New Technology Allows for Improved CT Scans

Promotional video from Universal Medical Systems shows the Equimagine system in action.

By Frank Angst

Equine veterinary surgeon Tom Yarbrough prefers to devote some time on long international flights to sleep, but after seeing new CT scan technology in Dubai that allows a horse’s entire body to be examined while standing, or even in motion, excited thoughts about the possibilities of the diagnostic tool kept that needed slumber at bay.

In Dubai Yarbrough met with George Papaioannou, chief executive of 4DDI Equine, about the Equimagine high-definition robotic CT system, which allows for open-area CT scans of horses. Yarbrough saw how the technology could immediately help him and he also couldn’t help but think about the possibilities for future use.

“It can examine extensive areas of the horse, while standing and not anesthetized—just sedated,” Yarbrough said. “The fact you can image them in motion raises the bar to a place very few of us would have imagined even a year ago. It’s pretty amazing to me.

“I can say for a fact that the 15 hours flying back from Dubai, after I had a chance to meet George the first time, was the first sleepless 15 hours of flight I’d ever spent. It was one of those kind of things, where my brain was buzzing at the possibilities of the things we’d be able to do with this technology.”

Yarbrough, the hospital director and chief surgeon for Cornell Ruffian Equine Specialists, took some time two days before the Belmont Stakes Presented by NYRA Bets (gr. I) to present the new technology, which recently was added to the equine hospital in Elmont, N.Y., located across the street from Belmont Park.

In the demonstration a horse named Marble was led into the hospital for a scan of his head. Because the technology functions in an open space, Marble only needed a light sedative and he remained standing throughout the scan.

Using four robots capable of operating several panels, high-speed cameras, 3D surface scanners, and emitters in coordinated maneuvers, Equimagine can shoot more than 900 images in a 90-second session. Yarbrough noted that previous CT scans would take an hour to 90 minutes when the time needed for anesthetization was considered.

Yarbrough said Equimagine allows a detailed, digital scan from every angle of an area of concern without subjecting the horse to a confined area that would require him to be anesthetized. The robotic arms have a lot of motion. Horses are given some time to see them, and if they don’t react, the procedure moves forward.

Yarbrough noted, a bit surprised himself, that most horses have no problem with the motion of the machine. If they do react, a bit more sedative can be added with care that it’s not so much the horse is unable to stand. Blindfolds also have been good additions to relax some horses during the procedure.

“Most horses don’t really process that this is anything they should be all that worried about,” Yarbrough said. “If they snort, look scared, and we don’t think we can take them down any further with the sedation without having them stumble, we’ll just blindfold them. They seem to react beautifully to having that blindfold in place. As long as there’s someone there touching them, comforting them, they’ll stand. When the machine is activated, it’s not all that loud.”

A standing horse is going to have some motion during a procedure, but unlike previous CT scans that could be thrown off by such movement, the Equimagine includes technology that allows the scanner to account for the movement and continue the scan. The robotic systems of the technology receive commands from a small camera that keeps an eye on the horse and adjusts to any movement.

“As that horse moves, the computer system automatically assesses the movement, and in real-time tells the computer to move that data to this new position,” Yarbrough said. “On the real-time images, you’ll see the horse moving on the screen, but by the time it’s crushed down to data, it’s like a still patient. That’s part of the beauty of this system.”

Trainer Donnie Von Hemel met with Cornell Ruffian Equine Specialists to discuss the capabilities of the new CT scan. He said the technology has the potential to better inform vets and horsemen about exactly what is wrong with a horse who may be showing outward signs of problems.

“Anything that’s going to promote better detection of injuries, promote soundness in our racehorses, and help preserve what is so special to us, is a good thing,” Von Hemel said. “There are times when you know a horse isn’t right and you’re trying to figure out exactly what the problem is. He may look 100% to everybody else, but you, as the trainer, know that there’s something not quite right. You do all of your X-raying, the ultra-sounding, then you’ll go do some nuclear scintigraphy, the bone scans; you want to help.

“Sometimes you wish they’d whisper in your ear to let you know what’s going on. There are still mysteries every day. I think I learn something every day about horses—what makes them tick. It’s something we can all do better.”

While the technology promises to be effective in determining a mystery ailment, Yarbrough said it also could be used in routine preventative scans or to help a trainer develop the best conditioning approach for each horse.

