A SURVEY OF RADIOLOGISTS AND REFERRING VETERINARIANS REGARDING IMAGING REPORTS

An imaging report is a vital communication tool between a radiologist and clinician. In a field where in‐person communication may not be readily available, it is imperative that the report clearly relays pertinent clinical information in a timely manner. The purpose of this observational study was to describe and compare opinions and expectations of small animal general practitioners, veterinary specialists, and veterinary radiologists regarding the imaging report. Online surveys were distributed, and data were collected from 202 veterinary clinicians and 123 veterinary radiologists. The majority (89%) of clinicians were satisfied with their imaging reports and stated that they read the radiology report as soon as it was available (92%). Just less than half (48%) of clinicians indicated it was standard of care that a board‐certified veterinary radiologist read all imaging studies. Radiologists and clinicians agreed that a clinical history (98% and 94%, respectively) and clinical question (82% and 68%, respectively) were needed to generate a good radiology report. Fifty‐five percent to 70% of clinicians prefer red bulleted reports, which included incidental findings (96%); while radiologists slightly favored prose reporting (37–46%). Clinicians found it helpful when additional imaging (86%), medical (71%), and surgical recommendations (73%) were made. About one‐third of specialists who had been in practice for >11 years thought they were better able to interpret imaging for their own specialty than the radiologist. Clinicians voiced discontentment with reports that were not completed in a timely manner or did not give a prioritized differential list. Further studies are warranted to provide a more in‐depth evaluation of veterinary radiology reporting structure and style.     

FORENSIC RADIOLOGY AND IMAGING FOR VETERINARY RADIOLOGISTS

Imaging studies are often of evidentiary value in medicolegal investigations involving animals and the role of the veterinary radiologist is to interpret those images for courts as an expert or opinion witness. With progressing interest in prosecuting animal crimes and strengthening of penalties for crimes against animals, the participation of veterinary radiologists in medicolegal investigations is expected to increase. Veterinary radiologists who are aware of radiographic and imaging signs that result in animal suffering, abuse, or neglect; knowledgeable in ways radiology and imaging may support cause of death determinations; conversant in postmortem imaging; comfortable discussing mechanisms and timing of blunt or sharp force and projectile trauma in imaging; and prepared to identify mimics of abuse can assist court participants in understanding imaging evidence. The goal of this commentary review is to familiarize veterinary radiologists with the forensic radiology and imaging literature and with the advantages and disadvantages of various imaging modalities utilized in forensic investigations. Another goal is to provide background information for future research studies in veterinary forensic radiology and imaging.     

THE CAREER PATH CHOICES OF VETERINARY RADIOLOGISTS

Concerns of a shortage of board certified specialists willing to work in academia have shadowed the medical and veterinary communities for decades. As a result, a number of studies have been conducted to determine how to foster, attract, and retain specialists in academia. More recently, there has been a growing perception that it is difficult for academic institutions to hire board certified veterinary radiologists. The objective of this study was to describe the career paths (academia vs. private sector) of veterinary radiologists and to determine what factors influenced their career path decisions. A mixed mode cross‐sectional survey was used to survey ACVR radiologists and residents‐in‐training, 48% (255/529) of which responded. There was a near unidirectional movement of radiologists from academia to the private sector: 45.7% (59/129) of the respondents who began their careers in academia had switched to the private sector while only 8% (7/88) had left the private sector for academia. If a shortage of academic radiologists exists, then perhaps the issue should be framed as a problem with retention vs. recruitment. The most influential factors in the decision to leave academia were remuneration (wages and benefits), lack of interest/enjoyment in research, geographical location, and family considerations. It is salient that average salaries increased by twofold after leaving academia for the private sector.     

