I would really appreciate your thoughts on the idea of a standalone diagnostic imaging centre.

RE: I would really appreciate your thoughts on the idea of a standalone diagnostic imaging centre.

Judith Joyce — Mon, 16 Jun 2025 08:50:57 GMT

Hi,

In case anyone read this before, I uploaded a draft - this one's a bit easier to read

I said I would let you know what I found so here it is. It isn't published or publishable, it's just my 'capstone project'. Numbers were small and analysis was superficial so I wouldn't read too much into itMany thanks to those of you who either contributed in the discussion or answered the questionnaire - it would have been much the poorer without you.www.vetsurgeon.org/.../1780.snippets-from-EMA.docx

RE: I would really appreciate your thoughts on the idea of a standalone diagnostic imaging centre.

Beats — Thu, 20 Mar 2025 17:26:03 GMT

The solution can only be balanced policy paradigm shifts. At base level, this just comes down to millennial strategic concepts. You really can't fail with knowledge-based strategic innovation. Only geeks stuck in the 90s still go for total modular matrix approaches.

(Gobbledygook generator) - could do with a revamp and reboot, having not been updated in last 20 years. Consultants say time we cascaded memos about our remote policy resources.

RE: I would really appreciate your thoughts on the idea of a standalone diagnostic imaging centre.

Judith Joyce — Thu, 20 Mar 2025 09:48:36 GMT

It's a bit of jargon that the OU uses for the final project in a course. A capstone is American I think for what we call a coping stone - the final stones you put on the top of a wall to finish it off. It could be a contender for management b***s*** bingo, where the winner is the one to come up with the most meaningless blue sky, outside the envelope managementspeak.

RE: I would really appreciate your thoughts on the idea of a standalone diagnostic imaging centre.

Arlo Guthrie — Wed, 19 Mar 2025 18:54:28 GMT

[quote userid="2131" url="~/f/non-clinical-questions/31131/i-would-really-appreciate-your-thoughts-on-the-idea-of-a-standalone-diagnostic-imaging-centre/246846#246846"]What is a "capstone project"? Why is it called that?[/quote]

I didn't know either, so I googled it. Unfortunately.

https://en.wikipedia.org/wiki/Capstone_course

I was unconscious before the end of the first sentence.

RE: I would really appreciate your thoughts on the idea of a standalone diagnostic imaging centre.

Evelyn Barbour-Hill — Wed, 19 Mar 2025 15:25:12 GMT

I've been wanting to ask this, but I didn't want to hijack the thread. Now it seems to be tailing off, can I ask:

What is a "capstone project"? Why is it called that?

RE: I would really appreciate your thoughts on the idea of a standalone diagnostic imaging centre.

David Mills — Thu, 06 Mar 2025 11:10:08 GMT

[quote userid="3607" url="~/f/non-clinical-questions/31131/i-would-really-appreciate-your-thoughts-on-the-idea-of-a-standalone-diagnostic-imaging-centre/246790#246790"]Many of these diagnostic facilities are supported not by experienced board-certified experts but by enthusiastic AVPs or certificate holders whose competence does not always match their confidence.[/quote]

As one of these myself (minus the enthusiasm) and having worked with several, I agree. Unfortunately, certainly where surgery is concerned, it is possible to gain a cert having done a limited amount of surgery which in itself is not independently verified, objectively audited or quality-assessed. In most cases it is simply the individual self-auditing and one-on-one tuition, external assessment of actual surgical competence is vanishingly rare. So a lot of cert work and qualification rests on the integrity of the individual and mainly theoretical knowledge as it is currently played out (CertAVP certainly; PGCert does have a greater practical element though the fast track over 12 months is, unless already an experienced surgeon, a little concerning) - and we all know how blinkered some surgeons are purported to be

RE: I would really appreciate your thoughts on the idea of a standalone diagnostic imaging centre.

Malcolm Ness — Wed, 05 Mar 2025 12:50:28 GMT

[quote userid="2131" url="~/f/non-clinical-questions/31131/i-would-really-appreciate-your-thoughts-on-the-idea-of-a-standalone-diagnostic-imaging-centre/246747#246747"] I think is sometimes called "received wisdom". Is it true?[/quote]

This question of doing two things under the same GA, especially when the first thing is diagnostic, is something that occupied my mind increasingly both as a referral surgeon and in the context of primary care practice.

Whilst to some extent in referral practice the risk of treading on the toes of the referring veterinary surgeon could be mitigated with good communication, the issue of informed consent seemed to loom ever-larger - especially when the first procedure is some form of diagnostic imaging.

