Advanced imaging: use and misuse

Features and functions of decision support systems for appropriate diagnostic imaging: a scoping review

BACKGROUND

Diagnostic imaging decision support (DI-DS) systems could be effective tools for reducing inappropriate diagnostic imaging examinations. Since effective design and evaluation of these systems requires in-depth understanding of their features and functions, the present study aims to map the existing literature on DI-DS systems to identify features and functions of these systems.

METHODS

The search was performed using Scopus, Embase, PubMed, Web of Science, and Cochrane Central Registry of Controlled Trials (CENTRAL) and was limited to 2000 to 2021. Analytical studies, descriptive studies, reviews and book chapters that explicitly addressed the functions or features of DI-DS systems were included.

RESULTS

A total of 6,046 studies were identified. Out of these, 55 studies met the inclusion criteria. From these, 22 functions and 22 features were identified. Some of the identified features were: visibility, content chunking/grouping, deployed as a multidisciplinary program, clinically valid and relevant feedback, embedding current evidence, and targeted recommendations. And, some of the identified functions were: displaying an appropriateness score, recommending alternative or more appropriate imaging examination(s), providing recommendations for next diagnostic steps, and providing safety alerts.

CONCLUSIONS

The set of features and functions obtained in the present study can provide a basis for developing well-designed DI-DS systems, which could help to improve adherence to diagnostic imaging guidelines, minimize unnecessary costs, and improve the outcome of care through appropriate diagnosis and on-time care delivery.

Incidental Findings in Computed Tomography Examination of the Head in Rabbits and Guinea Pigs

(1) Background: Rabbits and guinea pigs are popular pet animals and often undergo computed tomography (CT) examination for assessment of pathologies of the head. The goal of the study was to review CT examinations of the heads of rabbits and guinea pigs to identify and classify incidental findings. (2) Methods: 60 CT studies of the heads of rabbits and 65 of guinea pigs presented at 2 Institutions were reviewed and the indications for the study recorded. (3) Results: The presence of CT findings not directly related to the reason for the CT examination was present in 40/60 (66.7%) studies of rabbits and in 42/65 (64.4%) studies of guinea pigs. Most commonly, the incidental findings involved the ears, in 24/60 studies in rabbits and in 29/65 studies in guinea pigs. Incidental findings involved the nasal cavities, respectively, in 9 and 7 rabbits and guinea pigs. Soft tissue mineralization was present in 11 rabbits and 17 guinea pigs. (4) Conclusions: Based on the present study, incidental findings detected on CT studies are often present in rabbits and guinea pigs. Veterinarians should be aware of the possible clinical impact of these findings.

Prevalence and Features of Incidental Findings in Veterinary Computed Tomography: A Single-Center Six-Years' Experience

Computed tomography (CT) is an advanced imaging technique that may lead to detect "incidentalomas", unexpected asymptomatic lesions found during unrelated examinations. Their clinical meaning and management are not clear for veterinarians, who risk unnecessary investigations that harm the patients. This study is a retrospective analysis that aims to investigate incidentalomas in CT exams and to describe their prevalence, location, types and follow-up, their correlations and associations with the species, breed, sex, and age of patients examined and with the kind and number of sites scanned. The reports of 561 CT scans performed in 512 dogs and 49 cats in a veterinary facility over six years were reviewed and compared to the clinical records of the patients. Eighty incidentalomas were found in 57 dogs and four cats. A significant positive correlation was found in dogs between age and the prevalence of incidentalomas. In dogs, the prevalence of incidentalomas was significantly higher in Boxers and in neck, thoracic, and abdominal scans. Spinal incidentalomas were the most common typologies in dogs. This study can represent a tool that allows clinicians to acquire greater awareness about incidentalomas and to carry out the evidence-based clinical management of them.

Ethical Challenges Posed by Advanced Veterinary Care in Companion Animal Veterinary Practice

Simple Summary

Veterinary care of companion animals, particularly dogs and cats, continues to advance, with some companion animals receiving a standard of care equal to or exceeding that of human patients. While this has the potential to improve animal welfare and benefit other stakeholders, including animal owners and veterinary team members, it also poses ethical challenges. We discuss key ethical challenges associated with AVC, including its relationship to standards of veterinary care, its potential to perpetuate poor quality of life and suffering, cost and accessibility of veterinary care, conflicts of interest, and concerns about experimentation without appropriate ethical review. We conclude by suggesting some strategies for veterinary teams and other stakeholders, such as professional bodies and regulators, to address these concerns.

Abstract

Advanced veterinary care (AVC) of companion animals may yield improved clinical outcomes, improved animal welfare, improved satisfaction of veterinary clients, improved satisfaction of veterinary team members, and increased practice profitability. However, it also raises ethical challenges. Yet, what counts as AVC is difficult to pinpoint due to continuing advancements. We discuss some of the challenges in defining advanced veterinary care (AVC), particularly in relation to a standard of care (SOC). We then review key ethical challenges associated with AVC that have been identified in the veterinary ethics literature, including poor quality of life, dysthanasia and caregiver burden, financial cost and accessibility of veterinary care, conflicts of interest, and the absence of ethical review for some patients undergoing AVC. We suggest some strategies to address these concerns, including prospective ethical review utilising ethical frameworks and decision-making tools, the setting of humane end points, the role of regulatory bodies in limiting acceptable procedures, and the normalisation of quality-of-life scoring. We also suggest a role for retrospective ethical review in the form of ethics rounds and clinical auditing. Our discussion reenforces the need for a spectrum of veterinary care for companion animals.

Surgical Anatomical Landmarks of the Thoracolumbar Vertebral Column on Magnetic Resonance Imaging in Dogs

Magnetic resonance imaging (MRI) in veterinary medicine profoundly improved spinal cord disease investigation in canine patients. We aimed to further describe the anatomical landmarks of the thoracolumbar junction in sagittal MRI sequences. MRI studies from 90 dogs were reviewed retrospectively, representing a broad cross section of breeds and body weights. The ratio of the distance from the dorsal aspect of the vertebral canal to the dorsal aspect of the transverse process or rib articulation relative to the length of L2 vertebra was determined for T12, T13, L1 and L2 vertebrae. A statistically significant difference was noted with the transverse processes being more ventrally located than the cranial fovea costalis. The lumbar transverse processes and rib articulations dramatically varied in shape, being oval or round, respectively. The sagittal image at the level of the lateral margin of the articular facet joint proved to be the most consistent for review of these structures.