Buying a CT Scanner

RE: Buying a CT Scanner

Beats — Fri, 01 Dec 2017 07:44:45 GMT

[quote user="grumpyoldman"]Contrast urography to isolate urethral obstructions in second kidney cats that look like antifreeze in places you would expect antifreeze poisoning.[/quote]

Can you explain what this is - not that i'm likely to spot it myself - but interested.

RE: Buying a CT Scanner

grumpyoldman — Thu, 30 Nov 2017 23:44:35 GMT

things that we found with the CT that may have formed a banana skin for those without in the last few weeks were:-

Intranasal mast cell masses ,the contrast ct enabling accurate intranasal biopsy.

A contrast CT hunt for mets on a dog that was diagnosed with a haemangiosarcoma 11 months ago that had mysteriously lived on.

Finding mammary mets when the X-Rays looked clear.

Contrast urography to isolate urethral obstructions in second kidney cats that look like antifreeze in places you would expect antifreeze poisoning.

Accurate isolation of surgical spinal lesions

better decision making with elbows deciding when to DUO ,DOPUO ,and PAUL . or not.

RE: Buying a CT Scanner

Beats — Thu, 30 Nov 2017 21:43:14 GMT

[quote user="James Dunne"]As for IOHC….this is where I stray off the reservation….I think that people are basing decisions on papers that, while well designed, produced anomalous results. The studies on screw repair of IOHC/ICF lesions should be repeated. My experiences of prophylactic treatment of these cases is positive and does not mirror the high complication rates reported. I do not think that waiting for a fracture is reasonable[/quote]

Interesting, James. Thanks for sharing your experiences/insights.

[quote user="James Dunne"]We have treated 24 dogs with prophylactic screw repair and none have yet fractured. I have treated a few others where I was not sure that a fissure existed on the contralateral elbow, which may be surgical trespass[/quote]

24 without problems sounds much better than good luck! (And maybe enough for a case series alongside a colleague or two?) For total clarity (if you know the numbers without putting you to more digging through data work), how many of these were confirmed IOHC? What technique/screw did you use? All Springers? How many (estimate) were symptomatically lame?

I have been massively put-off this procedure by what I've read, remaining unclear on what technique to favour if conclude surgery good idea, and the one case I saw operated which had fractured screw and chronic lameness (and very little thread poking out to retrieve it by etc...) and speaking to a colleague with heavy orthopedic case load who confessed to having less than satisfactory experience with these.

RE: Buying a CT Scanner

James Dunne — Thu, 30 Nov 2017 21:20:07 GMT

Hi David

I still do quite a lot of myelography and am looking forward to the day we get a CT scanner. Nearly every colleague that uses one reports a shorter postoperative recovery for the patients that have surgery without myelography compared to those that do. With CT you still need to sometimes use myelography anyway but reportedly, the dye volume is much less - this may be significant for dogs whose cords are being compressed, who knows…but there is some [weak, anecdotal, before I get crucified] evidence that avoiding myelography may shorten postoperative recovery times.

CT is priced at a fraction of MRI, at least in Ireland. The going rate for MRI is €1300-1700 and CT is less than half of that usually, which is comparative to the costs of myelograms where time is factored in.

As for IOHC….this is where I stray off the reservation….I think that people are basing decisions on papers that, while well designed, produced anomalous results. The studies on screw repair of IOHC/ICF lesions should be repeated. My experiences of prophylactic treatment of these cases is positive and does not mirror the high complication rates reported. I do not think that waiting for a fracture is reasonable - 18% of Springer spaniels with a lesion fractured when treated by benign neglect in one recent natural history study. In our clinic, the rate of contralateral fracture with benign neglect approached 90% over time when a contralateral ICF was identified. We have treated 24 dogs with prophylactic screw repair and none have yet fractured. I have treated a few others where I was not sure that a fissure existed on the contralateral elbow, which may be surgical trespass - I didn't have CT to know and the owners knew that I didn't know, but weren't prepared to risk the contralateral limb fracturing. CT would help make these decisions more precise in our practice.

WRT to endoscopy, we scoped a dog 2 weeks ago [N=1 so I'm going to be 100% right with this statement….], pretty unremarkable scope, biopsied what looked angry, returned as lymphocytic plasmacytic rhinitis, didn't believe it - sent for a CT, large mass apparently in the nasal chamber. We had spent ages looking and couldn't see. A paper I think from Northwest a year or two ago indicated that more than one imaging modality is preferable for diagnosis of intranasal pathology.

