July 7, 2018: I am refreshing the series of blogs for CT in Veterinary Medical with updated information. -RW
CT machines have begun to make their way onto the wish lists of many general veterinary practitioners. A few general practitioners who already own a CT. These veterinarians are known as the ‘early adopters’ when it comes to adding new equipment and technology. If you are a veterinarian who is seeking information on CT, you have come to the right place!
I love veterinary technology and CT is at the top of my list. It is one of the most effective diagnostic tools in advanced veterinary imaging. I am intimate with this imaging modality as I have worked with several practices that own CT and Cone Beam CT equipment. CT is like an iceberg. What you see on the surface is but only a small portion of what is actually there. This is why I am writing a 3-part series on CT. One article cannot do this technology any justice.
Part 1 covers some of the basics. Part 2 will be more detailed as I explain the different types of CT systems currently available to veterinarians. I also outline the indications for veterinary use of the CT in detail. Part 3 covers the critical nuances of integrating CT technology into a general veterinary practice. I also share how I have developed a return on investment for a CT machine.
The basic concept of modern computed tomography is based on x-ray technology with a spin…or shall I say…spins. Essentially, x-rays are used to acquire cross-sectional images of a specific region within a medical patient. CT machines have two halves. The couch (aka table) and the gantry (aka donut). The business end of the CT is all inside of that gantry. What makes one type of CT different from another really cannot be seen on the outside.
There are two types of CT scanners available for sale today.
SPIRAL / HELICAL CT CONE BEAM CT (CBCT)
The spiral CT machines are the most popular and widely used in human and veterinary medical facilities. I plan on diving into the differences between CT and CBCT in part 2.
As stated earlier, CT machines are being used in all specialty practices and vet schools but are becoming more popular with general practitioners. CT diagnostics include but are not limited to the following:
- Skull / Nasal / Brain
- C-Spine / T-Spine / Lumbar Spine
- Thorax / Met Checks / Masses
- Abdomen / Masses / GI Tract / Adrenals
- Hips / Pelvis / Extremities
Will CT reduce the need to use X-Ray and ultrasound?
No. It will not replace those modalities nor will it reduce your use of them. CT is often the next step in imaging diagnostics once an ultrasound and/or radiographs point to a more significant issue within the animal patient.
Clinical Scenario #1
A two-year-old yellow lab presents with abdominal pain. An ultrasound is performed and the findings indicate that there is a mass in the abdomen. The size and exact location of the mass cannot be determined with accuracy. A CT exam will be ordered and the information it provides from the radiologist will indicate the following: 1) where the mass is 2) what it is attached to 3) exactly how large it is. From there a clinician can give the client more information about their pet and provide better options in treatment and prognosis.
Clinical Scenario #2
A ten-year-old DSH feline presents for labored breathing, nasal discharge and lethargy. Radiographs taken of the thorax are reported as normal. A quick view of the heart with the ultrasound reveals there is no pericardial effusion or cardiomegaly. A CT is performed on the skull of the kitty which indicates there is a mass in the nasal cavities and the mass penetrates into the bone. This is where CT provides an answer when ultrasound and x-ray could not. Could we have scoped the nasal cavities of the kitty? Certainly. However, sedation or anesthesia would have also been required to do this and with a CT in the hospital, it is the easiest path to a more comprehensive diagnosis. A rhinoscopy would have provided minimal information in comparison to the 2D and 3D images generated by the CT.
Can I use CT instead of ultrasound or X-ray?
No. CT machines are meant to provide additional answers when the ultrasound or the radiographs fail to provide a comprehensive evaluation of the targeted anatomy. With that said, CT machines are not perfect, as they too have limitations. Example: Ultrasound exams are more suitable than CT for evaluating the heart. All CT exams require anesthesia for the patient and the procedure itself will often cost the client twice as much as an ultrasound or radiographs. It is unwise to think CT can replace an ultrasound or a digital x-ray. This becomes obvious once a veterinarian gains more understanding of the technology and the physics that drive it.
Is there special training required for adding a CT to my practice?
Yes. There is special training required for all doctors and technicians. Operating the machine is the easiest training. Sadly, that is mostly all a veterinarian will get from a vendor. If you are planning on buying a CT for your practice, clinical team training will be the most important factor in whether or not the equipment will return the investment. In the specialty hospitals and the universities, veterinary technicians (and sometimes veterinarians) attend a CT camp to learn diagnostic operations and protocols associated with performing CT studies on patients. Unfortunately this type of training features only human patients. The good news: Veterinary Intelligence (www.vetxq.com), has developed a formal CT training program specifically for veterinarians and veterinary technicians. We will have a team of veterinary CT technologists and board-certified veterinary radiologists who teach our clients all that they need to know about CT procedures in a general veterinary practice.
Do general practices in veterinary medical have any business whatsoever purchasing a CT machine?
The answer to this question depends on several factors. 1. What is the culture of your veterinary practice? If your practice normally implements the best technology in imaging, labs, surgery, and treatments; then CT may be a good option. 2. Is your veterinary practice geographically isolated from veterinary referral centers? If so, adding a CT is definitely a good investment to consider. However, there are some general veterinary practices who are not isolated geographically and they have added CT with success. 3. Does your practice have frequent turnover of technicians and DVM associates? If so, CT would not be a good investment to consider because you obviously have larger problems to address in your hospital. The success of advanced procedures in any discipline of veterinary medical greatly depends on the attrition rate of team members such as technicians and associates. If a practice spends a great deal of time and money training new team members on a regular basis, CT (among other diagnostic tools) is not forgiving.
Part 1 has been aimed at the most basic questions that I get asked when speaking with veterinarians who are looking into buying a CT. Please contact me by email with any questions and please take some time to visit our website http://www.vetxq.com.
Robert Whitaker’s Email: email@example.com