Clinical Exposures: Why it's important to examine the entire radiographic image - Veterinary Medicine
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Clinical Exposures: Why it's important to examine the entire radiographic image


VETERINARY MEDICINE


DISCUSSION

This case is an excellent example of the importance of evaluating the entire radiographic image. In this case, the cause of the gagging and presumed vomiting was found not in the abdomen, where the study was focused, but in the thorax on the edges of the radiographic views.

Other examples of significant findings that are located in an area different from the usual focus of radiographs include pulmonary metastatic nodules on the edge of an abdominal study and a lytic lesion on a proximal humerus seen on a thoracic study.


Figure 2A. The same radiographs as in Figures 1A & 1B with the contrast and brightness adjusted to make the caudal esophagus more apparent.
Developing a systematic method for reading radiographs can help veterinarians avoid missing a lesion. This process is much like the systematic approach to the physical examination. My method of reading abdominal radiographs is to first evaluate nonabdominal structures such as the thorax, ribs, spine, pelvis, hindlimbs (if included), and peripheral soft tissues. Then I evaluate the overall abdominal contrast followed by an examination of specific structures. I move in a cranial-to-caudal direction—diaphragm, liver, gastrointestinal tract, spleen, kidneys and retroperitoneal area, urinary bladder, and sublumbar region. The particular method you use is unimportant, as long as a methodology is in place and used consistently. Some people like to read radiographs right to left, cranial to caudal, top of the film to the bottom, or periphery to center by organ or organ system.


Figure 2B. The same radiographs as in Figures 1A & 1B with the contrast and brightness adjusted to make the caudal esophagus more apparent.
When evaluating radiographic films of the abdomen, a bright light source (hot light) should be used to evaluate any anatomic areas that are overexposed. Overexposure of thoracic structures routinely occurs with abdominal radiographic technique.

If the images are made by using a digital radiography system, it also is important to adjust the brightness and contrast as needed, so all parts of the image can be fully evaluated. One of the advantages of using digital radiography is the ability to adjust contrast and brightness during image interpretation (Figures 2A & 2B).

Editors' note: The American Association of Veterinary Radiologists offers interactive radiology rounds online every other week. To learn more, visit http://aavr.org/.

Julie Ekedahl, VMD, DACVR, Veterinary Imaging Specialists of Idaho, Boise, ID 83702, provided this case report.


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Source: VETERINARY MEDICINE,
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