Artificial intelligence in veterinary diagnostic imaging: Perspectives and limitations.

The field of veterinary diagnostic imaging is undergoing significant transformation with the integration of artificial intelligence (AI) tools. This manuscript provides an overview of the current state and future prospects of AI in veterinary diagnostic imaging. The manuscript delves into various applications of AI across different imaging modalities, such as radiology, ultrasound, computed tomography, and magnetic resonance imaging. Examples of AI applications in each modality are provided, ranging from orthopaedics to internal medicine, cardiology, and more. Notable studies are discussed, demonstrating AI's potential for improved accuracy in detecting and classifying various abnormalities. The ethical considerations of using AI in veterinary diagnostics are also explored, highlighting the need for transparent AI development, accurate training data, awareness of the limitations of AI models, and the importance of maintaining human expertise in the decision-making process. The manuscript underscores the significance of AI as a decision support tool rather than a replacement for human judgement. In conclusion, this comprehensive manuscript offers an assessment of the current landscape and future potential of AI in veterinary diagnostic imaging. It provides insights into the benefits and challenges of integrating AI into clinical practice while emphasizing the critical role of ethics and human expertise in ensuring the wellbeing of veterinary patients.

2024 RECOVER Guidelines: Basic Life Support. Evidence and knowledge gap analysis with treatment recommendations for small animal CPR.

OBJECTIVE: To systematically review evidence and devise treatment recommendations for basic life support (BLS) in dogs and cats and to identify critical knowledge gaps. DESIGN: Standardized, systematic evaluation of literature pertinent to BLS following Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Prioritized questions were each reviewed by 2 Evidence Evaluators, and findings were reconciled by BLS Domain Chairs and Reassessment Campaign on Veterinary Resuscitation (RECOVER) Co-Chairs to arrive at treatment recommendations commensurate to quality of evidence, risk to benefit relationship, and clinical feasibility. This process was implemented using an Evidence Profile Worksheet for each question that included an introduction, consensus on science, treatment recommendations, justification for these recommendations, and important knowledge gaps. A draft of these worksheets was distributed to veterinary professionals for comment for 4 weeks prior to finalization. SETTING: Transdisciplinary, international collaboration in university, specialty, and emergency practice. RESULTS: Twenty questions regarding animal position, chest compression point and technique, ventilation strategies, as well as the duration of CPR cycles and chest compression pauses were examined, and 32 treatment recommendations were formulated. Out of these, 25 addressed chest compressions and 7 informed ventilation during CPR. The recommendations were founded predominantly on very low quality of evidence and expert opinion. These new treatment recommendations continue to emphasize the critical importance of high-quality, uninterrupted chest compressions, with a modification suggested for the chest compression technique in wide-chested dogs. When intubation is not possible, bag-mask ventilation using a tight-fitting facemask with oxygen supplementation is recommended rather than mouth-to-nose ventilation. CONCLUSIONS: These updated RECOVER BLS treatment recommendations emphasize continuous chest compressions, conformation-specific chest compression techniques, and ventilation for all animals. Very low quality of evidence due to absence of clinical data in dogs and cats consistently compromised the certainty of recommendations, emphasizing the need for more veterinary research in this area.

2024 RECOVER Guidelines: Methods, evidence identification, evaluation, and consensus process for development of treatment recommendations.

OBJECTIVE: To describe the methodology used by the Reassessment Campaign on Veterinary Resuscitation (RECOVER) to re-evaluate the scientific evidence relevant to CPR in small and large animals, to newborn resuscitation, and to first aid and to formulate the respective consensus-based clinical guidelines. DESIGN: This report describes the evidence-to-guidelines process employed by RECOVER that is based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach and includes Information Specialist-driven systematic literature search, evidence evaluation conducted by more than 200 veterinary professionals, and provision of clinical guidelines in the domains of Preparedness and Prevention, Basic Life Support, Advanced Life Support, Post-cardiac Arrest Care, Newborn Resuscitation, First Aid, and Large Animal CPR. SETTING: Transdisciplinary, international collaboration in academia, referral practice, and general practice. RESULTS: For this update to the RECOVER 2012 CPR guidelines, we answered 135 Population, Intervention, Comparator, and Outcome (PICO) questions with the help of a team of Domain Chairs, Information Specialists, and more than 200 Evidence Evaluators. Most primary contributors were veterinary specialists or veterinary technician specialists. The RECOVER 2024 Guidelines represent the first veterinary application of the GRADE approach to clinical guideline development. We employed an iterative process that follows a predefined sequence of steps designed to reduce bias of Evidence Evaluators and to increase the repeatability of the quality of evidence assessments and ultimately the treatment recommendations. The process also allowed numerous important knowledge gaps to emerge that form the foundation for prioritizing research efforts in veterinary resuscitation science. CONCLUSIONS: Large collaborative, volunteer-based development of evidence- and consensus-based clinical guidelines is challenging and complex but feasible. The experience gained will help refine the process for future veterinary guidelines initiatives.

