What We Know, May Not Be So

I am pretty sure that crow must be a distasteful bird. When one admits he or she is wrong and retracts previous statements, in Texas, we call that eating a plate of crow. Although I have never tasted crow in the literal sense; I have eaten a few pounds of it over my life time. It is embarrassing, and it crushes my pride.

Crow Ha Ha

So, here I am about to eat a plate of crow in front of God and everyone else in veterinary medical. In March of 2017, I wrote and published a three-part series about Computed Tomography (aka CT or CAT Scan) and Cone Beam Computed Tomography (aka CBCT) and how they are used effectively (or ineffectively) in veterinary medical applications.

Here are the links:




I have learned that these articles about CT and CBCT were outdated publications before I even finished the first draft! I retract every word. It is time to start over with fresh information and some additional help from my peers.

I sincerely apologize to everyone who may have been misled by my CT articles. I was not thorough in my research. I allowed myself to be blinded by my own pre-suppositions. My 20+ years of experience in veterinary imaging technology had given me a false sense of security and self-righteousness. I hope that you each will forgive me. I aim to leave room for what I do not know in the future. I must allow more cross-examinations by a more diverse group of my peers than I have allowed in the past.

I have encountered a brand-new diagnostic imaging technology. The CT and CBCT imaging technologies I wrote about are now outdated because of this technology. This new tech will change the veterinary world before it moves into human medical and changes that world too. Yes, you read that correctly. This technology does not exist in human medical nor does it exist in human dentistry.

The fire inside of me had nearly been snuffed out but something brand new has rekindled that fire and stoked it into a white-hot blaze. I will publish about this new tech once I complete my research.

I will continue publishing what I am learning in this journey called life. I will always address my readers with respect and admit when I am proven to be wrong.

Thank you for taking valuable time out of your day to read what I write.


(512) 256-6794


My Scar is a Miracle of God

God works in mysterious ways. I think most folks have heard that at least once in their lifetime from a parent or a pastor. I have seen God work miracles both large and small in my lifetime. I have never once questioned a miracle that I witnessed. Why? Faith. My faith in God took root when I was only 4 years old on our farm. We had a cow that was paralyzed in the rear limbs due to a rough delivery of a baby calf. She was down for a few days and she could not nurse her calf. Dad had to milk her while she was laying down and then bottle fed the vital colostrum to the calf. Dad discussed euthanizing the cow with my mom and I overheard this conversation. It brought me to tears. I did not want the baby calf to go on without a mother. I could not imagine it. I ran out of the house and came to the side of the momma cow and I laid my hand on her and prayed for God to heal her. Well…she got up…right then and there. It was awesome and I went running back to the house screaming in joy to my parents that she was up and she was okay. I do not know how many years she stayed with our herd after that. I do know that my parents both recognized it as a miracle of God.

I work in veterinary medicine and I will admit that cows with acute onset paralysis from dystocia can sometimes suddenly recover, however, it is rare. Does this make the miracle a non-miracle? If one has no faith in God and the healing power of Jesus Christ, sure you can dismiss it as purely a fluke, a medical recovery. However, one who has faith and stood there as a witness would not dismiss this event as anything less than a miracle of God.

Fast forward about 37 years and we arrive at August 12, 2017. Holly, Sam, and I were moving into our new home on Creekside street in San Antonio. We had been living in College Station and decided to move back to San Antonio so that I could be close to Sam during his high school years. We brought with us a Murphy bed. For anyone who does not know, a Murphy bed is a bed that attaches to a wall and folds straight up parallel with the wall when not being used. I had assembled that bed only once before about 4 years prior when Holly and I were first married and had moved into a home together.

The entire summer of 2017 was consumed with much work and preparation for this move to San Antonio. I was being quite a grouch that day. I was weary and had been working hard. We all had been working hard. I had enlisted Holly and Sam to help position and mount the heavy bed frame into its place on the two spring loaded steel arms which control the lowering and raising of the bed.

I was being a cowboy and not being safe. The bed was finally mounted on the guide bolts of the spring-loaded steel levers. I was dangerously crouched over the spring-loaded steel arm on the left side of the bed.

Bed 2

I thought the guide bolts would hold everything in place while I inserted the mounting bolts. I took a bad risk. The weight of the bed was unbalanced on my side because I was squatted inside and on the frame with all my 240lbs. This unbalance eventually made the frame shift downward and that is when the steel lever dislodged and hit me in the face. It was just like lightning at close range. A flash with an immediate BANG! I saw blood and clutched my face.


Bed 3


I was bleeding everywhere and cursing like a sailor.  Holly ushered me to the kitchen where we had water, ice, and towels. She saw the wound and it was bad. She said we had to leave for the ER immediately. A cable guy was in our home installing our internet when this all took place. Sam had to stay behind to make sure that work was completed while we took off to Methodist Hospital in Stone Oak. Holding a towel with ice to my face on one side, I used my free hand to call my friend Kevin on the way to the ER and asked if he would go to our house and look after Sam and/or take him back to his mother’s house. He responded and took care of Sam for us. Not 3 weeks prior to this event, I took Kevin to the same ER for stitches in his hand from an accident working on his flip house.

