ALTERNATIVES FOR IMPROVING VETERINARY MEDICAL STUDENTS' LEARNING OF CLINICAL SONOGRAPHY

With the widespread clinical use of sonography there is a need to introduce the topic into the curriculum. A new problem-based course in clinical sonography without lectures was developed to emphasise experiential learning, and engage students actively in individual and collective acts of discovery. Four different approaches were used to deliver the new course to 141 veterinary medical students over four semesters. The physical principles of sonography were taught by computer-assisted instruction and a practical class, clinical examinations were introduced during a session with a tutor, and finally each student wrote an essay on a sonographic topic of their choice. To evaluate the new course, students' responses to a questionnaire were analyzed. Students gained reasonable understanding of the physical principles of sonography and had some confidence in conducting a sonographic examination of an animal. Of most use to student learning was discussion with the teachers. Surprisingly, half the students thought the topic should also be taught by lectures. The students learned the material and acquired the sonographic skills through processes which required more independence and self-responsibility than traditional teaching methods. The teachers' interaction with students on an individual basis, as they encountered individual problems, was the most important resource in learning about sonography. The continued request for lectures suggests an insecurity in some students caught between two different paradigms of teaching and learning (experiential, problem-based learning versus lectures).     

THORACIC COMPUTED TOMOGRAPHY IN FELINE PATIENTS WITHOUT USE OF CHEMICAL RESTRAINT

Computed tomography (CT) and thoracic radiography were performed in nonsedated, nonanesthetized, cats with thoracic disease. The final diagnosis was obtained with echocardiography, cytology, histopathology, necropsy, or response to therapy. For CT imaging, cats were in a positioning device using a 16 multislice helical CT system. Fifty‐four cats had CT imaging of which 50 had thoracic radiography. The most common diagnoses were lung neoplasia, lower airway disease, and cardiomyopathy (nine each). Other disease groups included mediastinal mass (eight), infection (seven), trauma (four), and hernia (three). CT provided additional correct diagnoses in 28% (14/50) and additional information in 74% (37/50) of the cats. Additional correct diagnoses achieved only with CT were most common for cats with lower airway disease. The most common additional findings with CT were lung nodules (n=4), lung masses (n=4), bronchiectasis (n=4), and mediastinal lymphadenopathy (n=3). Survey CT led to a significant different diagnosis or different prognosis in 20 of the 50 cats that were imaged both modalities. Contrast CT was performed in 19 cats, most commonly in cats with lung neoplasia (n=6), a mediastinal mass (n=4) or an infection (n=3), and provided additional correct diagnosis in two cats not achieved with survey CT. Thoracic CT using a positioning device in diseased awake cats is feasible, safe, and clinically useful.     

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.     

THE EFFECT OF POSITIONING ON THE APPEARANCE OF SELECTED CRANIAL THORACIC STRUCTURES IN THE DOG

In this retrospective study the effect of thoracic positioning on the visibility and size of selected cranial thoracic structures in dogs was investigated. Dorsoventral (DV), ventrodorsal (VD) as well as left lateral recumbent (LLR) and right lateral recumbent (RLR) thoracic radiographs of 17 large, 15 medium, and 10 small skeletally mature dogs were evaluated. The craniodorsal and cranioventral mediastinum, the cupula pleura and sternal lymph nodes were examined. The effect of obesity was also evaluated. The craniodorsal mediastinum was better delineated on DV radiographs and was wider on VD radiographs. The craniodorsal mediastinal width: width of T2 cranial end-plate on VD radiographs was 2.41 for all groups combined and obesity significantly influenced this value. The cranioventral mediastinum was more visible in RLR and VD radiographs. A normal sternal lymph node soft tissue opacity was seen most commonly in RLR in large breed dogs and had a mean length of 30 mm. The pulmonary cupula extended beyond the first rib on all views and extended more cranially and was better visualised on VD than DV views.     

USE OF MAGNETIC RESONANCE IMAGING FOR DIAGNOSIS OF A SPINAL TUMOR IN A CAT

Magnetic resonance imaging was used to identify a spinal mass at the level of the 6th-7th cervical vertebral body in a cat. The MRI images were most consistent with the presence of an intradural, extramedullary meningioma that was confirmed by subsequent histological examination.     