Yarbrough said the technology makes it so easy to see the microfractures and small bone injuries that have been linked to catastrophic breakdowns that “a monkey could see it.” But Yarbrough said the technology has improved so much that now it will be possible to see areas of concern before they develop to the point of being a microfracture.

“We want to know when there’s a small density cluster that might be half a centimeter around. We’ll be able to say, ‘Yeah that’s just stress from training—back off,'” Yarbrough said, noting that Equimagine already is capable of picking up such potential problems and will only improve as more scans are conducted. “It’s going to come with numbers—time and numbers.”

Bone re-modeling is essential to the proper development of young horses. Yarbrough said the CT scan is capable of determining the difference between proper re-modeling and potential problems.

Currently, when trainers arrive at the hospital to have a horse receive a bone scan, Yarbrough said they’ll offer to use the new CT scan as well, to allow horsemen to see the difference in results. Papaioannou said the actual cost of scans currently can vary from $300 to $500 on the low end to $2,000 or $3,000 on the high end, but those high-end searches would typically be for less conventional uses.

Papaioannou added that the system is set up to add new camera and scan technology as it becomes available. He said Equimagine systems also are available at New Bolton Center in Pennsylvania and about a half-dozen will go into equine hospitals in Kentucky, New Jersey, Texas, and California.

Because of its use of digital aspects, Yarbrough said the technology could soon be used to help a surgeon place a screw in an exact location. He said down the road it could be used to make a perfect custom saddle or someday provide a model to be used to make an artificial joint or bone. Beyond that, he said he can’t wait for experts in other fields to think about the possibilities.

“There’s a whole burgeoning industry out there once that data is out there,” Yarbrough said.

Just out of the gate: A CT scanner fit for a horse

Clem Murray / Staff Photographer

by Tom Avril,

Hevona, a 9-year-old bay mare, stood patiently as two massive robotic arms swiveled around to capture a CT scan of her right foreleg.

The horse was under moderate sedation Wednesday morning at a University of Pennsylvania veterinary facility, so she did not move much. But traditionally, any motion at all is the bane of a CT scan, rendering the images blurry and near-worthless.

Not anymore.

The robotic system, newly installed at Penn’s New Bolton Center in Kennett Square, has sophisticated cameras and software to correct for any movement by the patient. That allows veterinarians to capture high-resolution images of a horse without the risks of using general anesthesia, and it enables them to see much more of the animal.

After all, there is only so much of a horse that fits into one of those traditional doughnut-shaped CT scanners, said Dean Richardson, professor of equine surgery at Penn’s School of Veterinary Medicine.

“The problem is, we have really, really big patients, and they don’t fit into those tubes,” Richardson said. “There are so many horizons out there that we need to investigate, and this gives us the opportunity to do so.”

The robotic-arm technology also could be used on human patients, especially children who might not hold still for a traditional CT scan, said Barbara Dallap Schaer, the medical director at the New Bolton Center, who led the effort to acquire the robotic system and will help develop treatment protocols.

Also in development: software that would allow the system to capture X-ray-style videos of a horse while it runs on a treadmill. That application also could be used on people, such as patients with back pain, the Penn team said.

The advantage of scanning bones in motion is that clinicians can see what is happening while force is applied, said Yiorgos Papaioannou, chief executive officer of 4DDI, the New York-based company that designed the system.

He said clinicians using the system will be able to discern microfractures and other problem areas before they turn into full-blown injury.

“We’ll have a way of predicting lameness before it actually happens,” said Papaioannou, whose company sought guidance from Penn’s team as it developed the system.

Penn Vet’s Thomas Schaer, who is directing translational research with the system and is married to Dallap Schaer, said he already has spoken to physicians at Penn, the Rothman Institute, and the Nemours health system about using the technology on humans.

Penn officials declined to reveal how much the system cost, saying only that it was funded partly by a gift from the estate of Mimi Thorington, a longtime benefactor who lived in nearby East Fallowfield.

But Richardson said the purchase made economic sense.

“Veterinary medicine is a market-driven business,” he said. “I’m confident that this is realistic. We’re not subsidizing the cost of this.”

So far, the equipment has been used only on test subjects, not for the treatment of injured animals. Hevona is the property of Penn, which is the first veterinary teaching hospital to acquire the equipment. It was installed in February.