In recent years the Guide to Professional Conduct has become a Code, which removes the primacy of individual professional judgement and implies that permission must be sought at every possible juncture. In days of yore, veterinary professionals, like their counterparts in other Liberal Profession like medicine or law, were regarded as acting to a large extent 'in loco parentis' such that it wasn't unusual when managing a case to gain client-consent along the lines of 'I will take some X rays then operate, or not, as appropriate.' Today, that level of consent would be considered inadequate, certainly falling well short of the benchmark of being adequately informed. That evolution, in my opinion, is a good thing.

Apropos the notion of doing two procedures under the same anaesthetic when the first is a diagnostic imaging technique, the purpose of the imaging must surely be either to inform an erstwhile provisional diagnosis or to provide information about therapeutic, and usually surgical, decision-making. Either way, that evidence is essential to the discussions around 'informed' consent which surely need to happen prior to any subsequent procedure. I agree with Evelyn's implication that any advantage of combining procedures is nothing more than 'received wisdom' and something that should be reconsidered.

In another thread, Arlo implied that the installation of Advanced Imaging equipment appears to be an important part of the corporate business model. Many of these diagnostic facilities are supported not by experienced board-certified experts but by enthusiastic AVPs or certificate holders whose competence does not always match their confidence. I think that there is a strong case for a two-step approach whenever possible (and it usually is) such that the case can be reviewed and discussed before properly informed consent is obtained, a process that should always include a full and frank discussion of ALL the treatment options available along with a similarly full and frank discussion of the experience and expertise of the veterinary surgeon who might perform the treatment.

RE: I would really appreciate your thoughts on the idea of a standalone diagnostic imaging centre.

Michael Woodhouse — Tue, 04 Mar 2025 21:54:48 GMT

[quote userid="13891" url="~/f/non-clinical-questions/31131/i-would-really-appreciate-your-thoughts-on-the-idea-of-a-standalone-diagnostic-imaging-centre/246781#246781"] Is it near you?[/quote]

Near Harrogate so about an hour away. They sent the PDF via email the other day

RE: I would really appreciate your thoughts on the idea of a standalone diagnostic imaging centre.

Judith Joyce — Tue, 04 Mar 2025 09:10:52 GMT

Thanks Michael,

Somebody did tell me about this.. Think it's a new start up primary care practice with a CT that they allow other practices the use of? Is it near you?

RE: I would really appreciate your thoughts on the idea of a standalone diagnostic imaging centre.

Michael Woodhouse — Mon, 03 Mar 2025 01:31:28 GMT

Have you seen this?

www.vetsurgeon.org/.../CT-services-2.pdf

RE: I would really appreciate your thoughts on the idea of a standalone diagnostic imaging centre.

Olivia Cook — Sun, 02 Mar 2025 11:47:13 GMT

It's something that was discussed several times for the greyhound racing industry, the idea of one or more centralised hubs that track injuries could be sent to. It didn't get any further because it was decided there simply weren't enough injuries to warrant its provision, those injuries we did have were already being dealt with well at local level and the transport of an injured dog wasn't comparable to the transport of an injured human who could be equipped with a splint and told to sit still for the journey! I suspect the lack of uptake would be the problem.

RE: I would really appreciate your thoughts on the idea of a standalone diagnostic imaging centre.

Judith Joyce — Sun, 02 Mar 2025 10:28:53 GMT

Mmm, interesting. I guess I was thinking of the superficial view that it was more convenient for the client. But is it better for the patient necessarily or the decision making process for the client, except perhaps in emergenicy treatment.?

I know it is often said by veterinary nurses that patients have a long wait under anaesthetic to be transferred from imaging to theatre, especially if there is a call to the client in the middle involved. Is that better than two shorter anesthetics with a gap in the middle?

RE: I would really appreciate your thoughts on the idea of a standalone diagnostic imaging centre.

Evelyn Barbour-Hill — Sun, 02 Mar 2025 02:03:50 GMT

[quote userid="13891" url="~/f/non-clinical-questions/31131/i-would-really-appreciate-your-thoughts-on-the-idea-of-a-standalone-diagnostic-imaging-centre/246535#246535"]Your comment about doing other things under one GA is a tricky one. it's the right way to go about things[/quote]

Is it?

This seems to be what I think is sometimes called "received wisdom". Is it true?

I wonder.

RE: I would really appreciate your thoughts on the idea of a standalone diagnostic imaging centre.

Judith Joyce — Thu, 27 Feb 2025 10:04:35 GMT

Hi Everybody,

I just wanted to say a big thank you to everyone who has responded to this or answered my survey. I am collecting a lot of really useful data and am very grateful for your input.

