“Thermography provides another link in the chain of diagnostics”
Lucinda Ticehurst BSc BVMed Sci (Hons) BVM BVS MRCVS Equine Veterinary Surgeon at Averley Equine an ambulatory veterinary service covering Leicestershire, Warwickshire and Northamptonshire.
Lucinda graduated from the School of Veterinary Medicine and Science, Nottingham University in 2014. She was involved in a number of diverse equine cases during her training where she spent time in Australia, Argentina, Africa and India. During this time, she undertook charity work with animals affected by extreme poverty to top class polo pony medical and surgical management and reproduction. In a personal and professional capacity, Lucinda has a keen interest in orthopaedics as well as the performance horse with the aim to optimise performance and longevity, as well as preventative care. She works with all types of horses including American Miniatures, hairy cobs and elite eventers.
Lucinda has been using infrared imaging for her own horses and those of her clients since 2016. She currently uses Vet-IR services and prior to that SyncThermology.
Thermography doesn’t yet feature extensively (if at all) in mainstream veterinary education so peoples’ first experience of the technology vary. How did you first find out about it?
I learnt about thermography several years ago when I came across a basic heat detecting camera used by some horse trainers and dealers. I could see the potential but also all the flaws associated with poor quality scanners, insufficient software, poor protocols and non-specialist interpreters. Any technology that could help a horse in a non-invasive manner appeals to me. I believe multiple different modalities are often synergistic in identifying pathology in a horse and ultimately aiding treatment and recovery.
Vet-IR’s mission is to make infrared imaging an integrated part of the veterinarian’s diagnostic toolkit through education and providing access to a clinical standard imaging service. How did you first cross paths with Vet-IR?
Several years after my first encounter with thermography I came across Julia La Garde, Imaging Consultant for Vet-IR (when I first met her, SyncThermology). She was based at a clients yard so came up in discussion. It turns out that we have a mutual friend that Jules used to work with who is an expert human physiotherapist. I also had Jules highly recommended to me as a classical dressage and biomechanics coach.
From the beginning Jules’ extensive knowledge and faith in the technology has been evident. It’s invaluable to be presented with case studies, science, advanced software, caring, efficient and experienced technicians and specialist veterinary interpreters along with acknowledgement of when it can be beneficial alongside the limitations.
Veterinary interpretation is the cornerstone of Vet-IR’s imaging service. What did you think about your first imaging experience and report?
I was very impressed at the speed of the report, the clarity in the layout and how comprehensive it was. The whole process was really facilitated. Clear protocols that are easily followed then patient and thorough technicians resulting in calm and happy horses and owners. There was positive feedback immediately from the client.
How did your relationship with Vet-IR develop to the point that you now refer regularly?
Via strong communication. We had a meeting with SyncThermology at work, everything was explained very well. I then invited the company to speak at one of our client evenings. Once people were more educated about the clinical standard of thermology available we had requests for its use in appropriate cases and realistic expectations.
Like any imaging modality, case selection is key. How do you select cases to put forward for infrared imaging?
I use thermography in a variety of cases. I try and ask the technology a question but I also find it useful for generic symptoms too, or possible behavioural cases. I want to try and eliminate certain pathology as well as look for localising a problematic area. I use it when suspecting nerve dysfunction, neck pain (what I think is an under diagnosed area), SI disease, temporo mandibular pain, mild dorsal spinal process impingement… When working with the advanced performance horse I want to know about areas of concern and potential problems to aid future and current management and look to prevent major structural changes before they are irreversible.
At times thermographic imaging is used as a last resort when all other diagnostics have been inconclusive or money has run out. At what point do you use it in the lameness or poor performance investigation timeline?
I like to use thermography sooner rather than later. A lot of other diagnostics carry risk (excessive radiation with survey radiographs), a big price tag (MRI) and significant stress to the horse (nuclear scintigraphy). I do a comprehensive physical exam and use that alongside thermography to help plan onwards. This means I can use an appropriate imaging modality relevant to the specific area that has been localised as having activity. In other cases I use it to eliminate (or not) areas of high suspicion, for example, the sacroiliac. I make a case by case judgement based on the individual and the relevant stakeholders.
How do you use the thermographic report to help inform the next step of your investigation?
Once I’ve received the report I have a thorough discussion with the owner and rider. The report greatly facilitates this as it’s segmented into anatomical areas with a ‘Discussion of findings’ at the end. Within the discussion the specialist interpreting vet highlights the finding that they would consider most relevant and significant and they order the other findings based on importance thereafter.
I often find the scan results correspond with my suspicions, however I have also discovered areas of interest that I may have dismissed without using thermography. I also find it very useful as a future management tool and note what areas may have instability or a potentially progressive issue that is currently subclinical but will need investigating at some point. Therefore, even a scan that doesn’t provide immediate answers or direction to the current questions may well still be very useful as time passes.
The applications for thermographic imaging aren’t limited to assisting with lameness or poor performance investigations. Do you use thermography for ongoing monitoring or monitoring rehabilitation?
I’ve had limited use of thermography to monitor and aid rehabilitation of cases. This is a real shame because I think it would be really beneficial long-term. This is an owner driven limitation. They don’t consider quite how dynamic all the processes involved in the physiology of the horse are. Changes over time can be a lot more helpful than a snapshot in time in forming the full clinical picture.
What is the biggest benefit of having thermography in your diagnostic toolkit and the reason that you continue to use it?
Thermography provides another link in the chain of diagnostics. A real plus point to me is that it does not cause stress to the horse. It can be done in their home or a relaxing environment, no drugs are needed, no discomfort, no risk to personnel etc. It is very helpful in localising areas of activity as a screening tool.
Does offering thermography improve your client relationships?
I pride myself on offering an informed choice – the gold standard option and the other options, along with their pros and cons, be it financial, suitable for their individual horse etc. I think my clients like the fact that I am all about the horse. I understand their specific individual character, that they have a certain role and they’re often fundamental in family life. I have very good trust from all my clients and they know whatever advice I give would never be biased to financial gain – (a pet hate of mine is any vet that acts differently.) I am a horse owning vet so I know how bills can mount up. In fact I probably warn about money too much!
The worst thing that could happen with thermography is a minor loss of money. The best thing is that we could crack the clinical dilemma and get their horse back on the road.