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In Discussion With Diagnostic Imaging

29 July 2020

The Diagnostic Imaging team at Pride Veterinary Centre is involved in many of the cases we see in our hospital. Working with all the other disciplines gives the team a varied caseload and the opportunity to see some rare conditions and injuries. Because the team are based on-site, they are able to acquire images and prepare a diagnosis immediately, often whilst the patient is still under anaesthesia.

What Made You Choose To Pursue Diagnostic Imaging?

Caroline, “My passion for imaging was "transmitted" to me by my very inspiring professor in Radiology in the Veterinary School of Alfort, Paris, where I studied - Professor Dominique Begon. She was, and she is still an amazing radiologist, a pioneer, and one of the founders of the European College of Veterinary Radiology. As a veterinary student, I quickly confirmed my interest for imaging during our clinical rotations. I found the images and the days spend there fascinating, thanks to the diversity of imaging modalities and cases. It is extremely rewarding because radiologists are often the ones that get the diagnosis, allowing to unblock the situation so I could never have done anything else. I also love the fact we get to be in the centre of all disciplines (medicine, surgery, neuro) and work with everyone.”

Maria, “During my rotating internship I discovered that diagnostic imaging is a specialist field that I love and it motivates me to study every day. It is a speciality in which there is a great variety of cases and you have to have knowledge of all the other specialties to reach a diagnosis. We need to know how to relate the imaging findings with the anamnesis that the clinician transmits to you, leading to great teamwork.”


Olga, “Veterinary diagnostic imaging is a challenging, fascinating speciality. I like its diversity, that makes us deal with a range of different disciplines, from orthopaedics to endocrinology and internal medicine. It is truly transversal – all the other specialists need our input and any of their patients are ours too. It requires a detail-orientated mind, and an ability to focus. I love many aspects of my profession, but neuroradiology is by far my favourite; I love discussing cases with our friends in the neurology team at Pride. The hardest aspect of the profession for me, is letting go of my patients, when I have formulated my diagnosis, even though I am sending them on the path towards recovery."

Carlo, “During my third year of Veterinary school one of my brothers started to work as an informatic engineer in a department involved with human radiology. He was very enthusiastic, and he told me to explore radiology and see if I find it interesting too. This made me intrigued and nextyear, during the Erasmus in Spain, I met
Dr. Joaquin Jimenez Fragroso, a brilliant radiology professor who definitively instilled in me the passion for this discipline. This passion then was enhanced by many talented radiologists I found in my radiology path. Why I like it? We can see through the body, what should I add? Radiology is an amazing science that is helping our patients to be diagnosed not invasively and treated accordingly. Definitely in love with this discipline as the first day.”

How Does A Typical Day In Imaging Look?

Each day is different and depends on what cases are in the hospital. We have some heavy days, but some are a lot easier. We don’t know in advance what cases will come through imaging so we have to prepare every morning when we know what our workload looks like.

Caroline says, “Regarding structure, we aim to have a similar structure each day. We start each morning by improving knowledge within the team, with a different activity – book club, journal club, case reviews etc. We usually have some time in the morning to do this before the first hospital cases arrive in the imaging department, which is usually around 9.30am.” Each member of the team then goes to their modality.

Maria and Pierantonio are based in ultrasound, and so start to image their patients. They are also available to help clinicians with radiography if they are required."

Maria adds “In addition to taking care of the ultrasounds, we carried out other dynamic procedures like fluoroscopy and radiograph contrast studies”

Andreanna, Ella and Natalie are based in the CT/MRI control room. Caroline and Carlo each spend one day per week scanning in ultrasound, then the remainder of the week cross sectional imaging (CT and MRI) with Olga working solely in CT/ MRI. “Of course we have to adapt our work to the flow of the cases” added Caroline.

How Many Cases Do You Typically See?

The number of cases seen by the imaging team is very much dependent upon how busy the rest of the hospital is. If the other disciplines are busy, then this is reflected is their workload.

In ultrasound, they will sometimes see 7 in a day, but on a busier day there can be 10-12 cases being scanned.

In CT and MRI, the norm is about 10, but there have been those busier days when they have managed 13 or 14 in one day. Much of the workload is also dependent on the availability of the anaesthesia service, because they work alongside the imaging team for sedation. If a longer procedure such as MRI is later in the day, then it will be postponed until the following morning if the anaesthesia team are busy with other procedures.

Because they are a good sized team, it allows them to be more available for the other disciplines. Other clinicians will rely on the imagers to decide whether there is a particular tissue that needs to be sampled on a patient, or whether the patient needs another image based on what they have seen.

Caroline, “Our Radiographers are very good at knowing what we need – they acquire the images. We receive the images instantaneously so we can look at them whilst the animal is still in imaging. If we suspect a particular disease, we can tell the Radiographers what images further we require, such as a further MRI sequence for example or a delayed phase with some contrast (CT). We have constant dialogue with the Radiographers to ensure this is a smooth process and the animal is under sedation/anaesthesia for the minimal time.”

What Other Disciplines Do You Work With?

The imaging team work with all the other disciplines, from sampling tissue for internal medicine to staging for oncology, and pre-surgical imaging. Neurologists, Surgeons and Medics will see the patient, undertake a clinical examination, take bloods and then come with a list of possible conditions with a differential diagnosis. Imaging is required to confirm one of their hypotheses and so is a central part of their diagnosis. And in addition to diagnosis, there is sampling, particularly in oncology. They even work with dermatology cases on occasion as sometimes dogs are presented with ear problems and they need to image them with CT.

If an animal presents with a mass, sometimes a tumour is suspected. Imaging will help by checking the thorax or abdomen for metastases.

The Diagnostic Imaging service plays a central role within all the teams – there is no discipline that does not use us. Imaging is at the core of the hospital.

What Are The Most Common Cases You See?

We use CT to image the whole body – we are able to image everything in 3D, particularly the head which can be challenging to image, which could be very helpful for the surgeons when planning a surgery. Ultrasound is extremely useful to evaluate the abdomen and is used a lot by the Internal Medicine team. Neurology use MRI a lot for their cases.

Most of our specialists have good knowledge of the imaging modalities as part of their examinations.

In imaging we know the advantages (and limits) of each modality. When the clinician presents us with a case we advise which is the best modality in each situation and sometimes more than one would be necessary to obtain the diagnosis.

Are There Any Cases That Particularly Stand Out For You?

Caroline, “The Bella case stands out for me. Imaging was a major part of guiding this surgery. Pre-operative CT assessed everything and checked that there was nothing inside her brain. It gave a complete picture of everything. This was a really good example of working hand in hand with the anaesthesia and surgery teams.”

The team do get to see some very rare cases. It is very satisfying when the diagnosis is very difficult, but they manage it and help the patient, with a positive outcome.

Another case was Prince, a border collie puppy. He had complex vascular malformations in his liver. The case was being managed by surgery and internal medicine. His diagnosis was confirmed by imaging. The teams then used imaging regularly to ensure that he was recovering well.

Carlo, “Pablo had a brain tumour in 4th ventricle. We use MRI for pre-operative imaging to help to diagnose the lesion. Post-operative imaging then assessed the brain after surgery to remove the whole tumour."

What Would You Like People To Know About Imaging At Pride Veterinary Centre?

We have the most advanced techniques available for diagnosis. State-of-the-art equipment that vets won’t have in a normal clinic. Dedicated team of imagers and referring vets can benefit from the skill and experience of the imaging team. Ability to interpret the cases immediately. Results are very quick, unlike in human medicine, MRI results interpreted and fed back the same day so a quick decision can be made on treatment. We are lucky to have on-site radiologists to help with fast treatment.

 

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