The zero-helium 1.5T MRI machine for dogs and cats is designed to be more sustainable that earlier generations of the Hallmarq technology. (Photo courtesy of Hallmarq)

Hallmarq Veterinary Imaging, a developer of animal diagnostic imaging, recently announced the installation of its first zero-helium small animal 1.5T MRI machine in the United States, which is now in use at the Wisconsin Neurology and Surgical Center in Mequon.

 The company’s third-generation zero-helium 1.5T MRI machine, the newly installed machine builds on Hallmarq’s second-generation system—and 

 1.5T veterinary specific MRI—through its departure from reliance on helium.

Rather than using liquid helium to cool its MRI coils, the third-generation machine employs a different method to produce a superconducting magnet: it utilizes vacuum technology and a cooling system based on conduction.

 The move away from helium marks a new step towards a sustainability effort, as helium is a finite source, and its extraction process is energy-intensive and can lead to the release of greenhouse gases.

“Hallmarq’s zero-helium small animal 1.5T MRI system increases access to diagnostic care for small animal patients, while lessening the financial, environmental and supply chain risks associated with traditional helium-based MRI systems,” Steve Roberts, PhD, and chief technology officer of Hallmarq Veterinary Imaging, said in a news release.

“Because [the machine] is zero-helium, we’ve reduced the complexities of installation–there is no requirement for an RF shielded room, a quench pipe, conventional external chiller or oxygen monitoring within the scanning and operator rooms. This not only simplifies the process of adding 1.5T MRI to a diagnostics suite but saves both time and money,” Fiona Farmer, BVSc, MRCVS, level 3 FEI official veterinarian, and senior account manager at Companion Consultancy, a veterinary-focused communications firm based in the United Kingdom, told 

. Additionally, Hallmarq's remote operations service (ROS) offers veterinary clinics access to their licensed MRI veterinary technicians to help manage the system effectively, which can be helpful for clinics facing staffing difficulties. The company is also offering Imaging as a Service (IaaS), a rental, subscription-based model where monthly payments cover “everything,” according to Hallmarq.

The machine, which is designed for cats and dogs, contains a V-shaped patient bed that can scan animals ranging in size, such as Chihuahuas to large breeds like bull mastiff, Newfoundland, or long Irish wolfhound. According to Farmer, the machine can screen and diagnose the following:

Cranial and vertebral anomalies and genetic malformation screening

The veterinary-focused design of the machine allows for a clear image of the scans. The machine is “specifically designed with vets and pets in mind. Animals and humans do not share the same anatomy so a refurbished human MRI will not deliver the same image quality that the Hallmarq machine can with its veterinary specific coils, protocols, and software,” Farmer said.

Hallmarq is currently exhibiting its zero-helium small animal 1.5T MRI machine at the American College of Veterinary Internal Medicine (ACVIM) Forum 2024 in Minneapolis, Minnesota, in booth 1433. “We are looking forward to attending ACVIM…where we will have a machine on our stand, which is the first-time people will be able to see it in person. We welcome everyone to come and see the system and look forward to answering any questions,” Mike Torres, global vice president of customer success at Hallmarq Veterinary Imaging, said in the release.

Hallmarq installs its first zero-helium small animal 1.5T MRI machine in the US. News release. US Vet Press. May 20, 2024. Accessed June 6, 2024. 

https://www.companionconsultancy.co.uk/2024/05/hallmarq-installs-its-first-zero-helium-small-animal-1-5t-mri-machine-in-the-us/

Hallmarq releases its NEW zero-helium small animal 1.5T MRI machine. Hallmarq Veterinary Imaging Ltd. November 4, 2022. Accessed June 4, 2024. 

https://hallmarq.net/2022/11/04/hallmarq-releases-their-new-zero-helium-zhm-small-animal-1-5t-mri-machine/

Serra Leal JS, Incer-Valverde J, Morosuk T. Helium: Sources, applications, supply, and demand. Gases. 2023;3(4):181-183. 

