The Difference Between Diagnostic Radiology, Radiation Therapy and Interventional Radiology

radiation therapy

At first glance, these three disciplines within veterinary medicine seem pretty much the same, but at the Animal Medical Center, diagnostic radiology, radiation therapy, and interventional radiology represent three different groups of veterinarians with three very different sets of background and training. What ties these three disparate groups together is their use of radiation to diagnose and treat disease.

Diagnostic Radiology
These days you are more likely to find a Department of Diagnostic Imaging in a hospital than a Radiology Department. Radiology is an older term, used when x-rays were the only testing modality using radiation available in medicine. Today, AMC’s Diagnostic Imaging Service uses not only traditional x-rays but also ultrasound, computed tomography (CT) scans, and magnetic resonance imaging (MRI) in the diagnostic evaluation of patients. AMC’s Diagnostic Imaging Service also has a fluoroscopy unit, which is like a video x-ray. This machine allows us to watch bodily functions like blood flow or swallowing in real time. To see an example of fluoroscopy, read about Molly the Ganaraskan. Every veterinarian at AMC depends on our diagnostic imaging team for their expertise in imaging sick pets and helping us to make an accurate diagnosis.

Radiation Therapy
A very accurate description, AMC’s Radiation Oncology Service uses radiation to treat tumors. Specifically, we have a linear accelerator (linac), a giant machine that creates various types of radiation depending on patient needs. Our state-of-the-art linac can make electrons for superficial treatments, produce high energy pinpoint beams for stereotactic radiosurgery, and stereotactic body radiation therapy. Diagnostic Imaging’s CT scanner interfaces with Radiation Oncology’s 3-D computer planning system. The interface allows the linac’s multileaf collimator to sculpt the radiation beam to precisely target the tumor being treated. The veterinarians working in radiation therapy have training in both the physics of radiation as well as the management of cancer.

Interventional Radiology
Specialists in interventional radiology use minimally invasive techniques to make image-guided diagnoses and also deploy high tech treatments for a variety of diseases. Using a range of techniques which rely on the use of images generated by diagnostic radiology equipment such as fluoroscopy, ultrasound, CT scan, or MRI imaging, the interventional radiologist precisely targets various organs with treatments such as stents, occluders and medications. Watch a video where AMC’s interventional radiology team uses fluoroscopy to close off abnormal blood vessels in the liver. The veterinarians in our Interventional Radiology Service have diverse backgrounds in surgery, internal medicine plus specialized training to use minimally invasive equipment.

Linked together by their use of radiation as a diagnostic and therapeutic tool, diagnostic radiology, radiation therapy and interventional radiology are just a few of the highly trained specialists at AMC working to make sick pets healthy again.

Heart Healthy Tests for Pets

In addition to being National Pet Dental Health Month, February is American Heart Month. Veterinary patients suffer from heart disease, although coronary artery disease, which is common in people, doesn’t occur in dogs and cats. Even so, cardiologists at The Animal Medical Center use a variety of diagnostic tests to determine if their patients have heart problems requiring treatment.

Auscultation
The stethoscope has been around since the early 1800s when it was invented by French physician René Laennec. Every veterinarian has a stethoscope and they use their stethoscopes to determine the heart rate, heart rhythm and heart sounds. Abnormal heart sounds, also known as murmurs, may be “innocent” or of no concern. Innocent murmurs are most commonly heard in pediatric patients. In adult dogs and cats, the development of a heart murmur typically indicates leaky heart valves. If your veterinarian hears a heart murmur, consultation with a board certified veterinary cardiologist for additional testing may be recommended by your primary care veterinarian.

Electrocardiogram
An electrocardiogram measures the electrical impulses produced by the heart. The recording is a graphic representation of the heart’s rate and rhythm. The normal heart rate varies depending on whether your pet is a dog or cat. Cats have a higher heart rate than dogs, and small dogs tend to have a higher heart rate than large dogs. A normal heart beats regularly. Heartbeats that occur at irregular intervals, called an arrhythmia, indicate heart disease and often land a pet in the animal ICU for emergency treatment by a veterinary cardiologist to correct the abnormal rhythm. Pets with serious abnormal rhythms may be very weak, faint and in rare cases, die suddenly.

Chest X-rays
Radiographs or x-rays show the size of your pet’s heart and the surrounding lungs. Enlarged hearts can occur with diseases of the heart muscle or as a result of leaky heart valves. When the valves are extremely leaky or the heart muscle becomes very weak, heart failure occurs. Heart failure allows fluid to build up in the lungs. This buildup of fluid, called pulmonary edema, can be seen on an x-ray as fluffy white patches in the normally black lungs.

