Equine ultrasound top tips.pptx

Equine distal limb ultrasound ‘top tips’ Adelle Bowden Learning outcomes  Understand that the DGL exercises are preparatory work for practical sessions later in the week  Describe how to restrain a horse for ultrasonography of the distal limb  Recognise the clinical signs of tendon or ligament...

Equine distal limb ultrasound ‘top tips’ Adelle Bowden Learning outcomes  Understand that the DGL exercises are preparatory work for practical sessions later in the week  Describe how to restrain a horse for ultrasonography of the distal limb  Recognise the clinical signs of tendon or ligament disease  Be able to document normal anatomy of the equine distal limb with ultrasound  Be able to recognise significant pathology of the equine distal limb with ultrasound 2 Safety and restraint  Ensure horse is well restrained – held rather than tied up preferable with headcollar or bridle/chifney if needed  Competent handler (ideally adult) with appropriate footwear and helmet. Vet should also be wearing appropriate PPE  Stocks or stable best, can be conducted outside if needed but ensure no glare on screen  Need a power source for machine and stand or table dependent on setup and machine type  No radiation safety issues 3 Safety and restraint Sedation?  Some horses won’t like the machine and may be spooky – consider sedation with an alpha 2 agonist.  An oral formulation given prior to veterinary arrival may be appropriate in some circumstances or an IV formulation may be used.  Horse needs to be quiet for exam and not fidgety or ataxic whilst working around legs and to conduct a sequential examination with diagnostic images  depends on horses tolerance as to level of restraint required (and level of sedation) 4 Ultrasound – optimizing the image  Set up machine with appropriate settings prior to start Specifics for tendon ultrasound  Linear probe  High frequency (8.5-10mHz)  Standoff (if available)  Transverse and longitudinal views 5 How to conduct the ultrasound examination  Start at the proximal metacarpus and image systematically, working from proximal to distal down the palmar/plantar metacarpus/metatarsus and phalanges to the level of the hoof capsule  Image first in transverse section and identify the anatomy of the soft tissue structures, continue this whilst moving distally  Use the same systematic approach, but in longitudinal section to assess the fibre pattern of the different soft tissue structures  Identify any abnormalities and describe these based on location and appearance 6 Things to remember  Preparation of the limb – ultrasound waves don’t like air! So clip, prep, spirit, gel and appropriate pressure is imperative to obtaining a good image!  Cadaver legs behave differently to ‘live’ legs  Ensure they are stabilised and clamped on the dorsal aspect  Soft tissues are not under tension, therefore they move when pressure is applied (especially the more superficial structures)  Images will not look like the text books due to post mortem change (increased air/ decreased fluid in tissues)  If the image obtained isn’t as expected, think about the reasons why and try to address these (machine settings/ operator error/ contact issues/ artefacts?) 7