Certificate in Advanced Veterinary Practice

C-VDI.5 Large Animal Diagnostic Imaging B

Module Outline

Module Leader:

Stephen May MA VetMB PhD DVR DEO FRCVS DipECVS

Vice Principal for Teaching and Professor of Equine Medicine and Surgery

CPD Unit

Royal Veterinary College

Hawkshead Lane

North Mymms

Hertfordshire

AL9 7TA

Tel: +44 (0)1707 666201

Fax: +44 (0)1707 666877

Email: certavp@rvc.ac.uk

www.rvc.ac.uk/certavp

LEARNING OUTCOMES

The aim of the module is to enable the candidate to extend and consolidate clinical knowledge and

skills gained at undergraduate level, and to develop an in-depth understanding of the application of

that knowledge in a practice environment in relation to Veterinary Diagnostic Imaging.

Specifically, this module relates to diagnostic images obtainable with higher power mobile and fixed

X-ray units – the thorax and abdomen (particularly in foals), the neck, back and pelvis, and the upper

limb above the carpus and tarsus – and ultrasonography of the same regions. Candidates should also

be aware of the indications for scintigraphy, MRI and CT in the horse, and be able to recognise how

these can confirm or rule out ambiguous findings on radiographs.

CONTENT

At the end of the module, candidates should be able to:

Recognise and describe normal radiographic anatomy – candidates should possess a detailed

knowledge of the normal radiographic anatomy of the horse and its variation with breed and

age

Make appropriate use of contrast media – understand the nature of the more frequently used

media and indications for their use; the procedures for performing basic contrast techniques

Apply the principles of radiological interpretation – the recognition of tissue types; formation

of shadowgraphs; effects of superimposition and multiple shadows. Changes in opacity, size,

shape, position and function of organs. The use of simple positional and contrast aids to

elucidate radiographic problems. The applications of these basic principles to the evaluation of

radiological signs in relation to clinical problems

Understand the principles and apply diagnostic ultrasonography in veterinary practice –

physical principles of ultrasound, image production, display modes, artefacts, normal

ultrasound appearance of the major organs (heart, lung, liver, kidney, spleen, intestine,

bladder), recognition of major alterations to the normal architecture of these organs and the

possible diagnostic significance of these changes

Understand the principles of and the indications for scintigraphy, MRI and CT in the horse,

including basic image interpretation.

COMMENTARY ON THE CONTENT

Interpretation applies to the diagnostic radiological features of the more commonly encountered

clinical conditions seen in veterinary practice.

Digestive System

Common radiographic and ultrasonographic abnormalities of the oesophagus and

gastrointestinal tract

Obstructive lesions and functional disturbances

The significance of gas shadows

The use of contrast media

Differential diagnoses

Abdomen (in particular in the foal)

Recognition of changes in outline, position and opacity of organs

Abdominal masses and displacements caused by them

The presence of free gas or fluid

Differential diagnoses

Urogenital System

Common abnormalities affecting the bladder, including retrograde cystography

Differential diagnoses

Cardiovascular System

Common abnormalities affecting the heart and blood vessels and evidence of cardiovascular

disease which may be recognised on plain films

The principles of cardiac catheterisation and angiocardiography

Differential diagnoses

Respiratory System

Common abnormalities affecting the trachea, thoracic wall, pleural cavity, mediastinum,

diaphragm and lungs

Pulmonary patterns

Differential diagnoses

Musculoskeletal System

Common abnormalities affecting bones and joints of the upper limb

Fractures, dislocations, inflammatory and degenerative conditions

Congenital and developmental abnormalities, metabolic disorders

Trauma

Differential diagnoses

Axial Skeleton

Common abnormalities affecting the skeleton

Fractures, dislocations, congenital and developmental abnormalities

Degenerative conditions

Inflammatory and neoplastic changes

The principles and problems associated with the use of contrast media to demonstrate lesions

of the spinal cord

Soft Tissue

Trauma

Foreign bodies

Sinuses

Calcification

The use of contrast media

Differential diagnoses

Special techniques

Candidates should be familiar with the general principles of contrast examinations and the

performance and interpretation of the more commonly used techniques. They should understand the

principles of fluoroscopy with image intensification, and Doppler ultrasonography, including colour

flow, and the types of conditions in which these techniques may be usefully employed. They should

also understand the nature of the images generated by scintigraphy, MRI and CT, but do not require a

comprehensive knowledge of the interpretation of such images.