Optimization and validation of metabolomics methods for feline urine and serum towards application in veterinary medicine.

BACKGROUND: Metabolomics is an emerging and powerful technology that offers a comprehensive view of an organism's physiological status. Although widely applied in human medicine, it is only recently making its introduction in veterinary medicine. As a result, validated metabolomics protocols in feline medicine are lacking at the moment. Since biological interpretation of metabolomics data can be misled by the extraction method used, species and matrix-specific optimized and validated metabolomic protocols are sorely needed. RESULTS: Systematic optimization was performed using fractional factorial experiments for both serum (n = 57) and urine (n = 24), evaluating dilution for both matrices, and aliquot and solvent volume, protein precipitation time and temperature for serum. For the targeted (n = 76) and untargeted (n = 1949) validation of serum respectively, excellent instrumental, intra-assay and inter-day precision were observed (CV ≤ 15% or 30%, respectively). Linearity deemed sufficient both targeted and untargeted (R2 ≥ 0.99 or 0.90, respectively). An appropriate targeted recovery between 70 and 130% was achieved. For the targeted (n = 69) and untargeted (n = 2348) validation of the urinary protocol, excellent instrumental and intra-assay precision were obtained (CV ≤ 15% or 30%, respectively). Subsequently, the discriminative ability of our metabolomics methods was confirmed for feline chronic kidney disease (CKD) by univariate statistics (n = 41 significant metabolites for serum, and n = 55 for urine, p-value<0.05) and validated OPLS-DA models (R2(Y) > 0.95, Q2(Y) > 0.65, p-value<0.001 for both matrices). SIGNIFICANCE: This study is the first to present an optimized and validated wholistic metabolomics methods for feline serum and urine using ultra-high performance liquid chromatography coupled to quadrupole-Orbitrap high-resolution mass spectrometry. This robust methodology opens avenues for biomarker panel selection and a deeper understanding of feline CKD pathophysiology and other feline applications.

The use of telepathology in veterinary medicine: a scoping review.

Telepathology, as a subset of teleconsulting, is pathology interpretation performed at a distance. Telepathology is not a new phenomenon, but since ~2015, significant advances in information technology and telecommunications coupled with the pandemic have led to unprecedented sophistication, accessibility, and use of telepathology in human and veterinary medicine. Furthermore, telepathology can connect veterinary practices to distant laboratories and provide support for underserved animals and communities. Through our scoping review, we provide an overview of how telepathology is being used in veterinary medicine, identify gaps in the literature, and highlight future areas of research and service development. We searched MEDLINE, CAB Abstracts, and the gray literature, and included all relevant literature. Despite the widespread use of digital microscopy in large veterinary diagnostic laboratories, we identified a paucity of literature describing the use of telepathology in veterinary medicine, with a significant gap in studies addressing the validation of whole-slide imaging for primary diagnosis. Underutilization of telepathology to support postmortem examinations conducted in the field was also identified, which indicates a potential area for service development. The use of telepathology is increasing in veterinary medicine, and pathologists must keep pace with the changing technology, ensure the validation of innovative technologies, and identify novel uses to advance the profession.

Minimal criteria for reporting mesenchymal stem cells in veterinary regenerative medicine.

The widespread application of mesenchymal stem cells (MSCs) in veterinary regenerative medicine highlights their promising therapeutic potential. However, the lack of standardized characterization and reporting practices across studies poses a significant challenge, compromising the assessment of their safety and efficacy. While criteria established for human MSCs serve as a foundation, the unique characteristics of animal-derived MSCs warrant updated guidelines tailored to veterinary medicine. A recent position statement outlining minimal reporting criteria for MSCs in veterinary research reflects efforts to address this need, aiming to enhance research quality and reproducibility. Standardized reporting criteria ensure transparency, facilitate evidence synthesis, and promote best practices adoption in MSC isolation, characterization, and administration. Adherence to minimal reporting criteria is crucial for maintaining scientific rigor and advancing the field of veterinary regenerative medicine. Ongoing collaboration among stakeholders is essential for effective implementation and adherence to updated guidelines, fostering excellence and innovation in MSC-based therapies for animal patients.