COMPARISON OF THORACIC ULTRASONOGRAPHY AND RADIOGRAPHY FOR THE DETECTION OF INDUCED SMALL VOLUME PNEUMOTHORAX IN THE HORSE

Small volume pneumothorax can be challenging to diagnose in horses. The current standard method for diagnosis is standing thoracic radiography. We hypothesized that thoracic ultrasonography would be more sensitive. Objectives of this prospective, experimental study were to describe a thoracic ultrasound method for detection of small volume pneumothorax in horses and to compare results of radiography and ultrasound in a sample of horses with induced small volume pneumothorax. Six mature healthy horses were recruited for this study. For each horse, five 50 ml air boluses were sequentially introduced via a teat cannula into the pleural space. Lateral thoracic radiographs and standardized ultrasound (2D and M‐mode) examinations of both hemithoraces were performed following administration of each 50 ml air bolus. Radiographs and ultrasound images/videos were analyzed for detection of pneumothorax by four independent investigators who were unaware of treatment status. Sensitivity, specificity, positive predictive values, negative predictive values, and agreement among investigators (Kappa test, κ) were calculated for radiography, 2D and M‐mode ultrasound. Comparisons were made using a chi‐squared exact test with significance set at P < 0.05. Two‐dimensional (84%) and M‐mode (80%) ultrasound were more sensitive than radiography (48%) for pneumothorax detection (P = 0.02 and P = 0.04, respectively). Specificity and positive predictive values were similar for all three imaging modalities (P = 1). Agreement between investigators for pneumothorax detection was excellent for 2D ultrasound (κ = 1), very good for M‐mode ultrasound (κ = 0.87), and good for radiography (κ = 0.79). Findings from this experimental study supported the use of thoracic ultrasonography as a diagnostic method for detecting pneumothorax in horses.     

STUDENT PERFORMANCE AND COURSE EVALUATIONS BEFORE AND AFTER USE OF THE CLASSROOM PERFORMANCE SYSTEM™ IN A THIRD‐YEAR VETERINARY RADIOLOGY COURSE

Effective teaching of veterinary radiology can be challenging in a traditional classroom environment. Audience response systems, colloquially known as “clickers,” provide a means of encouraging student interaction. The purpose of this study was to compare student performance and course evaluations before and after using the Classroom Performance System? in the third‐year (fifth semester) didactic radiology course at the University of Tennessee College of Veterinary Medicine. Overall student performance was assessed by comparing median numeric final course grades (%) between years without and with use of the Classroom Performance System?. Grades of students were determined for individual instructors’ sections. Student evaluations of the radiology course were compared for the years available (2007–2010). Student interactions were also evaluated subjectively by instructors who used the Classroom Performance System?. There was a significant difference (p = 0.009) between the median student grade before (2005 – 2008, median 82.2%; interquartile range 77.6–85.7%; range 61.9–95.5%) and after use of the classroom performance system (2009–2010, median 83.6%; interquartile range 79.9–87.9%; range 68.2–93.2%). There was no statistically significant difference in median student grades for individual instructors over the study period. The radiology course student evaluation scores were significantly higher in years where the Classroom Performance System? was used in comparison to previous years (P = 0.019). Subjectively, students appeared more involved when using clickers. Findings indicated that the Classroom Performance System? may be a useful tool for enhancing veterinary radiology education.     