Articles

Hallmarq Veterinary Imaging is exhibiting the more sustainable version of its technology for small animal diagnostics at ACVIM Forum

Imaging developer installs its first zero-helium 1.5T MRI machine in the US

A veterinary journal recently announced it has retracted a published study, after its authors publicly announced a discovery of new data that would change the outcome of their findings.

At the American College of Veterinary Internal Medicine’s (ACVIM) Forum 2024 in Minneapolis, Minnesota, Brad Hanna, DVM, MSc, PhD, used multiple clinical trial examples to demonstrate how to tell their trustworthiness and accuracy.

Hanna then explained the tips that he gives veterinary students, and veterinarians, on how to identify key markers that make a randomized clinical trial (RCT).

Hanna kicked off his lecture by telling attendees that when he left veterinary school, he had trusted RCTs full-heartedly. He assumed that because they were published pieces of research, the researchers had the advanced knowledge needed for the study and everything was laid out for him, ready to be used for his patients. However, as he went through clinical trials and entered the veterinary profession, he began to learn that the assumptions he made about clinical trials when he entered his career were not always correct when it came to RCTs.

“I assumed randomized control trials were done by people with advanced training of the way experts and they were done correctly. I assumed that peer reviewers also had advanced knowledge and clinical trials, and they had caught any errors that may have been made in a clinical trial before it was published,” shared Hanna.

“I also assumed that to be able to detect an error in a clinical trial would require the advanced training that I didn't have. And so, if I tried it, a nonexpert like me would have performed a subpar analysis anyway, it wouldn't have been a good use of my time, and I thought this was very rational, and sensible,” he continued.

Hanna told the room that within veterinary schools, students might not be as prepared to analyze RCTs to ensure their accuracy. He shared that at the Ontario Veterinary College, University of Guelph in Canada he would have students write a 1-page RCT and ask them to identify 3 strengths and 3 weaknesses in the trial. He would also ask them how they felt when they were doing the task and share some of the top words, they used to describe it. Among the top words were confused, frustrated, overwhelmed, and surprised, to name a few. Showing the students what they do and do not know can help them better prepare to analyze studies on their own, or peak the ideology to not blindly trust what they read in the title or conclusion.

Checking RCTs is not something that has to be time-consuming and difficult. Hanna offered multiple ways veterinary professionals can check the study to see if it is dependable or not because, to him, triage is better than trusting.

He started by telling attendees that reviewing the participants of the study is part of that triage. Within the conclusion of a study, it should disclose the population it is aiming for with the study. A treatment being investigated within an RCT could be testing only on 1 population, which would provide data for that group, but not much for others not included. He used the example of a study that used healthy, young male beagles. Although the results may be helpful for those working within that niche group, they might not apply to females, other breeds, and dogs within different age groups.

“So the simple idea is that when you're looking at clinical trials, check to see if the conclusions are aimed at a population that is similar to the participants in the study.Here's [what else] to check, is there a reasonable belief or reasonably clear description of the animals in the study to begin with? And are they completely aimed at a similar population?” said Hanna.

Another way to help distinguish the accuracy of an RCT is through the primary outcome. Did the authors of the study identify the main measure of treatment success? Did they provide a conclusion based on it? Hanna explained that a common error in RCTs is the reader not realizing the risk applies to 1 measure. So, if you measure 2 things, each having a 5% risk, the overall risk of the study getting a false positive result is ~10. 

He provided an example to attendees from a feline cardiology paper that was published in 2022. “[The trial] says the primary endpoint was trying to time cardiac death. So they've identified a primary outcome. This is going to be the measurement that tells us whether this treatment is effective or not. The primary income did not differ significantly between groups and they were very clear on that. They emphasized it in the abstract, and the body of the paper, but they did then look at some other vendor, which we would refer to as a secondary measurement, and concluded that the treatment effect appears to be effective in doing something else.

“The problem is that increases the risk, and now you're looking at multiple measures and you're willing to draw conclusions on any of them and they actually measured more than 2 things, they actually measured 5 things, so really, the risk that they're going to see a difference is more like 25%, so it just increases the certainty,” explained Hanna.

When reading a clinic study, Hanna told attendees that need to check if the authors identified a primary outcome and are the conclusions of the study based on the primary outcome.