Academic and private practice partnerships in veterinary radiology residency training

As veterinary radiologists devote greater time to telemedicine consultation, residency training must evolve to reflect the skills of these services. The contribution of private practice/consultant radiologists to residency training has traditionally been minimal but academic and private practice partnerships in education and research can provide the framework for a well‐rounded residency. These partnerships can also lessen the impact of workforce shortages in academia and provide financial compensation to academicians through external consultation. The purpose of this commentary is to review existing collaborative interactions between academic and private practice veterinary radiologists; with a focus on ways to sustain, improve, and cautiously increase the number of veterinary radiology training programs.     

Characteristics of biosecurity and infection control programs at veterinary teaching hospitals

OBJECTIVE: To characterize biosecurity and infection control practices at veterinary teaching hospitals located at institutions accredited by the AVMA. DESIGN: Cross-sectional survey. POPULATION: 50 biosecurity experts at 38 veterinary teaching hospitals. PROCEDURES: Telephone interviews were conducted between July 2006 and July 2007, and questions were asked regarding policies for hygiene, surveillance, patient contact, education, and awareness. Respondents were also asked their opinion regarding the rigor of their programs. RESULTS: 31 of 38 (82%) hospitals reported outbreaks of nosocomial infection during the 5 years prior to the interview, 17 (45%) reported > 1 outbreak, 22 (58%) had restricted patient admissions to aid mitigation, and 12 (32%) had completely closed sections of the facility to control disease spread. Nineteen (50%) hospitals reported that zoonotic infections had occurred during the 2 years prior to the interview. Only 16 (42%) hospitals required personnel to complete a biosecurity training program, but 20 of the 50 (40%) respondents indicated that they believed their hospitals ranked among the top 10% in regard to rigor of infection control efforts. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that differences existed among infection control programs at these institutions. Perceptions of experts regarding program rigor appeared to be skewed, possibly because of a lack of published data characterizing programs at other institutions. Results may provide a stimulus for hospital administrators to better optimize biosecurity and infection control programs at their hospitals and thereby optimize patient care.     

IDENTIFICATION AND PREVALENCE OF ERRORS AFFECTING THE QUALITY OF RADIOGRAPHS SUBMITTED TO AUSTRALIAN THOROUGHBRED YEARLING SALE REPOSITORIES

We aimed to identify common mistakes made when radiographing yearling sale horses. Radiographic examinations from repositories at eight yearling sales held in Australia in 2003 were assessed by one of four veterinary radiology specialists. Each radiographic examination consisted of a maximum of 34 radiographs. Each radiograph was assessed for errors associated with movement, exposure, positioning, labeling or marker placement, and processing, and categorized as either ideal, less than ideal or nondiagnostic. In addition, from the first 800 sets catalogued, 167 were selected randomly and read twice by the four radiologists for agreement analysis. A total of 81,297 radiographs were examined for errors affecting quality. Positioning errors were the most common reason for radiographs to be considered nondiagnostic (2432/81,297; 3%), with the flexed lateromedial (LM) metacarpophalangeal joint, LM metatarsophalangeal joint, and the dorsomedial palmarolateral (DMPaLO) carpal views being the most frequently involved. Overexposure (14,357/81,297; 17.7%) was the most common reason for radiographs being categorized as less than ideal with the LM stifle view the most represented. Agreement within and between radiologists for reporting errors in positioning of the flexed LM metacarpophalangeal joint, LM metatarsophalangeal joint, and DMPaLO carpal views varied from slight to almost perfect. The low repeatability within radiologists on some views suggests that before declaring a radiograph nondiagnostic it is worth considering rereading it at another time. Care should be taken in positioning of the flexed LM metacarpophalangeal, LM metatarsophalangeal, and DMPaLO carpus views to maximize radiograph quality.     