This entire event that I experienced, as bad as it marked me, I will always claim as a miracle of God’s mercy. I did not realize the miracle until I was sitting in the triage area. I was seen to immediately in the Methodist Hospital ER. The physical exam revealed that I had a laceration on my face and another on my left forearm. The forearm laceration I had not noticed until I was in triage. It was 2 inches long and it was wide open where I could see my muscle tissue but it did not go deep enough to hit any tendons. They performed a CT scan of my head and determined that there were not any broken or cracked bones in my skull. All my teeth were unharmed. My sinus cavities and orbitals were perfect. The only trauma was a 4-inch laceration from just beneath my nose stretching directly out to my right cheek and it was deep. This laceration was 1 cm deep. Any deeper, the laceration would have removed my entire upper lip from underneath my nose and it would have penetrated my oral cavity.  The doctors and nurses were astonished and kept asking me how it happened over and over. They could not picture the injury happening from a bed. Some of them did not understand the concept of a Murphy bed. They had never seen one.


Left Arm

There was some bad news. Methodist Hospital of Stone Oak did not have a plastic surgeon on call and I needed one. They would need to transfer me to University Hospital over in the Medical Center. This had to be done by ambulance. I spent approximately 2.5 hours at Methodist. As soon as they had stitched my laceration on my left forearm, I was placed in an ambulance for transfer so I could be seen by a plastic surgeon for the delicate repair. Upon arrival at University, I was sent into their trauma unit. I was met by several doctors and nurses. They stripped my clothes off me and began taking vitals and placing an IV catheter for fluids. I was not happy about being naked. They also took a chest x-ray and the entire time they are asking me all the same questions I had been answering at Methodist. Again, I had to explain the basic mechanical principles of a murphy bed. Most had never heard of such a thing. Last thing, we need to check your rectum sir. AHHHH! I was flipped over and violated and then everyone just left except my charge nurse who just threw a hospital gown over me. I never knew what our calves felt like at branding until that day. I was processed into that place like a baby calf. Thank God, they did not put a fire brand on my ass. I did compliment their work as a team. It was fast but still…I was left anally violated and naked.

I was moved into a private room. It was only private because it was still 8pm on a Saturday and the usual crowd of stabs, gunshot wounds, and car accidents would not get going until later in the night. I was by myself except for the nurse. I was asking for Holly. The nurse went and got her from the waiting room and brought her back. The admissions person came in and began collecting all my insurance and other pertinent information. The charge nurse was great. He told us not to expect anything to happen fast. He said that nothing happens fast in this place and to expect no discharge until early morning the next day. It was almost 9pm when an attractive lady came into my room in green scrubs. She began asking me questions and performing an exam. Great, a tourist wanting to see the slashed up naked guy…so I thought. She then introduced herself as the plastic surgeon. You got here fast! She left the room and came back with her kit. It was her and us. No nurses were present. She washed the wound for what seemed like an eternity and it was unpleasant but not too painful. She began to inject my wound with the lidocaine. It stung like hell and that was painful. I then noticed that I had not really felt much pain before that. She delicately began to stitch the inside layers of the wound. I could feel some of the pokes and after 20-30 minutes, I began to feel more and more of the pokes and the pulls. I just kept still and put on my game face. Holly saw my demeanor change and asked me if I felt it and I nodded. The surgeon then placed more lidocaine injections. These hurt much worse than the first ones as they were right under the bridge of my nose. I believe this may have been the worst physical pain I have ever experienced. She began stitching slowly, diligently, and delicately. I still felt about every third poke but I just kept still and quiet. After just over 1 hour of stitching she was finished. The charge nurse came in and told me that I was lucky she showed up so quickly. He has regularly seen people wait 6 to 8 hours for plastic surgeons to show up. What a miracle. Again, the charge nurse warned us that nothing happened fast there and that we would need a few more hours to have my IV antibiotic delivered and then administered. Not 10 minutes later my IV antibiotic showed up and they placed it into my IV line told me it would take about 30 minutes to finish. Holly had left by this time to go get me more clothes at Walmart. When she came back, my IV was finished. I was up and getting dressed into my new clothes. The charge nurse came back again and told us that they were waiting for my CT report to come in for their records. They could not discharge me without that. An hour later, the report was there and our discharge papers were signed. I was released around midnight. The charge nurse said he had never seen anyone come in with my type of wounds that needed that level of care and the person be able to leave so quickly. It was a miracle. I was cleared to operate my life normally with two exceptions: no direct sunshine on my face and no submersing my face underwater. I could eat / drink normally and go back to work as long as I cared for the wound properly.


