Advanced Diagnostic Imaging Services

Transcription

1 Advanced Diagnostic Imaging Services

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3 Welcome to Moorview Vets Moorview Vets are able to offer many diagnostic services, these include more advanced imaging modalities such as Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). In January 2014, we became one of the few practices within the North East of England to have our very own CT scanner installed on site at Moorview Vets. It is a Toshiba Aquilion 16 slice Computed Tomography (CT) scanner - one of the most technically advanced scanners found in veterinary practice. This is a multi-slice helical scanner capable of acquiring 16 rows of data per rotation. This advanced CT scanner is able to deliver incredibly clear, highly detailed images. The fast scanning capability can effectively reduce image distortion of moving organs, such as the heart and lungs. We would like to introduce you to a new service at Moorview Vets. In order to increase the availability of these advanced imaging modalities to clinicians, Moorview can offer a CT outpatient service to your patients. You will be able to refer a case for CT only, as part of your investigations. We would not be involved in the case, other than ensuring the pet is fit for sedation or general anaesthesia on admission and obtaining good quality images for you. This service enables you to retain control of your own cases; we will not discuss diagnosis or treatment options with the owner. Alternatively, you can refer cases as usual to our referral team and we will discuss diagnosis and treatment options directly with the owner. There are many indications for a CT scan. Since installing the scanner, we are using it on a daily basis for a wide range of conditions, elbow dysplasia, tumour staging, nasal disease and lung disease amongst the most common, but there are many more applications for the technology. To get in touch, use the contact details on the back page. Jonathan Deacon Owner, Moorview Vets 3

4 The CT Scanner Toshiba Aquilion RXL In January 2014, we became one of the few practices within the North East of England to have our very own CT scanner installed on site at Moorview Veterinary Practice. The 16-slice helical system - the most technically advanced of its kind in the North East - is housed at our extended Backworth practice. This highly soughtafter resource adds to the multitude of referral services already offered at Moorview. With a whole-body, multislice helical CT system now in place, your clients will have immediate access. We will be able to perform CT scans as and when required: no small fixed window for bookings, and no more anxious waiting for diagnosis. Coupling state-of-the-art diagnostics with warm and professional service, we take great pride in providing the best possible care for your clients and their pets. 4

5 The Specs AIDR 3D, personalized dose reduction SUREExposure XYZ ma modulation XR 25 Dose Check software Active collimation IHE Structured Dose Report Single or optional dual console configuration 3D advanced visualization on console SURETechnologies 0.5 second rotation 0.5 mm x 16-row, high-resolution detector conexact Double Slice technology, 32 slices per rotation 72 cm gantry opening with +/- 30 deg tilt Industry-leading, low-contrast resolution Low-dose technology The unit delivers an integrated solution to facilitate diagnostic decision-making at the lowest possible radiation dose without compromising image quality. Lightning speed A newly developed reconstruction system enables reconstruction speeds beyond 16 images per second, ensuring rapid diagnosis and high patient throughput. Cutting edge technology Our CT scanner substantially reduces the patient exposure dose whilst producing high quality images. The new generation console unit and application software further improve throughput, reducing the time required for diagnosis. With such a CT scanning system now installed at our Backworth site, Moorview can provide a state-of-the-art scanning service for your referral cases. 5

6 Why CT? Find out more at moorviewvets.co.uk Thyroid carcinoma in a 12 year old cat Uses of CT Thorax - Lung tumours, pulmonary metastases, diaphragmatic rupture, rib masses, pleural effusion, mediastinal masses, penetrating foreign bodies Abdomen - Portosystemic shunts, abdominal masses, ectopic ureters, insulinomas, adrenal masses Musculoskeletal - Angular limb deformities, elbow dysplasia, incomplete ossification of the humeral condyle, bone tumours, lumbosacral disease, discospondylitis, pelvic and complex fractures, osteochondrosis, brachial plexus tumours, vertebral anomalies and malformations Head and neck - Nasal disease, orbital swelling and masses, mandibular/maxillary masses, head trauma, assessment of local lymph nodes, ear disease, stick injuries, thyroid masses, interscapular fibrosarcoma 6 Any oncological disease for metastatic screening and staging

