A room that can be darkened, an exam table that can be accessed from both sides, and a power outlet. I will bring all the other equipment that I require for the ultrasound, sampling, etc. You will have to provide sedation medications and administer the sedation. You do not have to pre-shave animals for ultrasound, but you may want to in order to gauge their need for sedation - if they cannot tolerate being shaved in dorsal recumbency with one person restraining, they will not likely tolerate ultrasound unsedated.

We will provide an assistant to restrain the animal so your staff does not have to be present for the entire ultrasound. If you prefer your patient not to be sedated there is a higher chance a staff member will need to assist in restraint. Your staff may be required to administer sedation, and you will need to provide sedative medications, recover animals from sedation and help load and unload animals into the room used for ultrasound. There may be times when our assistant is unavailable and we will do our best to make you aware of this beforehand.

No. All findings will be in written report form. Sedation orders and contingency orders (if initial sedation is ineffective) should be planned and written out prior to the scan. A staff member from your practice needs to be available to facilitate drawing up sedation and discussing any emergent concerns with the pets owners.

Yes. In order for the ultrasound machine to work properly the probe must have close contact with the skin with no interference from fur. Alcohol and gel will also be used to allow proper conduction of the ultrasound waves. Exceptions can be made on a case by case basis, but imaging quality will be compromised.

• You should get pre-approval for sedation from your clients. I am willing to try without sedation and many animals do not require sedation, however, if sedation is required and not pre-approved, the ultrasound may have to be rescheduled. We will likely need a member of your staff to help restrain any unsedated pets.

• Pre-shaving the pet in dorsal recumbency prior to ultrasound will give you a good idea of their tolerance for imaging.

• Painful animals should be given pain medication minimally - a tense abdomen does not image well.

• Sedation is nearly always required for cervical ultrasound.

• Recommended sedation protocols - moderate to heavy sedation to allow adequate imaging

  • 5-10ug/kg dexdomitor + 0.2-0.4mg/kg butorphanol IV/IM

  • DKT for especially fractious pets

  • 0.3mg/kg butorphanol + 0.2mg/kg midazolam/diazepam IV (if dexdomitor not desired)

  • I do not recommend acepromazine
    

• You should get pre-approval to OBTAIN aspirates of any abnormalities. Small volumes of abdominal effusion are most evident and aspirable at the beginning of the ultrasound. The best time to get a sample of any other abnormalities is at the time of ultrasound, while the pet is sedated. If the owner approves aspirates, but elects not to submit the samples, we will charge only for the first aspirate, even if multiple samples are taken. Please inform us of this within one week or full charges will be incurred.

• You should attempt to get pre-approval to SUBMIT aspirates for cytology of any abnormalities. This is especially true if you anticipate abnormalities or if we are investigating why liver enzymes are elevated.

• If obtaining aspirates is not pre-approved, but subsequently desired by the owner after hearing results of the ultrasound, they may have to be obtained at a later date.
  

I will generate a written report with ultrasound findings and case specific recommendations including differential diagnoses, treatment and next diagnostic steps. This will be available before I leave the office. Any samples for cytology will be left at the clinic for you to submit. The images will be transferred to a USB drive which will be left at your clinic and which you can upload to your PACs system for storage. I will also store all images and reports.

Yes! Please feel free to call or email for case discussion any time. If I am not available immediately, I will contact you as soon as possible. I am also happy to discuss cases which have been imaged or discuss any questions about reports, recommendations, etc as needed.

Elevated liver enzymes are a common reason to order an abdominal ultrasound. Whether there is no explanation for elevated liver enzymes on ultrasound, or there are any abnormalities in the liver parenchyma, I recommend liver FNA. Liver cytology is useful to diagnose hepatic lipidosis, can help classify inflammation and rule in or out major diseases such as lymphoma, mast cell disease, etc. Liver biopsy is often required for more definitive diagnosis, but is more invasive. I recommend checking a CBC to ensure normal platelet count prior to sampling. Coagulation factors (PT/PTT) can be checked, but are not required. They are recommended if liver function parameters (high Tbili, low Alb, BUN, Glu) are off on the chemistry panel. Hemorrhage is a small but present risk with any FNA.