An equine digital radiography (DR) system is a major capital investment for any clinic. If you’re going to spend $50,000 or more on a new modality, it should be just as reliable five years from now as it is today. And as your practice evolves, you’ll need a system that will be able to evolve with you as you grow as a practitioner. But no two DR systems are created equal, and to guide you in this important decision, let’s look at the most important factors to consider when evaluating an equine DR system.
- Ease of Use
- The Right Size Tool for the Right Job
- Manufacturing Quality
- Image Quality
Workflow is Everything
Needless to say, the vast majority of the DR market is the human medical sector, and so the majority of software/user interface development is geared towards that application. Some DR manufacturers have not properly adapted their units to the needs of veterinary clinics, either due to lack of resources or expertise. This leads to more cumbersome workflows that take time away from your patients.
Far from the human hospital with convenient desks and wall mounted monitors, the equine world presents serious workspace challenges. The ability to use a bale of hay or the back of a truck or even the ground as an imaging station is critical, as is having a piece of equipment that transforms itself to each of those situations.
If you’re with a horse owner, you should be able to pull up the X-ray images on your tablet, iPad, or smartphone so they have a visual representation of their horse’s health, and the tremendous value of the digital radiographic procedure. Numerous complicated toolbars and sub-windows just get in the way of the take-home message: that you were able to quickly and accurately make a radiologic assessment of their horse’s health. While software may seem like a frivolous thing to spend money on, an investment in DR system with a quality interface saves money in the long run.
Beyond expanding your caseload, your DR system should make it easy to send X-rays to radiologists and other specialists either from the Cloud or directly from the DR unit. This enhanced connectivity shortens the time between image capture and diagnosis, which not only improves patient outcomes but also impresses clients.
The Evolution of Plate Size
Plate size in Equine DR has two driving factors: one is the size of the anatomy being imaged, and the other is the need for maneuverability around the horse. Obviously technology has come far to help push the issue, since the wireless detectors of today are thinner and lighter.
In the beginning, when detectors were a little heavier, the 8”x10” panel was most popular. This was the most manageable solution to have in the hands of a technician or veterinary as they moved from point-to-point around the horse, whether it be necks, backs, limbs, and everywhere in between. The obvious downfall to this is the smaller amount of anatomy on a large animal that fit in the field of view.
Practitioners tried to move a little farther back (increase source-to-detector distance) to fit more on the panel, but both the inverse square law of radiation intensity as well as a finite plate sensitivity puts a limit on diagnostic power.
On the opposite end, there are 14”x17” and even 17”x17” panels available. These are the gold standard in the small animal DR world, where the panel is fixed under the x-ray table, and so manufacturers have worked to make them as lightweight and sensitive as possible. Still, in the equine world, these are often too cumbersome.
And the fact remains that for as big as a horse’s spine (for example) is, the entire anatomy is never going to fit into the field of view of one image with diagnostic image quality; you ALWAYS have to take multiple, overlapping images anyway.
This is why the sweet-spot of equine DR plate size has fallen into the 10”x12” to 11”x14” category. This is the best balance of portability and coverage.
A Trusted Partner
In general, the phrase “you get what you pay for” holds in the veterinary DR market, and most of this cost comes in the reliability of the panels, both in their ability to consistently produce quality images as well as in their longevity in the clinic. The most reputable panel manufacturers in the world (both human and veterinary) are Varex, Canon, Samsung, Toshiba, Fuji, GE, Siemens, Philips, and AGFA, with a whole slew of second–tier panel manufacturers (mostly southern-Asian) entering the market space.
With the high sensitivity needed to image the thicker anatomies of the equine patient, Cesium (CsI) is the scintillator (x-ray absorption material) of choice for equine DR. However, when Cesium is concerned, there is a much higher manufacturer-dependence on this quality. Cesium is “sprayed” onto a substrate at a given concentration, then “baked” in an oven causing crystals to form and grow upwards and in parallel. The cool part is that these crystals serve as “light tubes” that increase the efficiency and resolution of the scintillator light leading to the higher sensitivity we spoke of earlier. The issue is that the quality of the end-product depends greatly on the concentration of the initial deposition, the time-temperature profile of the baking process, and the angle of crystal growth (if they grow even slightly diagonally, their efficiency significantly decreases). Only the manufacturers with years of experience growing Cesium have developed a consistency and quality you need.
For more information on Cesium scintillators and how they work, read the article here: https://soundvet.com/the-scintillator-question-gadox-vs-cesium/
Digital radiography has advanced tremendously over the last decade. Pathologies that were once undetectable can now be diagnosed and treated earlier, but that’s only true if your DR system has a sophisticated panel.
Assuming a “good” quality DR panel, whichever manufacturer is used, these hardware differences produce only minor variation in panel sensitivity. All of this is very much secondary to the most important step in the acquisition process: Image Processing. The minor pixel-level differences only yield the raw image data, which is virtually useless diagnostically. The importance of image processing is not only in the ability to create a sharp, diagnostic image. Virtually any commercially available software can do this. More important, though, is the ability to produce this image quality consistently across a wide range of patients, anatomies, and positions. Again, any image processing software worth its weight CAN produce a nice image of a mini’s stifle as well as one of warmblood’s C-spine. The ones that demand a premium price tag are the ones that don’t require any individual tuning of the parameters to achieve this consistency. A “hands free” image processing suite that is used on daily basis in thousands of human and veterinary DR panels every day for the last decade; now that’s worth the price of admission.
Reliability and Support
When evaluating a DR system, reliability is just as important a factor to consider as your budget and the needs of your practice. If your DR system does break down, how long will it be until you receive a loaner unit? Will it arrive the next morning? Or do you have to send it to the manufacturer, wait for an evaluation, and then wait several more days until you receive the loaner system?
Losing time and revenue aren’t the only drawbacks of a DR malfunction. It’s embarrassing when a client expects to hear a diagnosis but is told instead that the DR isn’t working. How does that reflect on your credibility as a doctor?
This is why this is probably the most important section of this article. You need to make sure you are working with a DR partner that has a long history of quality service in the veterinary market and with its vendors. The worst thing you can do is leave yourself vulnerable to ala carte support or worse, an un-supportable device (because the manufacturer no longer produces parts for the system). Extended warranty/service packages are often a salesman’s least favorite talking point, because they just want to get the deal done, but this is an enormously important part of your buying decision.
The Current and Future Needs of Your Practice
How would you describe your practice? Is it a lameness or a sport horse-type clinic? Do you plan on taking X-rays of necks, backs, and extremities? Will you use the DR system for surgeries? How will your needs change over the next five years and beyond?
Having a clear idea of your practice’s current and future needs will help you find a DR unit that has the right features but lacks the unnecessary extras that inflate the price.
If you would like to learn more about SOUND’s Equine DR Systems, call Sound® at 800-268-5354 or visit our website.