We use thyroid scans to determine whether or not a cat is in fact hyperthyroid before proceeding with I-131 treatment. Below are thyroid scan images from two different cats, one who was positive for feline hyperthyroidism, the other negative. Without looking at the second picture below, can you tell the difference between the positive and negative images? (Click on each to view full-size versions.)

Here is the answer:

It’s February. And February means that National Pet Dental Health Month is here! Prior to anesthetic cleanings, patients must go through a thorough exam that includes chest X-rays and blood work. This screening is not only good to make sure the pet is able to undergo anesthesia but it is also useful in early disease detection. Our radiologists are here for you and your patients during this process, so please keep us in mind for any chest X-rays and/or ultrasounds you may recommend as a result of abnormal blood work.

Thank you to everyone who attended our CE event Intro to DICOM & Digital Image Transfer!

We really enjoyed having you here, and we hope that you came away from the seminar with a better knowledge of DICOM systems and how they can improve your workflow. If you have any lingering questions, please do not hesitate to give us a call. We’d be happy to speak with you!

For those of you who missed this event or need a refresher of the contents, we have uploaded the PowerPoint presentation with audio for you to view.

Click here to receive email updates of future rounds and seminars

Using a 16-slice helical scanner, we conducted a CT study on a Doberman for lipoma surgery. These videos are of the 3-D reconstruction. Notice the total scan time!

The following MRI fistula study shows the entire depth of the draining tract above the right eye of a cat.

 
Real-Time Ultrasound is the Wave of the Future

There will soon be three options for veterinary ultrasound imaging: 1) refer the case out to a radiologist or cardiologist, 2) have the radiologist or cardiologist come to your clinic for the ultrasound, and 3) have a sonographer perform the study while a radiologist or cardiologist remotely reads the case via real-time technology.

“Wait, what is that third option?” you ask.

Real-time ultrasounds are streamed over the internet from a sonographer — who travels to the DVM’s hospital — to a specialist, who reviews the images from their location, using real-time streaming. (Note: Real-time ultrasound should not be confused with the failed model of still image ultrasound transmission that results in missed information.)

Benefits of this service are many.

Combining the hands and skills of sonographers with the extensive knowledge of radiologists and cardiologists, DVMs can offer their clients a quality service at a lower cost, since the specialist no longer needs to travel to their hospital. Furthermore, the DVM has access to a larger pool of specialists, and the specialists’ report turnaround time is significantly faster. In many cases a report is sent to the DVM even before the sonographer has left the building.

Critical care veterinarians will have the added bonus of speaking with someone over the phone while both parties are looking at images. This will also allow for the radiologist or cardiologist to answer questions or help out with image interpretation.

Real-time ultrasound is unique to our company and is a service that we have been performing for the San Diego Humane Society every week for the past two years, and later in 2012 will be available to local veterinary practices.

The ability to perform the ultrasound will be limited to critical care veterinarians and sonographers, but the hope is that it will be an option for DVMs in the future. Our ultimate goal is for real-time ultrasound to one day allow for specialists from all over the country to consult on cases in the general practitioner’s hospital as the exam is being done.

So, as we say goodbye to 2011, we can also say goodbye to the old way of still ultrasound transmission and make way for for a new wave… real-time ultrasound.

René Garcia, DVM
Staff Veterinarian/ Imaging Intern

Dr. René Garcia joined our practice earlier this year as our staff veterinarian and imaging intern, making him in charge of all of our I-131 therapy feline patients. He is the doctor veterinarians and owners discuss cases with, and he helps to oversee all of the the pretreatment imaging, treatment, and hospitalization. We are very happy to have such a talented young man join our practice for a one-year stay with us, and we thoroughly enjoy hearing about his professional and life experiences that he brings with him from all over the world.

Here is Dr. Garcia’s story…

Growing up in South Miami, across the street from the Everglades, wildlife conservation and reptiles were always a big part of my life. After a brief career as a firefighter and EMT, I decided that my desire to be a veterinarian and travel the world were too strong for me to continue a stationary, lifelong career with the fire department. My career goal to become a veterinarian led me on the journey of a lifetime, to one of the most respected veterinary schools in the world at Massey University, in Palmerston North, New Zealand. After seven years of living abroad, experiencing different cultures, making friends all over the world, all while focusing on becoming the best veterinarian I can be, I returned to America to start a mobile veterinary hospital that services Los Angeles and Ventura counties.

