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The anatomy of the skull, temporomandibular joints

(TMJ), and region of the tympanic bullae in the dog

and cat is complex because of superimposition of

cavities, sinuses, mandible, maxilla, dental arcades,

and neurocalvarium. Radiography of specific areas requires

close attention to the details of normal anatomy that will

aid in proper positioning for each image, based on the type

of study being done.

Improperly positioned radiographs can lead to anatomic

distortion of the skull anatomy, resulting in potential false

positive diagnoses.

RADIOGRAPHIC EXPOSURE

Exposures should be made using:

•High mAs: Lowest mA that, if there is an option, allows

use of a small focal spot in order to improve geometric

sharpness and, thus, ability to see fine osseous detail.

•Grids: Use if areas thicker than 10 cm are being imaged;

otherwise, tabletop technique is recommended.

Routine PRojections:

skull, tMj, & tyMPanic Bullae

LATERAL PROJECTION (Figure 1, page 54)

Positioning

1. For the right lateral projection, place the patient in right

lateral recumbency, with the nose and skull in an ex-

tended position.

2. In dolichocephalic and mesaticephalic dog breeds, place

a small rectangular sponge under the tip of the nose to

keep it parallel with the table. For brachycephalic dog

breeds and cats, use a 45-degree oblique sponge (wide

end away from the head).

3. Place the cervical spine, thoracic limbs, and thorax in a

lateral straight position relative to the skull.

4. Pull the thoracic limbs caudally.

To ensure the patient is straight in a lateral position:

•Place your hand along the ventral mandibles, positioning

your hand perpendicular to the table and the mandibles.

•Feel for the external occipital protuberance along the

caudodorsal margin of the skull (not as prominent in

brachycephalic breeds).

•Compare the relative level with the middorsal aspect of

the nasal cavity; this imaginary line should be parallel

to the table.

THE NEED FOR ANESTHESIAalthough some basic skull views may be obtained

with heavy sedation, general anesthesia is required to

obtain diagnostic skull radiographs for several reasons:

•During each imaging series of the skull, one of the

projections requires the mouth of the dog or cat to be

open when an exposure is made.

•The oblique and skyline projections require exact

positioning that is not possible in an awake dog or

cat, even if heavily sedated.

Imaging Essentials provides comprehensive

information on small animal radiography techniques.

The following anatomic areas have been addressed

in previous columns; these articles are available at

tvpjournal.com (search “Imaging Essentials”).

RadiogRaphy of the Small animal Skull:

TEMPOROMANDIbULAR JOINTS & TYMPANIC bULLAEMary Wilson, RT(R), CT, MR, CV;

Danielle Mauragis, CVT; and

Clifford R. Berry, DVM, Diplomate ACVR

University of Florida

•Thorax

•Elbow and antebrachium

•abdomen

•Carpus and manus

•Pelvis

•Tarsus and pes

•stifle joint and crus

•Cervical, thoracic, and lumbar spine

•scapula, shoulder, and humerus

•nasofacial and frontal sinuses

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| ImagIng EssEnTIals

Today’s Veterinary Practice May/June 201454 tvpjournal.com

detail and to reduce geometric magnification. The radiograph

should be reviewed to ensure that the right and left sides of the

skull are symmetrical for evaluation.

Positioning

To obtain the VD projection:

1. Place the patient in dorsal recumbency.

2. Extend the skull, with the external occipital protuberance rest-

ing on a thin sponge.

3. Ensure the ventral aspect of the mandibles and the hard pal-

ate, which cannot be visualized because the animal’s mouth is

closed, are parallel to the table.

4. Use a V-trough to help maintain the patient in a straight posi-

tion.

To obtain the DV projection:

1. Place the patient in ventral or sternal recumbency.

2. Extend the skull, with the mandibular rami placed on the table/

cassette/detector.

3. To ensure stabilization, place a thin radiolucent sponge be-

tween the patient’s ventral skull and the table/cassette/detec-

Collimation

1. Set the central beam to the mid cranium, with

the collimator opened to just include the crani-

um and nasal cavity (cross hairs just caudal and

ventral to the eyes).

2. Place an external radiopaque marker ventral to

the caudal mandible on the table or radiograph-

ic cassette.

3. If the area of interest is lateralized to one side,

place the side of interest closest to the detector,

in which case, the marker indicates which recum-

bency the patient has been placed.