If anyone has anything else they'd like to chip in, I'm still collecting data

I'll let you know what comes out of it.

RE: I would really appreciate your thoughts on the idea of a standalone diagnostic imaging centre.

Judith Joyce — Fri, 21 Feb 2025 17:04:31 GMT

Hi Rob,

Thanks for the suggettion. . I haven't up ttill now as I became a bit inundated with information, I wanted to concentrate on the primary care practices and pet owners and didn't want to overcomplicate it for the pet owners. I've had a look at the website which raises a couple of logistic issues for the standalone though.

RE: I would really appreciate your thoughts on the idea of a standalone diagnostic imaging centre.

Rob Loxley — Fri, 21 Feb 2025 14:19:38 GMT

Have you spoken to Paddy Mannion who has run for many years Cambridge Radiology Referrals https://www.cambridgeradiologyreferrals.com/ - CT and ultrasound outpatient imaging?

RE: I would really appreciate your thoughts on the idea of a standalone diagnostic imaging centre.

Judith Joyce — Fri, 21 Feb 2025 10:32:46 GMT

That's great, thanks Janine, very helpful. I'm getting the impression that the clients don't realise how well they are looked after by their primary care practices. Its a lot more customer/consumer focussed than GP services.

RE: I would really appreciate your thoughts on the idea of a standalone diagnostic imaging centre.

janine redman — Wed, 19 Feb 2025 20:09:57 GMT

In my area this would be a great idea but my clients are reluctant to travel 5 miles down the road let alone further for a diagnostic work up . On occasion I would have appreciated being able to get an mri or cy without referral however I have a peripatetic ultrasonographer and two good referral centres locally so might only use such a facility infrequently

RE: I would really appreciate your thoughts on the idea of a standalone diagnostic imaging centre.

Alasdair Hotston Moore — Tue, 18 Feb 2025 00:22:41 GMT

[quote userid="13891" url="~/f/non-clinical-questions/31131/i-would-really-appreciate-your-thoughts-on-the-idea-of-a-standalone-diagnostic-imaging-centre/246601#246601"]communication between pet owner, their vet and the centre would be paramount, as has been highlighted by a number of folk.[/quote]

Indeed. This is critical.

RE: I would really appreciate your thoughts on the idea of a standalone diagnostic imaging centre.

Judith Joyce — Mon, 17 Feb 2025 12:54:16 GMT

[quote userid="8663" url="~/f/non-clinical-questions/31131/i-would-really-appreciate-your-thoughts-on-the-idea-of-a-standalone-diagnostic-imaging-centre/246583#246583"]And I've seen examples in China: focussed on MRI and CT with veterinarians on site to provide anaesthesia/sedation and not much else[/quote]

The one above certainly has similarities to the SDI centre I envisage, but the factors which differentiate from other UK modells I think are

Separately owned (albeit it could be a co-operative of local vets setting up a separate company.

24/7 service at one site available to the pet owner and primary care practice at all times

Continuity of care with the primary care practice preserved, enhanced by pretty much instantaneous provision of images for reporting by primary care practice , resulting in better bonding of clients

Reduced loss of revenue streams (treatment plans and proecdures where appropriate. (only outsourcing DI, no case referral)

Reduced capital expenditure on imaging equipment and radiation safety compliance, might be of interest to new start ups for Xray and ultrasound as well as MRI and CT.

There are obviously disadvantages for both vets and pet owners but it would be expected to have a high enough caseload to offer a less expensive alternative for diagnostic imaging and communication between pet owner, their vet and the centre would be paramount, as has been highlighted by a number of folk.

RE: I would really appreciate your thoughts on the idea of a standalone diagnostic imaging centre.

Arlo Guthrie — Sun, 16 Feb 2025 17:16:07 GMT

[quote userid="13891" url="~/f/non-clinical-questions/31131/i-would-really-appreciate-your-thoughts-on-the-idea-of-a-standalone-diagnostic-imaging-centre/246581#246581"]

That's a bummer. I totally get that this is a forum not the workplace, but honest, it's mild compared to what we had to deal with on both sides of the fence sometimes, as a referral practice, and as a referring practice, and it shows the depth of feeling.

I know referral practices who spend all the clients insurance money, over treat, and disrespect the primary care vet unneccessarily, On the other hand I have spent a long time staring down a microscope at an army of Cheyletiella, trying to think what to say to the owner of an itchy patient, where the primary care vet has already spent hundreds of pounds on skin tests before referral.

A lot of primary care practices feel very chippy towards referral practices.