We left the University Hospital parking garage at 12:30am and headed straight to Whataburger and then to Kevin’s house for my first K-Laser treatment. I have been sold on therapy laser as a treatment option on animals and people since Kevin first began working for K-Laser. This technology uses different frequencies and wavelengths of light to program the body’s cells to do what they do naturally but to do it faster and more efficiently. I have seen wounds on horses, dogs, and cats heal at a significantly faster rate than normal. We were home and in bed by 2:00am and I slept well. I woke up with a new perspective. Holly and I discussed how this event was a series of small miracles from God.

  1. Somehow, supernaturally, I was removed from the direct hit of this spring-loaded steel lever. It should have hit me directly on my left side of my skull. Instead, it somehow hit my left forearm first. My left arm was not in the path as the bed frame shifted. But it hit my left arm first and then it struck the RIGHT SIDE of my face as if my had turned just at the right moment and I was just sliced instead of directly struck. Had I received a direct hit on the left side of my skull it could have shattered any bone in its path. It could have gouged out my sinus or my eye or both. It would have knocked me unconscious and rendered Holly and Sam powerless to help without dialing 911 and waiting for EMS to show up. I am convinced this was divine intervention. Why did God allow it to even slice me? Because I was being stupid. I could have suffered more for the bad decision of working too closely and being careless. Now I have a mark to remind me that I am not invincible and that I need to think more when doing projects. I have that scar to remind me that God can protect us from much worse harm, even though we do get harmed. Could He have saved me completely? Yes. Then what? I would still have been a grouchy ass barking at my wife and kid to help install the bed. No lesson would have been learned. I would only have counted the incident as a near miss and moved on as the same person. Today, I am different than I was then. On the outside and on the inside.
  2.  Time is precious. When you have deep lacerations, time is precious. The longer they stay open, the higher the chance that it becomes infected. I received that injury around 5:00pm. My wounds were closed and healing began at 10:45pm. The charge nurse and the plastic surgeon said that I was lucky to have been tended to so quickly. This is also miracle status. They each told me that people never get treated as quickly as I did. I thank God for this. It was a miracle.
  3. The wheels of bureaucracy are slow. I was admitted to a publicly funded, university owned, teaching hospital. Nothing happens there at a rapid pace when it comes to paperwork. The charge nurse and the doctors were all surprised at my rapid discharge. This may be the largest of all miracles contained within this event.

I did not want to finish installing the Murphy Bed. It sat in my office for almost 4 days before I could bring myself to deal with it. I decided to destroy it. It is a dangerous piece and it is not worth the risk of it hurting anyone else in this family or other families. I could have sold it. I could have given it away to a family that needs it. No. I committed it to destruction. IT WILL BURN! Piece by piece in my backyard firepit over the next few months this bed will be consumed by fire. Sound familiar? Our struggle is not against flesh and blood. Someday, those powers, principalities, and dark forces that are bent on destroying humans…they will burn too. It says so in God’s Word. Want to learn more? Start reading. I will let you know where to go for study resources that can last you months. My journey in God’s Holy Word has been ongoing since I was a kid. But in the last few years I have learned more and studied it more than I ever have. You can too, if you choose to.

Bed 4

Bed 5

Bad things happen to good people every day. Good things happen to bad people more often. This confuses many and creates animosity toward God. Sometimes it can be what inspires a person to not believe in God. I do not have the answer as to why I was spared from a more severe injury. I can only say that I hope I will make this miracle count. My life is a gift. Each of us are only given one life to live. It is special. Each day that I get to be a husband, a dad, and a friend is a miracle.

Aug 21

I hope I can continue to be a better person than I was the day before. I hope I can work smarter on my projects in such a way that I do not endanger myself or others. I hope that I can help others know God and His love, His Mercy, and His story. Each time I look in the mirror, that scar will be there. I hope it will always remind me that God is there for us all. I hope it will remind me that it is not about me. It is about Him. -RW

Veterinary Medical and CT – Part 2 – Is CT right for my veterinary practice?

Learning about CT and Cone Beam CT in veterinary medical applications.

July 7, 2018: I am refreshing the series of blogs for CT in Veterinary Medical with updated information. -RW

Considering investing in a CT for your vet practice? Read this first.

You’ve probably already spoken to at least one sales person who has promised you the moon, and you’d like to trust that they have your best interests at heart. But how can you be sure that you’re investing in the right CT system that will help you round out your hospital’s imaging capabilities? You use ultrasound like a champ and your techs take fantastic digital radiographs. So…what about CT or Cone Beam CT? Purchasing one of these units is a lot more expensive than your ultrasound and your DR combined! You probably have more questions than a sales rep has good answers to.

What about asking a veterinary radiologist?

