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
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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.