With the recent news of the JAVMA retraction bringing the concept of deeper reviews of clinical trials to the forefront of veterinary professional’s minds, it is important to know how to better identify errors in RCT. For Hanna, it’s better to triage than trust.

“When I graduated from veterinary school, I would have seen major veterinary journal authors from major veterinary schools. The conclusion is that the treatment works. And I would think, well, there's something I can use in my patients. And what I hope you've seen during my talk is, thatit isn't hard for a busy primary care practitioner to look at the study and say, well, for these reasons, this study doesn't look right. You need better evidence,” Hanna concluded.

Amundson M, Motsinger LA, Brejda J, Hancock L. Sixteen years of canine hepatic copper concentrations within normal reference ranges in dogs fed a broad range of commercial diets. 

Journal of the American Veterinary Medical Association

. Published online March 7, 2024:1-6. doi:https://doi.org/10.2460/javma.23.11.0621

Kincaid E. Veterinary journal retracts pet food company’s paper about copper in dog food. Retraction Watch. Published June 5, 2024. Accessed June 6, 2024. https://retractionwatch.com/2024/06/05/veterinary-journal-retracts-pet-food-companys-paper-about-copper-in-dog-food/

Amundson MD, Motsinger LA, Brejda J, Hancock L. Notice of Retraction: Amundson et al. Sixteen years of canine hepatic copper concentrations within normal reference ranges in dogs fed a broad range of commercial diets. J Am Vet Med Assoc. Published online March 7, 2024. 

. Published online May 21, 2024:1-1. doi:https://doi.org/10.2460/javma.2024ret

Hanna B. The Clinical Trial You Are Reading May Not Be Accurate: Simple Ways to Tell. Presented at: American College of Veterinary Internal Medicine (ACVIM) forum; Minneapolis, Minnesota. June 6-8, 2024.

How trustworthy are randomized clinical trials?

Triaging clinical trials

Daniel Kraft, MD, delivers the keynote lecture at the ACVIM Forum 2024 conference in Minneapolis, Minnesota.

Artificial intelligence (AI) and digital technology are rapidly moving health care forward with the recent evolution of telehealth serving as an example. Along with other modern technological innovations, veterinary care providers should expect to see much more innovation to come in the next decade and at an even faster pace, according to Daniel Kraft, MD, founder of NextMed Health and the digital database Digital.Health, which includes Veterinary.Health. “It’s an interesting time,” he said.

American College of Veterinary Internal Medicine (ACVIM) Forum

 in Minneapolis, Minnesota, Kraft delved deep into the various ways that digital and AI technologies are being combined with medical knowledge and research to create new ways to manage health care for humans and animals. But first, he demonstrated to the audience just how these modern technologies can be adapted for many different uses by playing a song he created using AI that celebrated the veterinary professionals in attendance. “It’s not bad for a first pass,” he said.

According to Kraft, a human medicine doctor who specializes in pediatrics, modern technology offers the promise of health care tools and resources that are more intelligent, digitized, personalized, data-driven, precise and preventive, democratized and equitable than ever before. He acknowledged that pet owners and human patients are already using AI services such as ChatGPT to self-diagnose medical conditions. A proponent of crowdsourcing information, Kraft noted the ease in which medical communities can also share research and innovation. One example he used is the crowdsourced Dog Aging Project.

Kraft’s lecture itself also demonstrated the value of technology and the ability to drive crowdsourcing with its livestream broadcast from Minneapolis. In the session’s digital chat, audience members provided locations from which they were virtually watching throughout the US and Canada, as well as from countries around the world that included The Netherlands, Germany, France, Ireland, Switzerland, South Africa and Australia.

One tool that could prove useful to veterinary practices is virtual reality (VR) applications. Notably, VR technology can be applied to telehealth visits or other digital resources for patients. “In real time, I can show up in a Zoom [call] as an avatar,” Kraft explained. “Avatars feel real and interact like they’re real.”