It is wise to seek good counsel from an experienced veterinary radiologist. I’ve talked to many veterinary radiologists about CT, and I’ve found two camps. The first is of the opinion that general practice veterinarians should avoid purchasing a CT, leaving specialty imaging to those who will “do it right” – which gets you high quality images that support accuracy of diagnosis. The second camp recommends CT as a good investment for a general practitioner. They believe that CT imaging in general practice, with proper staff training, continues the advancement of patient diagnostics at that level. In other words, a rising tide floats all boats.

Radiology Humor

A quick laugh about radiologists. A human radiologic technologist once told me that if you put 5 radiologists in a room and you will get 6 different opinions.

Investing in a CT scanner is no small decision

Before diving in, you must learn what CT is as a technology and what it is designed to be used for in veterinary applications. Not all CT machines are created equal in form and function. As stated in Part 1 of this blog, there are two types of CT technology available to veterinarians today, Spiral or Helical CT and Cone Beam CT.  This post goes into detail about the differences between Spiral or Helical CT and Cone Beam CT.


What sales reps probably don’t know about Cone Beam CT (CBCT)

Why CBCT was developed

CBCT technology was originally developed for applications specific to human dentistry. These units are designed to produce high resolution cross-sectional exams of the human skull. The factory software in all CBCT machines can render the exam into a 3D model onscreen or into a more traditional stack of 2D images. This is really awesome. However, there are diagnostic limitations with 2D and 3D images from a CT scan of soft tissue organs in the abdomen. 3D images are of little diagnostic value to board-certified veterinary radiologists. Radiologists always rely on the 2D image stack in cross-sectional imaging modalities to report their findings.

So manufacturers of CBCT took a technology originally developed for human dentistry and adapted it for the veterinary market. This can be problematic if you plan to use the machine outside of dental applications in small animals.

Veterinary Medical Indications for Use of Cone Beam CT Technology:

Bone: skull fractures / nasal masses / dentistry / distal extremities / spine IVDD (requires contrast)


The Science behind CBCT

CBCT emits a cone-shaped pattern of radiation, earning it the name “cone beam”. Essentially, a CBCT is a digital radiography system fitted onto a wheel inside of the familiar looking CT gantry. It contains a small flat panel detector (usually about 18cm x 16cm) and it is positioned perpendicular to a cone beam x-ray tube (like the tube in a conventional x-ray system). As the wheel with the components is moved 1 degree at a time around the target anatomy, a digital radiograph is acquired, and then it advances another 1 degree and takes another and so on, until it completes a full revolution around the animal patient. The data is then rendered by software into several different image data sets and transmitted to a PACS for storage and review.

Cone beam tubes produce a wide cone shaped signal pattern, originating at the tube (the point of the cone) and scattering outward toward the panel. This typically produces more scatter and thus there is less detail in soft tissue images when compared to spiral / helical CT modalities.

This is especially problematic in animals over 20 lbs., or in animals that are much larger than a human skull.

Can CBCT be a good tool for a veterinary hospital?

The hardware and software of CBCT units were optimized to acquire high resolution images of the human skull and particularly, the human mandible and maxillary portions of the skull. This means that it can definitely be a good tool for veterinarians who are passionate about canine and feline dentistry. Some veterinarians would be very interested in acquiring high resolution images of the patient’s skull which is crucial for quality performance of veterinary dental procedures such as extractions and reconstructive surgery.

The CBCT can also be used successfully for studies in the spine (IVDD with the use of proper positioning, collimation, and contrast). CBCT is also good when evaluating the integrity of joints and extremities (ex. canine elbow disease and osteosarcomas).

If the CBCT user can be trained to operate the technology within these limited indications, it can be diagnostically useful to a veterinary hospital, yet it will remain limited as compared to the spiral CT technology.

Some shortcomings of CBCT

  1. CBCT units were not designed to perform scans of the thorax or abdomen on human or animal patients.
  2. Most CBCT manufacturers’ machines do not allow cranial to caudal movement of the patient. The table or couch does not move automatically. This means that operators need to move the table or move the patient if the targeted anatomy does not fit within the finite field of view. Essentially, the CBCT unit remains stationary over the targeted anatomy and the field of view is limited to the finite dimensions of the selected capture area (L x W x D) in the acquisition software. This results in more than one series of images which will need to be either stitched together into a single stack of images or organized separately as individual image stacks. This can often frustrate a veterinary radiologist when reading a Cone Beam CT case that does not utilize automated and precise movement of the patient on the couch during the scanning process. When attempting to image the spine with CBCT, this can be a challenge for the operator to perform and for the radiologist to read.
  3. CBCT scans can also take more time to complete. If the thorax / lung fields were to be the targeted anatomy; as animals breathe and the heart beats distortions are produced from the motion within the chest cavity during the scan. A manually induced breath-hold (while under full anesthesia), can reduce the effects of “motion artifact” from the lungs but the heart continues to beat so motion artifact remains problematic if the heart is what is targeted. In the animal patient, the most precise evaluation of the heart should be performed with ultrasound (i.e. an echocardiogram) and thoracic radiographs.

