Detection of rib trauma in newborn foals in an equine critical care unit: a comparison of ultrasonography, radiography and physical examination

REASONS FOR PERFORMING STUDY: Previous studies have shown that in man ultrasonography is more accurate than radiography for detecting rib fractures. OBJECTIVES: To describe clinical, radiographic and ultrasonographic findings related with rib fractures in newborn foals in an equine critical care unit; and to compare diagnostic accuracy of ultrasonography to radiography. METHODS: A prospective ultrasonographic study was performed on 29 foals presented to the emergency unit. This study was performed at the Centre Hospitalier Universitaire Vétérinaire (CHUV), University of Montreal. Physical examination as well as radiographic and ultrasonographic examinations were performed. RESULTS: Thoracic radiographs revealed 10 rib fractures in 5 of 26 (19%) foals. Ultrasonography revealed 49 fractures in 19 of 29 (65%) foals of which fillies (n = 13; 68%) were significantly over represented as were fractures to the left thorax (n = 15; 78%). Seventeen of 19 foals (90%) had rib fractures located 3 cm or less from the costochondral junction, the distal part of the rib being displaced laterally in all cases. In 2 foals, where both thoracic radiographs and ultrasonography detected rib fractures, the site of fractures was located on the mid portion of the rib. Rib fractures were detected only by thoracic radiographs in one foal. Sixty-five percent (32/49) of fractured ribs had a moderate displacement (1-4 mm). CONCLUSIONS: Rib fractures are seen frequently in newborn foals in equine critical care units. Ultrasonography is more accurate than radiography and reveals fractures in most patients presented in emergency. The position (costochondral junction) of rib fractures and of the fragments suggest that most thoracic trauma probably occurs during parturition. POTENTIAL RELEVANCE: Ultrasound imaging increases awareness and improves the diagnosis of rib fractures in newborn foals.     

RADIATION EXPOSURE DURING EQUINE RADIOGRAPHY

All personnel present in the X-ray examination room during equine radiography were monitored using low energy direct reading ionization chambers (pockets dosimeters) worn outside the lead apron at neck level. The individuals' task and dosimeter readings were recorded after each examination. Average doses ranged from 0 to 6 mrad per study. The greatest exposures were associated with radiography of the shoulder and averaged less than 4 mrad. The individual extending the horse's limb was at greatest risk although the individual holding the horse's halter and the one making the X-ray exposure received similar exposures.
A survey of the overhead tube assembly used for some of the X-ray examinations also was performed. Meter readings obtained indicated an asymetric dose distribution around the tube assembly, with the highest dose occurring on the side to which the exposure cord was attached.
Although the exposures observed were within acceptable limits for occupational workers, we have altered our protocol and no longer radiograph the equine shoulder unless the horse is anesthetized. Continued use of the pocket dosimeters and maintenance of a case record of radiation exposure appears to make the technologists more aware of radiation hazards.     

Comparison of radiography and ultrasonography for the diagnosis of osteochondritis dissecans in the equine femoropatellar joint

Reasons for performing study: Osteochondritis dissecans (OCD) lesions of the femoropatellar (FP) joint are diagnosed routinely by radiography, but lesions located in the trochlear groove or without accompanying subchondral bone changes can be difficult to visualise. Ultrasonography allows evaluation of articular cartilage and subchondral bone in the FP joint. Objectives: To document the radiographic and ultrasonographic appearance of OCD lesions in the equine FP joint, grade ultrasonographic lesions and compare their accuracy in the diagnosis of these lesions. Methods: The medical records of all horses diagnosed with FP OCD between 1995 and 2006 were assessed. Inclusion criteria included availability of both radiographic and ultrasonographic images. Lesion characteristics were evaluated in each trochlear ridge and trochlear groove. For assessment of the accuracy (sensitivity and specificity) of both imaging techniques in the diagnosis of OCD, only cases with an arthroscopic or necropsy examination were studied. Results: Twenty‐one horses were included. OCD lesions were diagnosed by radiography (30/32 joints) and ultrasound (32/32 joints). The lateral trochlear ridge (LTR, 91%) and the medial trochlear ridge (MTR, 17%) were involved on radiography. The localisation on ultrasound examination was similar (97% LTR, 25% MTR). All but one lesion seen on radiography were also detected with ultrasound; 2 LTR and 3 MTR lesions, not seen on radiography were diagnosed by ultrasound and confirmed at arthroscopy or necropsy. The specificity was 100% regardless of the site and imaging procedure except for the distal third of the MTR (94% for ultrasound). The sensitivity varied, depending on lesion site. Conclusion: Ultrasonography is a valuable diagnostic tool to diagnose OCD lesions in the FP joint and more sensitive than radiography for lesions affecting the MTR of the distal femur. Clinical relevance: Ultrasound should be considered as a useful adjunct to radiography for diagnosing equine FP OCD, especially in cases of high clinical suspicion but equivocal radiographic findings. Images can be generated immediately when digital radiography is not available, permitting an immediate on‐site diagnosis.     