Augmented reality (AR) has the ability to enhance what health care providers and patients are actually viewing. It can perform body scans and show a patient the implications of their behaviors and health decisions in the years ahead. For example, poor eating habits, frequent screen time, and smoking would all have a negative physical impact on an individual. What a patient sees in their augmented reality may encourage them to make healthier choices, Kraft noted.

Although he used some human examples for demonstrating uses for VR and AR innovations, Kraft pointed out that technology used in human medicine can often be applied to animal health while the reverse is also true. “There are so many cross-connections between human medicine and veterinary medicine. We can help each other,” he said.

As the science of genomics continues to advance and be applied in both human and veterinary medicine, Kraft said this evolving innovation may one day yield vaccines for cancer, Alzheimer disease and Parkinson disease, among others. “Almost every disease can now be understood at its genomic level. We’ll leverage that for more precise and personalized care,” Kraft said.

He referenced the consumer-facing DNA at-home test kits from Basepaws, for dogs and cats, and 23andMe, for humans, as examples of how genomics can become more accessible. Kraft noted that these types of tests are also becoming less expensive. “The cost of sequencing is dropping,” he said.

For both humans and animals, at-home testing and diagnostics are evolving. Tools for at-home urine analysis and “poop’ables” relying on fecal matter to detect health data, for example, are on the horizon for wide health care use, Kraft predicted. “They’re coming to our homes and maybe our litter boxes,” he said.

Wearable technology is continuing to evolve beyond smart watches with smart rings, patches, digestibles, and even socks being used to monitor health and collect data. “These technologies are getting smaller and [more] wearable for any human or animal,” Kraft said.

Meanwhile, smartphone cameras are not only being used for telehealth but can now capture vital signs as well as conduct a fast urinalysis by using a photograph of a collected sample. Furthermore, innovations such as electroceuticals are on the verge of transforming medical care for patients with conditions such as Parkinson disease, for which tremors are detected and a pulse delivered to help manage them.

Along with telehealth, avatars and genomics, Kraft noted how veterinary and pharmacy services are being delivered are also changing. One way to visit a patient mimics the services of ride share companies like Uber, he noted, while drone deliveries of medical supplies is another area that is seeing growth. “The future of health is exiting,” Kraft said.

Despite all the recent and future advancements in health care advancements and innovations, Kraft told the ACVIM audience that instead of being replaced by technology, these tools will serve as “intelligent augmentation.” Rather than getting disrupted by these modalities, Kraft encouraged the audience to blend new technology into their practice and make it work to their advantage. For example, using tools that improve efficiencies can allow a veterinarian more time with patients.

He challenged the audience to re-imagine their practices and keep up with the profession’s technological evolution. He noted that just how COVID-19 ushered in an era of telehealth, the veterinary profession will change with AI and other advancements. “AI won’t replace veterinarians but veterinarians that use AI will replace those who don’t [use AI],” he said.

Kraft D. The Accelerating future of health and medicine, what’s now, near and next for veterinary care. Presented at: American College of Veterinary Internal Medicine Forum 2024; Minneapolis, MN. June 6-8, 2024.

A health care technology expert discussed recent advances in medical tools and digital enhancements, and what to expect in the next decade, during the keynote lecture at the 2024 ACVIM Forum

The future of veterinary medicine is here

Canine idiopathic epilepsy (IE) is one of the most commonly diagnosed and treated chronic neurological conditions, according to Zoe Bailey, DVM, neurology/neurosurgery resident at the University of Wisconsin-Madison.

 The cause of this epilepsy type is unknown, but a higher prevalence has been seen in purebred dogs vs mixed breed dogs, and male dogs are more commonly affected than females.

To treat IE, starting an antiepileptic drug (AED) is the most common route and usually the first line therapy. However, this is not always the best option for every patient and client. Bailey explained in her lecture at the 2024 

American College of Veterinary Internal Medicine Forum

 in Minneapolis, Minnesota, that adverse effects of this medication can negatively impact the client’s perception of their dog’s quality of life. Additionally, approximately 30% of dogs will be drug resistant to this specific treatment.

 Bailey noted some other therapies for this condition can include dietary changes, use of cannabidiol products, neurostimulation, and more.