                 4 Slice CT Lungs                  CBCT Lungs

Note: the entire lung field is captured by the CT. The CBCT leaves out some of the lung field due to its confined field of view. Lung views in the CT image stack are much higher in resolution. In the CBCT image, there are too many artifacts, and in this case an incomplete field of view for a radiologist to read it successfully.

                  CBCT Abdomen      4 Slice CT Abdomen

Veterinary Radiologists and CBCT

In general, all boarded veterinary radiologists are familiar with spiral CT as it has been around in veterinary specialty clinics for a couple of decades. However, most, but not all veterinary radiologists have done little or no research on the cone beam CT technology. Therefore, most veterinary radiologists will have a negative opinion about cone beam CT simply because they know very little about it and how it’s meant to be properly used.

Radiation Safety

The CBCT folks claim their technology produces less exposure to radiation for patients and operators. They argue that lead-lined walls are not required. Depending on various state regulations, this claim may be true. The accuracy of such statements are at the mercy of the local regulations of the end user. In addition to that, we are simply comparing apples to oranges when comparing CBCT to CT. Remember, the core design of CBCT technology is limited in application to the skull or extremities. These anatomy indeed require less radiation for acquisition of diagnostic images. However, in reality, it is not much less radiation than what a spiral CT uses to acquire diagnostic images on the same anatomy.

In my opinion, it is always better to err on the side of safety. Go ahead and design your CT room with lead-lined sheetrock and place the acquisition workstation outside of the CT room behind a lead-infused glass barrier where your technologist can see the patient and the attending technician. Yes, this costs more money up front but it can save a practice from safety citations and lower the potential for employee / client litigation in the long run.

Can a veterinary hospital be successful with CBCT?

The short answer is yes. The CBCT can be applied successfully in animal hospitals that perform a high volume of dentistry cases, and can be used effectively with imaging extremities as well as IVDD.


Computed Tomography Training for Veterinary Teams

CBCT and CT are not easy modalities to add in a veterinary hospital environment. Floor plan and power are not the only challenges we face either. The proper amount of training and the proper types of training are what make CT the greatest challenge of all imaging modalities. Even ultrasound (which requires copious amounts of personnel training) is actually easier to integrate into a vet practice than CT is. The bummer is that most vendors who are selling CBCT and CT to veterinarians are doing minimal training with their buyers.

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.

CBCT Summary:

PRO: Perfect for small animal dentistry applications. Good image quality in canine and feline skulls as well as distal extremities.

PRO: Always sold brand new. Cost $175k – $250k depending on the vendor. 5-year warranty and service programs are offered with the purchase of CBCT from most vendors.

CON: Soft tissue image detail in the abdomen and thorax of animal patients is inferior to those generated by spiral CT.

CON: Field of View. A finite field of view on most CBCT machines can cause increased operator errors during acquisition. Most CBCT units do not move the patient or move through the patient cranial to caudal (automatically) which requires the manual movement of the patient by the operator and this produces multiple image stacks.

CON: Training. Most vendors do not offer a comprehensive training program for vet techs and veterinarians. Most invest a few hours to teach the client basic operation with safety training after installation. This is problematic because the client is left to learn more valuable lessons by trial and error.

CON: Radiologist review and reporting. Most boarded veterinary radiologists will refuse to read and report on CBCT cases from veterinary hospitals. Only a select few are willing to read CBCT cases. VitalRads.com is one of the few veterinary teleradiology services that read veterinary Cone Beam CT exams.

What you need to know about Spiral CT (CT)

Spiral or helical computed tomography equipment is specifically designed for cross-sectional scans of soft tissue and bone in human patients. The CT couch or table slowly moves the patient through the spiraling signal. One newer CT design has a mobilized gantry that uses a motorized wheel system underneath to “crawl” over the table or couch where the patient is positioned.

An acquisition workstation and software render the acquired dataset and organize the data into one or more readable exams based on selected anatomy and protocol.

So this is also a technology that was adapted for veterinary from human medicine.

Veterinary Medical Indications for CT Scans

Soft Tissue: met checks / mass ID / lungs / liver / spleen / GI tract / urinary tract

Bone: skull fractures / nasal masses / dentistry / distal extremities / complete spine / hips / pelvis

The fundamental technology consists of a specially designed x-ray tube that emits a confined linear beam of photons which pass through the patient that is received by a linear array of sensors as the scanning unit it continuously spins around the patient at high speed.

What’s the deal with CT and the number of “slices”?

You may have overheard a conversation about CT where someone refers to the number of “slices” their particular CT has. This is because the higher the number of “slices”, the better the image quality. Ultimately, image quality in a CT is determined by the number of channels (aka slices) available in the sensor array. Please note that “slices” is a misnomer that is essentially ‘medical slang’ referring to the number of channels in the CT’s sensor array.

