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TEXTBOOK of
Veterinary
Diagnostic
Radiology
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TEXTBOOK of
Veterinary
Diagnostic
Radiology Seventh Edition
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Publisher (other than as may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our understanding, changes in research methods, professional practices, or medical
treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds, or experiments described herein. In
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Previous editions copyrighted 2013, 2007, 2002, 1998, 1994, and 1986.
v
vi CONTRIBUTORS
Jennifer Kinns, BSc, VetMB, MRCVS, DACVR, DECVDI Mark Owen, BVSc, DECVDI, FANZCVS
Assistant Professor; Residency Program Director Adjunct Associate Professor
Diagnostic Imaging/Radiology Veterinary Diagnostic Imaging
Departments of Small and Large Animal Clinical Sciences Institute of Veterinary, Animal & Biomedical Sciences
College of Veterinary Medicine Massey University, New Zealand
Michigan State University
East Lansing, Michigan Anthony Pease, DVM, MS, DACVR
Section Chief
Martha Moon Larson, DVM, MS, DACVR Diagnostic Imaging Department of Small Animal Clinical
Professor of Radiology Sciences
Virginia-Maryland Regional College of Veterinary Medicine College of Veterinary Medicine
Virginia Tech Michigan State University
Blacksburg, Virginia East Lansing, Michigan
Jimmy C. Lattimer, DVM, BS, MS, DACVR Kathryn L. Phillips, DVM, DACVR
Associate Professor of Radiology Veterinarian
Department of Veterinary Medicine and Surgery Veterinary Surgery and Radiology
Veterinary Medical Teaching Hospital University of California, Davis
College of Veterinary Medicine Davis, California
University of Missouri
Columbia, Missouri Rachel E. Pollard, DVM, PhD
Assistant Professor
Wilfried Mai, Dr. Med. Vet., MS, PhD, DECVDI, DACVR Department of Surgical and Radiological Sciences
Associate Professor of Radiology School of Veterinary Medicine
Department of Clinical Sciences and Advanced Medicine University of California, Davis
University of Pennsylvania Davis, California
Philadelphia, Pennsylvania
Elissa K. Randall, DVM, MS, DACVR
Angela J. Marolf, DVM, DACVR Associate Professor
Associate Professor Department of Environmental and Radiological Health
Department of Environmental and Radiological Health Sciences
Sciences Colorado State University
College of Veterinary Medicine and Biomedical Sciences Fort Collins, Colorado
Colorado State University
Fort Collins, Colorado Elizabeth Riedesel, DVM, DACVR
Professor
Federica Morandi, DVM, MS, DECVDI, DACVR Department of Veterinary Clinical Sciences
Professor and Director of Radiological Services College of Veterinary Medicine
Department of Small Animal Clinical Sciences Iowa State University
College of Veterinary Medicine Ames, Iowa
The University of Tennessee
Knoxville, Tennessee Ian D. Robertson, BVSc, DACVR
Clinical Assistant Professor
Rachel Murray, MA, VetMB, MS, PhD, DACVS Department of Molecular Biomedical Sciences
Senior Orthopaedic Advisor College of Veterinary Medicine
Centre for Equine Studies North Carolina State University
Animal Health Trust Raleigh, North Carolina
Newmarket, Suffolk, United Kingdom
Celeste Guaraglia Roy, DVM, Diplomate AVDC
Nathan Nelson, DVM, MS Veterinary Dentist and Oral Surgeon
Clinical Associate Professor Telemedicine
Department of Molecular Biomedical Sciences IDEXX Telemedicine Consultants
North Carolina State University Clackamus, Oregon
Raleigh, North Carolina
Valerie F. Samii, DVM, DACVR
Adjunct Professor
Department of Veterinary Clinical Sciences
College of Veterinary Medicine
The Ohio State University
Columbus, Ohio
CONTRIBUTORS vii
Tobias Schwarz, MA, Dr. Med. Vet., DVR, DECVDI, Susanne M. Stieger-Vanegas, DVM, PhD
DACVR Associate Professor
Royal (Dick) School of Veterinary Studies Diagnostic Imaging
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A
s with all previous editions, this book serves primarily interpreters. Details of positioning, and specific anatomic features
as an instructional aid for students of imaging, principally of the body part in question are some of the topics covered
the veterinary student. However, another goal is to in these introductory chapters. These basic chapters offer a
provide useful information for those pursuing advanced training framework upon which to base an understanding of more
in imaging and those in private veterinary practice. Students detailed chapters dealing with specific anatomic areas.