Bailey participated in a study aimed at investigating the microbiota-gut-brain axis and its impact on epilepsy. In humans, probiotics have been found to decrease seizure frequency and severity,

 however, there has yet to be a large-scale study on dogs with IE. Bailey and other researchers used a probiotic (Visbiome Vet) with 42-client owned dogs previously diagnosed with IE and already taking a prescription AED. Dogs in this study were between the ages of 1 and 9 years and had a seizure history of at least 6 months, with a frequency of at least 1 every 3 months. “Dogs were enrolled on a rolling basis from January 2022 through May of 2023. So we did a prospective, placebo controlled, masked, crossover clinical trial, both with a 9- or 12-month period, there was a total of 3 or 4 phases, each of which was 3 months in duration,” Bailey explained during the ACVIM session.

The first phase was used as an observational period, also to have some control data as a basis before moving forward in the study. The second phase administered a daily placebo capsule provided by Visbiome Vet to the enrolled dogs. A daily dose of the probiotic from Visbiome Vet was given during phase 3 and adjusted based on the dog’s body weight. The study concluded with phase 4 in which dogs were observed again, now evaluating any changes in data with the introduction of a regular dose of probiotics.

By the end of the study, only 21 dogs had completed all 4 phases. “The other 21 dogs were excluded at various time points throughout the study due to the development of new diseases, the need for additional non-AED medications, dietary modifications, owner compliance, and death due to other circumstances,” said Bailey.

Seizure logs were maintained by owners and every seizure was documented. At the start of the study, 17 of the 21 completed dogs were on 2 or more AEDs and 12 of 21 dogs had their AED prescription adjusted by their veterinarian.

The study results revealed the following:

The mean seizure frequency in phase 1 (observational) was 8.3 seizures per month.

The mean seizure frequency in phase 2 (placebo) was 8.1 per month.

The mean seizure frequency in phase 3 (probiotic) was 6.5 per month.

Bailey concluded that, although there was some improvement discovered, the measurement of seizure frequency was not statistically significant enough to prove the use of probiotics improves the outcomes of dogs with IE. Some of the limitations of this particular study was a small population size and reliance on owners for seizure detection and documentation. “So really, the next steps that we're still in progress with are evaluating the microbiome of this population of dogs with refractory idiopathic epilepsy. And then [also] to determine if this biome alters their microbiome,” Bailey said.

Bailey Z. Effect of a probiotic on seizure frequency in dogs with idiopathic epilepsy receiving anti-epileptic drugs. Presented at: American College of Veterinary Internal Medicine Forum; Minneapolis, MN; June 5, 2024.

Canine Idiopathic Epilepsy. University of Missouri Veterinary Health Center. Accessed June 6, 2024. 

https://vhc.missouri.edu/small-animal-hospital/neurology-neurosurgery/facts-on-neurologic-diseases/canine-idiopathic-epilepsy/

Gómez-Eguílaz M, Ramón-Trapero JL, Pérez-Martínez L, Blanco JR. The beneficial effect of probiotics as a supplementary treatment in drug-resistant epilepsy: a pilot study. 

. 2018;9(6):875-881. doi:10.3920/BM2018.0018

Zoe Bailey, DVM, presented her research findings to attendees at the 2024 American College of Veterinary Internal Medicine Forum

Studying the effects of probiotics for idiopathic epilepsy

Nicola Lakeman explains her tip to communicating nutrtion needs without arguments

Interview with Nicola Lakeman

When it comes to change, it can be tricky to adapt, especially when it comes to pets. However, when it is time to talk to clients about changing something about their pet's diet, clients might not be as open to the idea as the veterinary team would hope. So, what can professionals do when this happens to them?

 in Minneapolis, Minnesota, Nicola A. Lakeman, MSc, BSc (Hons), RVN, CertVNECC, CertSAN, VTS (Nutrition), shared her advice for veterinary professionals to use when they are communicating with clients who may not be too fond of changing things about their pet's diet. 