Cone beam computed tomography and intraoral radiography for diagnosis of dental abnormalities in dogs and cats

The development of veterinary dentistry has substantially improved the ability to diagnose canine and feline dental abnormalities. Consequently, examinations previously performed only on humans are now available for small animals, thus improving the diagnostic quality. This has increased the need for technical qualification of veterinary professionals and increased technological investments. This study evaluated the use of cone beam computed tomography and intraoral radiography as complementary exams for diagnosing dental abnormalities in dogs and cats. Cone beam computed tomography was provided faster image acquisition with high image quality, was associated with low ionizing radiation levels, enabled image editing, and reduced the exam duration. Our results showed that radiography was an effective method for dental radiographic examination with low cost and fast execution times, and can be performed during surgical procedures.     

ESTIMATED OPERATOR EXPOSURE FOR HAND HOLDING PORTABLE X‐RAY UNITS DURING IMAGING OF THE EQUINE DISTAL EXTREMITY

Hand holding of portable X‐ray units is common in large animal ambulatory veterinary practice. Portable X‐ray equipment manuals, veterinary teaching institutions, and state regulations discourage, or prohibit, hand holding of portable X‐ray units. Our goal was to quantify surface radiation leakage of a typical portable X‐ray unit and to measure operator exposure at simulated hand and collar positions during imaging of the equine distal extremity. Each exposure for the study was performed at 80 kVp and 7.5 mAs and repeated 10 times. Measurement of tube radiation leakage was performed along each surface of the portable X‐ray unit. To determine the operator exposure more accurately, an equine cadaver limb was used to generate scatter radiation for the following views: lateral carpus, lateral foot, palmaroproximal–palmarodistal, and dorsal 60° proximal–palmarodistal obliques of the navicular region. A Pancake Ion Chamber was placed at the handle and at simulated collar position to record estimated occupational exposure. To estimate the effect of lead shielding, exposure measurements were performed within the primary beam and behind a 0.5 mm lead equivalent apron and within an >0.5 mm lead equivalent glove. The average hand and collar dose was 0.471 and 0.327 mR/exposure, respectively. The lead apron and glove attenuated the primary beam 96.9 and 99.2%, respectively. This reduced average hand and collar exposures to 0.0038 and 0.0101 mR/exposure, respectively. Theoretical occupational limits are reached for the collar (whole body) before the hand (extremity).     

COMPARISON OF COMPUTED TOMOGRAPHY, TANGENTIAL VIEW RADIOGRAPHY, AND CONVENTIONAL RADIOGRAPHY IN EVALUATION OF CANINE PELVIC TRAUMA

Thirteen dogs with fractures requiring surgical repair were evaluated by standard two-view (i.e., lateral and ventrodorsal) radiography, tangential view (ventro 20 degrees cranial-dorsocaudal [inlet] and ventro 20 degrees caudal-dorsocranial [outlet]) radiography, and computed tomography (CT). Radiographic and CT examinations were reviewed independently by the three authors, and specific anatomic sites were graded for the presence or possibility of lesions. The results of radiographic interpretations were compared to CT scan interpretations. Eighty-one percent of skeletal lesions detected by CT scans were diagnosed definitively radiographically. Differences between the interpretation of CT and radiographic examinations included abnormalities associated with soft-tissue structures (P < 0.0001), the sacroiliac joints (P = 0.02), and the acetabula (P = 0.04). Interpretation of the lateral/ventrodorsal and inlet/outlet radiographic series were not statistically different, although inlet views may be complimentary to the standard radiographic examination. Its use deserves further study. Reader variation was less on evaluation of CT examinations than radiographic examinations. CT multiplaner reformations and three-dimensional reconstructions were useful for surgical planning in seven dogs. CT scanning is superior to survey radiography in assessing skeletal and soft-tissue injuries in dogs with pelvic trauma, although all clinically significant surgical lesions were described accurately radiographically. Based on this small series, the routine CT examination of dogs with pelvic trauma may not be justifiable for diagnosis but may be advantageous for surgical planning, especially if acetabular fractures are suspected on radiographs.     