Echocardiogram
An echocardiogram uses sound waves to create a real-time moving image of the heart as it beats inside the chest. The sound waves are created and recorded via a probe placed on the chest over the heart. As the probe is moved, different parts of the heart come into view. The computer inside the echocardiography machine is able to precisely measure the thickness of the heart walls, the valves and measure the rate of blood flow throughout the heart given your pet’s cardiologist an exact measure of how well all components of the heart are functioning. An echocardiogram is used to diagnose nearly all forms of dog and cat heart disease, including the most common form of heart disease in dogs, leaky valves, and in cats, heart muscle disorders.

Brain Natiuretic Peptide (BNP)
If your veterinarian recommends a BNP test as part of a cardiac evaluation, she has not lost her mind. Although the name seems just plain wrong for a heart test, BNP is actually a small hormone produced by the heart. Production increases when the heart muscle is excessively stretched, as in cases of heart failure. Sometimes the clinical signs of heart failure overlap with the signs other diseases causing breathing difficulties, including heart failure and pneumonia. This blood test provides a non-invasive method to help differentiate between cardiac and non-cardiac causes of respiratory problems. This test is most useful when combined with the other tests mentioned previously.

What can you do to have a heart healthy pet?

  • Keep in mind no test is perfect. It may take a battery of tests to determine your pet’s cardiac condition.
  • Excessive coughing or breathing difficulty in your pet should be evaluated immediately by a veterinarian.
  • Packing on the pounds puts extra stress on the heart. Keep your pet in ideal condition.

National Veterinary Technician Week 2012

October 14- 20, is a celebration of the contributions to the healthcare of animals made by veterinary technicians. Often called “nurses,” these licensed professionals practice under the supervision of a licensed veterinarian. In New York State, veterinary technicians prepare and give medications as ordered by the veterinarian, take x-rays, induce and maintain anesthesia, and assist with medical and surgical procedures. Most importantly, they are critical members of the team caring for your pet. Last year, in honor of Veterinary Technician week, I wrote about the care received by Jack Black the Cat.

Just as in human healthcare, nurses for animals are in great demand. Not only are career opportunities available for veterinary technicians to work in general veterinary offices, but specialization in various disciplines such as oncology or anesthesia, participation in biomedical research, enlistment in the military and even working as a technician in zoo and wildlife medicine are also widely available.

Like all professionals, there is a backstory about the day-to-day life of veterinary technicians. If you are considering a career as a veterinary technician or just know someone whose job it is to be a technician, you may be unaware of what a typical day entails. Hopefully this blog will give you a bit of the inside scoop and provide a greater appreciation for the labors of love they each perform every day for our pets.

Fashionistas need not apply

Looking for a job where you look great and wear fabulous clothes? Unless your skin tone becomes more ravishing when you wear scrub-suit green, being a veterinary technician is probably not for you. However, if you like to change clothes frequently, we can accommodate your needs. A shake of the head can send ear drops flying right onto your freshly laundered ensemble or a pooch with a bloody nose can change you plain shirt into a polka dot one!

Adoption options

Seeing cute animals all day, every day brings a smile to every technician’s face, since like veterinarians, they love being around animals. But loving animals occasionally has a darker side. Every animal hospital provides its employees with plenty of options to adopt a new pet: a basket of kittens left on the doorstep or a dog tied to the lamppost, but every family, even those with a member skilled in providing pet care, has a limit to the number of pets they can handle, both emotionally and financially.

Compassionate technicians may run the risk of trying to help too many of the animals in need that they encounter. Reliable resources for helping these animals are at the tip of the fingertips of the best technicians who know or have learned the limits of their care.

Injury report

Like many businesses, The AMC tracks statistics on workplace injuries. No surprises here: topping the list are bites and scratches, followed by back injuries. Fortunately, licks and kisses are not considered injuries, just part of the fun of being a tech.

A heartfelt thanks to all veterinary technicians

During National Veterinary Technician Week 2012, the veterinarians of The AMC would like to recognize our nearly 80 technicians – and every technician nationwide – for their commitment to their profession and the support of ours.

If you are thinking of a career as a veterinary technician, visit http://www.veterinarytechnician.com.

You will find lots of useful information and even job opportunities in your area.

The AMC Goes Electronic

This past week was a watershed week at The Animal Medical Center. With the flip of a switch, an electronic medical record (EMR) became a new part of practicing veterinary medicine.

What is an EMR?