at all levels should be able to find material in the 7th edition Veterinary imaging is becoming increasingly complex and
that helps in the interpretation of basic and challenging images. in private practice there is continuing transition from analog
Valuable features of prior editions such as the self-assessment to digital imaging. As a result, chapters on the basic principles
questions and the normal anatomic material has been retained of digital imaging and the MR imaging features of brain disease
and widespread revision in content has been undertaken. The in small animals have been expanded. Also, the breadth of the
normal anatomy material remains dispersed throughout the CT and MR imaging features of diseases outside of the brain
text so that it can be consulted conveniently, and it is also has been broadened, and chapters covering the physical
available on the Elsevier website. principles of ultrasonography and CT and MR imaging updated
The interface between the book and the world-wide web significantly. New chapters in the 7th edition cover dental
is an important feature of this book. The web portal hosts radiographic technique and interpretation, and radiographic
self-assessment exercises that can be completed online and contrast media, important topics absent from prior editions.
feedback obtained immediately. For some chapters, movies are Details regarding techniques that were once a mainstay of
available online that will assist in the explanation of complex veterinary imaging, such as the upper gastrointestinal examina-
subjects, such as computed tomography (CT) or magnetic tion and myelography, remain available on the Elsevier website
resonance (MR) imaging physics, or dynamic disease processes, for reference when needed.
such as tracheal collapse and esophageal disorders. The basis of interpretation used in this textbook remains
As in the 2nd through 6th editions, all chapters have been centered upon description of radiographic abnormalities in
reviewed carefully, making for an extensive, substantive revision. terms of Roentgen signs—changes in size, shape, location,
No chapter has escaped in-depth scrutiny, ensuring that the number, margination, and opacity. I believe that students who
latest and most accurate information is included. Chapters have a firm understanding of Roentgen sign description will
covering the basic aspects of interpretation, applicable when be less inclined to make errors by jumping immediately to a
assessing radiographic images of the axial and appendicular diagnosis rather than thoroughly considering radiographic
skeleton in small and large animals, and the thorax and abdomen changes in an orderly and efficient manner.
in small animals, should be of particular value to beginning Donald E. Thrall
ix
Acknowledgments
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I
t is impossible for one person to prepare a meaningful, participation. Appreciation is also extended to all who have
comprehensive textbook of veterinary imaging, and I would used prior editions of this work and provided meaningful
like to acknowledge the many talented authors who took feedback, thereby allowing this 7th edition to be what I believe
time from their busy schedules to prepare material for this is the best yet. I also wish to acknowledge IDEXX Telemedicine
book. Several new authors have also contributed to this 7th Consultants for permission to include several images in this
edition and many familiar names are again found as contributors. edition.