4. If the area of interest is at the level of the max-

illa or mandible, the upper and lower jaw can

be separated (opened) by placing a syringe case

between the mandibular and maxillary canines.

Ensuring Image Quality

The lateral projection of the skull should extend

from the rostral end of the nose (nasal planum)

through the first cervical vertebra (C1). The wings

of the atlas and C1 should be even and superim-

posed, and all aspects of the skull should be super-

imposed, such as the zygomatic arches, mandibles,

and tympanic bullae.

Superimposition is more difficult in brachy-

cephalic breeds because their skulls are much

wider—geometric distortion from the divergent na-

ture of the x-ray beam may make superimposition

of all structures impossible.

VENTRODORSAL/DORSOVENTRAL

PROJECTION (Figure 2)

Ventrodorsal (VD) or dorsoventral (DV) position-

ing is dependent on the breed of dog or cat; while

deep-chested dogs are better imaged in VD position,

brachycephalic and small breed dogs and cats may

be better imaged in a DV position.

The area of interest should be as close to the

film/cassette/detector as possible for the best overall

Figure 1. Dog positioned for a right lateral radiograph of the caudal skull centered over the TMJ and tympanic bullae (A)

and corresponding radiograph (B). Collimated radiographs can be obtained if the area of interest only includes the TMJ

and tympanic bullae (C and D). A syringe case can be used to open the mouth for the lateral or the oblique projections to

ensure separation of the maxillary and mandibular dental arcades.

A b C D

Figure 2. Dog positioned for

VD radiograph of the caudal

skull centered over the TMJ

and tympanic bullae (A) and

corresponding radiograph (B).

A

b

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tor, as needed.

To ensure the patient is properly

positioned, place your hands:

•On either side of the skull, feeling

for the symmetry of the mandible

and/or zygomatic arches.

•Relative to either anatomic location

to be equidistant from the table on

the right and left sides.

Collimation

1. Set the central beam to the level

of the caudal zygomatic arch (at a

level just caudal to the eyes) with

the collimator opened to include

C1/C2, the neurocranium, and the

caudal portion of the nasal cavi-

ty (approximate level of maxillary

premolar 3).

2. Place the radiopaque marker on

the right side of the dog or cat, tak-

ing care to avoid superimposition

of the marker over any part of the

skull.

Ensuring Image Quality

For VD or DV images of the skull, the

rostral extent of the image should be

the nasal planum, while the caudal

extent is C1. Make sure the various

parts of the skull are symmetrically

positioned right and left, and not

obliqued. This may be impossible in

patients that have skull trauma with

multiple fractures.

bREED-bASED POSITIONING

although positioning for many of these projections is similar, use of sponges and tape will vary based on skull size and shape:•Dolichocephalic breeds (eg,

Doberman pinscher) have long, narrower heads•Mesaticephalic breeds (eg,

beagle) have medium sized and shaped heads•brachycephalic breeds (eg,

bulldog) have short, wide heads, with foreshortening of the nasal cavity and absence of frontal sinuses•Cats have more standard sized

and shaped heads; however, some brachycephalic cat breeds (eg, Persian) require the same considerations as brachycephalic dog breeds.

Figure 3. Dog

positioned for

an open-mouth

rostrocaudal

oblique radio-

graph of the

TMJ and tym-

panic bullae

(A) and corre-

sponding radio-

graph (B).

A

b

sPecific PRojections: tMj & tyMPanic Bullae

OPEN-MOUTH ROSTROCAUDAL ObLIQUE PROJECTION (Figure 3)

Positioning

1. Place the patient in dorsal recumbency.

2. Flex the neck, positioning the hard palate and mandibles perpendicu-

lar to the table and x-ray collimator system.

3. Place small triangle sponges under the external occipital protuber-

ance to help maintain a symmetric position on the table.

4. Place tape—starting from one side of the table at the level of the ab-

domen—and pass it around the patient’s nose, fastening it to the

other side of the table at the same level.

5. Angle the hard palate approximately 10 degrees rostral to the perpen-

dicular plane of the body.

6. Extend the mandible caudally (open mouth) with the endotracheal

tube secured to the mandible, taking care to avoid kinking the tube

and stopping the flow of oxygen/inhalation of anesthetic agent.

