Veterinary Medical and CT: Part 1

It is officially Spring down here in South Texas. I have seen the first bloom of our bluebonnets today on my drive to and from Houston. They are beautiful! Western Veterinary Conference will begin next week in Las Vegas. There are new CT systems on display at the WVC trade show this year and I am pumped to see them and talk with the vendors. Computed Tomography is used in virtually all veterinary specialty hospitals in North America. CT machines have made their way onto the wish lists of many general veterinary practitioners. There are a few general practitioners who already own a CT. Maybe you are one who has begun to seek information on CT. If so, you have come to the right place!

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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 have become familiar with this modality over the last few years. Learning about CT seems easy at first but I must compare it to an iceberg. What you see on the surface is but only a small portion of what is needed for a veterinarian to make it successful. This is why I am writing a 3-part series on CT. One article cannot do this technology any justice.

This article will cover some of the basics. Part 2 will be released after WVC and will be highly detailed as I move through the different types of CT systems that are available to veterinarians. I will also outline the indications for veterinary use of the CT in more detail. Part 3 will cover the most critical nuances of CT technology such as contrast studies and the challenges that a general practice will have to meet head on when adding a technology that is advanced beyond anything purchased prior to ultrasound. Last but not least, I will share how to develop a return on investment for a CT.

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)

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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:

  1. Skull / Nasal / Brain
  2. C-Spine / T-Spine / Lumbar Spine
  3. Thorax / Met Checks / Masses
  4. Abdomen / Masses / GI Tract / Adrenals
  5. 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 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 10 year old DSH feline presents for labored breathing, nasal discharge and lethargy. Radiographs of the thorax are 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 been required to do this and with a CT in the hospital, it is the easiest path to a definitive answer. Scopes are not in this case.

CT will add a new level of diagnostics to a practice. A veterinarian should not see a drop in the use of ultrasound nor will they use their x-ray system less.

Can I use CT instead of ultrasound or X-ray?

No. It is unethical, unnecessary, and expensive for our clients. CT machines are there for giving us a more complete answer when the ultrasound or the radiographs cannot give us a complete view of what is going on inside the animal. Moreover, even CT machines will have their limitations. Ultrasound is actually more suitable than CT for things like urinary tract infections and scans on other internal structures such as the heart. Furthermore, a CT scan requires anesthesia for the patient and the procedure itself will often cost two or three times as much as an ultrasound or radiographs. It is unwise to think you can replace an ultrasound or a digital x-ray with your CT. This is pure folly and certainly this should be obvious to any licensed veterinarian.

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Is there special training required for adding a CT to my practice? 

Yes. There is special training required for all doctors and technicians working in that hospital. Operating the machine is the simplest part of this training and sadly that is mostly all one will get from a vendor. If you are planning on buying a CT for your practice, training will be the most important factor in whether or not the equipment will return the investment. In the specialty hospitals and the universities, CT technicians are sent to schools for few days at a time to learn the operations and protocols associated with performing CT studies on patients. Here is the tricky part; all of these “CT schools” are taught from a human medical perspective for human patients. Shameless plug alert! Instruction Intelligence is presently developing a formalized CT training program within the Veterinary Intelligence product line specifically for veterinarians and veterinary technicians. We will have a complete team of veterinary CT technologists and veterinary radiologists who will teach our clients all that they need to know about CT procedures that should be performed in a general veterinary practice. This program will launch in the Summer or Fall of 2017.

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.

I will release part 2 of this blog at a later date and it may not be until late March 2017. 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 feel free to leave any questions in the comments and I will answer them as I have time to do so. Thank you for your valuable time and attention.

-RW