I do agree that 3D imaging has the potential to be overused, all that being said, but I thought it would be useful for you to get some feedback on concerns you raised - hope they make sense!!

Kind regards

James

RE: Buying a CT Scanner

Beats — Thu, 30 Nov 2017 08:39:14 GMT

[quote user="David Mills"]

[quote user="Beats"]based on no direct experience of interventions for IOHC, and purely what I've read or heard on the grapevine, I'm in the camp of treat any pain (I can do that from my clinical exam on a young labrador/springer elbow with no imaging at all) and on the rare case which breaks (hopefully just laterally...) down the line fix it then. I think it's plenty of time to be imaging this once a fracture has occurred, though appreciate that might, quite validly, not be the accepted viewpoint and I might need re-educated.[/quote]

It isn't, especially in Spaniels showing clinical signs associated with the disease.

[/quote]

So the accepted wisdom then is that IOHC is potentially a surgical condition in a lame patient?

If that is your view, then would CT to assess elbows of lame dogs not make more sense than plain radiographs? (This might be what you're saying all along and I've just got a bit lost along the way - I think you were in favour of Anthony's use of CT for elbows earlier up the thread)

Presumably the most expensive imaging option is plain radiographs followed by CT scan, and the plain radiographs add little to a CT scan I would assume, so are an unecessary addition?

RE: Buying a CT Scanner

David Mills — Thu, 30 Nov 2017 00:01:45 GMT

[quote user="Beats"]"Bear in mind that even if you confirm your diagnosis, there is little if anything that can be done surgically that has been shown to improve the prognosis. There are many, very many reported techniques that have been used but not one has been properly evaluated AND shown convincingly to help the dog. It is massively popular to attack these cases with an arthroscope and while it is great fun and immensely satisfying (as well as comfortably profitable) to be able to identify and remove a fragmented coronoid, there is next to nothing other than surgeon anecdote to support the practice."[/quote]

Oh yes, well aware of this, and it was ringing in my ears when I had my spaniel done.

I take the points regarding problems with recollection and cognitive bias in these centres but the surgeon in question had done (and documented) over 3000 elbows - he showed me his database. One of the other members of the centre was also writing questions for my surgery certificate exams. Both reasons (as well as a fairly long-standing professional and personal relationship) for me having trusting the centre's figures, probably with more justification than we trust colleagues' (and CPD-imbued) advice!

RE: Buying a CT Scanner

David Mills — Wed, 29 Nov 2017 23:54:50 GMT

[quote user="cathal rafferty"]Compared to radiography in the same animal, so much more information is gained. [/quote]

Blanket statement, be interested to see whether CT improves outcomes in ear and thoracic pathology when compared to a competent and experienced reader of radiographs in these areas. Noses I can understand, to an extent, given their relative inaccessibility with radiographs (but I would still venture endoscopy is adequate in most cases, and cheaper).

What are people seeing on chests with CT that all the rest are missing, and if we are how does this translate to improved clinical outcome? So, you may pick up mets earlier - you're not going to extend the dog's life by doing so. Ears - we can see middle ear disease on radiographs (if it's severe enough to cause signs), we can see end-stage calcification. Again, what is CT doing here that improves outcome?

[quote user="cathal rafferty"]We've had plenty of mcps and humeral condyle kissing lesions where I saw nothing on rads. [/quote]

Be interesting to see some figures as opposed to anecdote.

[quote user="cathal rafferty"]We have avoided surgery in many dogs with abdominal masses based on ct evidence of metastasis. These were animals where ultrasound and chest rads showed nothing. These dogs likely would have been euthanased earlier if surgery had been done[/quote]

I don't understand this logic (maybe there are words missing), as it reads as: CT showed mets in addition to primary tumour, so surgery not done, and lived longer. As opposed to doing the surgery to remove the primary and living a shorter life? Or not being euth'd on the table? And living for how much longer?? Seems a bizarre justification.

[quote user="cathal rafferty"]With regard to myelography, half the time you can see which disk is affected without any dye, such is the detail with ct, the lesion can also be easily lateralised.[/quote]

I don't understand this either. With competent myelography (and interpretation), disc location and lateralisation can usually be viewed. Yes, extra detail is nice but how does it improve clinical outcome?

[quote user="cathal rafferty"]It takes a fraction of the time of mri, at a fraction of the cost.[/quote]

If only it were priced at the same fraction.