Use of FTA card for the detection of two RNA (CSFV and SV-A) and two DNA viruses (ASFVand SuHV-1) of importance in veterinary medicine.

The FTA card has emerged as a promising alternative for nucleic acid extraction. The FTA card is a filter paper impregnated with chemicals that preserve and stabilize the genetic material present in the sample, allowing for its storage and transport at room temperature. The aim of this study was to test the card for the detection of RNA and DNA nucleic acids. Two RNA viruses (Senecavirus A and classical swine fever virus) and two DNA viruses (African swine fever virus and suid alphaherpesvirus 1) were tested, and in all cases, there was a decrease in sensitivity. The methods exhibited good repeatability and demonstrated a rapid and practical use for sample transport and nucleic acid extraction.

AI chatbots in pet health care: Opportunities and challenges for owners.

The integration of artificial intelligence (AI) into health care has seen remarkable advancements, with applications extending to animal health. This article explores the potential benefits and challenges associated with employing AI chatbots as tools for pet health care. Focusing on ChatGPT, a prominent language model, the authors elucidate its capabilities and its potential impact on pet owners' decision-making processes. AI chatbots offer pet owners access to extensive information on animal health, research studies and diagnostic options, providing a cost-effective and convenient alternative to traditional veterinary consultations. The fate of a case involving a Border Collie named Sassy demonstrates the potential benefits of AI in veterinary medicine. In this instance, ChatGPT played a pivotal role in suggesting a diagnosis that led to successful treatment, showcasing the potential of AI chatbots as valuable tools in complex cases. However, concerns arise regarding pet owners relying solely on AI chatbots for medical advice, potentially resulting in misdiagnosis, inappropriate treatment and delayed professional intervention. We emphasize the need for a balanced approach, positioning AI chatbots as supplementary tools rather than substitutes for licensed veterinarians. To mitigate risks, the article proposes strategies such as educating pet owners on AI chatbots' limitations, implementing regulations to guide AI chatbot companies and fostering collaboration between AI chatbots and veterinarians. The intricate web of responsibilities in this dynamic landscape underscores the importance of government regulations, the educational role of AI chatbots and the symbiotic relationship between AI technology and veterinary expertise. In conclusion, while AI chatbots hold immense promise in transforming pet health care, cautious and informed usage is crucial. By promoting awareness, establishing regulations and fostering collaboration, the article advocates for a responsible integration of AI chatbots to ensure optimal care for pets.

Itraconazole in human medicine and veterinary practice.

Diagnosis and management of fungal infections are challenging in both animals and humans, especially in immunologically weakened hosts. Due to its broad spectrum and safety profile when compared to other antifungals, itraconazole (ITZ) has been widely used in the treatment and prophylaxis of fungal infections, both in human and veterinary medicine. The dose and duration of management depend on factors such as the type of fungal pathogen, the site of infection, sensitivity to ITZ, chronic stages of the disease, the health status of the hosts, pharmacological interactions with other medications and the therapeutic protocol used. In veterinary practice, ITZ doses generally vary between 3 mg/kg and 50 mg/kg, once or twice a day. In humans, doses usually vary between 100 and 400 mg/day. As human and veterinary fungal infections are increasingly associated, and ITZ is one of the main medications used, this review addresses relevant aspects related to the use of this drug in both clinics, including case reports and different clinical aspects available in the literature.

Critical Advances for Democratizing Ultrasound Diagnostics in Human and Veterinary Medicine.

The democratization of ultrasound imaging refers to the process of making ultrasound technology more accessible. Traditionally, ultrasound imaging has been predominately used in specialized medical facilities by trained professionals. Advancements in technology and changes in the health-care landscape have inspired efforts to broaden the availability of ultrasound imaging to various settings such as remote and resource-limited areas. In this review, we highlight several key factors that have contributed to the ongoing democratization of ultrasound imaging, including portable and handheld devices, recent advancements in technology, and training and education. Examples of diagnostic point-of-care ultrasound (POCUS) imaging used in emergency and critical care, gastroenterology, musculoskeletal applications, and other practices are provided for both human and veterinary medicine. Open challenges and the future of POCUS imaging are presented, including the emerging role of artificial intelligence in technology development.

