The Puchol Veterinary Hospital in Madrid, Spain, is the largest independent, veterinary referral hospital in the country. Established in 2017, by Veterinarian, José Luis Puchol, it now treats over 9,000 patients per year and has 120 staff. The Hospital, which is operational 24 hours a day, offers a full range of veterinary specialisms including trauma, orthopedics, oncology, neurology, ophthalmology, cardiology, internal medicine, dermatology and rehabilitation and physiotherapy. With such a comprehensive remit and high workloads, high quality imaging across all modalities is essential to deliver accurate diagnoses and treatment. The Hospital turned to Canon Medical to meet its evolving imaging needs. Some of the specialists at the Hospital explained to VISIONS how Canon Medical’s Vantage Elan MRI, Aquilion Lightning CT and Aplio i900 Ultrasound, provide the advanced capabilities required.

The clinical opportunities offered by advanced imaging equipment actually inspired José Luis Puchol to set up the independent veterinary hospital. He has dedicated his entire professional life to small animal surgery, and has practiced for more than 40 years as a soft tissue surgeon, traumatologist, and neurosurgeon. Along this long period he was collaborating with Clínica Puerta de Hierro en Madrid.

“The decision to take the huge leap from working at a veterinary clinic to creating my own veterinary hospital started when I needed a room at the clinic, in which I could install an MRI machine that would allow me to properly address my neurological patients,” he said. “Although I am not a neurologist, over the years I have received hundreds of patients with herniated discs that required immediate surgical intervention. One thing led to another...since we put MRI, why not also a CT to help us with our orthopedic and oncology patients...? Finally, the answer came to me that to address this situation with a 360º vision, I needed to create a facility that could offer all possible referral options to veterinarians, the best conditions and with the maximum guarantees... this was the start of the Veterinary Hospital project, Puchol.”

A clear choice
In the process of equipping the new hospital, they met with many companies that offer advanced diagnostic imaging technology, studied the features of their equipment and listened to their offers, they considered Canon Medical to be the best option by far.

“We first purchased a Vantage Elan 1.5T MRI and an Aquilion Lighting 16-slice CT from Canon Medical, to which we added advanced ultrasound through the Aplio i900 and echocardiography equipment that would be used by different specialists,’ he said.

“Looking back, I still wonder how we were able to diagnose and medically and surgically treat some patients with complicated pathologies without advanced imaging capabilities,” he added. “We tend to take for granted that we need it to help our patients on a day-to-day basis - not just traumatologists or neurologists, but for all specialties: internal medicine, cardiology, dermatology, intensive care, and so on.”

Fast and reliable MRI benefits Neurology
Approximately 50% of the patients referred to the Neurology Department at the Hospital require an MRI. Many of them almost immediately or at least within 24-48 hours.

“As a Neurologist, the possibility of having advanced MRI examination equipment, such as the Vantage Elan, 24-hours a day and being able to interpret the images, on many occasions in real time, represents an enormous advantage for the entire neurology service, since we can make the best therapeutic decision in the shortest possible time for each patient,” remarked Pablo Amengual, Neurology Specialist at the Hospital.

Essential CT capabilities in Trauma Care
Veterinary trauma specialists often require CT for optimal care of their patients.

“CT images enable us to make specific diagnoses, for example, in the case of elbow and shoulder dysplasia,” said Pedro Godinho, orthopedic surgeon and traumatologist. “In the field of soft tissue surgery, examinations with the Aquilion Lightning allows us to decide if a surgical intervention needs to be performed on a patient, what type of technique we are going to use and what the prognosis might be. For example, in the case of abdominal or thoracic masses, or in other cavities depending on their extension and the invasion of adjoining areas.”

Meeting diverse Internal Medicine needs
The work of the veterinary internist can be especially complicated, as patients generally present chronic pathologies, with or without diagnosis, and may not have responded to previous treatments. In order to characterize the pathology in these patients, the internist must rely on the physical examination and the performance of complementary examinations, among which Ultrasound and CT, which frequently have a central role as diagnostic imaging tests.

“Especially abdominal and thoracic Ultrasound, helps us to evaluate the anatomical structures and take samples by fine needle aspiration of the different organs and abdominal fluids, which are then used mainly for cytological examination and culture, but we can also obtain biopsies for histological examination with the ‘tru-cut’ technique,” explained Isabel Rodríguez, Internal Medicine Veterinarian.

“CT has infinite applications in internal medicine, for example, on many occasions we use it in association with endoscopy to characterize respiratory pathologies affecting the nasal cavity, trachea or bronchi,” she added. “In these cases, CT helps us locate structural problems and endoscopy allows us to take samples (biopsies, bronchoalveolar lavages) or even apply treatment (foreign body removal, aspergillosis treatment, polyp removal). Other frequent indications for CT in internal medicine are the characterization of portosystemic shunts or pathologies of the urinary tract.”

Providing Intensive Care
Abdominal- and thoracic ultrasound, as well as echocardiography, either in its FAST exam, or as an advanced diagnostic test, are essentials for Intensive Care in the Hospital.

“Our patients need constant monitoring and frequent reviews to assess the progression of their condition and to enable us to make quick decisions, as they are often unstable,” said Gloria Cerviño at the Intensive Care Unit. “Our state-of-the-art ultrasound system - the Aplio i900 – means we can minimize patient movement and save time.”

Investigating eye diseases
Advanced imaging is essential in the diagnosis of many eye diseases in animals.

“Although ultrasound is the most widely used modality in veterinary ophthalmology, CT and MRI provide us with high-quality 3D images, as well as elucidating the relationship between the different structures and cavities,” said Fernando Laguna at the Hospital’s Ophthalmology Department. “The CT also allows us the possibility of taking biopsies in a guided way, as well as draining orbital abscesses.

“We take advantage of the high contrast resolution of MRI on soft tissue to diagnose muscle diseases, such as myositis of the masticatory or extraocular muscles,” added Manuel Villagrasa. “It also allows examination of the optic nerve, which clarifies the diagnosis of inflammatory, infectious and neoplastic diseases.”

Long-term technology partner
Veterinary healthcare is, of course, evolving just as rapidly as human healthcare. It is just as important for imaging systems used in veterinary healthcare facilities to be of the latest generation and of the highest possible quality.

“We have recently renewed our collaboration with Canon Medical as a technology partner of the hospital because its equipment has always been very reliable, but we must also highlight its technical service and its commercial department, which have always responded quickly to any need that has arisen, taking into account that we are a hospital open 24 hours a day that has a high demand for imaging tests,” said Dr. Puchol.

“We are confident that we can continue to provide the best service to our referring veterinarians, which is the most important thing for us, and always hand-in-hand with companies, such as Canon Medical.’

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