While the research advances will be exciting, the most immediate benefit may be equine safety. When recovering from the anesthesia used for traditional CT scans, animals can injure themselves, Dallap Schaer said.

“The process of recovering from general anesthesia is an athletic event for the horse,” she said.

 

Penn Vet Launches Revolutionary Robotics-Controlled Equine Imaging System

By John McDevitt and Stephanie Stahl

PHILADELPHIA (CBS) — It’s the first of its kind — a robotics controlled imaging system that can be used on standing or moving horses. It was debuted today at the Penn Vet’s New Bolton Center in Chester County.

The new technology combines robotics and 3-D imaging, that’s easier on the patient whether they have four legs or two.

First, a training horse is led into position between two giant robot c-arms for the demonstration. The target was the horse’s front right leg. The imaging system, called Equimagine, can collect two-dimensional CT images, create three-dimensional images, produce 360-degree digital radiographic studies, and get fluoroscopic images up to 16,000 frames per second.

Dr. Dean Richardson is Professor of Equine Surgery and Chief of Large Animal Surgery at Penn Vet’s New Bolton Center.

“The uniqueness of this technology is that we are going to be able to do horses that are not under anesthesia and get remarkable images,” Richardson said. “It will also open up new areas that we never have able to see before because of the difficulties with imaging certain parts of the equine anatomy. So we think it holds tremendous promise.”

This revolutionary technology allows the horse to stand sedated, but awake.

“It’s much safer for the patient and the level of resolution is much higher than we’ve seen in standard CT scanning,” said Barbara Dallap Schaer, the medical director of the Bolton Center at the University of Pennsylvania.

So the horse won’t be scared by the moving parts. Its eyes are covered, which also helps keep it still. The CT scans provide three-dimensional views of the anatomy.

Clinical trials could start later in the spring.

Dallap Schaer says the precise imaging system could one day help other animals and even have translational possibilities in human medicine.

“Not just in the field of sports medicine or orthopedic surgery,” she said, “but also in neurology, ophthalmology and internal medicine.”

Dr. Dallap Schaer says robots were brought into the field of Equine imaging because of the existing challenges. A standard CT scanner has a fixed ring and it is a particular size. A large animal has to undergo the risks of general anesthesia.

“We have made plenty of advances in general anesthesia in large animals, but there are still some risks associated with it,” she said. “So the process from recovering from general anesthesia is an athletic event for the horse and the advantages of this system obviously are that we don’t necessarily have to do that.”

For this technology, horses are paving the way for humans. Right now, it just works on patients who are still. Eventually, researchers hope to program it to capture images of a horse or human in motion, yet another new horizon.

Horse sense: Penn Vet displays new robotic-controlled imaging system

A demonstration with 9-year-old bay mare Hevona of the new robotic-controlled imaging…

By John George

Horses, the veterinarians at the University of Pennsylvania School of Veterinary Medicine’s New Bolton Center will tell you, are not the best patients when it comes to diagnostic imaging.

“We’ve all seen imaging scanners,” said Dr. Dean Richardson, the Kennett Square, Pa., center’s chief of large animal surgery. “They look like giant Krispy Kremes. We have really big patients and they don’t fit in little tubes.”

Additionally, noted center director Dr. Barbara Dallap Schaer, traditional imaging devices can only scan small areas of a patient’s body, which limits their use for horses.

But now Penn Vet has a new way to get the images they need.

The New Bolton Center showed off its new robotic-controlled imaging system Wednesday, developed in collaboration with Wisconsin-based Four Dimensional Digital Imaging (4DDI). It is designed to be used on standing and moving horses.

The Equimagine imaging system arrived at New Bolton Center in February and has been going through a complex installation process.

The system is capable of capturing a horse’s anatomy in ways never before possible. The system is unencumbered by an enclosed gantry or a C-arm, making it possible to scan any part of the patient.

“The robots can easily move all around the horse in any orientation while the horse is standing, so we can see many parts of the anatomy we’ve never seen before, and do it in a patient that is awake,” Dallap Schaer said.

The robot-powered imaging modality can collect typical, two-dimensional CT images; create three-dimensional images; produce 360-degree digital radiographic studies; and capture fluoroscopic images at up to 16,000 frames per second.