Diagnostic radiology of pet and wild birds: a review. I. Radiographic techniques and radiographs of healthy birds.

By the radiographic examination of pet and wild birds, veterinary clinicians may relatively easily obtain additional information that can be used routinely in their everyday diagnostic and therapeutic work. The first part of the present review summarizes the basic technical conditions of radiological examinations, analyses the radiographic features of healthy birds, and describes the procedure and radiological indications of contrast radiography.     

Computed tomography and magnetic resonance imaging of the equine head.

Horses are frequently presented with clinical conditions warranting diagnostic imaging of the head. Unfortunately, evaluation of the equine head can be difficult using conventional radiography. The anatomic complexity and superimposition of the osseous, dental, and soft tissue structures complicate radiographic interpretation and diagnoses. Multiple radiographic projections may be necessary to image specific regions, and side-to-side comparison is often essential.     

Common artefacts and pitfalls in equine computed and digital radiography and how to avoid them

Radiographic technology has rapidly advanced over the last decade with the use of both computed radiography and digital radiography now being common in equine practice. Image quality is critical for optimal diagnostic accuracy, so identification of factors that negatively influence quality is vital. The most commonly encountered problems include positioning errors, exposure anomalies, movement artefacts, labelling errors and image processing faults. The aim of this review is to describe common radiographic faults that will allow the equine practitioner to recognise and learn how to prevent these issues, thus improving image quality. This will aid in improving diagnostic accuracy and will enhance radiation safety by reducing the number of repeat exposures required.     

COMPARISONS AMONG RADIOGRAPHY,ULTRASONOGRAPHY AND COMPUTED TOMOGRAPHY FOR EX VIVO CHARACTERIZATION OF STIFLE OSTEOARTHRITIS IN THE HORSE

A better understanding of imaging characteristics of equine stifle osteoarthritis (OA) may allow earlier detection and improve prognosis. Objectives of this ex vivo, prospective, methods comparison study were to (1) describe the location and severity of naturally acquired OA lesions in the equine stifle using ultrasound (US), radiography (XR), computed tomography (CT), and macroscopic evaluation (ME); (2) compare the diagnostic performance of each imaging modality with ME; and (3) describe subchondral bone mineral density (BMD) in equine stifle joints with OA using CT. Radiographic, CT, and US evaluations were performed on 23 equine cadaver stifles and compared with ME. Significant associations were found between osteophyte global scores for all imaging modalities (CT, P ? 0.0001; XR, P = 0.005; US, P = 0.04) vs. ME osteophyte global scores. Osteophytes were detected most frequently in the medial femorotibial (MFT) joint. A specific pattern of osteophytes was observed, with a long ridge of new bone at the insertion of the MFT joint capsule cranially on the medial femoral condyle. A novel caudo‐10°proximo‐5°lateral‐cranio‐disto‐medial oblique radiographic projection was helpful for detection of intercondylar osteophytes. Multiplanar CT reformatted images were helpful for characterizing all osteophytes. Osteophyte grades at most sites did not differ among modalities. Low sensitivity/specificity for subchondral bone sclerosis and flattening of femoral condyles suggested that these signs may not be reliable radiographic and CT indicators of equine stifle OA. Equine stifle OA was associated with a decrease in BMD and specific sites of focal subchondral bone resorption/cyst formation were found in some specimens.     

Endoscopically guided nasojejunal tube placement in dogs for short‐term postduodenal feeding

Objective – To evaluate a method for endoscopically guided nasojejunal tube placement allowing short‐term postduodenal feeding and chyme withdrawal in dogs. Design – Pilot study. Setting – University teaching hospital. Animals – Three healthy Beagle dogs with jejunal nipple valve fistulas. Interventions – After the dogs were anesthetized, an 8 Fr, 250‐cm polyvinyl chloride catheter was advanced through a gastroscope into the jejunum. Correct jejunal placement was established using endoscopic visualization and confirmed by fluoroscopy and radiography. The proximal end of the tube was pulled out through 1 nostril and sutured to the skin of the forehead. Thereafter, jejunal feeding was administered for 4 days. Follow‐up examinations included daily confirmation of the tube's position using radiography, physical examination, and blood analyses. Withdrawal of jejunal chyme was performed after jejunal and oral feeding. Measurements and Main Results – Fluoroscopic examination confirmed that endoscopic visualization alone allowed correct jejunal placement. During a 4‐day postduodenal feeding period, repeated radiographic examination revealed stable positioning of the tubes within the jejunum with minor cranial displacement. The tubes were functional throughout the study without causing identifiable problems. Repeated physical examinations and blood analysis showed no abnormalities. We were able to administer the daily caloric requirements as a liquid diet. Jejunal chyme was successfully withdrawn via the tube. Conclusions – Endoscopically guided nasojejunal tube placement was shown to be a minimally invasive, well‐tolerated method for short‐term jejunal feeding in healthy dogs. This technique is a viable option for dogs requiring jejunal feeding but not laparotomy. The feasibility of chyme sampling is another unique application of the procedure.     