The more channels a CT sensor array has, the faster it can scan a patient, raw data acquisition also increases and then is processed into higher resolution images. The more raw data that acquired, the clearer the image quality. A 40 slice CT system can perform a full body scan on a 90 pound Labrador retriever in less than 15 seconds and still produce impeccable image quality. This occurs when the operator (aka technologist) is experienced and well-trained in applications and protocols for small animal veterinary medicine.

CT Software

Just like all software based technology, CT acquisition software applications have improved immensely over the last ten years. Most modern CT units (manufactured after 2012) will have highly-advanced acquisition software which allows a fully trained technologist to set up customized protocols which is great for applications in animal patients. CT units come from the factory with human presets (scanning protocols) in the software which means that it is up to the veterinarian and the CT technologist to adjust those protocols and customize their own presets for animal patients of various sizes and anatomy.

Some shortcomings of CT

  1. They can cost a lot. Brand new CT units can easily cost a veterinary clinic well over $600k which is often more expensive than the real estate the vet hospital sits on. Purchasing a new or refurbished CT scanner can reduce the investment to below $250k for the equipment purchase. Then you need to add the service and warranty contract after the first year is over. There are older, refurbished, 4 slice CT machines available for sale that cost less than $90k (before you add facility modification, training costs, and extended service agreements). A good rule of thumb is to buy refurbished, buy a well-known brand (GE, Philips, Siemens, Toshiba), and stay between 4 and 16 slices. Always purchase the preventive maintenance package with an extended warranty on the CT x-ray tube.
  2. They are big. Most of the refurbished spiral CT units are huge by comparison to the brand new CBCT units. Spiral CT rooms need to be at least 15’ x 15’ when developing the room’s floor plan. All of the CBCT units I know of can exist in a 12’ x 12’ sized room.

Veterinary Radiologists and CT

In general, all boarded veterinary radiologists are familiar with spiral CT as they each were trained on how to read CT images from spiral CT units. You should have no problem finding a boarded radiologist to read your CT scans from a spiral CT.

If a vet hospital can maximize the use of a CT, it is a good investment to go with a spiral CT because it’s simply more versatile. Radiologists are more open to reading CT scans. They do take up more room but a spiral CT makes more sense for most general veterinary practices.

Can a veterinary hospital successfully use CT?

Absolutely yes. CT can be used successfully in animal hospitals who are looking to up their game on imaging and who want to raise the level of practice inside their clinic walls. However, CT is not an easy technology to add to a veterinary hospital. It requires a new level of thinking about when and how imaging is ordered for animal patients. It requires specific training for veterinarians and technicians.

CT Summary

PRO: Versatility. Spiral CT has a broader set of applications than CBCT.

PRO: Reads. All veterinary radiologists are trained and prepared to read CT studies.

PRO: Clarity: Spiral CT is faster, so the “motion artifact” problem is greatly reduced vs. CBCT

PRO: Easy: Spiral CTs come with pre-programmed protocols and can be manually programmed with protocols that your hospital uses frequently. This makes image capture faster and more consistent.

CON: Cost. Higher resolution means better, more diagnostic images, but it also means a higher price tag.

CON: Space. The room size for a spiral CT is greater than the space required for CBCT.


How does this information help my decision?

Decide what’s important to you! You want to improve your vet hospital’s ability to get great images. CT is a good way to go if you already have an active ultrasound modality and use your DR system to its fullest capacity.

If cost is a major consideration, you will want to consider how to start making your investment back as quickly as possible. That may mean getting some great training with experts in veterinary CT. Look for a full discussion about ROI on CT in an upcoming blog.

If space is a major consideration, that will play into your decision. If you are landlocked in a strip center or your imaging suite simply cannot expand beyond its current footprint, look carefully at the space required for each. We can help you design a new hospital or add on to your new one. See our website: https://vetxq.com/consulting/


What is the culture in your veterinary practice?

Look at your culture and how you practice vet medicine. Maybe you don’t need a CT. You may not know if it will fit into your culture (i.e. your team’s collective philosophy of how you practice vet medicine). That is okay. It is imperative that you know your practice culture.

Part 2 has been aimed at the comparison of Cone Beam CT and traditional Helical or Spiral 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: rwhitaker58@me.com

There Ain’t No Strings On Me! Wireless Digital Radiography in Veterinary Medicine

There are still many veterinarians today who do not have the benefit of digital radiography in their hospitals. The majority have indeed made the move into digital over the last 10 years but there remains a remnant of veterinarians who still use film. Most of these film users claim that they are waiting for the price of DR to come down. This excuse is preposterous in my opinion.

Veterinary Digital Radiography at Basic User Level (Tethered DR Panel + New X-ray Table):

Any veterinarian practicing small animal medicine exclusively can add a digital radiography system (and a brand-new x-ray table) to their hospital for a little less than $60.00 per day.


