Baseline diagnostic images are basically just what it says. It gives us the baseline of what is normal versus what may be abnormal. They're important in certain situations, like if your pet comes in for a wellness exam and we diagnose a heart murmur, but the pet is not clinical, meaning they're not breathing hard or coughing, and they're not having any exercise intolerance. We may recommend what we call survey x-rays of the chest or even a survey echocardiogram. That is because we can look at the lungs and get a baseline of what is normal for this pet later down the road. When they're experiencing symptoms and clinical signs, we have that as a comparison.

So you can see a progression or not a progression. The other reason why we might consider baseline imaging would be that our patients tend to hide their problems. What we feel might be nonclinical or non-symptomatic, we might actually find a problem in the early stages of a disease that would carry a better prognosis if we started treatment early.

The x-ray frequently comes first because it's more available in general practice. It's also generally less expensive than advanced imaging or even ultrasound. So that may come into play if we feel like that will give us a high yield for less cost. We would also use that primarily for the big picture, like if we want to look at the whole abdomen or the whole chest, and we're not looking at a specific organ. For lameness or suspicions of trauma with fractures, that's where I feel like x-rays would kind of trump the others.

The different imaging tools listed out would be x-ray, ultrasound, ultrasound of heart versus the abdomen, and then procedures that we would refer for, such as CT, MRI, or scintigraphy. The actual procedure that the pet would go through for an x-ray would be positional. For the most part, that's on an exam table, on a tabletop. The ultrasound would require your pet to either lie or stand for that procedure. For the advanced imaging, they would require sedation or general anesthesia.

It's possible that it might. I would say, a lot of the time, the one we choose first, which we feel is the best, will probably give us the most answers. There are situations where it doesn't like if we see something on an x-ray, which I kind of describe as a big picture, our ultrasound kind of zeros in on that. If we see something that looks like a mass or a tumor in the abdomen, we might want to know what it is attached to and what the likely cause is. So after a big picture x-ray, an ultrasound can go in and look at the individual organs, like the kidney or the spleen. We want to see where the suspicious mass is and what it's attached to. We may not see other things, like fluid, which are more sensitive on ultrasound than on an x-ray. So you try to prioritize and start with what might give you your answer, and then it may lead you to further diagnostics. But you start with the one you feel might give you the highest yield.

I would say the most accurate tool depends on the best position we can get on a pet. So there may be a reason we take an x-ray because maybe the pet wouldn't do well with an ultrasound. Some of that depends on the type of sickness or injury, and some of that depends on the patient and what the pet allows us to do.