Equitom Equine Clinic

Robot CT

Equitom's equine clinic puts into operation a highly advanced robot, EDAMIS, for making standing CT images of the horse: a revolution in medicine.

INTRODUCTION

This very futuristic-looking robot allows doctors to take CT images of the upright horse. The technique is so innovative that it has yet to be used even on humans.

Thanks to this unique device, a CT scan can be made while the horse is standing up, thus avoiding a general anaesthetic. In addition, this robot is extremely powerful and fast. The room where the robot was installed has also been converted into an operating theatre so that certain surgical procedures can now be performed with very high precision under the robot's control. The use of the robotic CT-scanner to control surgical interventions is unique in the world and puts the Lummen Horse Clinic back on the world map!

WHAT IS A CT SCAN

A classical CT-scan is a tunnel-shaped device in which you, as a human being, have to lie down for examination. It uses X-rays and is able to obtain 3-dimensional images of the body. It mainly provides very precise information about the bones and bone structure. The CT scan is very frequently used to detect pathologies/diseases that cause pain or lameness in the horse. These can include chronic bone inflammation, arthrosis, cracks and micro-fissures, bone cysts, but also sinus and tooth problems, tumours, etc. By using a contrast medium, additional information can be obtained about soft tissue (tendons, ligaments, cartilage, menisci, etc.).

The classical CT-scanner, which originates from human medicine and has been used in our clinic for several years, usually requires a general anaesthetic and is not without risks for the horse. Both the anaesthetic and waking up are and always will be delicate moments for horses. Horses can hurt themselves or even break their legs when waking up. Sport horses have besides their emotional value also a high economic value (sometimes several millions of Euros), which makes their owners try to avoid anaesthesia.

The robot-CT is the solution to this problem and sport horses from Belgium and surrounding countries come for a robot examination precisely because a general anaesthetic can be avoided.

UNIQUE IN EUROPE

The robotic scanner at Equitom is the first on the European continent. There are currently 3 in the world: one at Equitom, one at Dubai Equine Hospital and one at the University of Pennsylvania.

The robotic scanner at Equitom is similar to the two others in the world. It is more modern and the generator is even more powerful, which improves the quality of the images.

With the arrival of the robotic CT scanner, Equitom therefore has one of the best-equipped equine medical imaging departments in the world. Besides already advanced radiography and ultrasound, there is an MRI-scan (Magnetic Resonance Imaging), a scintigraphy (bone scan), and a classic CT-scan (Computer Tomography) with an extra large tunnel of up to 90cm (Large Bore CT).

Our medical imaging specialist Zoë Joostens (Diplomate ECVDI) works closely with the American company that developed the robot and Equitom has become the European research centre to further develop the robot.

ADDED VALUE FOR HORSE AND OWNER

The robotic CT scanner allows three-dimensional CT imaging of bone and soft tissue structures of the horse without general anaesthesia.

The scanner consists of two robotic arms and several cameras that register the horse's movements. The arms of the robot rotate around the sedated horse taking a series of images. These images are converted by a computer system into a detailed three-dimensional image, as in a conventional CT scan. The cameras allow movement correction to be made. Mild movements can thus be filtered out in order to guarantee razor-sharp image quality.

The major advantage over a conventional CT is that a general anaesthetic is avoided. General anaesthesia of a horse always entails a certain risk because of their size, weight and their possible panic reactions in the event of danger. As a result, horses can seriously injure themselves during the awakening phase, in exceptional cases resulting in a broken leg.

For the owner of the horse, the standing CT can also be of golden value. The standing CT can allow extremely advanced imaging in a low-threshold manner. CT images are obtained under mild sedation and so diagnoses can be made before, during or after the competition season without the need for general anaesthesia. This is a special and exceptional benefit for every animal and every owner, but especially for valuable sport horses.

ADDED VALUE FOR VETERINARY MEDICINE

The robotic CT scanner is also a true revolution in veterinary medicine. Certain conditions that were previously impossible to diagnose with conventional radiography and ultrasound on a standing horse are now easy to detect thanks to the robot. Thanks to the robot, we can make more diagnoses at a very early stage so that preventive action can be taken in time.

Moreover, the standing CT examination can be combined with a standing MRI examination. Both imaging techniques have different characteristics and can therefore be used complementarily in complex and multiple pathologies. As a result, the doctors have very detailed information that helps them to make a correct and complete diagnosis. If necessary, the horse can be treated and followed up optimally.