THE VETMOUSETRAP™: A DEVICE FOR COMPUTED TOMOGRAPHIC IMAGING OF THE THORAX OF AWAKE CATS

The VetMousetrap^?, a novel device that allows computed tomography (CT) of awake cats and provides a clinically supportive environment, is described. Ten normal cats were used to test the device for ambient internal oxygen, carbon dioxide levels, and temperature. Twenty‐two awake normal cats were imaged using a 16‐multi‐slice helical CT unit to evaluate dose‐equivalent protocols. Two different X‐ray tube potentials (kV), 80 and 120, and two different helical pitches, 0.562 and 1.75, were evaluated. The signal intensity of the pulmonary parenchyma (SI_lung), signal intensity of background (SI_backgr), contrast, noise, signal‐to‐noise ratio (SNR), and contrast‐to‐noise ratio (CNR) were calculated. Three evaluators ranked the images for sharpness of liver margins, motion, helical, and windmill artifacts. CT was successfully completed in 20 of 22 cats. No artifacts directly related to the device were detected. Overall, 75 of 80 (94%) examinations were judged to have absent or minimal motion artifact. A statistically significant difference was found for SNR (P=0.001) and CNR (P=0.001) between all protocols. The higher pitch protocols had significantly lower noise and higher SNR and CNR, lower motion artifact but greater helical artifacts. A protocol using 80 kV, 130 mA, 0.5 s, and 0.562 pitch with 1.25 mm slice thickness, and 0.625 mm slice reconstruction interval is recommended. The VetMousetrap^? appears to provide the opportunity for diagnostic CT imaging of the thorax of awake cats.     

PRELIMINARY CLINICAL USE OF COMBINED BLOOD POOL AND BONE PHASE RADIONUCLIDE IMAGING IN DOGS

The case reports of three dogs, in which combined blood pool and bone phase radionuclide imaging was done, are presented. The procedure is accomplished by injecting ^99mTc-MDP and imaging at 3–5 min and 2 hours postinjection. These three cases suggest that a greater number of animals with varied etiologies should be scanned in this manner to determine the usefulness of the procedure.     

CLINICAL AND DIAGNOSTIC IMAGING FINDINGS IN HORSES WITH SUBCHONDRAL BONE TRAUMA OF THE SAGITTAL GROOVE OF THE PROXIMAL PHALANX

Eight sports horses with unilateral (4) or bilateral (3) forelimb or unilateral hindlimb (1) lameness had subtle radiologic abnormalities of the subchondral bone of the sagittal groove of the proximal phalanx associated with moderate or intense increased radiopharmaceutical uptake. High‐field or low‐field magnetic resonance (MR) imaging confirmed the presence of a fissure fracture or subchondral and trabecular bone trauma. Seven of eight lesions were located approximately midway between the dorsal and palmar cortices of the proximal phalanx; the eighth was sited more dorsally. Two horses underwent follow‐up MR imaging and abnormal signal intensity persisted, with little change.     

USE OF RADIOGRAPHY IN COMBINATION WITH COMPUTED TOMOGRAPHY FOR THE ASSESSMENT OF NONCARDIAC THORACIC DISEASE IN THE DOG AND CAT

Computed tomography (CT) of the thorax was performed in 28 dogs and five cats and findings were compared with previous thoracic radiographs. The sample population included all animals that had thoracic radiographs and a CT study within 5 days of each other, where the complete imaging studies were available for review. Thoracic radiographs were considered indeterminate in 31 patients and CT examinations were done to acquire additional information. The presence of additional information from CT relating to presence of pathology, location of pathology, extent of pathology, and involvement of mediastinal structures was recorded. Whether there was a change in diagnosis based on the CT findings was also recorded. In only 4/33 animals (all dogs) did CT fail to provide any new information for the parameters evaluated when compared with survey thoracic radiographs. Additional information about the pathology that was present was gained by CT in 5/5 cats and 21/ 28 dogs. New information on compartmental location of pathology was seen in 4/5 cats and 19/28 dogs. New information on pathology extent was noted in 5/5 cats and 20/28 dogs. Additional information regarding involvement of mediastinal structures was obtained in 2/5 cats and 10/28 dogs. A change in diagnosis was made in 3/5 cats and 13/28 dogs. In conclusion, CT is a valuable tool for evaluating intrathoracic disease. CT provides additional cross-sectional anatomic information that can aid in anatomic localization and evaluation of the extent of the pathology in question.     

