IDEAS ON IMAGING. Dr. Phillippe Benoit, a speaker at the Cornell Farrier Conference, believes farriers must learn to work with veterinarians to get the X-rays they both need to help an injured horse.
Dr. Phillippe Benoit, equine veterinarian to the French Olympian Equestrian Team, told those in attendance at the Cornell Farrier Conference in early November that Xrays can be an important tool for veterinarians and for farriers — if they are good X-rays.
Benoit, who is known in France for his efforts at promoting better working relationships between farriers and equine vets, says farriers need to learn to recognize what a good X-ray is and insist on seeing good ones.
“You need to push veterinarians for better X-rays,” he says. “Make sure that the focus is good and that you can see what you want to see and need to see.”
X-Ray Pros And Cons
As a diagnostic tool, Benoit says X-rays offer the advantage of being common, relatively inexpensive and easy to take, as well as being non-invasive. They are effective in showing hard-tissue injuries and changes.
He says limitations of X-rays include the quality of the system, the quality of the image taken and the fact that X-rays cannot be used when a horse is in motion. X-rays also offer little information regarding soft-tissue injuries.
But while X-rays may not be perfect, they can be a useful tool. They can provide good images of hard tissue such as bones and those bones are important.
“Bone is alive,” Benoit says. “It can give you the story of the horse for the last 6 or 7 months.”
Getting The Shots You Need
You can read more of that story if you work with the veterinarian to get as many of its chapters as you can. Benoit says that involves using your knowledge of the horse’s conformation, how it moves, its weight bearing tendencies and how it loads the foot to ask for the specific X-rays you need. You may need to ask for multiple X-rays, showing different angles.
Benoit says you may want to ask that X-rays be taken with the beam set at varying levels of power. He mentioned one case he was familiar with in which a horse’s toe area was being eaten away by white line disease. He said a high-powered beam went right to the bone and didn’t show the damage caused by the white line. An X-ray from a different angle and taken with a lower-powered beam, allowed him to see the damage.
Benoit says X-rays should be read “from the outside to the inside.” He says it’s important to take the quality of an X-ray into consideration as you use it. Don’t try to read too much into any X-ray, especially one that isn’t well-focused.
You need to learn to identify landmarks within the foot, both in soft and hard tissue, Benoit says. In examining structures, you want to be able to decide if a change in shape or contour is an old changes or a recent one. Look for things like changes in synovial cavities and membranes, joints and insertion areas.
Benoit also stresses that it’s important to realize that not everything you see on an X-ray may be significant.
Other Imaging Techniques
Ultrasound and magnetic resonance imaging are other imaging tools that are being used in some cases. Benoit says untrasound may be more effective than X-rays for detecting soft tissue problems, however he cautions that anyone using them needs to have a very thorough knowledge of anatomy, plus practice in interpreting ultrasound images.
MRI is relatively new in equine veterinary medicine. Benoit says the techniques and equipment needed are still being developed.
“We’re still learning how to view MRI with horses and we’re just pioneering the technique on horses’ feet,” he explains.
The advantage of MRI is that the technique can provide a “slice-by-slice” overview of the area being imaged. But it is expensive and has the same drawback of not being able to provide images when the horse is in motion that virtually all forms of mechanical imaging do. He says there are cases when information gathered from a combination of X-rays, ultrasound and MRI can help provide a more useful picture of what is bothering a horse than any of them could alone.
A Tool — But Not A Perfect One
While Benoit believes good X-rays are a useful tool for farriers and veterinarians, he also warns that farriers and veterinarians should not use X-rays — or any other form of imaging — as their sole diagnostic tool.
“Images are something that you must use to confirm your clinical exam,” he says. “They cannot replace it.”
Benoit believes that actually seeing an X-ray — which may seem to offer concrete evidence — may make farriers distrustful of their own skills and knowledge.
“You have your hands. You have your eyes,” he says. “Be confident about what you find, not what you think you see in an X-ray. Give significance to your clinical exam. Examine the horse and make your guess, then use imaging to look for information that supports it.”