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CT FOR HORSES – IMAGE QUALITY AND SAFETY ARE CRUCIAL

July 14, 2021

VISIONS spoke with Dr. Andre Böhmer and Dr. Thorben Schulze.
Dr. Andre Böhmer is an equine veterinary specialist who has been working for the Telgte veterinary clinic since 2002. Dr. Thorben Schulze is a dual equine and diagnostic imaging specialist who developed the Qalibra-CT, together with Vet-DICon GmbH.
A new Canon CT scanner was recently installed on a height-adjustable platform in the Telgte veterinary clinic in Germany, the 'Qalibra-CT'. The combination of a phenomenal CT and a unique lifting platform enables CT examinations to be performed on standing, non-anesthetized horses.

Dr. Böhmer from the Telgte veterinary clinic explains the advantages and opportunities made possible with this innovative design, developed by Dr. Schulze Vet-DICon, and installed in collaboration with Canon Medical.

What distinguishes the Telgte veterinary clinic?

Dr. Böhmer: The Telgte veterinary clinic is a national referral center that has existed for several decades. We specialize in the treatment of horses. Our customers are both national and international.
The height adjustment in combination with the excellent image quality of the CT is the real differentiating feature of the Qalibra CT.

“For the first time, we are now able to scan body regions like chest, knees and hips.”

The height adjustment in combination with the excellent image quality of the CT is the real differentiating feature of the Qalibra CT.

For which type of medical questions will you use your new CT?

Dr. Böhmer: Computed tomography is the preferred imaging modality for diseases in the area of the head and limbs, especially in the joints. Examinations of the joints, particularly the hyaline cartilage, have so far been almost impossible with veterinary medical imaging modalities, such as MRI.

With this CT, we can perform examinations of the front and rear limbs, head and neck of the standing horse. In addition, under general anesthesia, we can visualize upper limbs, from the stifle to the hips, the thoracic spine, and occasionally even the sacral joint and the back.

What exactly is the advantage if the horse is examined standing up in CT?

Dr. Böhmer: The greatest advantage is that we can now visualize structures that are normally difficult to access in high quality 3D. Orthopedic problems are one of the most common indications for equine CT examinations and being able to do these without general anesthesia is a great benefit. Standing examinations reduce both the risk to the horse and the cost of the examination. In the past, we only had the opportunity to examine the standing horse using low-field MRI, in which, for example, changes in the lamina of the hoof or the articular cartilage can hardly be detected. The new CT opens up completely new possibilities for equine medicine, with more reliable diagnoses and correspondingly more targeted therapies.

Why did you choose a CT from Canon Medical?

Dr. Böhmer: There are three main reasons why we chose Canon Medical's Aquilion Large-Bore CT.
  • Firstly it is known for its superior soft tissue imaging, which is particularly important for visualizing ligaments and tendons during orthopedic exams.
  • Secondly, with a gantry opening of 90 cm, it has the world’s largest field-of-view of up to 85 cm, so we can examine our rather large patients more easily.
  • Finally, the high image resolution of the system, in all three dimensional planes, was a key feature for us. Even structures as small as 0.31 mm can be displayed. This is the only way we can reconstruct, and visualize the scanned body region without losing quality due to distortion.
This special orientation of the images is particularly important in veterinary medicine, as we cannot persuade our patients to align themselves completely straight in the CT.

“Examinations without general anesthesia save time and money.”

Dr. André Böhmer, Telgte veterinary clinic.

The new Qalibra-CT solution is height-adjustable. Why?

Dr. Böhmer: The height adjustment in combination with the excellent image quality of the CT is the real differentiating feature of this system. This allows the horse to stand motionless on the solid surface during the examination, which ensures maximum safety.

We can examine many different anatomical regions regardless of the size of the patient, since the height of the CT can be adapted to the size of the horse, or the examination region. This feature enables us to have a unique range of applications. So far, very few centers worldwide have had these options.

Which aspects were particularly important in the development of a CT for horses?

Dr. Thorben Schulze, Qalibra: Our motivation was the need for a high-quality imaging system that would offer the horse and personnel the best possible safety. Since physically restraining a horse, known for its desire to escape, for example in an examination stand, always involves risks, it was essential to avoid this.

We wanted to find a new way for equine veterinarians to carry out examinations, safely and quickly, without compromising image quality. Until now, this has mostly been reserved for human medicine.

To this end, we have worked closely over the years with a diverse team including technicians from Canon Medical, mechanical engineers, radiation protection experts and innovative veterinarians.

After the first year of using the 'Qalibra-CT' equine clinics report a lot of new experience, especially with examinations of the thoracic spine, the fetlock and the stifle joints. We are looking forward to the first scientific publications resulting from this work.

The Qalibra System can be moved vertically and horizontally?

The CT system is connected to a microprocessor-controlled platform that can be adjusted in height and moved horizontally for the scan. The horizontal movement of the gantry over the patient is directly controlled by the electronics of the CT. Only in this way is it possible to fully exploit the potential of the Canon CT without any restrictions or loss of quality. To keep the horse comfortable and still access the isocenter of the CT, we turned the CT gantry 180°, while retaining the functionality of the original patient couch.

The height-adjustable patient couch works regardless of if the horse is standing or laying down, making it easier for the horse and veterinarian.

The result is that head/neck and even limb regions can now be examined more quickly by CT than previously possible with X-Ray. Even a complete examination of both stifle joints, which requires general anesthesia of the horse, often takes less than 10 minutes with this Canon Large Bore CT.

“Examination in the same standing position as with the farrier.”

Dr. Thorben Schulze, Vet-DICon GmbH, Qalibra CT.

To what extent do you address the safety and escape options in your system?

Dr. Thorben Schulze: Since the system was designed by veterinarians, this point was of particular importance.

We wanted to facilitate the CT examinations in such a way that the horse does not have to be in a restrictive examination stand. If a horse is in an unfamiliar environment, it must feel it can escape from a frightening situation in a fraction of a second. Therefore, our goal was to be able to position the horse freely in front of the CT and to keep the escape route open in all directions. When examining the limbs, the horse is in a position similar to that of the farrier. Due to the high speed of the CT, the examination only takes about 4-10 seconds. A special fixation is therefore not necessary. //
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