APPROACHES TO INSPECTING COMPUTED TOMOGRAPHIC AND MAGNETIC RESONANCE STUDIES

There is a need to better understand how to optimally inspect large image datasets. The aim of the present study was to complement experimental studies of visual perception by using an online questionnaire to collect opinions of practicing veterinary radiologists about the approaches they use when inspecting clinical computed X‐ray tomography (CT) and/or magnetic resonance (MR) studies, and to test associations between radiologist's approaches and their training, experience, or caseload. Questionnaires were received from 90/454 (20%) American College of Veterinary Radiology (ACVR) Diplomates and 58/156 (37%) European College of Veterinary Diagnostic Imaging (ECVDI) Diplomates, providing 139 complete responses for CT studies and 116 for MR. Questionnaire responses differed for the following variables: specialty college, years since Board Certification, CT and MR caseload, and type of practice. ACVR Diplomates more frequently inspected multiple anatomic structures in CT and MR images before moving on to the next image, and ECVDI Diplomates more frequently inspected a specific anatomic structure through a series, then went back and checked another structure. A significant number of radiologists indicated that they initially ignore the history, adopt relatively rigid search patterns with emphasis on viewing images in a predetermined order with minimal deviation, and arrange series of images to facilitate comparisons between images, such as pre‐ and postcontrast images. Radiologists tended to adopt similar approaches for both CT and MR studies. Findings from this study could be used as foci for teaching novices how to approach large imaging studies, and provide guidance for case‐based assessment of trainees.     

Utility of two‐view vs. three‐view abdominal radiography in canines presenting with acute abdominal signs

There are clear differences in the normal radiographic appearance of the abdominal organs between a left lateral vs. a right lateral view. While a few veterinary academic institutions have transitioned to a three‐view abdominal radiographic study protocol, obtaining only two views of the canine abdomen remains the current standard in veterinary medicine. In this combined retrospective and prospective, case‐controlled study, 48 canine patients presenting with signs of acute abdomen were recruited. Four board‐certified veterinary radiologists and four general practice veterinarians with greater than 3 years of experience in small animal practice were asked to determine if 10 predetermined findings were present within the set of images and if surgery was recommended based on those findings. Image readers were unaware of the clinical history. Three‐view studies did not yield statistically significantly greater accuracy than two‐view studies when evaluating all readers together. No statistically significant associations between the availability of the third view and increased accuracy or confidence were found in evaluations of general practitioners specifically. Evaluation of three‐view radiographic examination, as compared to two‐view examination, did not have perceived or statistically significantly increased diagnostic utility. Based on our findings, there is no statistically increased utility to justify a standard three‐view abdominal radiographic examination over a two‐view study for canines presenting with signs of acute abdomen.     

Overview of suspected adverse reactions to veterinary medicinal products reported in South Africa (March 2003 - February 2004)

The Veterinary Pharmacovigilance and Medicines Information Centre is responsible for the monitoring of veterinary adverse drug reactions in South Africa. An overview of reports of suspected adverse drug reactions received by the centre during the period March 2003 to February 2004 is given. A total of 20 reports was received. This had declined from the previous year. The general apathy with regards to the reporting of adverse drug reaction has prompted the Medicines Control Council to make reporting a legal obligation on all members of the veterinary and medical profession as from August 2004. The majority of reports involved suspected adverse reactions that occurred in dogs and cats. Most of the products implicated were Stock Remedies. Veterinarians predominantly administered these products. Only two reports were received from a veterinary pharmaceutical company.     

THE LITERATURE OF VETERINARY IMAGING: THE ANALYSIS OF A QUESTIONNAIRE

250 veterinarians, including 143(57.7%) non-radiologists, replied to a questionnaire on current literature of veterinary imaging. Veterinary Readiology & Ultrasound was considered the best overall journal, being chosen as first choice by 51.6% respondents. It was also judged to have the best photographic reproduction. No book was chosen as first choice by more than 18.4%. Three, Textbook of Diagnostic Radiology, Thrall; Diagnostic Radiology of the Dog & Cat, Kealy and Thoracic Radiography of the Dog & Cat, Suter & Lord, were chosen by 18.4%, 16.8% and 13.2% respondents respectively. Clinically orientated papers and review articles were the preferred contents of journlas. Experience of colleagues and journals were adjudged the best source of information on diagnostic imaging. Differences in results between radiologists and non-radiologists were not great and geographic differences were few. Of the 112 respondents who had published papers on veterinary imaging, 30 (26.4%) were non-radiologists.     

