DIAGNOSTIC IMAGING themselves and staff alike. In this excited state, the chances of taking an image that is useful in making a diagnosis are low, and you’ve charged the client for an unnecessary procedure as well as irradiated the staff unnecessarily. As part of our initiative to provide better patient care at our specialty clinic, we’re becoming a Fear Free hospital. We take patient stress, pain and fear seriously. Sedation is standard for all patient imaging in Fear Free hospitals—not only radiographs, but all other imaging as well. Our goal is to make the entire patient visit (including imaging) a positive, calm, stress-free event, which ultimately makes the process safer for our staff and also increases the quality of images obtained. Through sedation, we both assure patient safety and our ability to take the diagnostic images necessary to support treatment of the patient. Sedation also decreases radiation exposure to our staff because those images we do take are of the necessary quality and don’t need to be repeated multiple times. For us, sedation is better for the patient and the staff—and it’s better medicine. 4. Don’t take it easy Many images I see are taken from what I’d call the “easy” perspective, with the patient laying on its side— that is, a lateral view. Taking a single view from that position is one of the biggest ways to miss pathology. Taking two images (one with the patient on their side and the other with the patient on their back) should be standard for every patient and is always worth the effort for the significant amount of diagnostic return on investment. Because most of our patients are skinny, ventrodorsal images can be taken more easily with the help of a soft, padded, V-shaped trough. These are inexpensive, easy to clean positioning devices that help the patient lie both comfortably and still on their back for the duration of the imaging study. 5. A snapshot versus a photograph I work closely with both general practices as well as my radiology technicians, educating them about how to obtain a high-quality radiograph. For those individuals who haven’t received appropriate training, they may assume that if the patient’s in the radiograph, it’s also of adequate diagnostic quality. This is not their fault—it’s simply lack of training! In order to support understanding of a quality radiograph, I teach technicians and veterinarians objective criteria that can be easily utilised while obtaining the images. For thoracic radiographs, the position of the retrosternal lucency and the lumbodiaphragmatic recess during inspiration can be counted and compared to rib position. It’s easy to count the vertebrae compared to the position of the diaphragmatic cupola and the costodiaphragmatic recess as well. How do I know if the ventrodorsal radiograph is straight? Look to see if the sternum is on top of the vertebrae. Providing vet360 Issue 03 | JULY 2018 | 22 specific, objective criteria will help everyone assess the quality of their own images while the patient’s still on the imaging table and helps determine if the radiograph needs to be taken again. Anyone can take a snapshot on their phone. It takes a lot of training, practice and understanding to actually be a photographer. This is the difference between someone who can take a radiograph by pushing the expose button and someone who can take a good quality diagnostic radiograph. Training results in expertise, which in the end is an exceptional value for the patient and practice. 6. It’s all in the timing Haven't we always heard, "it's all about timing"? That adage is definitely true in radiology. An image of the thorax should be taken during inspiration, when the lungs are completely inflated. Conversely, the ideal time to take an abdominal radiograph is at complete expiration, when the lungs are the smallest. When the lungs are halfway between inflation and expiration, you’re taking a poor image of both areas. When an x-ray machine salesman says that a single whole-body radiograph can be taken versus taking a collimated radiograph of either the thorax or abdomen, he’s not telling you what is best practice or most diagnostic. He hasn't gone to veterinary school, nor is he a radiologist. Remember, just because you can do something doesn't mean you should. When you collimate, focusing on a specific region of the body with the appropriate image timing, you do the best for your patients and your clients. 7. Marker my words (and images) Many practices have grown accustomed to using digitised right or left markers, added to the image after it is taken. Unfortunately, sometimes those digital markers don’t transfer when images are sent to the radiologist. The result? Time-consuming phone calls to discuss what images were obtained. This can ultimately end in the teleradiologist not knowing left from right, thus limiting the ability to obtain a useful diagnosis. We encourage the use of an actual physical lead marker placed in the primary radiographic beam on every image. Markers are a quick and inexpensive solution that supports the accurate interpretation of images by a teleradiologist. Now it’s time to put these tips to work! Using the above helpful techniques will help us radiologists help you.