[quote user="cathal rafferty"]I wonder of those who are sceptical about ct, how many have much experience with it. [/quote]

I wonder of those who are sceptical about radiography and myelography, how many are or were competent at their execution and interpretation?

It isn't, especially in Spaniels showing clinical signs associated with the disease.

RE: Buying a CT Scanner

Beats — Wed, 29 Nov 2017 23:33:09 GMT

[quote user="cathal rafferty"]For elbows specifically, iohc is obvious.[/quote]

The most obvious benefit of CT over radiographs for elbows.

However, surely it's only a benefit if you do something about it?

Again, based on no direct experience of interventions for IOHC, and purely what I've read or heard on the grapevine, I'm in the camp of treat any pain (I can do that from my clinical exam on a young labrador/springer elbow with no imaging at all) and on the rare case which breaks (hopefully just laterally...) down the line fix it then. I think it's plenty of time to be imaging this once a fracture has occurred, though appreciate that might, quite validly, not be the accepted viewpoint and I might need re-educated.

RE: Buying a CT Scanner

Beats — Wed, 29 Nov 2017 19:57:31 GMT

[quote user="David Mills"]Of course it comes with risks, but in the right hands these are minimal. It's a bit like a computer game really, it's about dexterity and experience. "10%" means little, unless "complications" are detailed, and are likely to be surgeon and centre specific.[/quote]

100% agreed. You need to know the relevant anticipated complication rate for the surgeon/centre. It's actually quite hard to produce this however, and harder still to interpret it. Assuming a learning curve (a safe assumption), then past performance even if documented may not accurately predict future complications. A surgeon's estimate of risk of complication for a specific patient for a specific procedure may be the best you can get, but I do have a feeling that surgeons have a tendency to unconsciously under-estimate complication rates.

Here is the first paper that pubmed throws at me from the human field (for pediatric elbow arthroscopy complication rate):

https://www.ncbi.nlm.nih.gov/pubmed/28844419 (17% complications, 6% major ones; presumably more advanced and risky conditions and a higher complication rate than elbow scoping in dogs can be anticipated?)

https://www.ncbi.nlm.nih.gov/pubmed/?term=elbow+arthroscopy+complication+rate+dog is where the 10% figure comes from to see the breakdown for that centre/patient-population at that time. 2.8% severe pain would be an example of a "major" complication?

[quote user="David Mills"]I was told by the centre (whom I do trust) that 25-50% would get better/stabilise anyway, but it is difficult to predict which these are, although in their hands 75% would benefit from arthroscopy for MCP (either reduced analgesia requirements or curative) and 25% it would make no difference.[/quote]

Is this short-term or long-term benefit? If they're not doing a study (which I entirely understand is a lot of work if only to prove what they already know) on this then it does take quite a lot of trust that their experience is sufficiently valid to be recognizing the differences in these numbers - especially if they recommend the arthroscopic treatment every time and don't follow-up the ones not getting it? I guess they can compare their experience now to their memory of days before arthroscopy or a control based on published experience elsewhere, but there's quite a lot of room for error there.

These experts weren't necessarily convinced: https://www.ncbi.nlm.nih.gov/pubmed/22091562

My favourite orthopedic commentator (come back, Malcolm!), had this to say a few years back on the archives on here with reference to medial coronoid disease:

"Bear in mind that even if you confirm your diagnosis, there is little if anything that can be done surgically that has been shown to improve the prognosis. There are many, very many reported techniques that have been used but not one has been properly evaluated AND shown convincingly to help the dog. It is massively popular to attack these cases with an arthroscope and while it is great fun and immensely satisfying (as well as comfortably profitable) to be able to identify and remove a fragmented coronoid, there is next to nothing other than surgeon anecdote to support the practice." https://www.vetsurgeon.org/uk/small_animal/f/166/t/18998.aspx

[quote user="David Mills"]

[quote user="Beats"]I find myelography a faff.[/quote]

Fair enough, but is "I find it a faff" a reason to choose an easier yet vastly more expensive option, with similar outcome? I often think of fat bitch spays and open vs laparoscopic for this.

[/quote]

The expense is, I assume, in purchasing and keeping CT scanner (or laparoscopic equipment) more so than in running it. If I am already owning and maintaining a CT scanner, then is it significantly less expensive for me to do standard myelogram than use my CT scanner? I don't know, perhaps it is.