Note on Choice of Cases:

The scope of the examination is related to those conditions likely to be encountered in general

veterinary practice.

ASSESSMENT

A case report of up to 2,500 words in length. This case should be selected by the candidate to

demonstrate their ability to use the competences that have been acquired to cope with a

challenging situation, rather than necessarily using classic “textbook cases” of particular

conditions. It should be presented “editor-ready” in a format appropriate to one of the main

veterinary journals. Illustrations should be in a digital format and demonstrate the important

features of the case. (See section on “Instructions for Submitting Case Reports”.)

Examination – Two sections consisting of Multiple Choice Questions (MCQs) and Extended

Matching Questions (EMQs)

- Section A (30 minutes) - Radiation physics and principles of diagnostic imaging (can

be sat as part of C.VDI .4)

- Section B (30 minutes) - Radiography, ultrasonography, CT, MRI and scintigraphy

Examination – Practical diagnostic imaging reading

- Eight stations consisting of six sets of unseen diagnostic imaging cases, blinded to

history and other case details and two sets of films marked up to test radiographic

anatomy and/or film faults. Films will be read under examination conditions and

twelve minutes will be made available for each film reading station.

ANNUAL ASSESSMENT TIMETABLE

31st March If you are submitting work for assessment and plan to sit the exam on

the following date, please inform CertAVP Admin Manager by 31st

March

30th June Case report due in by 30th June. Work submitted after the deadline or

without prior notice as above will not be marked until the following

year.

Early July Examination early July – date to be confirmed

LEARNING SUPPORT ACTIVITIES

Candidates are strongly advised to have a supervisor with whom they can discuss cases. Ideal

supervisors would have post-graduate qualifications in your area of interest. The module leader will

not be discussing case management with any candidate.

If you pay for learning support you have access to a number of features that will make it easier, and

more enjoyable to study for your surgery modules:

Image posted once a month by Module Leader for comment by candidates.

Access to a discussion forum that is used only by candidates studying for the DI modules.

The forums can be used to discuss any topic relevant to the CertAVP DI C modules or simply

to find out who else is out there!

Access to the RVC online library which is invaluable when researching literature for writing

up case reports. This means that (with rare exception) all journal articles that you want to

view can be downloaded to your PC with a few mouse clicks. This includes research articles

as well as reviews and case reports. IT and Library support is available for this facility

Links to useful websites and relevant journal articles

Learning support is provided to aid self-directed learning and to provide easy access to published

articles.

INSTRUCTIONS FOR SUBMITTING CASE REPORTS

Please ensure that the beginning of your report includes:

your name

module name

title

word count (excluding the above, tables, photo titles and references)

Case reports should use a standard structure such as: “Introduction, History, Clinical Examination,

Diagnostic Imaging Methods, Description and Analysis, Diagnosis, Discussion”, or an alternative

systematic structure that makes sense in the context of the particular cases being considered.

Case reports should be referenced and references cited in a standard format.

Use The Veterinary Record or The Journal of Small Animal Practice as guidance to both

citation of references within the text and format of references in the reference list.

The Harvard Guide to Referencing is also available to candidates enrolled for learning

support or online (various web sites allow the guide to be downloaded).

Candidates are reminded that case reports should be written at Master’s degree level, and attention is

drawn to the document “Standard of CertAVP work” available on the RVC CertAVP website.

Previous submissions have occasionally failed because of failure to demonstrate the desired level of

knowledge and understanding of the learning objectives. Although diploma-level detail is not

expected, it is anticipated that to reach the required level to pass, candidates will have needed to

attend some advanced level diagnostic imaging CPD, spent some time with a diplomate in diagnostic

imaging, or spent the suggested learning hours reading relevant textbooks and scientific literature at

an advanced level.

Please submit your report as a

MS Word document (97-2003 format or later)*

attached to an e-mail and send it to: certavp@rvc.ac.uk

Please ensure digital images are submitted in a compressed format so that they can be easily

transferred via e-mail.

*Please note that as case reports in alternative formats have been unreadable in MS Office any other

format will be sent back to the candidate

SUGGESTED READING

Equine:

Butler JA, Colles CM, Dyson SJ, Kold SE & Poulos PW. Clinical Radiology of the Horse, 3rd

edition; Blackwell Scientific Publications, Oxford, 2008.