Thanks to our specialised team, the neck and back region and intra-venous/arterial contrast studies are also being developed on the standing horse.

The slight sedation of the horse allows this examination to be carried out in a day clinic. The referring colleague can thus very quickly start the appropriate therapy after the diagnosis has been made and after consultation with our imaging specialist.

Surgical interventions, such as complex fractures, can be prepared in advance thanks to the information from the standing CT scan. This allows the surgeon to determine the optimal surgical technique and significantly reduce anaesthesia time. In addition, the robot room is equipped with all the necessities to allow a general anaesthesia and to be used as operating room. A mobile operating table can be used to wheel a horse into this room under general anaesthesia. The robot can thus also be used to accompany complex surgical procedures (e.g. neurosurgery).

Furthermore, the device can be used not only for the diagnosis and therapy of existing medical problems. Due to its low-threshold character, the standing robot-CT can also be used for preventive medicine. Horses can be screened after an intense training period, even before the final competition season, to see if there are any abnormalities present that could develop into serious and even life-threatening pathologies. This can be important and even life-saving for racehorses. Prevention is better than cure!

TECHNICAL DATA OF THE ROBOT-CT

The robot, also called EDAMIS (Equine Dual-Arm Multi-modality Imaging System), was developed in the United States by Orimtech LTD.

The robot arms rotate around the horse and scan the region in as little as 30 seconds. A series of cameras continuously records the slightest movement of the horse and makes a movement correction to obtain razor-sharp images. The robot is more than 3 metres tall and weighs almost 6 tonnes.

Computed Tomography (CT) works by combining multiple X-ray images taken from different angles around the body and using computer processing to create cross-sectional images of the inside of the body. In our clinic, we offer two distinct technical modalities of CT scanning: multislice CT and cone beam CT.

Multislice CT under general anesthesia
As the name suggests, in helical multislice CT, the patient is positioned on a table that moves through a tunnel or gantry with a rotating X-ray tube, allowing for the creation of cross-sectional images composed of various slices acquired in a helical pattern.
MSCT offers a detailed view of the bone structures and provides a comprehensive overview of the soft tissue in various areas of the horse's body, including the lower leg, stifle, elbow, head, and neck. At our clinic, we have a high-voltage large bore CT scanner that also enables imaging of the shoulder and pelvis in most horses. By adding a contrast-enhanced acquisition (CECT) the activity of soft tissue injuries or the extent of cartilage lesion can be detailed as well.
Indications for a head or neck CT scan include issues with teeth, sinuses, jaw or skull fractures, cervical facet joint osteoarthritis, or neurological problems related to the brain or cervical spinal cord. A limb CT scan is beneficial for diagnosing multiple issues within the same leg or for horses unable to undergo a standing MRI due to temperament. In some cases, the diagnostic examination is immediately followed by a therapeutic surgical procedure, either in the fully-equipped surgical theater within the CT room or as a CT-guided procedure. Equitom is renowned as one of the global leaders in CT-guided procedures, particularly for fracture repair and treatment of osseous cyst-like lesions.

Cone beam CT in the standing horse
At our clinic, we have a state-of-the-art robotics-controlled cone beam CT scanner (EDAMIS), which enables precise CT imaging while the horse is standing. In cone beam CT, low-exposure pulsed X-rays are emitted from a high-voltage X-ray tube and projected in a conical volume onto a plate detector for image acquisition. Our robotic system is features with a high quality patented motion correction mechanism using a metallic bead sleeve. Since only a 210° rotation is necessary for a full 360° image, we can scan legs up to the knee and hock, as well as the caudal neck, with the horse in a standing position. This technique utilizes volumetric voxels for image acquisition, resulting in the highest spatial resolution (0.25-0.35mm) and exceptional bone imaging capabilities. Continuous advancements in technology are being made, with the possibility of CT imaging of the back becoming feasible in the near future. The main advantages of standing CT include the avoidance of general anesthesia, rapid examination, and the ability to combine it with standing MRI. CT images are obtained under mild sedation and so diagnoses can be made before, during or after the competition season providing accurate follow-up on lesion progression and management. Additionally, standing CT is also becoming the new gold standard for pre-operative planning of fracture repair and bone surgery in general.

The spa:

What’s a spa?

The spa is a cold-water bath with jet stream

Who can use it?

