Thursday, June 20, 2013

Three things I learned: Practical radiography for the general practitioner and environmentally friendly continuing education

The radiography course was focused on companion animals, but I could not help but include this fabulous radiograph of a poor echidna which sustained injuries from a dog attack (he made a full recovery). No, you aren't hallucinating - that pattern in the background is the spines (and the circles are end-on spines).

Last week I attended the Centre for Veterinary Education's one day workshop on "Practical Radiography for the General Practitioner", presented by Perth-based imaging specialist Zoe Lenard.

This was billed as "ecoCPD", i.e. the organisers tried where they could to reduce the carbon footprint of the entire event, keeping paper to a minimum, reducing or eliminating travel and reducing food waste associated with over-catering. Of course this translated into reduced cost too, but I think the fact that the organisers considered the bigger picture should be applauded.

So what did I learn?

  1. Positioning is the key and there are no shortcuts. Zoe recommends that we "aim for perfection with positioning" as shortcuts are a false economy - inevitably you need an additional image which means more time for the patient under GA. I am careful with patient positioning, but I was amazed at how elaborate her positioning devices were, ie she utilises custom-made foam "V" troughs (best way to cut foam is with an electric bread knife) covered with vinyl and liberal sand bags. [It sounds easy but remember we can't make our patients wear a paper gown and stand behind a plate and breath in - we have to sedate or anaesthetise and often manipulate animals of vastly different size and shape into different positions!]
  2. Vertebral heart score (VHS) is not absolute, but in general 11 indicates mild cardiomegaly, 12 moderate and 13 marked - but she finds this most useful in serial radiographs of the same dog (and she always radiographs right side down first for consistency). In cats an alternative to VHS is a base to apical measurement lined up from sternebrae 2. If the BA measurement is beyond S4, cardiomegaly is likely. (And heart disease is more subtle in cats due to concentric hypertrophy and difficulty in detecting left atrial enlargement).
  3. Her system for using radiographic location of lung changes to determine differentials for lung disease is really helpful (for example a focal or multifocal pattern is more likely primary or metastatic neoplasia, an abscess or granumloma while cranioventral changes are likely associated with pneumonia, haemorrhage and atelectasis and caudodorsal changes are likely due to haemorrhage or oedema which may be cardiogenic or non cardiogenic).
I actually learned much, much more and I've come away with some charts and tables that I will use in practice. Its good to see that despite the increase in use of advanced imaging like CT, radiography is still very important and provides useful information rapidly. It was also nice to participate in a course which very much emphasises what can be done in general practice. 

1 comment:

  1. Anne, I will need to look at your notes when I get back to Oz. Sounds like a very useful workshop!
    I now feel extra justified in my (probably) annoyingly anal attention to making sure my VD images are straight but would like special equipment.

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