Thomas E. Catanzaro, DVM, MHA, FACHE, Diplomate American College of Healthcare Executives
Imaging is a Bonding Activity
The human-animal bond is based on accepting the premise that the steward of another living thing wants to do what is best for their ward. For some reason, this premise is most violated in veterinary imaging........"Tincture of time" does not do anyone any good, yet it is a common delaying tactic in many veterinary facilities! The following observations should be assessed in a team meeting:
The minimum number of X-rays views will always be two (V.D. and Lateral), so the fee schedule has two as a minimum, plus additional films as needed - no more single X-rays to save clients money and under-diagnose medical conditions.
Limping animals deserve X-rays before we determine that we can treat the ailment medically.
All long-haired cats deserve kidney ultrasound screening for polycystic kidneys.
Moist rales need radiographic assessment.
Late dental grade two mouths require X-rays before cleaning; all dental cases can be enhanced with X-ray evaluation for client's peace of mind.
Chronic gut syndrome deserves an imaging assessment.
Cats with neck lesions on their teeth have a 40 to 60 percent re-absorption incidence; these can only be assessed by reviewing the X-rays of the roots.
The "over 40" consultation deserves a physical assessment that includes thoracic and abdominal screen radiographs.
Ultrasound is not a gimmick, it is an imaging system, which requires a high skilled professional to interpret.
Endoscopy has its place; in the colon, in the joint, and in other locations other than the storage closet.
Labrador dogs with predisposition to cardio-megaly are diagnostically enhanced with early baseline chest imaging for comparison at later semi-annual life cycle consults.
Many hollow body organs need either contrast radiography or ultrasound for proper physiological assessment, and palpation is not that sensitive!
Penn-Hip has its place in the early diagnosis of orthopedic conditions, and at 18 weeks, it can lead to a JPS electro-cautery surgery to prevent hip dysphasia later in life. It is not a "cure all"; practices using the Penn-Hip have increased their client image by sharing "inside" knowledge, not from publicity about training.
Pre-purchase equine x-rays deserve ultrasound for soft tissue evaluation.
The automatic processor will usually cause a 30 percent income/utilization increase in imaging procedures over the hand tanks, and provides a dry film in a safer atmosphere.
One of the easiest techniques we have used for practices who want to change their imaging habits is to have the entire veterinary practice team write a "job description" for the X-ray machine, ultrasound, endoscopes, Vet-scope, etc., to support the written wellness standards of care (SOC) then have them commit to use it for the appropriate tasks.
Narratives for each procedure are needed, and should be rehearsed
Day care is needed for most imaging initiatives, and hospitalization levels need to reflect this workload
Level I..........day care w/o overnight
Level II.........o.d., b.i.d., care w/overnight
Level III........t.i.d., q.i.d., care w/overnight
Level IV........I.V. care w/overnight
Level V.........ICU, CCU, care w/overnight
Nurse consults need to be tracked independently of doctor consults
In-service training (internal to practice) and external short courses at VTHs, regional, national meetings will be needed to refine imaging programs
Celebrate the negative films, clients like to celebrate when you find nothing!
Radiation safety is a staff "comfort zone", and ensures they feel safe
Clients have already learned that dental X-rays are essential, from their own dentist. Our veterinary research has already shown that dental X-rays are essential for animals, especially when there is any calculus or tartar. No ethical veterinarian attempt orthopedic surgery without X-rays, yet some veterinarians do not seem to realize teeth are embedded in bone and try to go in blind for an extraction. Dental X-ray machines are very economical ($1,000 to $1,500) from the pre-owned human dentistry radiology providers. There are quality new digital dental processors for less than $6,000. At appropriate pricing, virtually no client ever balks at the basic six screening dental X-rays (e.g., $45 for the basic six set), and neither do staff or associates. Clients perceive it as state of the art thanks to their personal dentist, and practices gain great insight into the pending procedure. This is called effective bonding.