Collimation

1. Set the central beam through the open mouth at the level of the soft

palate.

2. Take care to ensure the cranium is straight, without lateral rotation.

3. Assess this positioning by standing at the patient’s head and placing

your hands on either side of the cranium, at the level of mandibular

rami, verifying both rami are equidistant to the table.

Ensuring Image Quality

The open-mouth projection should include both TMJ and tympanic

bullae without rotation or superimposition of the endotracheal tube.

Collimation should extend caudally from C1 to include the full tympanic

bullae rostrally.

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LATERAL 30-DEGREE ObLIQUE PROJECTION

(Figure 4)

Positioning

For a complete study, both right lateral and left lateral

oblique projections are needed.

1. Place the patient in lateral recumbency, with the

nose and skull in an extended position.

2. Ensure the mouth remains open, which can be ac-

complished with a syringe case, and secure the en-

dotracheal tube to the mandible.

3. Place a 30-degree wedge sponge under the maxilla

to ventrally oblique the skull.

When the initial projection is finished, take the op-

posite oblique projection by:

1. Rolling the patient over, with the original nonre-

cumbent side now on the table.

2. Placing a wedge sponge under the maxilla to ven-

trally rotate the head by 30 degrees.

Collimation

1. Position the central beam just ventral to the nonre-

cumbent external auditory canal (that closest to the

tube head).

2. Adjust collimation to include only the tympanic

Figure 4. Dog positioned in left lateral recumbency for

a 30-degree oblique radiograph of the nonrecumbent,

right tympanic bulla and TMJ (A) and corresponding

radiograph (B). Note: A roll of tape or a syringe case

can be used to keep the mouth open.

A

b

bulla and TMJ from the level of the third maxillary

premolar to C1/C2.

3. If the patient is in right lateral recumbency, for ex-

ample, the left TMJ, tympanic bulla, and ear will

move ventrally when positioned correctly.

4. Place the radiopaque markers outside soft tissue

structures: For the right lateral projection, place

the right marker ventral to the oblique, recumbent

bulla and the left marker just dorsal to the skull.

For the left lateral projection, the opposite is true,

with the left marker placed ventral to the oblique,

recumbent bulla.

Ensuring Image Quality

The lateral oblique projection should extend from mid

mandible to C1. One of the TMJs and tympanic bulla

should appear ventral but without superimposition

of the cranium. Care should be taken to avoid over

rotating the patient, causing foreshortening of the

vertical mandibular ramus and tympanic bulla.

LATERAL 25- TO 30-DEGREE ROSTROCAUDAL

ObLIQUE PROJECTION (Figure 5, page 57)

Positioning

For a complete study, both right lateral and left lateral

oblique projections are needed.

1. Place the patient in lateral recumbency, with the

cranium and nasal passages in true lateral position.

2. Place a triangular- or wedge-shaped radiolucent

sponge under the rostral aspect of the nose and

mandible, which lifts the nasal planum, nasal cav-

ity, and mandible 25- to 30-degrees away from the

table.

3. Ensure the mouth remains open, which can be ac-

complished by placing a syringe case between the

upper and lower canines.

When the initial projection is finished, take the op-

posite oblique projection by rolling the patient over,

with the original, nonrecumbent side now on the

table.

It is important to note that, in left lateral recum-

bency, the:

• Right TMJ and tympanic bulla are caudal and,

therefore, best visualized by this projection

• Left TMJ and tympanic bulla appear superimposed

over the caudoventral aspect of the skull.

The opposite is true for right lateral recumbency.

Collimation

1. Direct the central beam just rostral to the TMJ (that

closest to the tube head).

2. Adjust collimation to include only the tympanic

bulla and TMJ.

3. Mark the recumbent side, which will appear more

rostral on the radiograph.

Ensuring Image Quality

The rostrocaudal oblique projection should extend

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from mid mandible to C1. One of the TMJs

and tympanic bulla should appear rostral

to the other; the more rostral structures

should be those on the recumbent side of

the patient.

CLOSED-MOUTH ROSTROCAUDAL

ObLIQUE PROJECTION (Figure 6)

This projection is used for rostrocaudal eval-

uation of the tympanic bulla in brachyce-

phalic dogs and cats, and replaces the open-

mouth rostrocaudal projection described

earlier.

