Elbow clearances and other countries....interesting, additional views
In the Penn-hip/OFA thread I mentioned that other countries require multiple elbow views. I talked to my breeder friend, of Labs, in Sweden yesterday. Here is her response to what they do:
"Yes Sue, we require two radiographs for certification. This is probably why we don't wait until the age of two.
The flexed lateral view (the only one mandatory for OFA) basically allows examination of secondary changes in ED. The fact that some of the crucial areas are overlaid by other structures makes them difficult to examine. This view does not pick up early changes and is not as reliable as the craniocaudal view which reveals evidence of primary disease which canot be identified on the lateral view. It also enables confirmation of secondary abnormalities. Some years ago, there was an interesting study by the GDC, whose goal was international harmonization on the matter, but..."
So, interesting. In the 20 years my lines have been tested (since elbows started getting looked at) of the dogs that have been tested, very few have failed elbows. Since my dogs are under sedation for x-rays, I will be doing the craniocaudal view too, for my information. The elbow is such a complex joint for numerous reasons, I'd like to keep track of what I get.
Any vets have thoughts on this? Do we have any radiologists on the list?
I know this is not technically training stuff...but is important for the health of our dogs.
Its been well known by DVM's that the single, flexed lateral view of an elbow is a mediocre screening tool. Multiple radiographs are better, but still not great unless their is obvious DJD present. In fact, multiple films are the standard of care for any other radiograph- its a 2D image and radiologists will tell you that you should ALWAYS be taking 2 orthogonal views, but OFA doesn't agree. If you show up at a teaching hospital with a dog with suspect ED, depending on the type they often recommend a CT for dx- because the joint is that complex. Now, obviously, running a dog through a CT for screening purposes is not practical either, but that's the gold standard for definitive diagnosis in dogs. I think a big part of it is the type of ED that labs get. We just had some GSD puppies that came in with ununited anconeal processes- these were easy to see on 1 plain film. But an FCP? Especially early? those can be very difficult to see even with multiple views.
If you send in additional views, the OFA will look at them. However, I don't know what they would do if they could see, for example, an FCP on a AP view (front to back) that was not evident in the flexed lateral. I believe that the dog would still "pass".
Unfortunately, I still see quite a few people that don't even bother to radiograph elbows... period.
Natalie Fraser, DVM
Home to my heart dog, Hudson:
Am/Can Ch. Marshyhope's Satisfaction, CGC, WC, CDX, RE, JH