Physical Rehabilitation in Zoological Companion Animals.

Animal physical rehabilitation is one of the fast-growing fields in veterinary medicine in recent years. It has become increasingly common in small animal practice and will continue to emerge as an essential aspect of veterinary medicine that plays a vital role in the care of animals with physical impairments or disabilities from surgery, injuries, or diseases.1 This is true now more than ever because of the increasing advances in lifesaving treatments, the increased lifespan of companion animals, and the growth of chronic conditions, of which many are associated with movement disorders. The American Association of Rehabilitation Veterinarians (AARV) defines APR as "the diagnosis and management of patients with painful or functionally limiting conditions, particularly those with injury or illness related to the neurologic and musculoskeletal systems." Rehabilitation not only focuses on recovery after surgical procedures but also on improving the function and quality of life in animals suffering from debilitating diseases such as arthritis or neurologic disorders. The overall goal of APR is to decrease pain, reduce edema, promote tissue healing, restore gait and mobility to its prior activity level, regain strength, prevent further injury, and promote optimal quality of life. Typically, a multimodal approach with pharmaceutical and nonpharmaceutical interventions is used by APR therapists to manage patients during their recovery. The purpose of this article aims to provide knowledge and guidance on physical rehabilitation to help veterinarians in the proper return of their patients with ZCA safely after injury and/or surgery.

Applying the indicator amino acid oxidation technique in the domestic cat: results of a pilot study and development of a non-steady state prediction model.

The aim of this study was to evaluate whether the indicator amino acid oxidation (IAAO) method could be applied in the domestic cat. Six adult male cats were used in a replicated 3 × 3 Latin square design. Three semi-synthetic diets were developed: a methionine (Met) and total sulfur AA (TSAA) deficient diet (T-BASAL; 0.24% Met+Cys - DM basis) and two Met and TSAA-sufficient diets in which either dl-Met (T-DLM) or 2-hydroxy-4-(methylthio)-butanoic acid (T-MHA) were supplemented, respectively, on an equimolar basis to meet the TSAA requirement (0.34%). After a 2-d diet adaptation, IAAO studies were performed. Cats were offered 13 small meals. The sixth meal contained a priming dose (4.8 mg/kg-BW) of l-[1-13C]-Phe and the remaining meals a constant dose (1.04 mg/kg-BW). Breath samples were collected every 25 min to measure 13CO2 enrichment. The following morning, fasted blood samples were collected. Cats returned to the T-BASAL top dressed with a dl-Met solution for 4 d prior to being fed a new dietary treatment. Isotopic steady state was evaluated through visual inspection. Data were analyzed using PROC GLIMMIX procedure in SAS 9.4. While 13CO2 enrichment was successfully captured in breath samples, cats failed to reach 13CO2 steady state. Thus, a non-steady state isotope model was developed and coded in ACSLX (V3.1.4.2) individually for each cat on each study day to predict 13CO2 enrichment, and then, calculate oxidation of l-[1-13C]-Phe (F13CO2). A higher predicted F13CO2 was observed for cats fed T-BASAL compared to the others (P < 0.05), while no differences were observed between T-DLM and T-MHA (P > 0.05). Cats fed T-DLM tended to have higher plasma Met concentrations compared to those fed T-BASAL with cats fed T-MHA intermediate (P = 0.0867). Plasma homocysteine concentrations were higher in cats fed T-BASAL compared to the others (P < 0.05), while threonine concentrations tended to be higher in cats fed T-BASAL compared to those fed T-MHA (P = 0.0750). In conclusion, short-term provision of a semi-synthetic diet deficient in Met may elicit a metabolic response aiming to conserve Met. The successful quantification of 13CO2 enrichment in breath and the higher predicted F13CO2 in cats fed a Met deficient diet suggest that the IAAO technique may be used in cats. Adaptations in the isotope protocol should be made to achieve 13CO2 steady state in breath and avoid mathematical modeling to predict F13CO2.

