specifically designed for large animal radiography are described. The unit has two examination rooms, one for routine radiography in the standing position and the other for special procedures and investigations utilizing a custom-designed table with a carbon fiber top. The table is computer operated and the x-ray tubes above and below it are capable of penetrating the thickest parts of horses as well as performing such procedures as linear tomography, angiography, and magnification radiography. The facility is equipped with an image intensifier, television monitor, 100 mm spot film camera, Potter-Bucky grid, and Puck film changer as well as a number of additional features for coping with anesthetized large animals. The unit has been in operation for three years and has greatly improved the quality of radiographic examinations as well as opening up some important lines of investigative research     

Assessment of on-screen measurements, magnification, and calibration in digital radiography

Objective-To compare calibration methods for digital radiography in terms of measurement accuracy and interobserver variability. Design-Prospective study. Sample-Digital radiographic images of a 155-mm-long Steinmann pin. Procedures-Measurement of pin length on digital radiographs was determined with a 25.4-mm-diameter calibration ball and commercially available software program via 3 calibration methods (ie, no calibration, autocalibration, and manual calibration). Digital radiographs of the calibration ball and pin were obtained with each placed at various vertical heights from the table (7 heights) and horizontal distances from the center of the beam (4 distances). Measurements of pin length on digital radiographs were made by 4 observers who were blinded to the orientation of the calibration ball and pin. Results-Pin lengths obtained by each calibration method were significantly different from each other and from the true value. Manual calibration was the most accurate. There was no significant interobserver variability in measurements. There was no significant change in measurements when the calibration ball was moved horizontally, but pin length measurements changed significantly when the ball was moved vertically (away from the table) with an approximate magnification error of 1% per centimeter of distance between the calibration ball and pin. Conclusions and Clinical Relevance-For digital radiography, manual calibration is recommended to achieve the most accurate measurements. Ideally, the calibration ball should be placed at the same vertical height as the object to be measured; however, if this cannot be achieved, the magnification error can be expected to be approximately 1% per centimeter of distance.     

RADIOGRAPH QUALITY EVALUATION FOR EXPOSURE VARIABLES—A REVIEW

Good quality radiographs are essential for making accurate diagnoses. Many factors influence the quality of radiographs including the x-ray machine specifications and settings, the darkroom environment and processing, and the choice of ancillary x-ray equipment (cassette properties, film/screen selection, use and properties of a grid). In compiling a technique chart, many of these variables are standardized so as to provide dependable guidelines for selecting the appropriate exposure settings (mAs and kVp) for a radiographic study. The systematic evaluation of image blackening, peripheral blackening, and the visibility of the gross image detail and contrast will facilitate the development of a technique chart as well as determining the source of the problem and necessary exposure setting changes for radiographs that are suboptimal. A flow diagram is described that will assist with the systematic evaluation of radiographic quality and provide guidelines for correcting exposure errors.     

Computed tomography and scintigraphy for evaluation of dental disease in the horse

Computed tomography (CT) uses x‐ray beams and reconstructive computer technology to create tomographic slices (sections) of the area being imaged. Computed tomography has higher contrast resolution than conventional radiography allowing for more accurate differentiation of soft tissues and fluids. This form of 3D imaging removes problems caused by superimposition of multiple anatomical structures, which is a major impediment when viewing radiographs of the equine head. Once the images are acquired, multi‐planar and 3D reconstructions can be performed to view different teeth or associated structures in an optimal way. Anatomical and pathological changes in the dental tissues, periodontal tissues, alveolar bone and adjacent sinuses can then be assessed. Scintigraphy with 99^m technetium methyl‐diphosphate (methylene‐diphosphonate) can detect changes in bone that precede radiographic changes, and this makes it a very useful imaging modality for diagnosis of early periapical infection of the equine cheek teeth. Additionally, it is invaluable for imaging suspected infections of supernumerary or dysplastic teeth where the results of radiography or even CT may be equivocal. Periapical infections of the cheek teeth typically result in focal and intense increased radionuclide uptake located over the apical region of the affected tooth.     