RE: Buying a CT Scanner

cathal rafferty — Wed, 29 Nov 2017 17:55:23 GMT

I wonder of those who are sceptical about ct, how many have much experience with it.

We got ct six months ago,a reconditioned machine from mius. We had zero experience of ct beforehand. The detail is amazing!

it makes a quick job of noses,ears,chests etc. Compared to radiography in the same animal, so much more information is gained.

We have avoided surgery in many dogs with abdominal masses based on ct evidence of metastasis. These were animals where ultrasound and chest rads showed nothing. These dogs likely would have been euthanased earlier if surgery had been done

For elbows specifically, iohc is obvious. Mcp is also really very obvious, what to do with it is another question. We've had plenty of mcps and humeral condyle kissing lesions where I saw nothing on rads.

With regard to myelography, half the time you can see which disk is affected without any dye, such is the detail with ct, the lesion can also be easily lateralised.

It takes a fraction of the time of mri, at a fraction of the cost.

Cathal Rafferty

PG cert SAS

RE: Buying a CT Scanner

David Mills — Wed, 29 Nov 2017 15:52:44 GMT

[quote user="Beats"] overall, it surely can't be declared a harmless-at-worst procedure?[/quote]

Of course it comes with risks, but in the right hands these are minimal. It's a bit like a computer game really, it's about dexterity and experience. "10%" means little, unless "complications" are detailed, and are likely to be surgeon and centre specific.

[quote user="Beats"]I did a quick search and didn't spot any recent clinical studies demonstrating the benefits of this, but that obviously doesn't mean it's not effective, just that trials are ongoing/absent/too-difficult-to-perform-due-to-the-individualised-treatment-decisions[/quote]

EBVM often lags behind the curve when it comes to new(ish) procedures, although the lack of arthoroscopic data is somewhat of an anomaly.

I was told by the centre (whom I do trust) that 25-50% would get better/stabilise anyway, but it is difficult to predict which these are, although in their hands 75% would benefit from arthroscopy for MCP (either reduced analgesia requirements or curative) and 25% it would make no difference.

I think some of the more invasive procedures touted at other centres are, er, more experimental.

[quote user="Beats"]I find myelography a faff.[/quote]

Fair enough, but is "I find it a faff" a reason to choose an easier yet vastly more expensive option, with similar outcome? I often think of fat bitch spays and open vs laparoscopic for this.

[quote user="Edward Jones"]following identification of plain radiographic abnormalities arthroscopy is necessary to diagnose and about 50% of the conditions are then treatable. This was without consideration to CT.[/quote]

Yes, interestingly, most places offer a fixed package for CT + arthroscopy these days. I still maintain that radiographs remain the initial diagnostic step.

RE: Buying a CT Scanner

Edward Jones — Wed, 29 Nov 2017 11:53:00 GMT

Regarding elbows I was once lead to believe that following identification of plain radiographic abnormalities arthroscopy is necessary to diagnose and about 50% of the conditions are then treatable. This was without consideration to CT.

I've had young dogs do very well indeed after elbow arthroscopy and none do badly (n=insignificant).

RE: Buying a CT Scanner

Beats — Wed, 29 Nov 2017 11:47:09 GMT

I'm tangenting awfully (apologies), however:

[quote user="David Mills"]

[quote user="Beats"]Some of which may be managed surgically and may give a worse outcome than conservative management? For what conditions would you wish for elbow surgery on your own dog?[/quote]

Bold statement, suspect without evidence.

It depends on the breed, likely future function of the dog, cost etc. I'm not sure the "your dog" thing has anything to do with it, ethically or otherwise. I would advise the same regardless of owner, given the above considerations.

As it goes, I've had two dogs with MCP disease. One, a labrador, was treated conservatively and was on 4mg/kg carprofen for 7 years, one a springer, who had arthroscopic removal and hasn't needed any analgesia post-operatively. Does this mean anything? No. Nothing at all.

[/quote]

If I lived near a centre of excellence where I trusted the expert opinion of the skilled surgeon, I may be considerably more inclined to consider surgery for elbow diseases. From a distance, without any personal expertise, i am rather left in the dark as to what cases may benefit from elbow surgery - juvenile dogs getting a fragment removed sound like a sensible contender. I did a quick search and didn't spot any recent clinical studies demonstrating the benefits of this, but that obviously doesn't mean it's not effective, just that trials are ongoing/absent/too-difficult-to-perform-due-to-the-individualised-treatment-decisions. I thought the arthroscopy complication rate had been touted at 10% (for actual surgical complications), but again this likely to be surgeon/establishment specific, then there's the non-surgical effect on the patient such as fearful experience etc - again going to be patient/establishment specific - overall, it surely can't be declared a harmless-at-worst procedure?