It is necessary to apply more sensitive techniques to improve our limited understanding of amino acid (AA) requirements of adult cats. The non-invasive indicator amino acid oxidation (IAAO) technique is highly sensitive in mature animals. However, while it has been widely applied in different species, this technique has yet to be used in cats. We used six healthy adult cats to evaluate whether the IAAO method could be successfully applied in this species. A similar continuous small meals regimen as reported in IAAO studies in dogs was used. An oral primed-constant isotope infusion protocol was applied where l-13C-Phenylalanine (l-[1-13C]-Phe) was used as the tracer and the oxidation of l-[1-13C]-Phe as the response of interest. Breath samples were collected to determine enrichment of 13CO2 in breath and calculate oxidation of l-[1-13C]-Phe. While we were able to collect breath samples using calorimetry chambers and capture enrichment of 13CO2 in breath, cats did not achieve steady state, which is necessary to calculate oxidation of l-[1-13C]-Phe. Modifications in the isotope protocol should be made to achieve steady state of 13CO2 in breath, and thus, to successfully apply the IAAO technique to determine requirement of AA in adult cats.

Application of the multi-theory model to explain veterinarians' intentions to use telehealth/telemedicine.

BACKGROUND: Telehealth adoption is being fueled by both technological breakthroughs and societal demands; however, veterinarians have yet to fully embrace the concept of telemedicine, limiting its use and potential benefits. The goal of this study was to evaluate how effective the multi-theory model (MTM) of health behaviour change explains the initiation and sustenance of telehealth use among veterinarians. METHODS: For this cross-sectional study, a research company was contracted to disseminate the MTM-based online survey to veterinarians currently engaged in clinical practice within the United States. RESULTS: A total of 243 veterinarians participated in this study. The most frequently reported age group among participants was 31-40 years (33.7%, n = 82). It was also noted that the majority of participants were female (70.0%, n = 170) and white (76.5%, n = 186). Hierarchical multiple regression showed that participatory dialogue (p = 0.037), species (p = 0.013) and previous monthly telehealth use (p = 0.040) were significant explanatory variables of initiation of telehealth use. Moreover, emotional transformation (p < 0.001) and previous monthly telehealth use (p = 0.035) were significant explanatory variables of sustenance of telehealth use. LIMITATIONS: The data were collected in July 2020, during a global pandemic, in which telehealth use surged across a variety of professions. As a result, the findings of the study may not be relevant in periods when there is no pandemic. CONCLUSIONS: Based on the findings of this study, researchers, educators and veterinary professionals should consider using MTM as theoretical framework to develop interventions to enhance telehealth use.

Googling for a veterinary diagnosis: A replication study using Google as a diagnostic aid.

BACKGROUND: The purpose of this study was to replicate in the veterinary context a BMJ study using Google to assist in diagnosis of complex cases. HYPOTHESIS/OBJECTIVES: To assess percentage of diagnoses identified using Google as a diagnostic aid in veterinary medicine. ANIMALS: None; 13 cases in cats and 17 in dogs published in JAVMA. METHODS: Cross-sectional survey of Google results from searches using keywords generated independently by a generalist and a specialist veterinarian who reviewed the published case history and diagnostic components while blind to the diagnosis. They offered diagnoses and generated up to 5 search strategies for each case. The top 30 Google results for each search were reviewed by the generalist to inform a final Google-aided diagnosis. Both veterinarians' initial diagnoses and the Google-aided diagnoses were compared with the published diagnoses. RESULTS: Google searching led to 52 diagnoses out of 60 possible. Twenty-two (42%, 95% confidence interval [95% CI] 29%-55%) Google-aided diagnoses matched the JAVMA diagnosis. This accuracy rate does not differ significantly from 58% (n = 15/26, 95% CI 38%-77%) identified in the BMJ study. Google-aided results were not statistically different from those achieved unaided by each veterinarian (33%, 95% CI 16%-50%). CONCLUSIONS AND CLINICAL IMPORTANCE: Published information found searching Google using keywords related to complicated or unusual cases could assist veterinarians to reinforce their initial diagnosis or consider other differential diagnoses. Search strategies using words representing either signs or the preliminary diagnoses can yield results useful to confirming a correct diagnosis.

Evidence-Based Complementary and Alternative Canine Orthopedic Medicine.

The use of complementary and alternative veterinary medicine (CAVM) continues to become more widespread, especially for the management of chronic pain conditions such as canine osteoarthritis. Many patients have comorbidities that preclude traditional medical options, have not adequately responded to conventional therapies, or have owners interested in pursuing a complementary approach. Evidence-based CAVM can serve as a safe and effective adjunct to manage chronic pain conditions. There is growing evidence in the veterinary literature for the use of acupuncture and some herbal supplements in the multimodal management of canine osteoarthritis. The majority of evidence supporting chiropractic is limited to equine and human literature.