Medicine In The Digital Age

Digital radiography has changed equine veterinary practice forever.

Digital radiography allows practitioners to get instant X-rays, saving veterinarians time and horse owners money.

Courtesy of Eklin

Accurately and efficiently diagnosing equine patients is critical to their well being. Efficiency is also crucial to a veterinarian’s bottom line.

Digital radiography has changed the way both small and large veterinary practices are diagnosing and treating their patients, and this is especially true in the case of equine practitioners.

“On the equine side, digital has had a really big impact,” says William Hornof, DVM, Dipl. ACVR. Dr. Hornof is the past president of the American College of Veterinary Radiologists and is the chief medical officer for Eklin Medical Systems in Santa Clara, Calif. He explains that because so many equine veterinarians are mobile, DR has allowed them to be far more efficient.

Instant Gratification

“In the old days, you had to leave a farm to process and read film,” Hornof says. If you didn’t get the right view, you had to go back and do it again. In some cases, the hassle could lead to accepting less than ideal images.

But with DR, equine veterinarians get the images they need stallside.

“When you leave the farm, you know you have what you want,” Hornof says. “From a quality and completeness standpoint, digital has had a very big impact.”

To some extent, practitioners may not have a lot of choices on whether to invest in digital. Client demand has fueled the DR market.

Not only does DR have diagnostic benefits, the pre-purchase exam becomes faster to perform.

“In most cases, the buyer knows by the time the vet leaves if the sale is going to move forward,” says Kevin Packer, veterinary sales and support for Melville, N.Y.-based AllPro Imaging.

Hornoff also believes digital is far more forgiving of bad user technique than film is.

“You can take one shot and get it right the first time. The images should be automatically optimized for diagnostic accuracy. You should have superb images with each exposure and everything within the field of view should be well exposed. But just in case you don’t like what you get, you can repeat on the spot.”

This level of accuracy allows for better and faster diagnosis, which leads to better and faster treatment.

“It’s a win-win all around,” Hornof says. “The veterinarian becomes more efficient and more accurate.”

Better Images

Digital, according to Hornof, is also superior in quality to film. “Digital has gotten so good now,” he says. “The best digital systems just outperform film.”

“The DR diagnostic image is superior,” agrees Greg Stoutenburgh, vice president of marketing for Sound Technologies in Carlsbad, Calif. “You can shoot things now that you wouldn’t have bothered to do with film.”

Jim Waldsmith, DVM, president of Vetel Diagnostics in San Louis Obispo, Calif., agrees. “With DR, you get a better image that is faster and more reliable.”

“Even with great films, vets can only work with what they see and can’t draw more information out of the image. With digital, you can,” Packer says, explaining that software technologies in DR have allowed more viewing options.

Info Management

DR systems also provide the ability to archive images and integrate them into a practitioner’s practice management software. Today’s DR systems offer picture archiving and communication system—or PACS—capabilities, which allows organization and storage of images online.

“It’s a huge advantage,” Hornof explains. “The ability to have images online—backed up and infinitely and permanently retrievable—makes a big difference.”

“The horse-owning public is well aware of the improvement in quality, efficiency and accuracy that comes with digital.”

~ William Hornof, DVM, Dipl. ACVR ~

Additionally, most DR systems today are DICOM (Digital Imaging and Communications in Medicine) compliant. DICOM has become the standard platform for the transport and storage of medical information.

“The beauty of DICOM is that it’s not only a file format standard, it’s a communication system that allows you to transport files to remote archives and other sites,” Hornof says.

The DICOM standard has really exemplified the value of having images in an online archive. “We’re seeing the value of integration with practice management,” Hornof says. The DICOM Modality Worklist, which is the file standard for communicating between practice management software and the DICOM devices, provides seamless integration.

“It allows you to pull up a patient in practice management and see every study associated with it,” Hornof continues.

This type of organization means missing or lost files become less of a problem.

“With digital, even if someone mislabels something, you can still find it,” Hornof says. With DICOM, it’s like Googling a patient record and finding every last detail about the patient. You can go back and search by day, by owner, by horse’s name.

While there are clear benefits to DR, Waldsmith does have some concerns regarding what he says are “myths” in the industry.

“DR is not regulated for veterinary use, so many claims are being made regarding what software can and cannot do.”

For practitioners considering investing in DR, Waldsmith recommends consulting with a board certified veterinary radiologist who is well versed in the various technologies available to equine practitioners.

The Future of DR

In terms of future upgrades, Hornof believes near-term advances include improved integration with practice management software. He says image quality is not likely to change any time soon because it would require higher patient irradiation, which is obviously undesirable.

But according to Hornof, a DR image is as good, if not better, than a very good film image.

Packer believes the DR market will continue to grow, especially in practices that deal with performance horses.

“Most equine vets are the equivalent of an orthopedic doctor, in that they need the detail in bone and joint spacing,” Packer says.

A high-quality DR system isn’t cheap, and cost justification depends on your practice.

“Take a good look at your workflow and where you’re spending your time,” Waldsmith advises, and he explains this is the most important issue to consider when evaluating whether DR is cost efficient for your practice.

“DR systems have come down substantially in cost over the last six months,” Waldsmith continues. “What once cost $100,000 can now be purchased for $70,000.”

“It gets down to volume—the number of studies you do,” Hornoff says. Drive time and film development cost money.

“If you’re doing more than 20 studies a month, DR is worth it,” Stoutenburgh says.

To some extent, practitioners  may not have a lot of choices on whether to invest in digital. Client demand has fueled the DR market.

“The horse community is closely knit,” Waldsmith says, explaining that DR is now the standard of care many have come to expect.

“The horse-owning public is well-aware of the improvement in quality, efficiency and accuracy that comes with digital,” Hornof says.

“Clients want quick diagnosis and they want to begin treatment for their horses as soon as possible. If you’re still using film, there’s a chance some of your clients may just switch to the guy down the road who uses digital.”


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