A COMPARISON OF TWO-DIMENSIONAL ULTRASONOGRAPHY AND RADIOGRAPHY FOR THE DETECTION OF SMALL AMOUNTS OF FREE PERITONEAL FLUID IN THE DOG

The detection of small amounts of free peritoneal fluid in the canine patient can be a diagnostic dilemma. Ultrasonography and radiography have been advocated to detect intraabdominal fluid not detectable by physical exam. The purpose of this study was to determine the more sensitive method for detecting small amounts of free peritoneal fluid. Ultrasound examinations and radiographs were performed after increments (1 ml/lb body weight) of fluid were injected intraperitoneally. Ultrasonography detected fluid in one animal at 2 ml/lb. AH other animals had fluid detected at 3 ml/lb. With radiographs fluid could be detected with a high degree of accuracy at 4 ml/lb. The lateral view was more accurate than the ventrodorsal view in detecting fluid. The authors concluded that Ultrasonography is more sensitive than radiography and is the method of choice to detect small amounts of free peritoneal fluid.     

EFFECTS OF X‐RAY BEAM ANGLE AND GEOMETRIC DISTORTION ON WIDTH OF EQUINE THORACOLUMBAR INTERSPINOUS SPACES USING RADIOGRAPHY AND COMPUTED TOMOGRAPHY—A CADAVERIC STUDY

The widths of spaces between the thoracolumbar processi spinosi (interspinous spaces) are frequently assessed using radiography in sports horses; however effects of varying X‐ray beam angles and geometric distortion have not been previously described. The aim of this prospective, observational study was to determine whether X‐ray beam angle has an effect on apparent widths of interspinous spaces. Thoracolumbar spine specimens were collected from six equine cadavers and left‐right lateral radiographs and sagittal and dorsal reconstructed computed tomographic (CT) images were acquired. Sequential radiographs were acquired with each interspinous space in focus. Measurements were performed for each interspinous space in the focus position and up to eight angled positions as the interspinous space moved away from focus (±). Focus position measurements were compared to matching sagittal CT measurements. Effect of geometric distortion was evaluated by comparing the interspinous space in radiographs with sagittal and dorsal reconstructed CT images. A total of 49 interspinous spaces were sampled, yielding 274 measurements. X‐ray beam angle significantly affected measured width of interspinous spaces in position +3 (P = 0.038). Changes in width did not follow a consistent pattern. Interspinous space widths in focus position were significantly smaller in radiographs compared to matching reconstructed CT images for backs diagnosed with kissing spine syndrome (P < 0.001). Geometric distortion markedly affected appearance of interspinous space width between planes. In conclusion, X‐ray beam angle and geometric distortion influence radiographically measured widths of interspinous spaces in the equine thoracolumbar spine, and this should be taken into consideration when evaluating sport horses.     

A bronchial foreign body in a chimpanzee

The paper reports a bronchial foreign body with unusual clinical signs in a chimpanzee. The illness lasted some months and was manifested by malaise, reduced appetite, loss in body weight and a spontaneous abortion. Routine auscultation and radiography could not be performed initially because of the size and disposition of the animal but chest radiography was later carried out under general anaesthesia and revealed a foreign body which was extracted through a bronchoscope from the right main bronchus. Methods of anaesthesia suitable for bronchoscopy are discussed but the Venturi technique using a jet air injector seems to be the method of choice.     

Pathophysiology and diagnosis of third carpal bone disease in horses: a review

Third carpal bone (C3) disease is a significant cause of lameness in Standardbred and Thoroughbred horses. The bone density of C3 increases as a result of exercise, reducing the compliance of the bone and predisposing it to injury. Currently, the most widely used method of diagnosis is subjective radiography using the tangential view. Radiographically, increases in bone mineral density (BMD) appear as sclerosis but it is not known at what point increases in sclerosis indicate the onset of disease or increased risk of C3 fracture. A quantitative assessment of the BMD of C3 in horses would improve understanding of the changes that occur within this bone and guide athletic management, as it is thought that BMD changes precede articular cartilage damage. Methods of non-invasive bone-mineral analysis used for the detection of osteoporosis in humans include single photon absorptiometry (SPA), dual x-ray absorptiometry (DXA), computed tomography (CT), radioabsorptiometry (RA), quantitative ultrasonography (QU) and magnetic resonance imaging (MRI). To date, DXA and RA are the most commonly used methods of quantitative non-invasive bone-mineral analysis in horses. The cost of equipment and difficulties in performing DXA in live animals preclude the routine use of this technique for diagnostic purposes. RA may become clinically applicable to C3 analysis in horses, but small variations in x-ray beam angle when taking the tangential view significantly affect results, making this technique clinically inapplicable at this time. Currently, methods of quantitative non-invasive bone-mineral analysis of C3 in horses are not suited to clinical application.     