The following is a partial transcript of the video:

Nicola A. Lakeman, MSc, BSc (Hons), RVN, CertVNECC, CertSAN, VTS (Nutrition): 

For some people, the default is 'No, I don't want to change' because none of us like change very well, very quickly. [They] might need time to think over that recommendation that you've given. They might need to talk to family members, or talk to other peers within their group to be able to process your recommendation before saying 'yes.' It's not that you've not done your job properly. It's not that they've not taken your recommendation. They just haven't taken your recommendation yet. So, don't feel [like] a failure, like you haven't done your job properly. We all go on a change cycle and that change cycle, it takes time.

Videos

Nicola A. Lakeman, MSc, BSc, (Hons), RVN, CertVNECC, CertSAN, VTS (Nutrition), shares a piece of advice for communicating nutrition with clients

Communication without argumentation

A recent study led by the University of Arizona College of Veterinary Medicine, Tucson (CVM) sought to discover if a partnership with a trained service dog was associated with decreased post-traumatic stress disorder (PTSD) symptom severity, lower anxiety, lower depression, and greater psychosocial functioning. According to the study’s findings, military members and veterans with PTSD reported having reduced symptoms after partnering with trained service dogs.

The nonrandomized controlled trial, which was funded by the National Institutes of Health (NIH), represents the largest study in the United States that compares service dog partnerships to standard care alone. The participants consisted of 156 military members and veterans with PTSD that were recruited from the database of K9s For Warriors, a nonprofit organization that provides service dogs for veterans with PTSD, traumatic brain injury, or military sexual trauma. Of the 156 participants, 81 received service dogs while 75 were placed on a waitlist. Following a 3-month period, the 81 participants who received service dogs reported significantly reduced severity of PTSD symptoms, anxiety, and depression. They also experienced decreased social isolation and increased companionship compared to the 75 participants in the control group. All participants had unrestricted access to their regular care throughout the study.

“When you add [the partnership of service dogs] to existing medical practices, it can enhance your experience and reduce your symptoms more,” Maggie O’Haire, PhD, associate dean for research, professor at the CVM, and coauthor of the study, said in a news article.

A veteran service dog is a carefully trained companion for military veterans navigating challenges stemming from their service. These canine companions are instructed in tasks like retrieving objects, opening doors, and providing stability to enhance the veteran's independence. They can also recognize signs of distress, wake veterans up from nightmares, calm panic attacks, and ease feelings of isolation and depression.

 Approximately 52% of veterans suffer from PTSD.

Service dogs are widely sought after by veterans suffering from PTSD. In fact, these service dogs make up more than 19% of assistance dog partnership in the world, making them the 4th largest category, following guide dogs, mobility assistance dogs, and assistance dogs for autism.

 published earlier this year also conducted by the CVM measured cortisol levels in veterans with a service dog and those without. The study found that veterans with a service dog had healthier levels of cortisol than those without a service dog. These findings correlate with those of CVM’s latest trial, underlining the impact of service dogs on the wellbeing of veterans with PTSD.

Service dogs may reduce PTSD symptoms for military members and veterans. News release. National Institutes of Health. June 4, 2024. Accessed June 5, 2024. 

https://www.nih.gov/news-events/news-releases/service-dogs-may-reduce-ptsd-symptoms-military-members-veterans

Johnson CK. Service dogs helped ease PTSD symptoms in US military veterans, researchers say.

https://apnews.com/article/ptsd-service-dogs-military-veterans-805783ec5b5ded646831fee0e88ed2da#

How service dogs benefit and impact veterans’ wellbeing. Mission Roll Call. September 13, 2023. Accessed June 5, 2024. 

https://www.missionrollcall.org/post/how-service-dogs-benefit-and-impact-veterans-well-being

Yankowicz S. Veterans report healthier cortisol levels from the support and companionship of service dogs. 

 February 15, 2024. Accessed June 5, 2024. 

https://www.dvm360.com/view/veterans-report-healthier-cortisol-levels-from-the-support-and-companionship-of-service-dogs

Leighton SC, Nieforth LO, O’Haire ME. Assistance dogs for military veterans with PTSD: A systematic review, meta-analysis, and meta-synthesis. 

The trial is the largest one in the nation that compares service dog partnerships to standard care alone