The name, electronic medical record, does not do this system complete justice. It is definitely electronic. Consequently, we have computers in every nook and cranny of the hospital attached to three types of new printers – one for collar-style name tags, one for cage cards, and one for blood sample labels. A paper medical record includes notes about examinations, results of blood tests and x-rays, surgery descriptions, and diagnoses. Our EMR includes all those components, but it goes further.

But wait, there’s more

With this new system, I can order x-rays from my 8th floor clinic computer and the radiology team on the 2nd floor knows exactly what I want – faster than we can transport the pet to radiology. Previously, the patient and a paper request were transported to radiology. The same software that records patient information also orders blood tests from the laboratory or pills from the dispensary. For hospitalized patients, all medications administered by the nursing staff are now requested on an electronic whiteboard and recorded with the click of a mouse.

My personal favorite

Each patient has an electronic clipboard and on the top is a handy little box. Once I figured out how to use it, I went back into all my patients’ clipboard records from this week and loaded them up. I can write anything I want in the box. My plan is to use it like an electronic post-it note to remind me when certain infrequently performed tests are due. In Vivian’s box I put the date for her next iron injection, for Cleo the date her urine needs a follow-up culture, and I added the dates of scheduled chest x-rays for several more pets. One of the reasons both physicians and veterinarians are moving to EMRs is to help them become better doctors, and this will definitely help me.

New tools

The EMR allows importing of photograph files, a feature particularly useful for oncologists like me who want to monitor the response of a tumor to treatment. The photographs also help the ER doctors who might not know what the tumor looked like before, but now can click open a JPEG file and see the tumor for themselves. The EMR contains dog and cat diagrams ready for annotation to mark the location of abnormalities found on examination.

Improving the health of all animals

In addition to improving care for individual pets, the EMR will help improve care for all pets by facilitating research. Old style paper medical records cannot be searched for information. Our electronic medical record allows us to search and find all patients with a particular diagnosis or disease. Information gleaned from the records will help us to share information with other veterinarians about successful new treatments. Thus, the EMR will benefit not only AMC patients, but patients everywhere.

Transitioning to any new system is hard work and takes persistence, but with all these benefits, we have entered a new era.

If your veterinarian uses an EMR, some store records in “the cloud” allowing you to view your pet’s medical information anytime. Ask about this feature the next time you visit your veterinarian, as the information could be very valuable during an ER visit.

Summer Bummer: Sand Impaction

This is the first in a series of blogs about pets who have been treated for intestinal problems.

Summer is a time for fun and relaxation, but not for poor Lola. After a restful weekend at the beach, she started vomiting and ended up at The Animal Medical Center waiting to be seen by the emergency service. Her story is a cautionary tale for dog owners.

Lola is a 5 year old female Havanese, a small breed dog unfamiliar to many Americans. Havanese are the national dog breed of Cuba. Lola was the picture of health until her trip to the beach. She started vomiting the day she returned home, and by the next morning would no longer eat or drink. Her family made a tense two-and-a-half hour drive back to New York City to bring Lola to The AMC while she progressively became more and more lifeless. The emergency service veterinarian noted Lola’s abdomen was painful during examination and ordered an x-ray in addition to administering intravenous fluid therapy.

Problem found

No one was expecting what the x-rays showed–over seven inches of sausage-shaped impacted intestine, which was filled to a diameter of nearly one inch with something that looked suspiciously like sand. It’s no wonder the poor girl was not feeling well; her stomach must have felt like a lead balloon.

Lola was admitted to the hospital and intravenous fluid therapy continued to compensate for fluid lost due to vomiting. Additional treatments included antacids and medications to protect her stomach from abrasion as the sand worked its way out of her system. The hospital staff walked Lola outdoors frequently, as too much bed rest can slow down movements of the intestinal tract. For Lola to get back on track she needed to pass the sand as soon as possible.

On the second day of hospitalization, Lola turned the corner. She felt much better and started to eat without vomiting. Sand started coming out the other end and we knew she was going to recover.

Sand impaction is a serious problem, most commonly for horses and cows. In an urban hospital like The AMC, we rarely see sand impaction. A recent study of sand impaction in British dogs reported surgical removal of the impacted sand in about half the dogs in the study. Sadly, not all dogs with sand impaction successfully recover.

Fortunately, Lola’s story had a happy ending.

Next time she goes to the beach, Lola’s activities will be monitored more closely to keep her from eating sand. If she goes swimming and starts gulping down sandy water, her beach time will be cut short. If your dog has tummy troubles after spending time at the shore, see your veterinarian, because sand impaction is no day at the beach.