7 Sinonasal aspergillosis Incomplete ossification of humeral condyle Left otitis media 7

8 Case Study: Shimmer Shimmer, a six-year-old female neutered Cocker Spaniel, presented with dyspnoea. One week previously she had been running through a field and had yelped. There was a small puncture wound at the left cranial thorax. Due to the limitations of thoracic radiography, a CT scan was performed. CT demonstrated a linear, tubular, soft tissue attenuating structure running through the thorax in a left craniodorsally to right caudoventrally direction. Surrounding this was right sided pleural effusion. 8

9 Left Post contrast dorsal and transverse MPR images showing left hepatic mass (green arrows). A second linear object was located in the right caudal thorax. A median sternotomy was performed and 12 cm and 4cm wooden sticks were removed from the thorax. It had penetrated through the right cranial lung lobe, necessitating a right cranial lung lobectomy. Shimmer went onto make a good recovery. Conclusion CT is an extremely useful imaging modality when diagnosing thoracic disease as it can highlight pathology that is often not visible on conventional radiography or is obscured by fluid as in this case. 9

10 Portoazygous shunt Cranial mediastinal mass - mast cell tumour 10

11 Fragmented coronoid process Angular limb deformity Lung metastases Pituitary macroadenoma 11

12 Why MRI? The advantages of our imaging services Syringomyelia and Chiari malformation in a Cavalier King Charles Spaniel. Note the cerebellar herniation into the foramen magnum We have a regular fortnightly visits every other Monday from Burgess Diagnostics mobile 1.5T MRI scanner, fully equipped for Magnetic Resonance Imaging on animals. After an initial appraisal by one of our referral vets, all of our MRIs are routinely interpreted by Dr Mike Targett MA VetMB PhD DipECVN MRCVS and an independent official report is made. Uses of MRI Brain diseases (tumours, strokes, cranial nerve disorders, meningitis) and investigation of seizures Spinal disease (Intervertebral disc degeneration, Ischaemic myelopathy (aka: Fibrocartilaginous embolism) neoplasia Middle/Inner ear disease Some musculoskeletal problems Congenital conditions such as syringomyelia in Cavalier King Charles spaniels and hydrocephalus in small breed dogs 12

13 L1/2 intervertebral disc disease in a Daschund L4/5 intervertebral disc protrusion and lumbosacral stenosis in a Cocker Spaniel 13

14 Our Diagnostic Outpatient referral Referring vets identifies a potential patient for CT and completes the request form, which is ed to referrals@moorviewvets.co.uk. Moorview vets confirm the appointment with the referring vet and explains the costs and scanning procedure via . Referring vet discusses the scanning procedure with the owner. A blood sample taken as required (see later in contrast media). Patient is taken to appointment by the owner. Patient is seen by a Moorview vet who performs a pre-anaesthetic assessment and answers any queries the owner has, regarding the procedure. Moorview vets take responsibility for anaesthesia/sedation and recovery. Images can either be: 1. Sent to a reporting Diploma holding radiologist on the scanning day. Images sent before 5pm will receive a next working day report (working day = Mon-Fri 8.30am- 5.30pm). These reports will be ed directly to you and we will also have a copy. Reports and images (DICOM format) are also available. 2. Burned onto a disc (DICOM) and either posted to you or given to the owner to pass onto you. You can then interpret them yourself or use a reporting radiologist of your choice. Referring vet explains results to the owner. 14

15 Patient Selection Patients will be scanned on an outpatient basis and therefore must be clinically stable and suitable for transport and anaesthesia/ sedation. Unstable patients may still be able to be scanned, but this will need to be discussed with a Moorview vet. CT can be extremely helpful in the diagnosis of certain clinical conditions. If you are uncertain of which body area requires imaging then it is best to consider full referral of the case. Moorview vets can assist you with advice on which imaging modality would be most suitable. Preparation Contrast Media Contrast media is frequently used in CT and MRI scanning. These carry a low risk of adverse reaction, such as anaphylaxis and caution is used in patients with renal disease. Therefore, we would recommend a biochemistry profile to assess renal function prior to the appointment. Contrast is not frequently used when scanning joints to look for elbow dysplasia or OCD for example, but is used for most other conditions. Patients are to be starved from midnight prior to admission/ 4-6 hours if less than 6 months old. They can have access to water until 2 hours prior to admission. Thorax and abdominal CT patients will have a general anaesthetic. Limbs and head can be scanned under sedation. 15

16 To arrange a referral, call our Backworth practice on: referrals@moorviewvets.co.uk Where to find us Station Road Backworth Newcastle-upon-Tyne NE27 0AA Design by copo.co.uk