Positioning

1. Place the patient in dorsal recumben-

cy, supporting the body in a V-trough, as

needed.

2. Flex the neck, tilting the hard palate and

mandibles 10- to 15-degrees rostral to the

perpendicular plane of the table and x-ray

collimator system.

3. Use small triangle sponges under the ex-

ternal occipital protuberance to help main-

tain symmetry of the skull on the table.

4. Flex the skull—then take tape, and start-

Figure 6. Position-

ing for a closed-mouth

10- to 15-degree ros-

trocaudal oblique ra-

diograph of the TMJ

and tympanic bullae in

a boxer/mixed breed

dog (A) and corre-

sponding radiograph

(B). This view can be

used for brachyce-

phalic dog breeds and

in cats for evaluating

the tympanic bullae.

A

b

Figure 5. Dog

positioned in left

lateral recumbency

for a 30-degree

rostrocaudal oblique

radiograph of the

nonrecumbent, right

tympanic bulla (A)

and corresponding

radiograph that

depicts caudal

position of the

nonrecumbent

tympanic bulla, which

is best visualized in

this position (B).

The marker in

this image denotes

that, despite the left

lateral recumbency

position of the dog,

the right tympanic

bulla is caudal and,

therefore, better

visualized in this

projection.

b

A

ing from one side of the table

at the level of the abdomen,

pass it around the patient’s

nose, fastening it to the other

side of the table at the same

level.

5. Secure the endotracheal tube

rostrally to the maxilla, keep-

ing the mouth closed.

Collimation

1. Direct the central beam to the

tympanic bulla.

2. Take care to ensure the crani-

um is straight, without lateral

rotation.

3. Assess this positioning by

standing at the patient’s head

and placing your hands on ei-

ther side of the cranium, at

the level of mandibular rami,

verifying both rami are equi-

distant to the table.

Ensuring Image Quality

This closed-mouth rostrocaudal

oblique projection should in-

clude the tympanic bullae with-

out rotation or superimposition

of the endotracheal tube.

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QUALITY CONTROL

For quality control of any diagnostic image, use a simple

3-step approach.

1. Is the technique adequate, with appropriate exposure

and development?

2. Is the correct anatomy present within the image? Compare

the images you obtain with the images in this article.

3. Is positioning anatomically correct? Was correct ana-

tomic coverage obtained?

Once it is determined that the technique is adequate,

make sure the appropriate anatomy is present and posi-

tioning is correct, straight, and symmetric. Symmetry of

the skull for VD/DV images is critical when evaluating all

structures and osseous anatomy.

Use the figures in this article as a guide as well as the

information provided in the Ensuring Image Quality

sections.

SUMMARY

Radiographs of the skull allow evaluation of a number of

clinical signs related to the skull, TMJ, and tympanic bul-

lae. The images included in this article illustrate how to

produce and evaluate the quality of these radiographs.

High-quality, correctly positioned and collimated radio-

graphs are required in order to accurately assess the TMJ

and tympanic bullae. n

C1 = first cervical vertebra; DV = dorsoventral; TmJ = temporomandibular joint; VD = ventrodorsal

Suggested Reading Burk rL, Feeney dA. Small Animal Radiology and Ultrasonography: A Diag-

nostic Atlas and Text, 3rd ed. Philadelphia: Saunders elsevier, 2003.Kealy JK, McAllister H, Graham JP. Diagnostic Radiology and Ultrasonography

of the Dog and Cat, 5th ed. Philadelphia: Saunders elsevier, 2011.Sirois M, Anthony e, Mauragis d. Handbook of Radiographic Positioning for

Veterinary Technicians. Clifton Park, NY: delmar Cengage Learning, 2010.Thrall de (ed). Textbook of Veterinary Radiology, 6th ed. Philadelphia: Saun-

ders elsevier, 2012.Thrall de, robertson id. Atlas of Normal Radiographic Anatomy and Anatomic

Variants in the Dog and Cat. Philadelphia: elsevier Saunders, 2011.

N1 % (n=415) N2 % (n=200)

Vomiting (with and without blood) 17 4.1 25 12.5

Dry/Flaky Skin 13 3.1 2 1.0

Diarrhea (with and without blood) 13 3.1 7 3.5

Lethargy 7 1.7 4 2.0

Anorexia 5 1.2 9 4.5

Treatment Group

Afoxolaner Oral active control

™NexGard and FRONTLINE VET LABS are trademarks of Merial.©2014 Merial. All rights reserved.

