For general practitioners, sending radiographs for consultation provides the benefit of a staff radiologist without the expense and improves diagnostic accuracy. Utilizing a specialist, whose skill is to find significantly subtle changes and occult lesions, can make for a quicker diagnosis and potentially better outcome for the patient. It also means avoiding the need to send a patient elsewhere.

Teleradiology services are also valuable for specialty practices with in-house radiologists. Sending radiographs for review supports the radiologists when they have a heavy workload or need to catch up on a busy backlog, and can also be useful during their off-hours.

Using Teleradiology Services for Certain Clinical Conditions

Radiology consultation services are always valuable. There are various anatomical regions and clinical conditions that benefit from a specialist review.

1. Thorax

A three-view thoracic radiograph study (right lateral, left lateral, VD and/or DV) provides important information about cardiac size and shape, pulmonary parenchymal and vascular disorders, conditions involving the pleura, mediastinum, esophagus, diaphragm, and thoracic musculoskeletal structures. There can be significant variation in the appearance of thoracic structures depending on patient species, breed, age, body condition, positioning, phase of respiration, and clinical condition. Teleradiologists consider these factors when evaluating images, in context with the history, physical examination, and results of other diagnostic tests. Examples of specific conditions that benefit from specialist interpretation include:

• Heart disease: Veterinary radiologists can help to identify abnormalities in the size and shape of cardiac structures and major vessels, look for evidence of cardiac disease and congestive heart failure and if necessary, recommend referral to a cardiologist for a definitive diagnosis, prognosis, and an appropriate treatment plan.
• Pleural effusion: Radiographs may show signs of pleural effusion; however, radiographs may not always indicate the underlying cause. There are many conditions that may lead to the development of pleural effusion, including intrathoracic causes (such as heart disease, neoplasia, etc.) and extrathoracic causes such as pancreatitis. A teleradiology consult can help determine the cause of the effusion and direct a diagnostic plan. As part of a consult, a teleradiologist with take into account patient history, clinical condition, and radiographic findings into consideration to provide a list of differential diagnoses and recommendations—typically this includes a thoracocentesis and fluid analysis, and potentially thoracic ultrasound for further evaluation.

2. Abdomen

A three-view abdominal radiograph study of veterinary patients can provide valuable insight into various disease states: e.g. gastrointestinal foreign body, functional ileus vs. mechanical ileus, mesenteric torsion, abdominal neoplasia, pyometra, etc. There can be considerable variation in the size and location of certain abdominal organs depending on species, breed, fasting status, phase of respiration, patient positioning, and clinical condition. Veterinary radiologists can help differentiate between what is normal and abnormal, and next best steps for a definitive diagnosis.

3. Musculoskeletal structures

Orthopedic radiographs require at least 2 well-collimated and well-positioned orthogonal views with appropriate technique and laterality markers to be effective. Occasionally additional views and/or other imaging modalities are necessary to pick up on subtle changes. Certain areas can be tricky to evaluate due to patient age (e.g. open physes), superimposing structures (e.g. carpus/tarsus/manus), and obliquity and technique, which may cause artifacts (e.g. Mach lines, rebound artifact, etc.) that are misinterpreted as pathology. Normal anatomy (e.g. nutrient foramina) and individual variation (e.g. retained cartilaginous cores, vertebral anomalies, etc.) can also cause confusion.

Early signs of disease (e.g. shoulder and elbow OCD, elbow or hip dysplasia, DJD, etc.) are often subtle and easily overlooked. Veterinary radiologists consider all these factors, along with patient signalment, history, and physical exam findings to help differentiate between artifacts, incidental findings, traumatic, infectious, degenerative, and neoplastic disease processes.

4. Multisystemic Disease

A patient who experiences significant trauma (e.g. hit by car, bite wounds, etc.) or multi-systemic disease can have clinically significant abnormalities in multiple body cavities. Veterinary radiologists can provide a prompt and thorough evaluation of every aspect of the body captured in the images to help determine the extent of disease and prioritize areas of greatest concern so that the patient can be stabilized as quickly as possible.

5. Dental Disease

Most dogs and cats have some degree of dental disease by 3 years of age, and radiographs are necessary to visualize the damage, which occurs subgingivally. A radiology teleconsultation can help diagnose and grade periodontal disease and recommend treatment that will help prevent disease progression. The veterinary dentist may also recommend further diagnostics to check for issues such as cardiac or kidney disease, depending on the extent of the periodontal disease.

Teleradiology services add significant worth to your practice because working with a veterinary radiologist ensures you extract every last piece of information and get the maximum value for the radiograph. Sending radiographs for review means that while the radiologist interprets the image's subtleties, you can concentrate on your patients and your workflow.

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