Total Equipment Cost (includes tax and freight)

$66,000.00 US

5 Year Equipment Loan with Interest at 6.0%

$1,276.00 US – Monthly Payment

X-ray Fee

$125.00 / 3 Views

Minimum Monthly Caseload (3 view studies)

11 Cases / Month – Break Even Point

If your veterinary hospital is open for business 7am to 6pm for 6 days each week this calculates into the DR system costing you $53.17 US, each day that you are open for business. Not bad!!!


New Technology: Wireless Digital Radiography for Veterinarians

Wireless DR technology is a perfect investment for all veterinarians. It works very well for those who work in zoos, wildlife preserves, and mixed animal veterinary hospitals. Typically, these “forgotten veterinarians” have been required to purchase at least two different flat panel systems (one portable and one stationery) if they wanted to truly be digital throughout all species. The other choices would include purchasing a CR unit (cassette based) or just buying digital for small animals and using film for everything else. These complicated scenarios, I am happy to report, no longer hold true.

Wireless digital radiography is market ready and a few hundred of these wireless systems have already been sold and installed. One portable wireless DR panel can now be used to take instant radiographs on horses, cattle, goats, sheep, dogs, cats, birds, reptiles and many more species. The first wireless DR panels were launched around 2011 or 2012, and they have vastly improved in design and reliability since then. The first generation of wireless panels had some trouble with interference from outside signals such as cell phones and electrical grids. An abbreviated battery life was another challenge with the first-generation wireless panels. The highly-paid propeller heads in Asia and Silicon Valley have eliminated most (if not virtually all) of the bugs from wireless technologies and this includes digital flat panels. Most buyers are now purchasing their second digital system and leaving technologies like Film, CR, and CCD in the past which is exactly where they belong. Wireless digital flat panels are no longer the future, they are here!


Advantages of Wireless vs. Tethered

NO MORE WIRES – Wireless panels do not need to be wired into and timed (synced) with x-ray tubes and generators. All wireless DR panels now have what is called Auto-Timing. The panel senses the x-ray photons and automatically opens to receive them to produce an image. Furthermore, if a veterinarian is seeing many equine or food animal patients, this unit will not have wires that have the potential to become tangled or in the way.

PORTABILITY – Unlike some of the tethered systems, wireless panels can be connected (paired) to both a laptop PC and a desktop acquisition stations. This makes the wireless digital solution much more compact and portable within a hospital and away from the hospital. Another advantage to this portability is intraoperative imaging in the surgery suite. Veterinarians who perform orthopedic surgeries can now bring the wireless panel into surgery, utilize a sterile panel sleeve, and snap radiographs to ensure the proper placement of hardware. Never again will a surgeon need to move the patient into radiology during surgery. Many surgeons are using CR in surgery, which means there is a delay in snapping the radiograph and then seeing it due to the digitizing process. A wireless DR panel produces an image almost instantly, no waiting.

IMAGE QUALITY – This is a draw at minimum but I still consider that an advantage. I would challenge any veterinarian or veterinary radiologist to determine whether a set of radiographic images were created from a wireless DR panel or a traditional tethered DR panel. The wireless DR panels produce high quality, diagnostically crisp images just like many of their tethered counterparts.       

Question: Which images came from Wireless DR panels?


Answer: Both of them were taken by a wireless DR panel. 

Disadvantages of Wireless vs. Tethered

PURCHASE PRICE – Wireless DR technology is indeed more expensive than the tethered DR systems. On the low end, we see a wireless system selling for about $60,000.00 US and the higher end they can cost up to $80,000.00 US. This may scare some of the film users but it is not as likely to scare those practitioners who are buying their second or third DR system.

CYCLE TIME – Some of the wireless systems will take a little longer to cycle and reset between shots versus the tethered systems. This slower cycle time seems to only be problematic with selenium based panels during an equine pre-purchase exam. Many equine veterinarians will push DR systems to their limit in cycle time when taking up to 40 images during a pre-purchase exam at a big event such as the Keenland Sale. However, a slower cycle time is really of no consequence when taking only a 3-5 views on a single patient.


Making the Wireless DR Purchase

What does it take to remove the fear and anxiety from this purchase? Let’s start with simple math.

Scenario #1 – Purchasing a high-end wireless DR system with a laptop & desktop station

Equipment Cost (includes tax and freight)

$80,000.00 US

5 Year Equipment Loan with Interest at 6.0%

$1,550.00 US – Monthly Payment

X-ray Fee

$125.00 / 3 Views

Minimum Monthly Case Load (3 view studies)

13 Cases / Month – Break Even Point

$64.59 US per day of operation

Scenario #2 – Purchasing the lower-end wireless DR system with only a laptop station.

Equipment Cost (includes tax and freight)

$65,000.00 US

5 Year Equipment Loan with Interest at 6.0%

$1,260.00 US – Monthly Payment

X-ray Fee

$125.00 / 3 Views

Minimum Monthly Case Load (3 view studies)

10 Cases / Month – Break Even Point

$52.50 US per day of operation

Most 2 doctor hospitals will take 20-30 x-ray case studies per month with digital. With that said, there are some veterinarians who rely heavily on radiographic studies to get answers and there are others who do not use x-ray to its fullest potential. I plan to address this tale of two veterinarians in a future blog, so please stay tuned.