“Three-dimensional imaging provides the opportunity to be more precise in our treatments,” Richardson said. “That’s a big step forward. The goal in veterinary and human medicine is to provide less invasive and more precise surgical procedures. We have a lot to learn about this technology. Three-dimensional imaging opens new doors to diagnosis and treatments. We are very excited to be on the forefront of those discoveries.”

New Bolton Center, Penn Vet’s large-animal hospital on nearly 700 acres in rural Chester County, cares for horses and farm animals. The hospital handles more than 4,000 patient visits a year and its field service treats nearly 37,000 patients at local farms. In addition, New Bolton Center’s campus includes a swine center, and working dairy and poultry units that provide research for the agriculture industry.

“We are thrilled to be the first academic institution to have this technology,” said Dr. Joan Hendricks, dean of veterinary medicine at the University of Pennsylvania.

Penn officials declined to discuss the specific investment it made to acquire and install the robotic-controlled imaging system. Dallap Schaer characterized it as similar to a hospital purchasing advanced imaging technology. Start-of the-art MRIs and CT scanner typically carry price tags in the seven figures.

Richardson believes the technology will have a large impact on the horse racing industry. “It will lesson the number of catastrophic injuries that occur at the racetrack,” he said. “We’ll be able to identify lesions earlier.”

Penn Vet also plans to include using the robotic system to collect images of horses on a treadmill in order to look for patterns to gain a better understanding of why joint degeneration occurs.

Dr. Tom Schaer, director of Penn Vet’s preclinical service core and translation in orthopedic surgery, expects the technology — while being used in animals at the New Bolton Center — will lead to improvements in human care as well.

“The system is going to allow us to explore tissues in a dynamic setting, in motion,” he said. “Being able to image a veterinary or human patient in motion can be a game changer. For example, evaluating joints or the spine when they move will allow us to expand our knowledge to better understand certain clinical symptoms.”

Studying the spine of a back injury patient in motion, he said, could help clinicians understand where the pain is coming from, which in turn can help them determine how best to alleviate the pain.

Schaer noted imaging capabilities such as MRIs and CT scans exist, but they are static.

If, as expected, the robotic system can gather high resolution images of patients in motion, having that ability to compensate for accidental motion in imaging could have applications for children and infants who are too compromised or too sick for sedation or general anesthesia.

Penn Vet specialists are working with colleagues at Penn Medicine and Nemours Children’s Health System to identify and develop applications of the technology in human medicine

Schaer is also excited about the potential research applications. “We will have the opportunity to explore beyond what we have ever been able to do,” he said. “This technology enables us to push the research frontiers in understanding potential new pathologies that haven’t been detected before.”

Another company was also involved in the project. ABB of Zurich, Switzerland, a leading global manufacturer of industrial robots, supplies the robots and many of the control components used in 4DDI systems.

Yiorgos Papaioannou, CEO of 4DDI, said his company — which previously focused on human diagnostics — had not worked in animal health before starting its collaboration with Penn Vet.

“[Horses] are the nicest, most aesthetically pleasing, but most challenging patients you’ll ever find,”

Papaioannou said.

New Bolton Center unveils revolutionary robots

By Katie Byrne

Penn Vet’s New Bolton Center unveiled revolutionary robots this morning.

Fox 29 got a behind-the-scenes look at the robot-controlled imaging system that will now be implemented at the University of Pennsylvania School of Veterinary Medicine (Penn Vet). The robot system, also called “EQUIMAGINE”, was put in action with a live horse.

Experts from New Bolton Center and Four Dimensional Digital Imaging explained the system and its use on the standing horse.

4DDI & EQUIMAGINE @ AAEP 2015

ABOUT AAEP

The American Association of Equine Practitioners (AAEP) was founded in 1954 by a group of 11 charter members who saw that together they could direct the focus of equine veterinary medicine.

The AAEP’s mission is to improve the health and welfare of the horse, to further the professional development of its members, and to provide resources and leadership for the benefit of the equine industry. These principles have guided the AAEP for more than six decades in the activities and services it provides.

THE SHOW

Practical content, abundant networking opportunities and a premier entertainment destination proved an engaging combination as 7,394 veterinary professionals, students, exhibitors and guests converged on Las Vegas, Nev., Dec. 5-9, for the American Association of Equine Practitioners’ 61st Annual Convention. Convention attendance ranked behind only the 2009 edition that also was held in Las Vegas.