Comparison of radiographic assessments of the tibial plateau slope in dogs

OBJECTIVES: To evaluate the accuracy of 2 radiographic methods used to assess tibial plateau slope (TPS) in dogs and evaluate effects of film digitization and radiographic beam placement on TPS measurements. SAMPLE POPULATION: 16 hind limbs from dog cadavers weighing > 20 kg. PROCEDURES: Radiographs of tibiae were made with the radiographic beam centered over the stifle joint and midshaft of the tibia. Tibiae were collected, the femorotibial contact area was determined, and slope of the medial tibial condyle in relation to the tibial shaft was measured. Radiographs were digitized. Slope of the medial tibial condyle was measured on printed and digitized radiographs read in random order by 6 examiners unaware of anatomic measurements. Three examiners used a conventional measuring technique, and 3 examiners used an alternative measuring technique. RESULTS: Anatomic measurements were significantly higher than radiographic measurements made by use of the conventional interpretation method but did not differ from radiographic measurements made by use of the alternate method. Measurements from printed radiographs were lower than measurements from digitized radiographs for the 4 most experienced examiners. CONCLUSIONS AND CLINICAL RELEVANCE: Measurements made by use of a line tangential to the cranial, linear portion of the medial tibial condyle at the femorotibial contact point were accurate measurements of the anatomic TPS. Measurements made by use of the conventional TPS measurement method underestimated the anatomic TPS. Measurements made on digitized radiographs were typically more accurate than measurements made on printed radiographs.     

Coxofemoral joint radiography in standing cattle

The objective of this study was to establish a technique for radiographic examination of the coxofemoral joint and adjacent bony structures in standing cattle. Left (or right) 30° dorsal-right (or left) ventral radiographic views of the coxofemoral joint region of standing cattle (n = 10) with hind limb lameness were evaluated retrospectively. In addition, an experimental study of oblique laterolateral views of the coxofemoral joint region of a bovine skeleton at angles of 15-45° was carried out to determine the optimal position for visualization of the hip region. In the 10 clinical patients, the bodies of the ilium and ischium, the acetabulum and proximal third of the femur could be assessed. Six of these cattle had fractures of the body of the ilium and body of the ischium, five with and one without involvement of the acetabulum, two had craniodorsal and one caudoventral luxation of the femur and one had a femoral neck fracture. The described laterodorsal-lateroventral radiographs of the hip region in standing cattle were suitable for assessing the coxofemoral joint, the proximal aspect of the femur and parts of the ischium, ilium and pubis. After testing the optimal angle on the skeleton, it was seen that distortion and superimposition were minimized by positioning the X-ray beam at an angle of 25° to the horizontal plane. It can be concluded that the described technique improves the evaluation of injuries of the coxofemoral region in cattle. With the appropriate angle, the technique can also be applied in recumbent cattle.     

Radiographic techniques for medical-dental research with minipigs

Techniques were developed to obtain standardised intra- and extra-oral radiographs in minipigs for use in medical-dental research. Twelve male minipigs (BR-1 Minipigs) were chosen at random. Two animals each at 3, 5, 7, 9, 12 and 15 months of age were anaesthetised and subjected to radiographic examinations to assess six techniques. Three intra-oral and three extra-oral techniques, standardised for humans, were used with variations of the angle of incidence of the X-ray beams, focus-film distance and exposure time. Two film positioners were developed for the intra-oral techniques. Two examiners then chose the radiographs with the least image distortion, greatest clarity and least superimposition of images. For each technique, the suitable angle of incidence of the X-ray beams, the focus-film distance and exposure time that produced the highest quality radiographs were standardised.     

