# Clinical Feasibility Studies and Potential Applications of Cone-Beam Computed Tomography Integrated in Multimodality X-Ray System for Small Animals

## TL;DR

A new veterinary imaging system combining X-ray, fluoroscopy, and cone-beam CT improves diagnostic accuracy and workflow in small animals.

## Contribution

A novel multimodality X-ray system integrating CBCT is evaluated for clinical feasibility in veterinary medicine.

## Key findings

- CBCT provided excellent bone detail and detected small fractures not visible on radiographs.
- The system reduced sedation time and improved workflow by integrating multiple imaging modalities.
- CBCT image quality was comparable to MDCT in 65% of bone structures but slightly inferior in soft tissues.

## Abstract

Veterinary medicine uses advanced imaging to visualize internal structures non-invasively, allowing precise diagnosis and treatment planning without exploratory surgery. Digital radiography is accessible and provides rapid information, but its two-dimensional nature with overlapping tissues can hinder the visualization of pathologies. Computed tomography, a three-dimensional imaging technique that uses a rotating X-ray source to build volumetric images, solves the tissue overlapping. This study evaluated a prototype of a new multimodality veterinary imaging system that combines digital X-rays, real-time moving X-ray imaging (fluoroscopy), and cone-beam computed tomography in a single device. Image quality was first optimized using animal specimens and then compared with images obtained with a conventional device: a multidetector computed tomography scanner. The prototype provided excellent bone detail, with slight dark-streak artifacts caused by the limited angular range required by the open-gantry design that crucially allows animal access. Clinical use in live patients showed that this device facilitated the detection of small fractures and mineralized structures that were indistinct on conventional radiographies. By integrating multiple imaging modalities into one unit, the system improved workflow and reduced patients’ sedation time. These results indicate that this device has strong potential for enhancing diagnostic capabilities in small-animal and exotic species practice.

Diagnostic imaging is essential in veterinary practice, and cone-beam computed tomography (CBCT) has emerged as a promising tool to complement radiography. This study aimed to optimize the image quality of a novel multimodality veterinary X-ray prototype integrating direct digital radiography, fluoroscopy and CBCT, and to assess its potential clinical applications, focusing on the CBCT component. The study was conducted in three phases: optimization of CBCT image quality using postmortem samples, comparison of CBCT and 16-slice multidetector CT (MDCT) images of four cadavers (two dogs and two cats), and potential clinical applications in 24 live patients. Comparative evaluation in postmortem scans revealed that CBCT achieved equal quality in 65% of bone compared to MDCT and a slightly inferior quality in 90% of soft-tissue structures using the bone reconstruction protocol, with beam hardening as the main limiting factor. Clinical validation showed that CBCT was particularly useful for identifying small fractures and mineralized structures, providing diagnostic information not clearly visible on radiographs. Integration of radiography, fluoroscopy, and CBCT in a single device facilitated workflow and allowed a more precise diagnosis in most of the patients examined with the prototype, which demonstrated promising diagnostic performance in small-animal and exotic veterinary practice.