Suspected adverse reactions to medicines during 1989

There was an increase in reports of suspected adverse reactions to veterinary medicines in 1989 with 329 reports (compared with 206 in 1988), from veterinary surgeons, farmers and the public, comments the Veterinary Medicines Directorate (VMD). Suspected adverse reactions to clostridial/pasteurella vaccines in sheep were a dominant feature and important experience was gained both in terms of liaison with the farming press, and in handling large scale incidents involving PML products. The general trend towards increased reporting of adverse drug effects continues. The UK is the only EC member state to have a PML system and the VMD is looking with some urgency at ways of ensuring the more representative reporting of all categories of drug. Substantial liaison with the veterinary pharmaceutical industry occurred during the year and 204 product reports were requested from companies.     

Echocardiography for the diagnosis of congenital heart defects in the dog

Echocardiography utilizing M-mode and real-time techniques is a safe, noninvasive diagnostic technique for use in veterinary cardiology. It provides a means to assess structural sizes and relationships and can be used to provide quantitative data for diagnosis of congenital heart disease. Although its availability is largely limited to veterinary colleges and specialty hospitals, the practicing veterinarian should know of its advantages and disadvantages. He or she is also encouraged to consider the use of ultrasound in the diagnosis and management of heart disease in all species of veterinary patients.     

Survey of Saskatchewan beef cattle producers regarding management practices and veterinary service usage

Saskatchewan cow-calf producers (n = 2000) were surveyed to determine what factors were associated with their uptake of veterinary services; how and where they access nutritional information and animal health advice; and whether they were comfortable with having non-veterinarians perform veterinary procedures. The survey response rate was 18.1%. Veterinarians were seen as a primary source of nutritional information and animal health advice. Over the past decade producers have shifted their veterinary service usage from individual animal events to herd-level procedures. Producers who pregnancy check were more likely to be large producers (OR = 1.9; 95% CI = 1.2 to 3.1; P = 0.007), to semen test their bulls (OR = 3.4; 95% CI = 2.0 to 5.8: P < 0.001), analyze their forages (OR = 2.3; 95% CI = 1.7 to 4.0; P = 0.006), and to farm in the brown versus the gray or dark brown soil zones (P = 0.004). Most (94.0%) respondents had adequate veterinary services within an hour’s drive of the farm and 90.4% were satisfied with their veterinary service provider. Approximately 25% of respondents would be comfortable with having a non-veterinarian pregnancy check and attend to prolapses.     

伊维菌素注射液含量测定的兽药检测实验室能力比对结果分析

为加强兽药检验检测机构能力建设,进一步提升检测技术水平,组织开展了全国省级兽药检验机构伊维菌素注射液含量测定的能力比对。依据《中国兽药典》2020年版一部附录0512高效液相色谱法以及中国合格评定国家认可委员会(CNAS)规定的程序进行本次能力比对。采用单因子方差分析对制备的测试样品进行均匀性检验,采用t检验对样品进行稳定性考察,采用Z比分数评价各参加实验室的测试结果,以稳健统计的平均值作为指定值。参加本次能力比对的34家兽药检测实验室中,32家结果为满意,满意率94.1%。     

Antimicrobial labelling in Australia: a threat to antimicrobial stewardship?