Radiographic Examination of the Equine Vertebral Column

A method is described for routine radiography of the horse's thoracolumbar (TL) spine from T2 to L3 in the standing position. Stocks were used for restraint, and the x-ray tube, which was mounted on an overhead gantry, was linked automatically to a cassette holder on the far side of the animal. A crosshatch grid with an ultra-fast system of screens and film was employed to provide adequate radiographic quality. An aluminum wedge filter (dodger) was used to help compensate for the marked variation in spine thickness. For radiography of the caudal lumbar spine and lumbosacral region, it was necessary to anesthetize the horse and make radiographs in the ventrodorsal position. Exposures of up to 150 kV and 400 mAs were required for heavy horses weighing up to 750 kg. Scatter radiation was kept to a minimum by using crossed high-ratio grids and by putting additional lead on the back of the cassette to prevent back scatter.     

IMAGE MAGNIFICATION IN DIGITAL FLUOROSCOPY

Image magnification is inherent in radiography. In digital fluoroscopy, the three components of magnification are geometric, electronic and photographic. In this study, the total magnification factor of a digital imaging system was determined by two methods, 1) comparison of measurements of a known object to its image and 2) calculation of geometric, electronic and photographic magnification from the imaging system specifications. Both methods were employed for various focal-film distances, image intensifier tube modes and laser printer formats. Results of these two methods were different due to the detrimental effect of penumbra on image quality with increasing magnification. If a radiographic image is to be used to approximate object size, then a technique should be used that will minimize magnification. In digital fluoroscopy this is achieved with the shortest object-film distance (assuming a fixed focal-object distance), largest image intensifler mode and greatest number of images per sheet of film.     

Safety and feasibility of stereotactic radiotherapy using computed portal radiography for canine intracranial tumors

Stereotactic radiotherapy is a highly conformal treatment option for intracranial and extracranial malignancies. Stereotactic radiotherapy utilizes specialized equipment specifically designed to avoid normal tissue while delivering ablative treatments with submillimeter precision and accuracy. Linear accelerator based stereotactic radiotherapy incorporates on‐board image guidance utilizing cone beam computed tomography (CT). Many institutions lack the ability to provide image guidance with cone beam CT but delivery of highly conformal treatments with submillimeter precision and accuracy is still feasible. The purpose of this retrospective, pilot study was to describe clinical outcomes for a group of dogs with neurological disease that were treated with an stereotactic radiotherapy technique utilizing intensity modulated radiation therapy, megavoltage computed portal radiography, a bite plate, thermoplastic mold, and mask based positioning system. Twelve dogs with neurological clinical signs were included. The diagnosis of intracranial tumor was made based on advanced imaging (12/12) and confirmed via histopathology (3/12). Twelve courses of stereotactic radiotherapy, utilizing three fractions of 8.0 Gy, were delivered on alternating days. Self‐resolving neurological deterioration was observed in two patients during stereotactic radiotherapy. Neurological progression free interval and median survival time were 273 days (range: 16–692 days) and 361 days (range: 25–862 days). Stereotactic radiotherapy using computed portal radiography may be a safe treatment option for dogs with intracranial tumors.     

Comparison of computed radiography and conventional radiography in detection of small volume pneumoperitoneum

The role of digital imaging is increasing as these systems are becoming more affordable and accessible. Advantages of computed radiography compared with conventional film/screen combinations include improved contrast resolution and postprocessing capabilities. Computed radiography's spatial resolution is inferior to conventional radiography; however, this limitation is considered clinically insignificant. This study prospectively compared digital imaging and conventional radiography in detecting small volume pneumoperitoneum. Twenty cadaver dogs (15-30 kg) were injected with 0.25, 0.25, and 0.5 ml for 1 ml total of air intra-abdominally, and radiographed sequentially using computed and conventional radiographic technologies. Three radiologists independently evaluated the images, and receiver operating curve (ROC) analysis compared the two imaging modalities. There was no statistical difference between computed and conventional radiography in detecting free abdominal air, but overall computed radiography was relatively more sensitive based on ROC analysis. Computed radiographic images consistently and significantly demonstrated a minimal amount of 0.5 ml of free air based on ROC analysis. However, no minimal air amount was consistently or significantly detected with conventional film. Readers were more likely to detect free air on lateral computed images than the other projections, with no significant increased sensitivity between film/screen projections. Further studies are indicated to determine the differences or lack thereof between various digital imaging systems and conventional film/screen systems.