The expertise of this team heightens the quality of the informa- Donald E. Thrall
tion contained on these pages and I am honored by their
x
CHAPTER 1
Radiation Protection and Physics
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SECTION I
of Diagnostic Radiology
Nucleus
e
of Interpretation
1 Radiation Protection and Physics of Diagnostic Radiology
Donald E. Thrall • William R. Widmer
2 Digital Radiographic Imaging
Ian D. Robertson • Donald E. Thrall
3 Canine and Feline Dental Radiographic Technique
Celeste Guaraglia Roy
4 Physics of Ultrasound Imaging
Wm Tod Drost
5 Principles of Computed Tomography and Magnetic Resonance Imaging
Marc-André d’Anjou
6 Radiographic, Computed Tomography, and Magnetic Resonance Contrast
Media
Mark Owen
N
7 Introduction to Radiographic Interpretation
Donald E. Thrall
H
1
1
CHAPTER 1
Radiation Protection and Physics of
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Diagnostic Radiology
X
-rays were discovered on November 8, 1895, by Wilhelm The energy of electromagnetic radiation is described accord-
Conrad Roentgen, a German physicist.1 X-rays were ing to the formula:
put to use quickly for medical purposes, and many speed of light
sophisticated applications were soon devised. For example, Energy = Planck’s constant ×
wavelength
angiography was described in 1896, only 1 year after the initial
discovery of x-rays. Roentgen’s finding revolutionized the Planck’s constant is a proportionality constant between the
diagnosis and treatment of disease, and in recognition he was energy of a photon and its wavelength, and the speed of light
awarded the first Nobel Prize for Physics in 1901. More than is also a constant. Therefore the energy of electromagnetic
120 years after their discovery, imaging using x-rays is one of radiation is inversely proportional to wavelength. The biologic
the most important and widely used diagnostic tests in people effects of electromagnetic radiation are a function of the
and animals. energy.
The unit of energy for electromagnetic radiation is the
electron volt (eV). One electron volt is the energy gained by one
BASIC PROPERTIES OF X-RAYS electron as it is accelerated through a potential difference
of 1V. On an absolute scale, this is a very small amount of
X-rays and gamma rays are part of the spectrum of electro- energy. However x-rays with energy of only 15 eV* can produce
magnetic radiation. The only distinction between x-rays and ionization of atoms. Ionization occurs when an electron is
gamma rays is their source; x-rays are produced by electron ejected from the atom, in this case by an x-ray. This creates
interactions outside the nucleus, and gamma rays are released an ion pair consisting of the negatively charged electron and
from inside the nucleus of unstable atoms having excess energy. the positively charged atom (Fig. 1.2). When x-rays strike a
There is a false impression that gamma rays are more energetic person they can result in ionizations in DNA, leading to (1)
than x-rays, but this is not universally true. The energy of a mutations, (2) abortion or fetal abnormalities, (3) suscepti-
gamma ray depends on the amount of energy released by the bility to disease and shortened life span, (4) carcinogenesis,
unstable atom, and the energy of an x-ray depends on the and (5) cataracts.2 This is why it is so important to minimize
energy of the electron that interacts with the atom. Familiar exposure of personnel working in a radiation environment.
types of electromagnetic radiation other than x-rays and gamma Of course, radiation also causes ionizations in patients under-
rays include radio waves, radar, microwaves, and visible light going medical imaging procedures, but the risk of radiation
(Table 1.1). injury from isolated imaging procedures is offset by the diag-
Electromagnetic radiation is a combination of electric and nostic value of the procedure. Radiation workers, on the other
magnetic fields that travel together, oscillating in orthogonal hand, are subject to potential low level exposure repeatedly
planes in sine-wave fashion (Fig. 1.1). Sine waves are character- in the course of their work and the chance for damage is
ized by two related parameters—frequency and wavelength. increased. Also important is the fact that radiation damage
The velocity of electromagnetic radiation is constant, the speed to DNA can be amplified biologically because DNA controls
of light, and is the product of the frequency and wavelength: cellular processes that extend into subsequent generations of
daughter cells. Additionally, although only 15eV of energy is
Velocity (speed of light in m sec) required for ionization of biologic molecules, the energy of x-rays
= frequency ( second ) × wavelength (m ) used for medical imaging is much higher, and each photon can
lead to multiple ionizations in tissue.