Antimicrobial resistance is a public health emergency, placing veterinary antimicrobial use under growing scrutiny. Antimicrobial stewardship, through appropriate use of antimicrobials, is a response to this threat. The need for antimicrobial stewardship in Australian veterinary practices has had limited investigation. A 2016 survey undertaken to investigate antimicrobial usage patterns by Australian veterinarians found that antimicrobial dose rates were varied and often inappropriate. Doses of procaine penicillin in horses and cattle were often low, with 68% and 90% of respondents, respectively, reporting doses that were unlikely to result in plasma concentrations above minimum inhibitory concentrations for common equine and bovine pathogens. Frequency of penicillin administration was also often inappropriate. Gentamicin doses in horses were largely appropriate (89% of dose rates appropriate), but 9% of respondents reported twice daily dosing. Amoxycillin and amoxycillin‐clavulanate were administered at the appropriate doses, or above, to dogs and cats by 54% and 70% of respondents, respectively. Here, we explore the potential reasons for inappropriate antimicrobial dose regimens and report that antimicrobial labels often recommend incorrect dose rates and thus may be contributing to poor prescribing practices. Changes to legislation are needed to ensure that antimicrobial drug labels are regularly updated to reflect the dose needed to effectively and safely treat common veterinary pathogens. This will be especially true if changes in legislation restrict antimicrobial use by veterinarians to the uses and doses specified on the label, thus hampering the current momentum towards improved antimicrobial stewardship.     

Diagnostic imaging – evaluating image quality using visual grading characteristic (VGC) analysis

Radiologists are regularly faced with the task of comparing image quality obtained using different imaging systems or settings. Visual grading techniques can be used to evaluate the quality of images by grading the clarity of reproduction of anatomical or pathological structures. The methods, which include “visual grading analysis (VGA)” and the “image criteria (IC) study”, are characterised by their attractive simplicity and reliability. Non-parametric rank-invariant statistical methods are suitable techniques for statistical analysis of VGA-data. Båth and Månsson (2007) introduced such a method and termed it “visual grading characteristics (VGC) analysis”. This paper gives an overview of the principle together with an example of its use in veterinary radiology. The aim of this review article is to encourage veterinary researchers to apply this method which has proven valuable in the human field. Basically, the method can also be applied for the analysis of other categories of images (e.g. histological sections, cytological smears) in cases where the task is to evaluate features subjectively on the basis of a score, allowing some degree of freedom of decision. Furthermore, the aim of the investigation is not necessarily restricted to quality aspects. Other questions such as the effects of treatment options on the appearance of certain structures can be compared as well.     

Survey of complications and antimicrobial use in equine patients at veterinary teaching hospitals that underwent surgery because of colic

OBJECTIVE: To determine current practices regarding use of antimicrobials in equine patients undergoing surgery because of colic at veterinary teaching hospitals. DESIGN: Survey. SAMPLE POPULATION: Diplomates of the American College of Veterinary Surgeons performing equine surgery at veterinary teaching hospitals in the United States. PROCEDURE: A Web-based questionnaire was developed, and 85 surgeons were asked to participate. The first part of the survey requested demographic information and information about total number of colic surgeries performed at the hospital, number of colic surgeries performed by the respondent, and whether the hospital had written guidelines for antimicrobial drug use. The second part pertained to nosocomial infections. The third part provided several case scenarios and asked respondents whether they would use antimicrobial drugs in these instances. RESULTS: Thirty-four (40%) surgeons responded to the questionnaire. Respondents indicated that most equine patients undergoing surgery because of colic at veterinary teaching hospitals in the United States received antimicrobial drugs. Drugs that were used were similar for the various hospitals that were represented, and for the most part, the drugs that were used were fairly uniform irrespective of the type of colic, whereas the duration of treatment varied with the type of colic and the surgical findings. The combination of potassium penicillin and gentamicin was the most commonly used treatment. CONCLUSIONS AND CLINICAL RELEVANCE: Results of this study document the implementation of recommendations by several authors in veterinary texts that antimicrobial drugs be administered perioperatively in equine patients with colic that are undergoing surgery. However, the need for long-term antimicrobial drug treatment in equine patients with colic is unknown.