New Technology Allows for Improved CT Scans

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.

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