Body Afoxolaner Per Chewables Weight Chewable (mg) Administered

4.0 to 10.0 lbs. 11.3 One

10.1 to 24.0 lbs. 28.3 One

24.1 to 60.0 lbs. 68 One

60.1 to 121.0 lbs. 136 One

Over 121.0 lbs. Administer the appropriate combination of chewables

CAUTION: Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian.

Description:NEXGARD™ (afoxolaner) is available in four sizes of beef-favored, soft chewables for oral administration to dogs and puppies according to their weight. Each chewable is formulated to provide a minimum afoxolaner dosage of 1.14 mg/lb (2.5 mg/kg). Afoxolaner has the chemical composition 1-Naphthalenecarboxamide, 4-[5- [3-chloro-5-(trifuoromethyl)-phenyl]-4, 5-dihydro-5-(trifuoromethyl)-3-isoxazolyl]-N-[2-oxo-2-[(2,2,2-trifuoroethyl)amino]ethyl.

Indications:NEXGARD kills adult feas and is indicated for the treatment and prevention of fea infestations (Ctenocephalides felis), and the treatment and control of American Dog tick (Dermacentor variabilis) infestations in dogs and puppies 8 weeks of age and older, weighing 4 pounds of body weight or greater, for one month.

Dosage and Administration:NEXGARD is given orally once a month, at the minimum dosage of 1.14 mg/lb (2.5 mg/kg).

Dosing Schedule:

NEXGARD can be administered with or without food. Care should be taken that the dog consumes the complete dose, and treated animals should be observed for a few minutes to ensure that part of the dose is not lost or refused. If it is suspected that any of the dose has been lost or if vomiting occurs within two hours of administration, redose with another full dose. If a dose is missed, administer NEXGARD and resume a monthly dosing schedule.

Flea Treatment and Prevention:Treatment with NEXGARD may begin at any time of the year. In areas where feas are common year-round, monthly treatment with NEXGARD should continue the entire year without interruption.

To minimize the likelihood of fea reinfestation, it is important to treat all animals within a household with an approved fea control product.

Tick Treatment and Control:Treatment with NEXGARD may begin at any time of the year (see Effectiveness).

Contraindications:There are no known contraindications for the use of NEXGARD.

Warnings:Not for use in humans. Keep this and all drugs out of the reach of children. In case of accidental ingestion, contact a physician immediately.

Precautions:The safe use of NEXGARD in breeding, pregnant or lactating dogs has not been evaluated. Use with caution in dogs with a history of seizures (see Adverse Reactions).

Adverse Reactions:In a well-controlled US feld study, which included a total of 333 households and 615 treated dogs (415 administered afoxolaner; 200 administered active control), no serious adverse reactions were observed with NEXGARD.

Over the 90-day study period, all observations of potential adverse reactions were recorded. The most frequent reactions reported at an incidence of > 1% within any of the three months of observations are presented in the following table. The most frequently reported adverse reaction was vomiting. The occurrence of vomiting was generally self-limiting and of short duration and tended to decrease with subsequent doses in both groups. Five treated dogs experienced anorexia during the study, and two of those dogs experienced anorexia with the frst dose but not subsequent doses.

Table 1: Dogs With Adverse Reactions.

1Number of dogs in the afoxolaner treatment group with the identifed abnormality.2Number of dogs in the control group with the identifed abnormality.

In the US feld study, one dog with a history of seizures experienced a seizure on the same day after receiving the frst dose and on the same day after receiving the second dose of NEXGARD. This dog experienced a third seizure one week after receiving the third dose. The dog remained enrolled and completed the study. Another dog with a history of seizures had a seizure 19 days after the third dose of NEXGARD. The dog remained enrolled and completed the study. A third dog with a history of seizures received NEXGARD and experienced no seizures throughout the study.

To report suspected adverse events, for technical assistance or to obtain a copy of the MSDS, contact Merial at 1-888-637-4251 or www.merial.com/nexgard. For additional information about adverse drug experience reporting for animal drugs, contact FDA at 1-888-FDA-VETS or online at http://www.fda.gov/AnimalVeterinary/SafetyHealth/ProductSafetyInformation.