COMPARISON OF FLAT-PANEL DIGITAL TO CONVENTIONAL FILM-SCREEN RADIOGRAPHY IN DETECTION OF EXPERIMENTALLY CREATED LESIONS OF THE EQUINE THIRD METACARPAL BONE

Radiographic diagnosis of equine bone disease using digital radiography is prevalent in veterinary practice. However, the diagnostic quality of digital vs. conventional radiography has not been compared systematically. We hypothesized that digital radiography would be superior to film-screen radiography for detection of subtle lesions of the equine third metacarpal bone. Twenty-four third metacarpal bones were collected from horses euthanized for reasons other than orthopedic disease. Bones were dissected free of soft tissue and computed tomography was performed to ensure that no osseous abnormalities were present. Subtle osseous lesions were produced in the dorsal cortex of the third metacarpal bones, and the bones were radiographed in a soft tissue phantom using indirect digital and conventional radiography at standard exposures. Digital radiographs were printed onto film. Three Diplomates of the American College of Veterinary Radiology evaluated the radiographs for the presence or absence of a lesion. Receiver operator characteristic curves were constructed, and the area under these curves were compared to assess the ability of the digital and film-screen radiographic systems to detect lesions. The area under the ROC curves for film-screen and digital radiography were 0.87 and 0.90, respectively ( P =0.59). We concluded that the digital radiographic system was comparable to the film-screen system for detection of subtle lesions of the equine third metacarpal bone.     

RADIOGRAPHY OF THE EQUINE STOMACH

To obtain radiographic information concerning the equine stomach, a gastrographic contrast examination is required. This study describes this procedure in detail. A powerful radiographic unit, the tubehead linked to an image intensifier and suspended by an electromechanical overhead gantry system, is required. To obtain accurately positioned radiographs during the fluoroscopic examination, a cassette holder with a stationary grid is mounted at the entrance window of the image intensifier. The examination is performed in the unsedated standing horse after 24 hours of starvation, using a combination of survey radiography and fluoroscopic viewing after the inflation of air, followed by the administration of barium sulphate suspension by stomach tube. The gastrographic contrast examination is performed in three experimental animals and 23 abnormal horses. Pneumogastrophy appeared to be valuable to diagnose gastric tumors, to differentiate between gastric tumors and other masses in the cranial abdomen, and to visualize gastric parasites, even in large horses. The use of barium sulphate suspension does not result in an adequate double contrast of the stomach, but it may aid to diagnose esophagogastric or pyloric stenosis and gastric or duodenal ulcers.     

Comparison between radiography and computed tomography for diagnosis of equine skull fractures

The equine head is a complex structure prone to traumatic injuries. To determine the value and limitations of radiography and (CT) for the diagnosis of skull fracture, the differences between the two modalities were described. Two observers retrospectively reviewed the radiographic and CT images of 18 horses with a skull fracture. To allow direct comparison between the two modalities, a simplified fracture classification system was used. In 3/18 cases the evaluation of the radiographic examination concluded no injuries visible. In 2/15 cases soft tissue involvement was not detected and in 7/15 cases the extension of the fracture was underestimated with radiography. Radiography classified 4/10 multiple fractures incorrectly as single fracture and 5/15 comminuted fractures on CT were diagnosed as simple fracture with radiography. The number of fragments was underestimated with radiography in 14/15 cases. In conclusion, radiography is able to diagnose a skull fracture in most cases. Skull fractures however are not similarly classified after radiographic and CT evaluation, which causes a difference in interpretation and perception of the fractures. Therefore, CT should be the modality of choice for surgical planning and prognosis.     