[/quote]

Yes, I do understand that there is sometimes (frequently?) friction between referral practices and general practice, and I don't have any problem with those issues being raised and discussed in these forums more generally.

My point is just the context - I don't think it's appropriate to be chippy to someone who has just come to contribute helpfully in this thread.

RE: I would really appreciate your thoughts on the idea of a standalone diagnostic imaging centre.

Alasdair Hotston Moore — Sun, 16 Feb 2025 13:56:40 GMT

It has been done before. What is now Godstone Medivet was previously pretty much this and seemed to have worked until the owner left. Its now aiming to be more multidisciplinary

And I've seen examples in China: focussed on MRI and CT with veterinarians on site to provide anaesthesia/sedation and not much else

And it could be argued that a visiting CT or MRI is somewhat similar.

When I was a a CD at Bath we did offer outpatient CT/MRI/US but it did present some problems on occasion. The receiving vet has to be confident altho the patients is suitable for whatever chemical restraint is required, and that the requested investigation is appropriate. Ideally, this is resolved by prior communication (not always forthcoming). And what if it is sensible to carry out other procedures during the same GA, or this becomes apparent during imaging (eg unexpected finding of pleural effusion)

And what is the owner's expectation of results ? At the time? later via the referral clinic? later via the imaging centre? We decided that nurse admission and discharge avoided some such conflicts.

So, I think a stand alone imaging referral centre is possible but needs attention to case transfer and expectations. And allowing an imagingbtransfer to become something more is going to lose referring practices fast...

Alasdair

RE: I would really appreciate your thoughts on the idea of a standalone diagnostic imaging centre.

Judith Joyce — Sun, 16 Feb 2025 13:01:43 GMT

[quote userid="2100" url="~/f/non-clinical-questions/31131/i-would-really-appreciate-your-thoughts-on-the-idea-of-a-standalone-diagnostic-imaging-centre/246569#246569"]Your approach does deter people from posting, which is the very last thing I need at the moment, thank you very much![/quote]

A lot of primary care practices feel very chippy towards referral practices.

RE: I would really appreciate your thoughts on the idea of a standalone diagnostic imaging centre.

Judith Joyce — Sun, 16 Feb 2025 12:44:20 GMT

[quote userid="3169" url="~/f/non-clinical-questions/31131/i-would-really-appreciate-your-thoughts-on-the-idea-of-a-standalone-diagnostic-imaging-centre/246568#246568"]I wouldn't send a dog for a CT of its chest to diagnose an inhaled FB to come back to me to send back to you to have it removed, I'd send it for you to investigate. The various times I believe referral institutions have overstepped the mark is when they go down a route of investigation of an unrelated/incidental/very much in the GP practice sphere issue that the animal was never sent for in the 1st place.[/quote]

Thank you Michael, you have eloquently put the other side of the lack of trust in referral services. I've been on both sides of this and recognise it as a real issue to address with the standalone. As above, I would be hopeful that the standalone DI centre would take the heat out by developing a relationship with the primary care practice, not least because it wants repeat business!

I think the ethical and professional approach of both vets would get over most problems, but there's always going to be the odd exception I guess which would needs a bit of thought on a case by case basis.

The standalone DI centre should for most cases have a fairly fixed remit which should remove the risk of taking over the case, over treating. If wholly separately owned, there wouldn't be a risk of losing the client either.

RE: I would really appreciate your thoughts on the idea of a standalone diagnostic imaging centre.

Judith Joyce — Sun, 16 Feb 2025 12:30:36 GMT

[quote userid="11020" url="~/f/non-clinical-questions/31131/i-would-really-appreciate-your-thoughts-on-the-idea-of-a-standalone-diagnostic-imaging-centre/246567#246567"]becuase it was done a long time ago and the disease has evolved, because it was done badly or because I just can't tell (ultraound done by someone without qualifications that I don't have an existing relationship with; did they miss something or minsinterpret something? how can I know? They frequently have!). [/quote]

Thank yo very much for your comments. They are very valuable and detail one side of the trust issue in traditional referral which has caused friction as long as I have been aware (1980s on) , often with the pet owner as piggy in the middle. . The outsourcing model is intended to reduce this friction by developing a primary relationship with its outsourcing primary care practices. It should also address many of the difficulties which you validly raise (thank you) and reduce the number of 'what ifs'.

The standalone DI model will not succeed without some mutual trust and the questions I am asking for the project focus on that, as well as cost and convenience. There's a snazzy bit of theory that the project is built on which you might like to have a look at - Engel Kollatt, Blackwell 1968 model of customer purchasing decisions, influenced by many non-economic factors.

The standalone DI centre recognises two customers - the vet and the pet owner.