As for humans, every horse can benefit from this treatment.

The spa can be used for precautionary measures (relaxation, relief for muscles and tendons after intensive training or in preparation of intensive training or competition) or for treating purposes (decreasing inflammation and acceleration of the healing process).

Explanation:

The horse is placed, similar to the aquatrainer, in the basin. Once the horse is at ease, the water will be added. The level of water will be determined individually for each horse, depending on its abilities, goals and medical history. A spa session will take between 10 and 20 minutes.

Benefits of the spa:

The salt water has a purifying and healing effect on the horse’s body.

The ‘jets’ will relax the horse and provide a direct mechanical stimulation of the blood flow and muscle metabolism.

Objectives

The spa will improve the healing and decrease the inflammation and is indicated for horses with:

Tendon injuries (tendinitis)
Inflamed joints (arthritis)
Swollen limbs (lymphangitis, stable legs)
Skin lesions (pododermatitis, dermatitis…)
Laminitis
Bad healing wounds

Several elements are responsible for the efficiency of the spa treatment:

Low temperature (between 4 & 6°C)

Reducing inflammation with decrease in swelling, heath and pain

Draining effect (reducing oedema)

Jet stream of water rich in oxygen

Decrease of swelling due to the pressure of the water (lymphangitis)

Massage and relaxing effect

Better wound healing

Concentration of salts:

Draining effect (decrease swelling).

Disinfection and better healing of skin lesions and wounds

The combination of these 3 elements explains a significant acceleration of the healing process.

Process of a spa session:

A complete screening of the horse will take place.
After screening the objectives and goals will be defined in collaboration with the owner.
Establishment of an individual schedule and follow-up.
For hygienic purposes, every horse is showered and washed before each session.
A dedicated person will guide the horse throughout the whole session.
At the end of each session, the horse will be placed under the solarium, to dry and relax completely.

Treadmill

A treadmill is an automatic system that allows different horses to be walked for a certain time at the same time and at the same place. Equitom has a large treadmill, inside the hospital to give the horses just the extra comfort they need and to protect them from harsh weather. The hard surface is ideal for the tendons and muscles. The walls on the sides are high and finished to prevent accidents. Thanks to the special way the horses are separated from one another inside the treadmill the horses feel free and less ‘confined’. With a diameter of 20 metres 6 horses can train at the same time in this large treadmill.

A treadmill is ideal for:

· Repair of lesions in the joints, tendons, ligaments and muscles.

Regular and controlled movement is the base of each rehabilitation program. A better blood circulation for the tissues begets a faster repair as the regular use of muscles and tendons without overloading them makes sure the tendons, muscles and ligaments get stronger.

· Preservation and/or building up stamina.

· Warming up horses before working them as well as cooling down after work.

Regular walking of hospitalised horses:

Colic: movement stimulates intestinal motility. Walking several times a day is necessary for horses that are being treated for colic. Also for horses after colic surgery or even other surgeries walking can be very helpful for rehabilitation. After every surgery the intestinal tract needs several days to become fully functional and motile again.

Swollen limbs and joints: Walking stimulates the circulation and drainage of lymfe and is therefore an important help for the treatment of these conditions.

After certain surgeries: Last years more and more horses that were operated are being given the chance for controlled movement for two specific reasons:

For one the stimulate the intestinal motility. We don’t only think about about colic surgeries but also other surgeries such as cesareans, certain tumors, cloacas and recto-vaginal fistulas but also several surgeries regarding the limbs to prevent adhesions and become a good circulation and drainage.

On the other side to raise morale. Horses are often very stressed after surgery because they have no idea what’s going on and are not used to these kind of situations. These pre- and post-operative periods are so stressful for some horses that even life-threatening complications such as intestinal paralysis (ileus), intestinal inflammation (colitis) and even laminits can occur. The Equitom team are therefor extra cautions during the post-operative period for every horse present at the clinic. It is therefore extremely important that every horse that had surgery is being walks post-operative. Additionally it raises morale and has a positive influence on the healing process.

Thanks to this treadmill we can offer your horse its daily movement in a veterinary controlled environment in our rehabilitation centre.

UTC

We are proud to present our UTC (Ultrasound Tissue Characterisation) device, a new type of ultrasound that will lead to a breakthrough in the management of tendon injuries AND the prevention of these troublesome injuries. Including our machine, only two UTC devices are available in Belgium.

