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is distal acoustic shadowing caused by mineralized structures such as urinary calculi. This artifact is
caused by complete absorption of sound waves by the mineralized structure with creation of a signal void or shadow distal to the surface of the calculus. If shadowing is present then the conclusion can be drawn that there
is mineralized material in the urinary bladder. Another artifact that can be used to determine presence of mineralized calculi is the twinkle artifact. When color Doppler is placed on a mineralized structure with a highly irregular surface it will create Doppler signal without any actual flow present.
A few helpful tips and tricks
Urinary bladder ultrasound is a very dynamic examination due to the mobile nature of the bladder contents. Repositioning the patient is therefore very helpful and commonly used. Turning the patient from one side to
the other or from lateral to dorsal recumbency or vice versa has several effects. It moves different portions
of the bladder wall to the surface and areas that were previously obscured by near field artifacts or artifacts originating from the colon can now be assessed. It
can also be used to determine if any observed lesions are intraluminal and mobile or if they are sessile and associated with the bladder wall. Sediment can be moved and stirred up that way to differentiate from artifacts as described above. Can’t see the trigone because the bladder is in a too caudal location? Try having someone do a rectal examination and have them try to push intrapelvic structures such as the prostate cranially. Not sure if a shadowing structure is a calculus or an aggregation of mineralized sludge? This question is sometimes difficult to answer. Repositioning the patient or rolling them from side to side a few times often stirs up sediment and results in altered shape or dissolution of an aggregate of sludge whereas a calculus may change its location but not its size and shape. Palpation of the urinary bladder to move intraluminal contents is another good option. Doppler ultrasound is useful not only to elicit the above-mentioned twinkle artifact but is essential to determine if a mural mass is perfused or not (tumor vs. hematoma). It is also often used to improve visibility of ureteral jets. Presence of a visible urine jet through both ureterovesicular junctions into the urinary bladder is proof of patency (for example in presence
of trigonal urinary bladder masses) and location of the ureteral junction in order to rule out ectopic ureters
in dogs with urinary incontinence. To increase the frequency and visibility of ureteral jets a diuretic can be administered intravenously or subcutaneously which will result in increased urine production within a few minutes. References
1. J Vet Sci. 2017, 18(3): 399-406.
2. Vet Radiol Ultrasound 2006, 47(4): 384-390.
M. Moran1
1Vets in Business Limited, The Head Honcho, Bridgwater, United Kingdom
Mark Moran, BSc. MBA Vets in Business Limited Ashcott, TA7 9QS Somerset, United Kingdom
People are the key to the success of any organization which is why recruiting and retaining the right staff for your clinic is critical to its future development.
Before commencing the recruitment process there are a number of key processes that need to be complete first
Your Clinic’s Vision and Values
You must be able to describe to any prospective member of the practice staff an inspiring vision for the future of your practice that will encourages them to join you in the journey, and to describe the values that you will uphold whilst you are on the journey.
The vision and values are key to attracting applicants and helping them to understand the type of clinic
they will be joining, whilst also providing you with a benchmark to determine whether a candidate will be a good “fit” for your clinic. Failing to live up to a clinic’s values is the most common reason why well qualified candidates do not work out as anticipated.
The Job Descriptions
Recruiting a new member for the team is a good opportunity to review the job description of the role, even if they are replacing an existing member of staff. Developing job descriptions helps you to reflect on the key tasks the individual is to perform, and will allow both you and the candidate to judge whether they are suitable for the role.
The Person Specification
This should define the type of person for whom this
role would be suited. This should include the obvious technical qualifications that might be required, however it is really about the personal attributes that are required. These should reflect the clinic’s values in terms of personal character (empathetic, conscientious, self awareness, willingness to help others, etc.)
Your Singapore, the Tropical Garden City

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