[quote user="David Mills"]Don't you spend time doing microscopy on OE cases? Or do you just swab and send away?[/quote] Risking a further tangent - I rarely do culture in otitis cases, but am addicted to cytology.

[quote user="David Mills"]It's hardly faffing, and it's a fairly easy skill to learn, the price of an x-ray and for most cases (along with a competent neuro exam) tells you what you need to know...after all the final common pathway is going to be surgery, so what use a detailed CT or MRI?[/quote]

I find myelography a faff. I may well find CT the same or bigger faff - I don't have any experience to compare. I assume CT shows you where compression is nicely, myelography (in my hands) does not always.

RE: Buying a CT Scanner

Michael Woodhouse — Wed, 29 Nov 2017 00:21:12 GMT

[quote user="David Mills"]With appropriate, veterinary-based evidence that it improves outcomes, I wouldn't argue. But that evidence is not currently available, nor will be for some time. Until that time, I will sceptically but fairly reserve judgement, especially as CT increases its reach, and the requirement for it to be paid for. The overuse of MRI for orthopaedic conditions has abounded for years.[/quote]

Exactly. We get back almost full circle to running some bloods in a healthy animal to check everything is normal (but basically to justify our new blood machine).

RE: Buying a CT Scanner

David Mills — Tue, 28 Nov 2017 23:11:34 GMT

[quote user="nick shackleton"]I know what I'd prefer my pet to have if money wasn't an issue.[/quote]

Again, hardly a strong ethical argument. I hope it is not one proffered to clients.

The complication rate for myelography in competent hands is extremely low. The cost is pennies, and, considering the vast majority of these are going to be to localise the extruded disc, nothing more, more than adequate information-yield-wise.

[quote user="nick shackleton"]In human healthcare, CT is now first line in certain situations, whereas before plain film radiography would be used. [/quote]

Hardly a bastion of sound clinical decision-making the NHS, nor cost-constrained. IVUs are not comparable to the argument above.

Let us not forget that an avergae CT scan is the equivalent of about 250 x-rays in terms of radiation.

[quote user="nick shackleton"]I can see a move towards CT being used for first line in certain situations instead of other modalities.[/quote]

With appropriate, veterinary-based evidence that it improves outcomes, I wouldn't argue. But that evidence is not currently available, nor will be for some time. Until that time, I will sceptically but fairly reserve judgement, especially as CT increases its reach, and the requirement for it to be paid for. The overuse of MRI for orthopaedic conditions has abounded for years.

RE: Buying a CT Scanner

David Mills — Tue, 28 Nov 2017 23:03:55 GMT

[quote user="Beats"]Some of which may be managed surgically and may give a worse outcome than conservative management? For what conditions would you wish for elbow surgery on your own dog?[/quote]

Bold statement, suspect without evidence.

[quote user="Beats"] think if I was going to image the average elbow at all then I can see much more benefit to CT than radiographs. Assuming ballpark similar pricing I would choose the CT every time i think?[/quote]

A CT same price as 4-6 elbow radiographs? There is something being badly priced if so

What exactly do you need to know more than a suitably interpreted x-ray will tell you in most cases (barring looking for IOHC)?

[quote user="Beats"]I don't think I would be faffing around with myelography[/quote]

Don't you spend time doing microscopy on OE cases? Or do you just swab and send away? It's hardly faffing, and it's a fairly easy skill to learn, the price of an x-ray and for most cases (along with a competent neuro exam) tells you what you need to know...after all the final common pathway is going to be surgery, so what use a detailed CT or MRI?

RE: Buying a CT Scanner

Beats — Tue, 28 Nov 2017 20:15:26 GMT

[quote user="David Mills"]This goes for a lot of veterinary medicine. For instance, why bother doing histo on lumps you remove? [/quote]

I'm not in disagreement. I've never found post-lumpectomy histopath to be a big seller.

[quote user="David Mills"]"Elbow dysplasia" is a catch-all for many different disease states, some of which may be managed surgically and may give a better outcome than conservative management.[/quote]

Some of which may be managed surgically and may give a worse outcome than conservative management? For what conditions would you wish for elbow surgery on your own dog?