Dik, K J and Gunsser, I (2003) Atlas of Diagnostic Radiology of the Horse: Diseases of the

Front and Hind Limbs. 2nd edition. Schlutersche.

Dyson, S J (Ed.) (2003) Equine Scintigraphy. Equine Veterinary Journal.

Farrow, C S. (2005) Veterinary Diagnostic Imaging - The Horse. Mosby, St Louis.

Murray, R C (2010) Equine MRI. Wiley-Blackwell.

Reef, V B (1998) Equine Diagnostic Ultrasound. W B Saunders Co.

Radiography and Physics:

Kealey, J K, McAllister, H and Graham, J P (2010) Diagnostic Radiology and Ultrasonography

of the Dog and Cat, 5th edition, Chapter 1. W B Saunders.

Thrall (2009) Textbook of Veterinary Diagnostic Radiology 5th edition, Chapters 1-5. W B

Saunders.

Weaver, M and Barakzai, S (2009) Handbook of Equine Radiography. W B Saunders.

Journals:

Relevant imaging articles and case reports in the previous 5 years of:

Equine Veterinary Journal

In Practice

Veterinary Radiology and Ultrasound *

* Veterinary Radiology and Ultrasound provides a comprehensive range of imaging articles much of

which is beyond the scope of the modular assessment. However, candidates should be familiar with

those articles relevant to the learning objectives set out in each module.

Version 3 25/01/2011

Marking Regulations

1.

Course: RCVS – Certificate of Advanced Veterinary Practice

2.

Section: C Module C-VDI.5 Large Animal Diagnostic Imaging B

3.

Applicable to Academic Year: 2009/10 onwards

4.

Aspects of course covered by Examination CertAVP C-VDI.5 Large Animal Diagnostic Imaging B – learning outcomes and topics

5. Requirement to be completed to permit entry to the examination:

1. Appropriate enrolment to the C module

2. Candidates are advised that they preferably achieve a pass grade in the relevant

practice B module.

6.

Form of Examination Part 1 Case report – 2500 words

Part 2 Examination – 2 sections consisting of MCQs and EMQs.

i) Section A (30 mins) - Radiation physics and principles of diagnostic imaging

(can be sat as part of C.VDI .4)

ii) Section B (30 mins) –Diagnostic ultrasonography, CT, MRI and scintigraphy

Part 3 Practical DI reading exam

7.

Marking Criteria

1. Case reports – grading on the RVC 0-100 (17 point) marking scheme

2. DI reading exam graded following the RVC 0-100 (17 point) marking scheme

8.

Allocation of Marks and any additional requirements

First Submission Mark aggregated and scaled to a percentage.

Re-submission Only those parts of the module identified as failing in the initial submission will be re-

marked

Version 3 25/01/2011

9.

Requirements to Pass Overall Work must be submitted and assessed within the 10 year registration period, or if

enrolled after 1st July 2010, within the 2 year registration period.

First Submission

50% or greater in the grading of the case report mark 50% or greater in the grading of the DI reading exam

Re-submission

Sections graded below 50% in the first submission are re-graded on re-

submission and the following criteria must be reached taking that new grading

into account: 50% or greater in the grading of the case report mark

50% or greater in the grading of the DI reading exam

10.

Consequences of Failure

1. A candidate who fails at their first submission will be required to re-submit the

sections that have been graded below 50% in the next or a future assessment cycle,

or withdraw from the Certificate.

2. A candidate who does not meet the requirements to pass overall after taking all the

allowed opportunities to resubmit their work will normally be required to

relinquish the course of study but s/he will have the right of appeal as described in

the College Regulations.

3. Should a candidate successfully appeal to be re-admitted to the Certificate they

would normally have to repeat the entire module with new case material and

would incur a further assessment fee.

11.

Classification

The examination is only classified as a Pass or a Fail. Candidates that pass the

examination will be allocated 10 credits in the CertAVP structure and the RCVS will be

appropriately informed.

12. Disclosure of Marks Candidates will be advised of their marks by email and they can request a letter

confirmation.

13.

Late submission of work Work that is submitted after the annual deadline cannot be accepted for grading in that

year. Work may stay on file for grading at the next submission date or the candidate

may re-submit before that date.