Advanced imaging

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For some routine radiographic examinations of cats and dogs there are several alternative positioning techniques, and a number are described in Figure 11.1. The indications and patient positioning for a selection of more specialized radiographic examinations is also described. These views are not part of a routine radiographic interpretation, but should be used at the specific request of the veterinary surgeon when trying to answer a specific question about the condition being investigated. These advanced radiographic positioning techniques are also described in Figure 11.1. This chapter informs on Advanced contrast radiography; Digital radiography; Fluoroscopy; Ultrasonography; Magnetic resonance imaging; Scintigraphy; and Other advanced imaging techniques.

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11.1 Positioning techniques for advanced radiography. General anaesthesia is required to facilitate the positioning described. All images must be appropriately labelled with a L/R marker. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and are printed with her permission.
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11.2 Positioning the needle for shoulder arthrography. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and are printed with her permission.
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11.4 Portovenogram demonstrating a single congenital extrahepatic shunting vessel (arrowed) in a cat. (Courtesy of F Barr)
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11.5 Selective angiocardiography. The cardiac catheter is positioned in the right ventricle. The contrast medium demonstrates stenosis of the pulmonic outflow (arrowed) with marked post-stenotic dilatation (arrowhead). (Courtesy of F Barr)
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11.6 Peripheral angiograph demonstrating a vascular anomaly in a Basset Hound.
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11.7 Sialograph outlining a sialolith seen as a filling defect (arrowed) in the parotid salivary duct of a Bulldog.
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11.8 Sinograph outlining a stick foreign body (arrowed) at the end of the sinus tract in a dog’s neck. (Courtesy of F Barr)
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11.9 Lymphangiograph demonstrating an enlarged popliteal lymph node (arrowed) in a crossbred dog.
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11.10 The cassette is inserted into the computed reader. The reader will extract the imaging plate from the cassette, scan and then erase the image and reload the cassette ready for re-use.
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11.11 A flat panel positioned in the Bucky tray of an X-ray table. The wire attaches the panel to the computer, transferring the image information almost instantaneously on to the computer screen. (Courtesy of BCF Technology Ltd)
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11.12 The viewing screen can generally display two images satisfactorily. Where more images are displayed, it becomes increasingly difficult to assess the images accurately.
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11.13 A fluoroscopy system. The X-rays generated by the X-ray tube (left) are detected by the image intensifier (right) and then displayed on a remote viewing screen.
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11.14 The image intensifier comprises of an input screen, an electronic ‘focusing’ system and an output screen, housed within a vacuum chamber.
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11.17 A-mode ultrasound image.
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11.18 A sagittal plane B-mode ultrasound image showing echogenic material (arrowed) within the gallbladder.
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11.19 B-mode and M-mode images of a transverse section of the heart. Selection of position for M-mode beam is taken from the B-mode image (dashed line). Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and are printed with her permission. IVS = Interventricular septum; LV = Left ventricle; LVFW = Left ventricular free wall; RV = Right ventricle; RVFW = Right ventricular free wall.
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11.20 Acoustic enhancement artefact. In this ultrasound image of the liver, an area of relatively echogenic tissue is seen immediately deep to the gallbladder (arrowed). (Courtesy of F Barr)
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11.21 Acoustic shadowing artefact. In this ultrasound image of the bladder, a calculus within the bladder casts a hypoechoic shadow over the structures located deep to it (arrowed). (Courtesy of F Barr)
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11.22 Reverberation artefact. If echoes are bounced between highly reflective surfaces, a series of parallel echogenic lines (arrowed) can be seen deep to the original reflector. (Courtesy of F Barr)
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11.23 Mirror image artefact. The ‘real’ liver is seen to the right of the picture with the ‘mirror image’ on the left beyond the diaphragm.
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11.24 Ultrasound machine.
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11.25 Transducer probes. Sector probe. Linear probe. Curvilinear probe.
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11.26 Ultrasound machine controls.
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11.29 Obtaining a urine sample via ultrasound-guided cystocentesis.
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11.30 CT scan. The X-ray tube is rotated around the patient taking exposures at multiple angles around the body.
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11.32 CT image showing otitis media of the right ear. Note the presence of fluid in the tympanic bulla (arrowed). (Courtesy of G Hammond)
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11.33 Mobile scanners mean that MRI is increasingly available to veterinary practices in the UK.
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11.34 A patient positioned within the MRI scanner.
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11.35 MR image of a dog’s stifle demonstrating a tear through the medial meniscus (arrowed). This injury is most likely to have occurred secondary to cranial cruciate ligament rupture.
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11.36 The strong magnetic field used with MRI creates a potential safety hazard.
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11.37 Scintigraphic image of a hyperthyroid cat demonstrating increased uptake of the radionuclide by the thyroid gland (arrowed).
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