Because the speed of light is constant, frequency and The relative risk of biologic injury from x-rays or gamma
wavelength are inversely related; therefore, as frequency rays is greater than from other types of electromagnetic radiation.
increases, wavelength must decrease, and vice versa. For example, the wavelength of visible light is 10,000 times
Properties of x-rays and gamma rays are given in Box 1.1. longer than the wavelength of x-rays, and the wavelength of
Some properties of electromagnetic radiation cannot be radio waves is even longer (see Table 1.1). Therefore, the energy
explained adequately by the theories of wave propagation of light waves and radio waves is many orders of magnitude
illustrated in Fig. 1.1. Therefore the photon concept was lower than the energy of x-rays, meaning that light and radio
developed to explain the apparent particulate behavior of x-rays
and gamma rays. A photon can be considered as a discrete
bundle of electromagnetic radiation as opposed to a wave. This
makes it easier to understand how x-rays create an image or *The electron volt (eV) should not be confused with the concept of
cause radiation damage. In this book, the terms x-ray and photon kilovoltage peak (kVp) applied in an x-ray tube during an exposure;
are used interchangeably. kVp is discussed later in the Production of X-rays section.
2
CHAPTER 1 • Radiation Protection and Physics of Diagnostic Radiology 3
Electric
field e
Wav
eleng
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th (
)
Magnetic
field
Prop
agatio
n
Fig. 1.1 All forms of electromagnetic radiation are characterized by
oscillating electric and magnetic fields that move in planes at right angles
to each other. Any form of electromagnetic radiation is described by the Photon
wavelength, λ, which is the distance between crests, and the frequency, f,
Nucleus
which is the number of crests per unit time. The frequency and wavelength
determine the specific characteristics of that form of radiation. The velocity
(c) of all forms of electromagnetic radiation is the same—the speed of
light. The product of wavelength and frequency equals the velocity; c = f
× λ. Therefore, because velocity is constant, as frequency increases the
wavelength must decrease, and vice versa.
e
Table • 1.1 Fig. 1.2 The principle of ionization. A photon ejects an electron from an
atom, causing ionization and forming an ion pair, consisting of a negatively
Wavelength of Common Types of Electromagnetic charged electron and a positively charged atom. After this ionization event,
the photon, depending on its energy, may be completely absorbed, or it
Radiation may interact with other atoms to produce more ionization. The ejected
electron can also interact with biologic molecules, such as DNA, and produce
TYPE OF ELECTROMAGNETIC damage. The relative size of the nucleus, electrons, and orbital shells in
RADIATION WAVELENGTH (CM) this figure is not to scale. The “+” symbol in the nucleus designates the
normal nuclear positivity created by the presence of positively charged
Radio waves 30,000 protons. In a neutral atom, this positive charge in the nucleus is balanced
Microwaves 10 by an equal negative charge of orbital electrons.
Visible light 0.0001
X-rays 0.00000001
Box • 1.1
Properties of X-Rays and Gamma Rays
Have no charge
Have no mass
Travel at the speed of light
Are invisible
Cannot be felt
Travel in a straight line
Cannot be deflected by magnetic fields
Penetrate all matter to some degree
Cause certain substances to fluoresce
Can expose photographic emulsions Fig. 1.3 Careless and unacceptable approach to radiography. The technolo-
Can ionize atoms gist’s hands are in the primary x-ray beam. Careless habits such as this are
perpetuated because of the stealthy properties of x-rays and lead to
unnecessary personnel exposure that could become biologically
significant.
Exposure Exposure
Table • 1.2
Radiation Weighting Factor (Quality Factor) for
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Table • 1.3
Radiation Units
QUANTITY CGS* UNIT VALUE SI† UNIT VALUE
Otto Cycle, 8
Oil Engine, Brayton, 77
” Campbell, 82
” Capitaine, 85
” Crossley-Holt, 98
” Griffin, 100
” Grob, 82
” Hornsby-Akroyd, 90
” Knight, 98
” Koerting-Boulet, 97
” Merlin, 89
” Niel, 101
” Priestman, 79
” Ragot, 94
” Root, 95
” Sécurité, 79
” Trusty, 99
” Vulcan, 93
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