At the center of a display space at the recent American Association of Equine Practitioners Convention stood a life-sized, fiberglass horse with enormous robotic tentacles zooming around it, holding plates and lenses. Computer screens behind the fiberglass horse sprang to life, drawing colorful models of what the inside of a living animal’s spine or legs might look like after the swarm of high-tech activity. The whole thing looked like something out of a movie, and its producers believe that it will indeed prove as magical.
The Equimagine system is celebrated as one of the first to use robots to take CT images of horses standing or in motion. CT scans use x-rays to capture three-dimensional images of the body in “slices” and are often used to look at bones as well as the head and spine. MRI, by contrast, does not use radiation, and while it also produces three-dimensional image ‘slices’ of the inside of the body, it’s more commonly used for soft tissue imaging. A computer program takes the two-dimensional images picked up by the machine and constructs a three-dimensional model of the body based upon them.
The Equimagine system promises to simplify the process of computed tomography scanning for veterinarians by allowing a horse to remain standing during the scan. The equine spine has long been a tricky beast to image because of the thickness of the body tissue surrounding it. For some areas of the body like the spine or head, clinics have previously had to anesthetize horses to do a CT scan, which not only takes a greater toll on the patient (and the client’s wallet), it also means the horse is lying down during the scan. In some cases, the best way for a veterinarian to understand a horse’s issue could be to see it as the body holds itself naturally. The system could also be used to conduct a scan of part of the body while the horse is in controlled motion, on a treadmill.
According to its maker, Universal Medical Systems, the robotic system can also be used with different types of imaging capture systems to save veterinarians some cash. The Equimagine can do fluoroscopy (a stream of radiographic image), dexa (bone density scanning), tomosynthesis (three-dimensional imaging of tissue), dynamic video radiography, and digital radiography in addition to CT.
The computer imaging in the Equimagine system is quite advanced — it actually builds a four-dimensional picture of the body section and takes some of the scaling work out of the process for the radiologist. A one-millimeter section of bone in reality is represented as one millimeter on the image, helping veterinarians better understand what they see.
“It’s an easy thing to say, but a very difficult thing to do, and it can produce a lot of errors, especially when you’re preparing for an operation,” said George Papaioannou, president of Four Dimensional Digital Imaging and 4DDI Equine, which collaborated with Universal Medical Systems on the technology.
Many horse people took a look at the whirring, quick-moving robotic arms zipping around the plastic horse’s head and wondered how well a live animal would tolerate the process. David Zavagno, president of Universal Medical Systems, said the horses who have been scanned so far have handled the motion of the robots well, particularly for leg scans. Many of them have worn blinkers and had the scan done in an open room to prevent too much anxiety during spinal scans. Ultimately, Zavagno envisions the system positioned around stocks, where a horse could develop a sense of comfort within their immediate environment. In case they do get jittery, the computer modeling system that accompanies the high-resolution images is designed to compensate for small movements on the horse’s part.
Early users of the Equimagine include Sheikh Mohammed Bin Rashid Al Maktoum, who installed one of the first machines in a hospital setting. According to Dr. Tom Yarbrough, hospital director/chief surgeon at Dubai Equine Hospital and at Cornell Ruffian Equine Specialists, Maktoum plans to have his racehorses scanned regularly to look for bone changes that could warn of future injury. The system’s makers hope that this kind of broad use of the machine in a population of working horses can provide veterinarians with more information about what types of anomalies to look for on high-powered CTs and other scans when trying to predict an injury.
“The ability now to start to see an active horse moving, walking, running, and see the dynamics of weight bearing, that’s a whole new frontier of imaging that no one’s ever been able to do,” said Zavagno. “Hopefully that will open some new doors to new understanding.”
Zavagno remains hopeful that the speed of the scan (demo sequences took seconds to show images of isolated areas of the spine or legs) will help the clinics pay back the expense of the machine more quickly and keep prices low, making it affordable for horsemen to use scans not just as diagnostic tools but as progress trackers for follow-up. The cost of the two-robot system for veterinarians is $425,000, while the four-robot system runs $895,000.
“Typically what you can do (for an injury) is rest. Well, how long do you rest? Just until he walks better? We’re guessing or nerve blocking. If you look at the dynamics of what we’ve been doing, it’s more guess than anything,” said Zavagno.
The New Bolton Center at the University of Pennsylvania has already installed an Equimagine system, as has Cornell, and Universal Medical Systems plans to install several more at major East Coast clinics this year.
See video of the system at work on our Facebook page.
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