Mode of Action:Afoxolaner is a member of the isoxazoline family, shown to bind at a binding site to inhibit insect and acarine ligand-gated chloride channels, in particular those gated by the neurotransmitter gamma-aminobutyric acid (GABA), thereby blocking pre- and post-synaptic transfer of chloride ions across cell membranes. Prolonged afoxolaner-induced hyperexcitation results in uncontrolled activity of the central nervous system and death of insects and acarines. The selective toxicity of afoxolaner between insects and acarines and mammals may be inferred by the differential sensitivity of the insects and acarines’ GABA receptors versus mammalian GABA receptors.

Effectiveness:In a well-controlled laboratory study, NEXGARD demonstrated 100% effectiveness against adult feas 24 hours post-infestation for 35 days, and was ≥ 93% effective at 12 hours post-infestation through Day 21, and on Day 35. On Day 28, NEXGARD was 81.1% effective 12 hours post-infestation. Dogs in both the treated and control groups that were infested with feas on Day -1 generated fea eggs at 12- and 24-hours post-treatment (0-11 eggs and 1-17 eggs in the NEXGARD treated dogs, and 4-90 eggs and 0-118 eggs in the control dogs, at 12- and 24-hours, respectively). At subsequent evaluations post-infestation, feas from dogs in the treated group were essentially unable to produce any eggs (0-1 eggs) while feas from dogs in the control group continued to produce eggs (1-141 eggs).

In a 90-day US feld study conducted in households with existing fea infestations of varying severity, the effectiveness of NEXGARD against feas on the Day 30, 60 and 90 visits compared with baseline was 98.0%, 99.7%, and 99.9%, respectively.

Collectively, the data from the two studies (one laboratory and one feld) demonstrate that NEXGARD kills feas before they can lay eggs, thus preventing subsequent fea infestations after the start of treatment of existing fea infestations.

In well-controlled laboratory studies, NEXGARD demonstrated >97% effectiveness against Dermacentor variabilis 48 hours post-infestation for 30 days.

Animal Safety:In a margin of safety study, NEXGARD was administered orally to 8- to 9-week-old Beagle puppies at 1, 3, and 5 times the maximum exposure dose (6.3 mg/kg) for three treatments every 28 days, followed by three treatments every 14 days, for a total of six treatments. Dogs in the control group were sham-dosed. There were no clinically-relevant effects related to treatment on physical examination, body weight, food consumption, clinical pathology (hematology, clinical chemistries, or coagulation tests), gross pathology, histopathology or organ weights. Vomiting occurred throughout the study, with a similar incidence in the treated and control groups, including one dog in the 5x group that vomited four hours after treatment.

In a well-controlled feld study, NEXGARD was used concomitantly with other medications, such as vaccines, anthelmintics, antibiotics (including topicals), steroids, NSAIDS, anesthetics, and antihistamines. No adverse reactions were observed from the concomitant use of NEXGARD with other medications.

Storage Information:Store at or below 30°C (86°F) with excursions permitted up to 40°C (104°F).

How Supplied:NEXGARD is available in four sizes of beef-favored soft chewables: 11.3, 28.3, 68 or 136 mg afoxolaner. Each chewable size is available in color-coded packages of 3 or 6 beef-favored chewables.

NADA 141-406, Approved by FDA

Marketed by: Frontline Vet Labs™, a Division of Merial Limited.Duluth, GA 30096-4640 USA

Made in Brazil.

1050-4493-00Rev. 7/2013

Mary Wilson, RT(R), CT, MR, CV, is a

registered radiologic technologist with the

American Registry of Radiologic Technologists.

She manages the diagnostic imaging section

at University of Florida College of Veterinary

Medicine.

Danielle Mauragis, CVT, is a radiology

technician at University of Florida College of

Veterinary Medicine where she teaches diag-

nostic imaging. She coauthored the Handbook

of radiographic Positioning for veterinary

Technicians and received the Florida Veterinary

Medical Association’s 2011 Certified Veterinary

Technician of the Year Award.

Clifford R. Berry, DVM, Diplomate ACVR, is

a professor in diagnostic imaging at University

of Florida College of Veterinary Medicine.

His research interests include cross-section-

al imaging of the thorax, nuclear medicine,

and biomedical applications of imaging. He

received his DVM from University of Florida and

completed a radiology residency at University of California–Davis.

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