USE OF RADIOGRAPHY, COMPUTED TOMOGRAPHY AND MAGNETIC RESONANCE IMAGING FOR EVALUATION OF NAVICULAR SYNDROME IN THE HORSE

Radiographic evaluation of navicular syndrome is problematic because of its inconsistent correlation with clinical signs. Scintigraphy often yields false positive and false negative results and diagnostic ultrasound is of limited value. Therefore, we assessed the use of computed tomography and magnetic resonance imaging in a horse with clinical and radiographic signs of navicular syndrome. Cadaver specimens were examined with spiral computed tomographic and high-field magnetic resonance scanners and images were correlated with pathologic findings. Radiographic changes consisted of bony remodeling, which included altered synovial fossae, increased medullary opacity, cyst formation and shape change. These osseous changes were more striking and more numerous on computed tomographic and magnetic resonance images. They were most clearly defined with computed tomography. Many osseous changes seen with computed tomography and magnetic resonance imaging were not radiographically evident. Histologically confirmed soft tissue alterations of the deep digital flexor tendon, impar ligament and marrow were identified with magnetic resonance imaging, but not with conventional radiography. Because of their multiplanar capability and tomographic nature, computed tomography and magnetic resonance imaging surpass conventional radiography for navicular imaging, facilitating earlier, more accurate diagnosis. Current advances in imaging technology should make these imaging modalities available to equine practitioners in the future.     

IMAGING DIAGNOSIS—USE OF MULTIPHASIC CONTRAST‐ENHANCED COMPUTED TOMOGRAPHY FOR DIAGNOSIS OF MESENTERIC VOLVULUS IN A DOG

A 4‐year‐old German shorthaired pointer presented with collapse and hematochezia. Radiographs showed gas and fluid‐distended small intestines and loss of serosal detail. Ultrasound examination showed hypomotile, fluid‐distended small intestines, and thrombosed jejunal veins. Multiphasic contrast‐enhanced computed tomography was performed and showed a CT “whirl sign,” an important but nonspecific sign of intestinal volvulus in human patients. At surgery, the majority of the small intestine was entangled in the volvulus and showed black discoloration. The patient was euthanized. Postmortem evaluation yielded a diagnosis of jejunoileal mesenteric volvulus secondary to a congenital omphalomesenteric duct remnant.     

IMAGING DIAGNOSIS—RADIOGRAPHY AND COMPUTED TOMOGRAPHY OF RADIOULNAR ISCHEMIC NECROSIS IN A JACK RUSSELL TERRIER

A 7‐year‐old Jack Russell Terrier with a history of minor trauma was presented for lameness of the left forelimb. Radiography and computed tomography demonstrated a localized radioulnar osteolytic lesion with cortical bone loss and enthesiophytes. Based on results of diagnostic imaging and histopathological examination, the final diagnosis was radioulnar ischemic necrosis (RUIN), complicated by pathologic fracture. A rare disorder of unknown etiology, RUIN may be secondary to tearing of the interosseous ligament and potential ischemia. It should be differentiated from neoplastic or fungal disease. To the authors´ knowledge, this is the first canine case report describing RUIN.     

99MTC-CIPROFLOXACIN IN IMAGING OF CLINICAL INFECTIONS IN CAMELIDS AND A GOAT

(99M)Tc-ciprofloxacin was used to image five adult camelids and a juvenile goat with clinical and/or radiographic signs of infection. (99m)Tc-ciprofloxacin (range 10-33 MBq/kg) was injected intravenously and a series of 2-min static images were acquired at 1- and 4-h postinjection. At 24-h postinjection, 5-min static images were acquired. Only the skull or abdomen was imaged in the adults; the whole body was imaged in the goat. The quality of the 1-, 4-, and 24-h studies was evaluated subjectively. Normal and abnormal areas of (99m)Tc-ciprofloxacin uptake were recorded and subjectively graded as mild, moderate or intense. Image quality was best 4-h postinjection. Twenty-four-hour images were poor because of insufficient radioactivity. (99m)Tc-ciprofloxacin imaging resulted in true positive or true negative scans in four of six animals. Two false-negative studies occurred. Intense (99m)Tc-cirofloxacin activity was seen in the lungs and urinary bladder, moderate/intense activity in the kidneys, and mild activity in the physes/epiphyses, liver and intermittently in the gastrointestinal tract. The normal distribution of (99m)Tc-ciprofloxacin in camelids/small ruminants differed from people. Further studies to determine the sensitivity and specificity of infection detection using (99m)Tc-ciprofloxacin in animals are warranted.     

