From the farm to cloud computing, the sky seems to be the limit for the latest in portable digital equipment for the equine practitioner. Wireless capability, remote access to medical records and high-quality in imaging are just some of favored examples of the latest digital technology. David Frisbie, DVM, Ph.D., Dipl. ACVS, associate professor of veterinary clinical sciences at Colorado State University in Fort Collins, considers a micro-arthroscope inserted in an 18ga needle a technological breakthrough. The needlescope enables the practitioner to perform procedures under partial sedation and with local blocks, rather than the traditional method that requires full anesthesia. Local anesthesia may be used and the horse remains standing, which Dr. Frisbie said lessens complications all around. For the past year, Frisbie has evaluated a number of horses’ stifle injuries with this new equipment, first developed for human medicine. “When you are trying to diagnose stifle problems,” he said, “X-rays and ultrasound can’t give you an accurate view and the joint is too big for an MRI. And there is not really a general arthroscope that practitioners can carry around. Needlescope vs. Arthroscope “We know that we can medicate the stifle with an 18ga needle, so with the horse lightly sedated, we used a micro-arthroscope inside the needle and went in and looked around,” Frisbie continued. “What you can see with a needlescope versus regular arthroscope lets us diagnose the stifle problem more accurately to start with.” He conducted his study using critical cases at Colorado State “to show utility,” he said, “and to make sure it works to the same degree in all cases. “Though the field of view is definitely smaller,” he added, the micro-arthroscope is “less invasive than a traditional arthroscope.” He also uses the modality to evaluate horses that have had multiple surgeries that didn't’t seem to work. “It can be used in the OR or in the field,” he said. “And it is fairly affordable tool. Its size also makes it more practical to carry with you than a full-size arthroscope.” Frisbie commented that his study is not the first to use the needlescope, though he is the first to have his study go through the rigors of a university study. “We had the ability to research and have the clinical cases to test,” he said. John Small, vice president of BioVision Technologies LLC of Golden, Colo., which makes the scope, said the micro-arthroscope may be used on companion animals as well. The needlescope is packaged with a Xenon light, a high-resolution medical camera, audio capability and a digital LCD monitor. The unit is the size of an 8.5 by 11 inch sheet of paper, where such equipment “used to encompass a 6-foot by 6-foot, 300-pound machine,” Small said. With about 1,000 units in the field now, Small said, “the industry’s leading practitioners are some of the early users of this new technology.” Tracey O’Driscoll, a practice management consultant working with Vetel Diagnostics of San Luis Obispo, Calif., said: “The most significant trend gaining attention at the moment is the ability to go wireless.” Wireless and Portable “Cables and cords are obstacles in any patient-care scenario but particularly around horses, for two reasons,” O’Driscoll continued. “[They are] the hazard it represents for both human and horse and the risk presented to the equipment itself. As handlers and technicians move around a horse to gain correct positioning, cables and cords move with them, creating a constant opportunity for getting them around or between a horse’s legs.” And often it’s not the patient but the handler, veterinarian or technician who gets caught up in cables, O’Driscoll said. “Often the victim is the equipment itself,” she said. “A 1,200-pound horse casually stepping on a digital radiography cable can make for a very bad day for the practitioner.” Another trend still gaining momentum is the ergonomics and ease of transport in portable equipment. “As the profession becomes more feminized,” O’Driscoll said, “manufacturers are coming under increasing pressure to design and package equipment that can be transported by someone approximately 5 foot 4 inches tall. “Just as we expect our computers and phones to get lighter and more powerful while remaining rugged enough for intended use,” she continued, “the veterinary practitioner is looking for the same value.” Wayne Browning, DVM, of Bayhill Equine in Redwood City, Calif., uses DR and digital ultrasound in his equine sports medicine practice every day. And he finds himself using his digital camcorder, camera, smartphone, laptop and tablet more often as well. “We use the digital camcorder in our pre-purchase exams,” he said. “And I use my iPhone to take pre-purchase videos of horses for evaluation, as well as before and after treatment.” The videos are easily emailed to present and potential clients. Dr. Browning’s assistant regularly uses his iPad to access medical records remotely. “We store all of our records in the cloud,” he said, referring to resources available on the Internet. “I can get access from my phone, too. I can get my email, link up to my office computer, send digital images and get access to ultrasounds and more.” Joe B. Stricklin, DVM, who owns an equine practice in Greeley, Colo., considers his portable digital radiography unit one of his practice’s greatest assets. “When DR first came out, units were expensive,” he said. “Now five to seven years later, everything is more portable and offers higher quality imaging.” Immediate Results Advantages for Stricklin's work, which mostly covers lameness and dentistry, include increased accessibility, shortened response time and portability. He uses DR as a diagnostic modality. He appreciates the ability to “do a radiograph on the farm or at the hospital and immediately—within seconds—have results.” He likes that pricing has decreased, too. “Units are half less than they were eight or nine years ago, when I first bought a unit,” Dr. Stricklin said. “And the quality of the machine and the images has gone up.” He also likes that the units are lightweight and portable. When Stricklin began his equine practice 31 years ago, his first X-ray machine was purchased from Army surplus and required developer tanks. Then he bought a portable unit, with auto processing, when that technology hit the market. Now, today’s DR units impress him greatly. He is considering replacing his 5-year-old units, which still work well, with wireless units that have newer software and more capability. “There is less chance of spooking the horse and the horse and the veterinarian can’t get as tangled up,” he said. Another advantage to digital is that the ability to manipulate images has improved. The better-quality images help practitioners explain diagnoses to horse owners. Stricklin also likes the animation features—he can show owners, for instance, how the muscles work, as well as use it himself to evaluate injuries and improvements. “It is amazing that technology keeps getting better and better,” he said. Browning has been in practice 26 years and agrees that radiographic images have greatly improved. “Today’s digital images are far better quality than analog,” he said. “We can get the images almost instantaneously.” Image Accuracy Pre-purchase exams are a large part of Browning’s sports medicine practice. “Image accuracy can save our clients a lot of money if we find something on the first exam, rather than the third,” he said. “It’s probably one of the best ways we have to enhance the horse’s health.” He also uses DR more frequently when he meets with farriers. “We can modify views and images right there and see immediately whether the farrier needs to make adjustments,” Browning said. He’s waiting to get the wireless DR units because they are so new. “I’ll wait until they work out the kinks,” he said. The only item now on his wish list is a larger plate for DR someday, but he still thinks that DR quality and portability are excellent. “We can image areas of the horse we couldn't’t before,” Browning said. “For instance, we can take cervical films in the field now, when it was difficult to do that out of the hospital before DR units got so portable and versatile.” Want more Veterinary Practice News? Go here. <HOME>