Purchasing a wireless DR system is not out of the realm of possibility simply because of the cost. If your hospital is already seeing over 10 patients each month through the x-ray suite and you are charging the proper fees, adding a wireless system is not a difficult decision.

Which of these are from a wireless DR system?

Answer: The one on the left, with the two screws in the hoof block. The one one the right is taken by a tethered DR system. 

Who Makes Them?

There are several wireless DR systems for sale in the veterinary market place today. I am pleased to report that those I have experience with are good systems hailing from good manufacturers who all have track records of sales and support dating back over 10 years.

I can only speak about these certain manufacturers so please understand I am leaving a few others off this list simply because I know very little about their systems.

Canon (multiple dealers in veterinary)

RadmediX (1 exclusive dealer in veterinary)


These manufacturers make a good wireless DR panel and they do a good job supporting their panels after the sale.

 Which of these are from a wireless DR system?

Answer: The one on the right is from a wireless DR system. 

Decision Time

Yes! You can own a wireless DR system and you won’t be finding yourself broke and living under a bridge! Be fearless and embrace this wonderful technology. I always say that veterinarians can get a nice bunch of “new friends” any time they begin wondering the trade shows and asking dealers about equipment. Please understand that not all equipment sales reps are used car salesmen…even though many act like it. Understand that the vast majority of these sales people know very little about the technical application of what they are selling. They are all highly trained to do one thing…getting you to sign their proposal. Please know that you do not have make your decision alone. I have many years of experience in buying, selling, and using imaging technology in veterinary hospitals. Contact me when you are ready and I will be your wingman. Please leave a comment and visit our website at www.vitalrads.com. I appreciate the fact that you took precious time from your day to read this blog.


What’s Next?

In March, I will showcase computed tomography (CT) in the general vet practice. Heads up! CT units are being carpet bombed into general veterinary hospitals all over the USA. I will outline the technology and teach you what to look out for from vendors. Stay tuned.


Spes et fides sans peur! 




Understaffed? Keep Going.

Keep playing Whitaker! There is no one available to be your backup! I don’t care how much it hurts, we are counting on each of you to stay in the game and give it all you have. Full speed. No time to look back and consider the previous play. We won some and lost some but we always kept playing the game the best we knew how.

They called us the dirty dozen. There were only 12 of us on my 8th grade football team. In the sparsely populated Texas Panhandle, we often traveled over 2 hours [one way] to play a game. Each of us played offense, defense, and special teams. Most teams we played were bigger, faster and had greater numbers. Only one player stayed on the sideline. It was usually the guy who had the most severe injury from the last game.

I was taught early in life that you cannot just take a break. You cannot even slow down. Does it feel like this in your work life somedays? I can recall several instances in my working career that my team was understaffed. I was being prepared for this in 8th grade and I appreciate that experience.

There is no replacement for you. Keep going. There is no one here to lighten your workload. Keep going. If you quit, you lose. Full speed. Keep going and know that someday, this season will be over.


The Black 40

According to a Google search, the average lifespan in the USA is presently calculated at 78 years. Today, I turned 40 years old so that means I am already beyond halfway through my expected life according to Google. When I was 18 and graduating from high school, I pictured my life to be a certain way when I turned 40. My expectations were met and I can honestly say that life has been good. I took an inventory of my life and this is what I came up with.

I pictured that I would be married to a woman that I love very much and she loved me back. CHECK!

I pictured that I would be the dad of some really awesome kids. Yep! CHECK!

I did not picture that I would be living in South Texas. I thought I would still be farming and ranching  in the Texas Panhandle instead of working in the veterinary medical industry.

I do hope that there is still some time to catch up with that farming and ranching aspiration. To somehow make that happen would be an awesome accomplishment over the next 40 years. Well, the ranching and farming part anyway. I am not so sure I would leave the paradise that exists down here below the 30th parallel. We have two seasons, hot and no so hot.

Here are some things that I consider a bonus that I never thought would happen to me:

I have built a fun and rewarding career in veterinary medicine that has provided well for my family for a few years now. BONUS!

I have traveled all over North America, Europe, Hawaii, and the Caribbean for recreational purposes. BONUS!

 I was able to enjoy learning and playing the sport of all sports in the Texas Rugby Union with an awesome group of mates at the San Antonio Rugby Football Club. BONUS!

 I was able to forge strong friendships with a few awesome people. BONUS!

 All of this I count, as blessings. I thank God for carrying my family and me through the good and bad. My first forty years have been one heck of a ride and I am excited about the next forty. Thank you to all of my friends and family who are always there for me and always support me…even when I am being a horse’s ass.