Page 669 - ONLINE PROCEEDING BOOK WSAVA 2017
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WSVA7-0307
NURSES II
IS IT STRAIGHT ENOUGH YET? TIPS AND TRICKS TO OPTIMIZE MUSCULOSKELETAL RADIOGRAPHS
S. Hecht1
1University of Tennessee, Small Animal Clinical Sciences, Knoxville, USA
IS IT STRAIGHT ENOUGH YET?
TIPS AND TRICKS TO OPTIMIZE MUSCULOSKELETAL RADIOGRAPHS
Silke Hecht, Dr. med. vet., Diplomate ACVR, Diplomate ECVDI
Professor in Radiology
C247 Veterinary Medical Center, University of Tennessee College of Veterinary Medicine, Knoxville, TN 37996, USA
shecht@utk.edu
Introduction:
Obtaining a high quality orthopaedic radiograph in a small animal patient represents a challenge. Both from
a diagnostic quality and a radiation safety perspective, all radiographs should be obtained under good sedation or general anesthesia unless contraindicated based
on patient health status. Even if presence of personnel in the examination room is be required under certain circumstances, ALARA principles (ALARA = as low as reasonably achievable) have to be honoured (1). These include consideration of the 3 factors time (i.e., minimize time in the examination room), distance (i.e., maximize distance between personnel and x-ray beam) and shielding (i.e., wear appropriate protective equipment).
Usually, radiographs in at least 2 planes of the area of interest are needed. Additional views (e.g., oblique views or stress radiographs) and comparison radiographs
of the other limb may be necessary for full evaluation.
As there is signi cant variation in normal radiographic anatomy between small animal patients (especially, different dog breeds), and physiologic variations are common (e.g., changes with age), establishment of an in-house teaching library of normal radiographs as well as acquisition of reference textbooks (2, 3) is strongly recommended.
Radiographic examination of the forelimb (4-7):
• Shoulder: Standard radiographs of the shoulder include a mediolateral view in which the affected
leg is positioned on the table/plate and the leg
is pulled forward. For the orthogonal projection
the patient can either be positioned in sternal recumbency (craniocaudal view) or dorsal recumbency (caudocranial view). For optimized evaluation of
the caudal humeral head, e.g. to rule out an OCD lesion, supinated and pronated radiographs with internal and external rotation of the antebrachium, respectively, may be useful. A skyline radiograph of the intertubercular groove in sternal recumbency and with the elbow pulled caudally is useful to evaluate the bicipital tendon region. Finally, in addition to a regular mediolateral view, a lateromedial view of the non- dependent shoulder with the limb pushed dorsally as far as possible can aid in evaluation of the scapula.
• Elbow: In addition to standard mediolateral and craniocaudal views, a  exed mediolateral view is indicated in most instances to evaluate the anconeal process and medial epicondyle. Craniocaudal oblique views can help in assessment of the region of the medial coronoid process, medial epicondyle and other structures.
• Carpus and manus: Routine views include mediolateral and dorsopalmar radiographs. Oblique views (dorsomedial-palmarolateral oblique (DMPLO) and dorsolateral-palmaromedial oblique (DLPMO))
can aid in evaluation of the dorsolateral, dorsomedial, palmarolateral and palmaromedial aspect of carpal bones, metacarpals and phalanges. If joint instability is suspected, stress views with application of a fulcrum are helpful in determining degree and exact location
of joint laxity. Stress radiographs can be performed in hyperextension, hyper exion, and lateral and medial fulcrum application. Radiographs of the opposite leg are usually obtained for comparison as degree of joint laxity is somewhat variable (especially in cats). Finally, for further evaluation of the phalanges, splayed toe radiographs in lateral recumbency are useful. These are obtained by af xing tape to each toenail and spreading the digits apart.
Radiographic examination of the hindlimb (4-8):
• Pelvis and femur: Routine views of the pelvis include a lateral (with legs superimposed and/or spread apart) and a VD view with the legs extended. An additional VD view with the legs  exed forward (“frog leg view”) is extremely useful for further evaluation of the femoral head and neck. The craniocaudal view of the femur is usually obtained the same way as the VD view of the pelvis. For the mediolateral view the opposite leg is either pulled caudally or dorsally dependent on patient
An Urban Experience
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