[quote user="David Mills"]CT will give you more information than radiographs (what use this extra information is is another debate), although I accept that it is overused, and should not substitute traditional radiography which will give you an answer in most cases.[/quote]

I think if I was going to image the average elbow at all then I can see much more benefit to CT than radiographs. Assuming ballpark similar pricing I would choose the CT every time i think?

Again, if I had CT, I don't think I would be faffing around with myelography, but I've never done CT to compare the experience.

RE: Buying a CT Scanner

nick shackleton — Tue, 28 Nov 2017 19:44:17 GMT

[quote user="Francisco Gomez"]

[quote user="David Mills"]

I accept that it is overused, and should not substitute traditional radiography

[/quote]

Why should not substitute it in the future?

[/quote]

This has happened in human healthcare, see my comments above

RE: Buying a CT Scanner

Francisco Gomez — Tue, 28 Nov 2017 19:43:01 GMT

[quote user="David Mills"]

I accept that it is overused, and should not substitute traditional radiography

[/quote]

Why should not substitute it in the future?

RE: Buying a CT Scanner

nick shackleton — Tue, 28 Nov 2017 19:42:54 GMT

[quote user="David Mills"]

[quote user="Beats"]My issue is really the same as for radiographs of bones - unless it's going to change my treatment, it's a little academic. How often does an elbow radiograph change my treatment? Once in a blue moon for me.[/quote]

This goes for a lot of veterinary medicine. For instance, why bother doing histo on lumps you remove?

"Elbow dysplasia" is a catch-all for many different disease states, some of which may be managed surgically and may give a better outcome than conservative management. CT will give you more information than radiographs (what use this extra information is is another debate), although I accept that it is overused, and should not substitute traditional radiography which will give you an answer in most cases. However, it is one of the few things I would consider CT scanning of "bones" to be useful for, with caveats. But yes, if the client can't or won't afford further intervention then it's pointless (much like the MRI for disc disease if can't afford surgery discussion (or even if MRI is superior to myelography)).

[/quote]

MRI is also safer than Myleography, less complications. except for the contraindications regarding the magnetic field. I know what I'd prefer my pet to have if money wasn't an issue.

In human healthcare, CT is now first line in certain situations, whereas before plain film radiography would be used. For example, the NHS Trust I used to work for moved away from performing plain film IVUs to doing them solely in CT, due to increased sensitivity seen with CT verses plain film.

I can see a move towards CT being used for first line in certain situations instead of other modalities.

RE: Buying a CT Scanner

David Mills — Tue, 28 Nov 2017 19:37:44 GMT

This goes for a lot of veterinary medicine. For instance, why bother doing histo on lumps you remove?

RE: Buying a CT Scanner

Beats — Tue, 28 Nov 2017 19:26:20 GMT

[quote user="David Mills"]

[quote user="Anthony Dennison"]I don't really have an interest in ortho, but the practice uses it a lot for elbows,[/quote]

I'm glad you said that

[/quote]

While I suspect if I had a CT scanner (I can but dream!) I would see the logic in doing elbows on a more regular basis, I do struggle a bit with the "so what" aspect of the results for the average case... this may reflect my ignorance more than anything else!

My issue is really the same as for radiographs of bones - unless it's going to change my treatment, it's a little academic. How often does an elbow radiograph change my treatment? Once in a blue moon for me.

RE: Buying a CT Scanner

Rob Loxley — Tue, 28 Nov 2017 18:59:14 GMT

[quote user="David Mills"]

[quote user="Anthony Dennison"]I don't really have an interest in ortho, but the practice uses it a lot for elbows,[/quote]

I'm glad you said that

Pleased it's not become the de rigeur for cruciate disease

[/quote]

Don't you need an MRI for that?

RE: Buying a CT Scanner

nick shackleton — Tue, 28 Nov 2017 17:42:06 GMT

We’ve not received any complaints regarding image quality from the diploma holder who reports our scans. We have a Siemens 16 slice Stomatom Scope. We do a fair number of ortho work as well as heads, chests and abdomens.

RE: Buying a CT Scanner

David Mills — Tue, 28 Nov 2017 16:01:50 GMT

[quote user="Anthony Dennison"]I don't really have an interest in ortho, but the practice uses it a lot for elbows,[/quote]

I'm glad you said that

Pleased it's not become the de rigeur for cruciate disease etc as happens it some establishments...