MAGNETIC RESONANCE IMAGING FOR THE DIAGNOSIS OF STRESS FRACTURES IN A HORSE

In humans, magnetic resonance (MR) imaging is the method of choice for the diagnosis of stress fractures. In this paper, bilateral stress fracture of the lateral condyle of the third metacarpal bone in a French trotter is described. Results of the radiographic, MR imaging, and histologic examinations are presented, with a focus on the MR signal abnormalities found. Based on this patient, the potential use of MR imaging for the diagnosis of stress fractures in horses is discussed.     

VALIDATION OF A NOVEL TRANSLUMBAR ULTRASOUND TECHNIQUE FOR MEASURING RENAL DIMENSIONS IN HORSES

A reliable method for obtaining renal ultrasonographic measurements in the horse is important for diagnosis and monitoring of clinical renal disease. The aims of this prospective study were to develop and validate a novel translumbar ultrasound technique for measuring renal dimensions in horses. Six Thoroughbred or Thoroughbred part bred horses were recruited. All horses were scheduled for euthanasia due to reasons unrelated to the kidneys. Two observers recorded renal length, width, and depth; and dimensions of the cortex, medulla, pyramids, and pelvis for both kidneys in each horse using novel translumbar and conventional transabdominal ultrasound methods. The same measurements were recorded from post‐mortem renal specimens. Both kidneys were consistently identified by both methods in the 15–17th intercostal spaces and paralumbar fossa. Using the translumbar technique, maximal dimensions were obtained for the left kidney in the 16th intercostal space (length 16.2 ± 2.0 cm, width 11.8 ± 0.5 cm, depth 6.4 ± 0.9 cm) and for the right kidney in the 15th intercostal space (length 16.1 ± 1.2 cm, width 13.4 ± 1.2 cm, depth 6.7 ± 0.7 cm). Renal dimensions obtained by transabdominal and translumbar projections did not differ (P > 0.05). Good correlations were found between overall renal dimensions and post‐mortem measurements for both ultrasound techniques (r² > 0.8), but were better for the translumbar method (mean r² = 0.92 cf. 0.88). Good‐to‐excellent reliability was found for all translumbar ultrasound measurements except for the renal cortex. Reproducibility was better for the larger (overall length, width, and depth) than the smaller (cortex, medulla, and pyramids) structures. Findings indicated that translumbar ultrasonography is a valid method for measuring renal dimensions in horses.     

USE OF A PETROLEUM-BASED BOLUS FOR PHOTON RADIATION THERAPY OF DISTAL EXTREMITIES IN DOGS

While skin sparing is an advantage of megavoltage beams, in certain clinical situations the planning target volume includes the skin surface and a skin sparing effect is not desirable. A tissue equivalent material, termed build up bolus, is used in these situations to provide adequate absorbed dose at the surface of the skin. However, an irregular patient contour can lead to air gaps between the build up bolus and the skin surface, which may result in variability in radiation dose across the target volume. The shape of the canine distal hind extremity is irregular, and commercially available bolus materials do not conform well to this region. The purpose of this study was to assess the dose homogeneity achieved using a petroleum-based bolus material, in combination with a commercially available sheet bolus, for radiation treatment of the canine tarsus. Repeated setups were performed to mimic daily treatment setups in the clinic setting, and computed tomographic scans were performed after each setup. Dose distribution achieved with a cobalt therapy machine and a 6 MV linear accelerator was assessed using three-dimensional treatment planning software. The dose to the clinical target volume fell within 95% and 107% of the prescribed dose for both treatment machines, which is considered clinically acceptable by the authors. This petroleum-based bolus is equivalent to water in its photon attenuation, conforms well to an irregular patient contour, and retains its shape after positioning. Applications to other anatomical sites could be considered.