Q. What is your life outside of VICSD like?

A. My life revolves around my best friend and buddy, Mako, a 7-year-old MN New Zealand Huntaway that was taken directly from the rugged, chilly, steep sheep country of central New Zealand, to the soft, warm, and pillowtop confines of his Sunset Cliffs home.

Q. We love Mako! What else are you passionate about in life?

An avid traveler, I have visited an average of three different countries a year for the past seven years. International travel has gone from being a hobby to a lifestyle. The next planned vacation is… six nights in Iceland in early spring, 2012! Two of those nights will be spent dogsledding, led by the strong Greenlandic dog team, while enjoying the wild and untouched Icelandic countryside!

Q. Which imaging modality have you most enjoyed learning about?

A. The advances in advanced imaging modalities over the past few years have been a fascinating trend to follow. And while the technology and quality of these amazing imaging modalities has improved exponentially, so has their affordability to the consumer. We can now perform a full CT scan of the thorax to more accurately look for pulmonary metastasis, or scan the abdomen for surgical planning for just a little more than 3 view radiographs of the same structures would cost the client. And as time passes, I expect the trend to move from traditional imaging practices to more advanced imaging modalities, just as the human field has done over the past decade. With all these tools and diagnostic capabilities at our fingertips, this is an exciting time to be a veterinarian!

Q. Is there a unique case where CT was used that really stands out in your mind?

A. One case that stands out to me was an older MN Labrador, with a history of thoracolumbar pain, elevated ALT, ALP, and cholesterol, with alopecia and a distended abdomen. Abdominal radiographs were unremarkable other than a mild hepatomegaly. Abdominal ultrasound revealed a diffusley hyperechoic liver, and a large right adrenal mass was identified, but it was not certain whether this adrenal tumor was invading the surrounding vasculature. After a CT with contrast was performed, accurate intraluminal invasion of the phrenicoabdominal vein and caudal vena cava was detected accurately. Surprisingly, local invasion into the epaxial and hypaxial musculature was also identified, helping explain the dog’s back pain in the absence of intervertebral disk disease.

Imagine your practice trying to operate without your practice-management software or without your radiograph machine. My intent is not to cause a scare, but rather to make you aware and stress that computers are mechanical devices that will fail.

The question is: Can your business risk an outage that could potentially last days?

Something that I’ve learned the hard way is that it’s not a question of if a computer will go bad, rather it’s when it will go bad. It may be a surprise, but most personal and entry-level business computers are not built to be rock solid, from a reliability perspective, so please understand that at some point a machine will fail. A machine going down can significantly impact your business until it is replaced or fixed. Sometimes this could be as trivial as replacing a wireless router, or could be as severe as a corrupted hard drive.

A Little Insurance

Spending a few extra dollars could pay off if and when your machine does fail. I think it’s a good idea to have a maintenance agreement on your machine that will ensure a replacement part is shipped to you within 24-48 hours that will get you back online. If your maintenance agreement will soon lapse, it’s time to consider a new machine.

Let us consider your server that houses your practice management software. Sure, you take daily backups, but what if the hard drive on the server fails? Even though you have the backup, you have to completely rebuild your server, which takes a great deal of time. Having a maintenance agreement or a backup machine will help minimize downtime that negatively affects your business.

Also consider other options that provide you immediate access to data via the web. VICSD has offered clinics the ability to submit, store, and review images for years through the cloud-based VPACS and will soon be rolling out Vetology, which will allow clinics to do the same and more via the web. Utilizing a service like VPACS or Vetology reduces the reliance on your in-house machines to be able to serve up images and ensures you will always have access to images.

What Should You Do Next?

First, think about the impact of a potential computer outage. If this has the potential to be significant, then consider how you would mitigate that risk. Are you tech savvy or do you know of a local computer shop that could help minimize risk of outages? If so, I strongly suggest you do a review of your infrastructure or engage a local team to get some help. If you have been running your practice-management software on a 4-year-old machine that has never failed, then consider yourself very lucky. I recently read a statistic that states hard drives fail 15 times more than vendors originally estimate. While you may not know computers that well, there are quite a few reasonably priced vendors that just want to help you. Finally, also consider services that will allow you to focus on your practice rather than on IT, such as Vetology.

-Josh Yoo, Head of IT

About me: I spent my previous life as a techophile working for IBM but have since seen the light and am following in my father’s footsteps to become a veterinarian. Seeing this industry firsthand, I have realized how hard veterinarians work and what little time they have to explore technology options that could help improve their practice. That’s where I might be able to offer a hand until I get my DVM.