Day at the Museum: The Animal Medical Center Sequel

The Animal Medical Center has a computer system to manage our diagnostic imaging, including x-rays, ultrasound, CT scans and MRIs. The Picture Archiving and Communications System (PACS) lists all the images for any given day. If you looked at the list for June 17, you would see my patient Dakota, who got a chest x-ray, Chippie, the dog who had a full series of dental x-rays, and BooBoo who had a brain MRI — a typical list for a Friday.

But reading down the list you get to Croc 1, Bird 2, Snake 3 and Ibis 4. These images come from the oldest patients ever seen at The AMC. No, not a 25 year old dog or a 30 year old cat. These 32 patients are 2,500 year old animal mummies.

Like many AMC patients, these animals came to The AMC across the Brooklyn Bridge into Manhattan. Unlike any other AMC patients, these patients belong to the Brooklyn Museum’s Egyptian collection.

Like all patients who come to The AMC, they came for our diagnostic expertise, utilizing our state of the art equipment. In this case, the animal mummies came to The AMC for CT scanning in our 64-slice CT scanner.

The AMC’s 64-slice CT scanner rapidly produces high quality images. So fast, all 32 were scanned in one day as outpatients! Rapid is better for our usual patients, since the faster the scan, the shorter the anesthesia time. For the animal mummies, the high quality images are critical in helping AMC’s board certified radiologist, Dr. Anthony Fischetti, collaborate with the curators from the Brooklyn Museum to decipher the mummy’s contents. The 64-slice CT scanner can recreate three dimensional and multiplanar images of the patient. In our usual patients, we use these features to better diagnose and treat illnesses. Our colleagues at the Brooklyn Museum plan to use the reconstructed CT images to study the mummies’ contents without disrupting the intricate linen wrapping.

If our CT scanner is so fast and can scan thirty two mummies in one day, you might wonder why your AMC veterinarian wanted your pet here all day when it had a CT scan. A CT scan in one of our usual patients requires administration of a short-acting anesthetic. Obviously, an animal mummy does not require anesthesia, the associated monitoring of the heart, respiration and blood pressure and does not have to recover from anesthesia. All these differences shorten the procedure time.

Most of our usual patients have two CT scans back to back. The first scan is before and the second is after administration of a contrast agent. The contrast agent highlights abnormalities the veterinarians are hunting for, such as inflammation and tumors. Administration of contrast was not possible or necessary in the animal mummies.

This animal mummy project between The Animal Medical Center and the Brooklyn Museum will culminate in an exhibition in 2013, so mark your calendars now!

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This may also be found in the “Tales from the Pet Clinic” blog on WebMD.com.

For over a century, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit www.amcny.org. To make an appointment, please call 212.838.7053.

Magnets, Toys and Dangerous Objects

One characteristic of pets that makes them so entertaining is their unpredictable nature. Some of them will eat anything — and when they do, the veterinarian is presented with a diagnostic challenge.

The veterinarian surgeons here at AMC have exceptionally good stories about the objects they have found jammed up inside of pets. Around the time of the first Toy Story, they removed an entire set of fast food plastic Toy Story characters from the stomach and intestines of a dog from a family with several small children. I remember a particularly challenging case where a cassette tape bunched up the intestines of a dog requiring a major surgical intervention to remove yards of Billy Joel’s “The Stranger.” Then there was the dog who had an entire kitchen knife lodged in his esophagus and lived to bark about it on the Jay Leno show.

X-rays are usually how veterinarians determine if a foreign object has been consumed and has resulted in an intestinal obstruction. Metallic objects like coins and knives, are easily seen with X-rays. Plastic and glass are not visible on X-rays and this is why the cassette tape and the plastic toys were particularly tough to diagnose.

Now, a new foreign body hazard has been reported in the May/June issue of the Journal of the American Animal Hospital Association — magnets. Ingestion of a single magnet is not likely to cause a problem. But ingestion of more than one magnet, or a magnet and another metal object, can cause serious problems. If these foreign bodies stick to each other through the intestinal walls of different intestinal segments, an obstruction can result. Even more serious is the potential for perforation. The pressure caused by two magnets, or a magnet and another metal foreign body sticking together, cuts off the blood supply to the intestine and the results can be deadly.

So a word to the wise, if your family has a precocious pup or a curious cat, keep small objects off the floor and provide plenty of safe toys to help prevent the inadvertent ingestion of dangerous objects.

Has your pet consumed a magnet or small toy before? Any close calls? Post your comments below.

This blog may also be found in the “Tales from the Pet Clinic” blog from WebMD.
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For nearly a century, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit www.amcny.org. To make an appointment, please call 212.838.7053.