The UTC device allows us to differentiate objectively between different types of tendon fibres through a three-dimensional image and the according colour codes: full-strength intact bundles (green), discontinuous, wavy bundles (blue), unorganised fibrous tissue (red) and completely torn fibres (black).

This device, available in our new orthopedics centre, will be a major aid in improving the rehabilitation process of your horse. Because the capacity of this device to determine tendon strength is much higher than in classic ultrasound, we can make a well-founded estimation of what load the tendon can endure.

On one hand, we can avoid that horses are put back into work too early leading to a re-injury (and the associated elongation of the rehabilation period with several weeks or months). On the other hand, we avoid an unnecessary long period of box confinement or walking.

Apart from the time you will save during rehabilitation, a UTC-guided rehabilitation will also help us to ensure that enough workload is provided. A certain workload is necessary to obtain a repaired, elastic, strong tendon. In short, the device enables us to make or adjust an individual rehabilitation schedule for your horse, leading to a quicker and better tendon repair!

Another truly revolutionary quality about the UTC system is that it is able to detect tendon overstrain before a true lesion (with “irreparable” damage, visible on classic ultrasound) or any symptoms are present. A regular screening of your sport horse enables us to predict and therefore also prevent many tendon injuries (and the associated months of rehabilitation). When such overstrain is detected, a simple period of decreased training (e.g. a few weeks flat work for a show jumping horse) will prevent further injury without loss of stamina. This way of prevention is already applied in elite athletes in some European football clubs!

Would you like to rehabilitate your horse in a well-grounded way with the aid of this revolutionary device or would you like to have a regular follow-up of your sport horse to prevent (re-)injuries? Don’t hesitate to contact our office for more information.

Aquatrainer:

What is it?

The aquatrainer is a treadmill placed in a basin filled with water.

Who can use it?

Every horse can benefit from this service!!

This type of hydrotherapy is very efficient in improving the physical condition as well as the muscle mass.

Several programs will be offered, whether it is for rehabilitation or training purposes.

The aquatrainer is great for horses that have been out for a longer period (operation, tendon injury…) to help them recover faster and at the same time gain muscles and improve their physical condition.

A major advantage of the aquatrainer is that it can already be used at an early stage in the rehabilitation program and that there is scientific proof it stimulates better and faster healing.

How does it work?

The horse will be placed safely in the basin. The treadmill will slowly follow the horse’s movement. Once the horse is confident and calm, the treadmill will be turned on and the water level will increase.

The pace, angle and level of the water will be determined by the pre-set goals and/or medical history. At the end of the session, the water will be evacuated gradually.

Benefits of water therapy:

As the water level increases, the horse’s weight will decrease (reducing gravity). Therefore, the joints, the bones, the ligaments and tendons can move without being overloaded. The blood flow is stimulated and healing improves. Another advantage is that exercise in water will stimulate the muscles. It’s an excellent workout for the hindquarters and the back. The horse’s back mobility and flexibility will improve.

In a later stage of the rehabilitation, the amount of water will be reduced in order to gradually increase loading on tendons, ligaments and joints.

To summarize:

The aquatrainer is a water treadmill allowing a safe and progressive rehabilitation of the injured horse.

It can also be used without water, as a basic treadmill.

Goals:

Development and strengthening of the muscles.
Strengthening of the back: increasing flexibility and reinforcing the back muscles.
Rehabilitation after tendon, ligament or joint injuries.
Helping the horse get back in shape after a long period of inactivity (due to injuries, illness, surgery, etc.).
Increasing health and performance in a sport horse.
Each horse can benefit from an aquatrainer. An individual program, adapted to the horses needs and its medical history is provided.

In a nutshell

Besides triggering the muscles, the aquatrainer also offers a moment of massage and relaxation to your horse.

After a few sessions, the horse’s physical condition will increase significantly.

Increasing the water level will decrease gravity. This will not only protect injured tendons, ligaments and joints from overloading during the workout, but improved blood supply will also stimulate the healing at the same time.

Process of an aquatrainer session:

- A complete screening of the horse will take place.

- After screening, the goals will be defined in collaboration with the owner.

- Establishment of an individual schedule and follow-up.

- For hygienic purposes, every horse is showered before each session.

- A dedicated person will guide the horse throughout the whole session.

- At the end of each session, the horse will be put under the solarium, to dry and relax completely.