For years, radiograph interpretation has been taught the same way. Read the films in to out. Be consistent. Find the abnormalities. Write down the list. There, you have your radiology report.

But honestly what do you have? A list. And what good is a list? A list needs to be in the context of something else to become useful. For example, go to your fridge and create a list of what is needed. Now you have a list, a list that is useful when you go to the grocery store. Without the grocery store that list is useless. Give that list to someone else and who knows what you’ll get back. Maybe they will go to the wrong store and/or buy the wrong brand. Therefore, a list is only useful if you know what to do with that information.

How do we turn a useless list into something useful?

Well, we need to put it in the context of the case. But even then the list becomes watered down by insignificant findings such as spondylosis in a vomiting animal or shoulder arthritis in a dog with heart failure. So maybe the list approach isn’t the best way to do it.

What alternatives exist?

If you’re willing to try some new approaches to radiology, give these a whirl.

The Crime Scene Investigator (CSI) Approach  Identify your victim — patient signalment. Factor their breed and age into your decision process from this point forward. Next, identify your crime(s) — the clinical signs. Based on the signalment and clinical signs, create a short list of the usual suspects or diseases that fit your victim profile and crime (I typically have three in mind prior to evaluating radiographs). From your usual suspects list, jot down a few radiographic findings you would expect to find. Now go investigate your radiographs for the proof that one of your usual suspects is guilty. But be careful. Don’t try to condemn an innocent suspect just because you want it to be so. If the crime doesn’t fit the proof, you need to reexamine your usual suspects. Lastly, if you feel you have a strong case, take your argument to a jury of your peers and see if they would convict with the evidence before them. If you decide to try this approach, let me know how it goes. If this one doesn’t connect with you, then maybe the Normal/ Abnormal approach may work better.

The Normal/Abnormal Approach is a variant of the original in to out radiograph review, with a slight case-based approach. Next time you evaluate radiographs, look at each organ and decide if it’s normal or abnormal. If its abnormal write down the organ and why you consider it abnormal. Once you have your list make a second column listing the clinical signs. Now go through each of your radiographic findings and try to create an association between what you found and diseases that would both fit your finding and the clinical signs. For instance, let’s say a vomiting cat has a big liver. How could you relate the two? How about acute hepatitis? Hepatic lymphoma? Or even hepatic lipidosis? This approach may get you headed down the path to a diagnosis and hopefully will allow you to trivialize less important findings such as thoracic spondylosis in a vomiting dog.

Whichever radiograph interpretation method you choose, always make sure to relate your findings back to the question at hand.

Why is this animal sick? Radiographs — and for that matter, all imaging — are no different than any other diagnostic such as bloodwork, CBC, or urinalysis. Above all else, keep the patient in mind and don’t look at imaging in a vacuum.

From time to time, I will pontificate on imaging interpretation. Let me know your thoughts at info@vicsd.com. And for those true imaging-philes out there, be sure to connect with your local radiologist or cardiologist, veterinary continuing education program, or check out the AAVR for upcoming online programs or radiology sabbaticals being offered.

-Seth Wallack, DVM, DACVR

We’re very excited to soon launch the freshest teleradiology platform out there. It is a modern solution to many of the workflow issues that radiologists and veterinarians have experienced over the years. Be on the lookout for our upcoming launch party and demo. If you’re not on our mailing list to receive notices for our rounds, seminars, and special events, please sign up below…

Get Email Updates

Marina Ivančić, DVM, DACVR

We recently added a fourth radiologist to our practice – Dr. Marina Ivančić [pronounced eh-von-cheech]. She is now working at our hospital a few days a week and is also the friendly face of our Saturday Mobile Ultrasound appointments! Dr. Ivančić recently sat down to answer some questions to help us and our referring veterinarians get to know her better, and here is what she had to say…

Q. Please describe your educational background and work experience.

A. Despite my strong family ties to the beautiful country in which I was born, Croatia, I am enormously appreciative of the limitless opportunities available for academic excellence here in the US. I have had the fortune to be educated at a number of fine universities, including the University of Virginia, California (Davis), and Pennsylvania, as I pursued my undergraduate degree, veterinary school, and radiology residency in turn. I was a full-time radiologist at a large specialty hospital in Vancouver and the radiologist for the Vancouver Aquarium for three years prior to my position here at VICSD.