Evaluation of an arthroscopic approach for transection of the equine collateral sesamoidean ligament

Objective: To evaluate: (1) an arthroscopic technique for transection of the collateral sesamoidean ligament (CSL); and (2) the healing response using magnetic resonance (MR) and microscopic examination. Study Design: Experimental study. Animals: Adult horses (n=6). Methods: Six sound horses with normal front foot radiographic and MR examinations were used. Lameness examination was performed before surgery and monthly for 12 months. Front foot radiography was performed at 180 and 360 days after surgery. Front foot MR was performed before, and at 7, 90, 180, and 360 days after surgery. Arthroscopic CSL desmotomy was performed on 1 forelimb. Gross and microscopic examination was performed on the CSL from both forelimbs at 360 days after surgery. Lameness scores were compared over time using the nonparametric Friedman's test for paired groups. CSL measurements were compared using paired t‐tests with a 2‐tailed significance level of P<.05. Results: Radiographs remained normal throughout study period. Surgery resulted in lameness on the operated limb for up to 2 months, after which all horses returned to soundness. CSL transection was confirmed during arthroscopy and with MR examination 7 days after surgery. Gross and microscopic evaluation confirmed ligament healing. Conclusions: CSL desmotomy resulted in short‐term lameness after surgery followed by healing of the CSL confirmed by gross and microscopic analysis.     

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.     

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.     

Standing CT of the equine head: Reducing radiation dose maintains image quality

Multiple published studies involving computed tomographic (CT) examinations of the equine head utilise a wide range of mAs parameters for image acquisition. This prospective, experimental study assessed the effects of lowering mAs during CT image acquisition on image quality and scatter radiation on 10 cadaver equine heads. Each head was scanned three times at 300, 225, and 150 mAs, with all other scanning parameters remaining constant between series. An anthropomorphic phantom was positioned adjacent to each equine head during image acquisition, mimicking a human bystander, with an ionization chamber attached to the phantom at eye level. Each series was reconstructed using filtered back projection, using medium (H30) and high (H80) frequency reconstruction algorithms. Quantitative image quality assessment was performed by calculating signal to noise ratio (SNR) and contrast to noise ratio (CNR). Two qualitative image quality assessments were performed independently by three blinded board certified veterinary radiologists with a 4 week interval, using a visual grade analysis model adapted from peer reviewed medical literature. Ionization chamber measurements, calculated volume CT dose index (CTDIvol), and dose‐length product (DLP) were recorded. Halving radiation dose during image acquisition from 300 to 150mAs resulted in comparable image quality between series. There was a statistically significant and linear relationship between mAs and scatter radiation to the bystander; halving mAs during image acquisition resulted in halving of scatter radiation. Results of this cadaveric study support the use of lower mAs settings during standing CT examinations of the equine head.     

RADIOGRAPHY OF THE EQUINE THORAX: ANATOMY AND TECHNIC

Radiographic evaluation of the entire adult equine thorax in the standing position requires a minimum of four overlapping lateral radiographs. Small horses could often be studied with fewer radiographs. This basic examination provided the optimal radiographic opportunity for detecting lung diseases in the horse. An understanding of normal gross and radiographic anatomy is an absolute necessity if one is to avoid the potential diagnostic pitfalls inherent in radiographic interpretation of the equine thorax. Of equal importance is an appreciation for the technic required to produce thoracic radiographs. The advent of rare-earth intensifying screen and highspeed film systems has enhanced the opportunity for obtaining diagnostic standing lateral equine thoracic radiographs.     

Cross-sectional survey of owner knowledge and husbandry practices, tack and health issues affecting working horses in Lesotho

Reasons for performing study: To establish baseline parameters of equine health, owner knowledge and husbandry practices and tack against which benefits to local horses arising from an equine charity's training programme in Lesotho could be measured. Objectives: To describe and investigate associations between owner knowledge and equine husbandry practices, horse health and tack‐related parameters prior to the start of the training programme. Methods: A cross‐sectional survey was undertaken in the catchment area of students attending the first training course. Owners from randomly selected villages were interviewed about horse care using a standardised, structured questionnaire, administered face to face in local language. Horses were clinically examined and tack assessed according to standardised protocols. Results: Clinical examinations were performed on 312 horses and 287 owners were interviewed. Owners had variable knowledge of equine husbandry and limited understanding of appropriate primary and preventive healthcare. Equine health problems identified included ecto‐ and endoparasite infestation, mouth lesions, overgrown and unbalanced feet and tack‐associated wounds. The majority of tack was in poor condition, dirty and ill‐fitting. With the exception of below‐average body condition score, no associations were found between key adverse horse‐related clinical findings and owners reporting their horse as being ‘unhealthy’. Conclusions: Working horses in Lesotho have a range of physical problems, many of which could be ameliorated through targeted owner education. With limited access to veterinary advice and scarce resources, improved availability of affordable local equine trade skills is key to improving equine health. Potential relevance: Findings could be used to inform and direct training programmes to maximise benefits to equine health and to serve as a baseline against which to monitor effects of educational and other interventions.