As an MRI continuing education initiative I spent a couple of days at a clinic that is well known to me and the rest of the equine world: the beautiful facility of Fairfield Equine in Newton, Connecticut. Fairfield offers complete hospital and ambulatory services including an on site laboratory, surgical suite for both emergency and elective surgeries, lameness diagnostics and lameness therapies. They have hospitalized care for medical cases including an isolation barn. The facilities are impeccable, the staff is caring and contentious and I quickly saw examples of why they have such a glowing reputation.
As I was there for MRI training, we needed a horse to work with. Arrangements had been made for one of the office staff members to bring in her handsome gelding as my patient. When the trailer turned down the driveway a group of five people went out to welcome him; turns out that this old guy (he is in his mid 20’s and looks fantastic) is their horse of choice for staff training. (They’ve even have brought him into a hotel conference room for training!)
Traci, my mentor, took me step-by-step through their procedure for admitting day patients. At Fairfield, preparing patients for the MRI includes removing their front shoes and administering sedation, much like we do at MPES. Once we had him situated comfortably in the MRI room, myself, Traci, and Becky (another imaging technician with tremendous anaesthesia and radiography skills) got down to business. Our goal for the morning was to go over fetlock MR imaging and trouble shooting.
The two most critical elements for a successful scan are maintaining a uniform level of light sedation and correct positioning. In spite of his hotel room experience, our patient presented us with some challenges in these areas. When it came to sedation, he was a bit of a light weight; a tiny dose and that was all she wrote. However, and unfortunately, he would snap out of his sedation very quickly and without much warning. Secondly, he was not interested in standing with his weight evenly distributed on all four legs. For some procedures this would not be a problem. But to achieve diagnostic quality MR images, it is paramount that the horse not move. Now, it is possible to alleviate movement by adjusting the sedation, which Becky was dutifully managing. However, in this case, the level of sedation did not appear to be the problem. Rather, this horse was simply uncomfortable having the magnet touch his leg. Turns out it tickles him. So we wrapped his leg in a polo bandage so he could no longer feel the magnet and, bingo, problem solved. For me, this was an excellent learning experience. It reminded me that every horse is different, and that solutions come in all different shapes and sizes. All in all, the imaging portion of our morning was very informative and I came home with some great information about scanning protocol and image acquisition.
The following day a patient was admitted for a single hoof scan. For me, this was familiar: at MPES, 98% of the images I take are of feet. During the scan, we were able to visualize what we believed to be the cause of his lameness. We followed the MRI by taking radiographs of the specific area in question. The radiographs did in fact support our suspicions and a treatment plan was developed for this horse based on these findings.
Armed with my notes, a lot of reading to do, and with Traci and Becky as resources, I left Fairfield feeling motivated to continue improving my MR scans.