Topics in Medicine and Surgery

Clinical Technique: Application of Computed

Tomography in Zoological Medicine
Elizabeth B. Mackey, DVM,
Stephen J. Hernandez-Divers, BVetMed, DZooMed, MRCVS, Dip. ACZM,
Mason Holland, VMD,
and Paul Frank, DVM, Dip. ACVR

Abstract
Computed tomography images generate multiple views of a target site of a patient,
resulting in 2-dimensional scans of the area. This form of imaging provides visualization of
internal anatomy without interference of adjacent and overlying structures, contributing to
our knowledge of normal anatomy and allowing us to more accurately assess changes in
clinically ill patients. Computed tomography has proven to be beneficial in establishing
diagnoses, prognoses, and treatment plans in numerous zoological species when used in
conjunction with other imaging modalities, and with the involvement of a dedicated
radiologist. Additional studies are needed to establish protocols for image collection and
criteria for evaluating the images. Copyright 2008 Elsevier Inc. All rights reserved.
Key words: computed tomography; zoological medicine; exotic pets; reptiles; small
mammals; avian

dvances in diagnostic techniques are continuously sought to assist clinical practitioners of

zoological medicine with making a definitive
diagnosis, providing an accurate prognosis, and determining the most appropriate treatment strategy. Many
of these techniques are extrapolated from those used
in domestic animal medicine and must often be altered to suit the unique anatomy and physiology of
zoological species. Imaging modalities, such as radiography and ultrasonography, have become part of our
standard protocol for many cases, whereas computed
tomography (CT), magnetic resonance imaging (MRI),
nuclear scintigraphy, and other more advanced tools
are used to a lesser degree. An increasing number of
studies are being performed with exotic pets and zoo
animals, contributing to our understanding of normal
anatomy, and verifying the benefits of using these modalities in conjunction with other diagnostic tools. The
Zoological Medicine Service at the University of Georgia has seen an increase in client acceptance in the use
of CT and MRI for bird, reptile, fish, and mammal
patients. However, there has been a disproportionate

198

growth in the use of CT, most likely related to its lower

costs and greater availability compared with those of
diagnostic MRI evaluations.

Computed Tomography
The CT (Siemens Somatom Star CT scanner; Siemens Medical Solutions USA, Malvern, PA USA)
From the Zoological Medicine Service, Department of Small
Animal Medicine and Surgery, College of Veterinary Medicine,
University of Georgia, Athens, GA USA, and Radiology, Department of Anatomy and Radiology, College of Veterinary Medicine,
University of Georgia, Athens, GA USA.
Address correspondence to: Elizabeth B. Mackey, DVM,
Department of Small Animal Medicine and Surgery, College of
Veterinary Medicine, University of Georgia, Athens, GA
30605. E-mail: emackey@uga.edu, shdivers@uga.edu.
2008 Elsevier Inc. All rights reserved.
1557-5063/08/1703-$30.00
doi:10.1053/j.jepm.2008.05.007

Journal of Exotic Pet Medicine, Vol 17, No 3 ( July), 2008: pp 198 209

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199

Figure 1. A Siemens Somatom AR. Star CT scanner illustrating the gantry (1) and anesthetized rabbit on the table. (2) After ensuring accurate
patient positioning, the technician moves to a safe control room to initiate scanning.

image is created by rotating an x-ray tube, located in

the gantry, around the anesthetized patient, who is
lying on the table (Fig 1). The x-rays, which penetrate the patient, are detected on the opposite side
of the patient. The x-ray tube emits a fan-shaped
beam of x-rays from multiple positions (often 1000
or more) as it rotates around the patient. This generates a slice of the imaged anatomy. The patient is
then moved to a position slightly further into the
gantry and the next slice is imaged, while the machine detects the new position of the table. This
process is repeated until the region of interest has
been scanned. A computer built into the scanner
then uses the x-ray dose received by the x-ray detectors in these multiple positions to generate a map of
x-rayattenuating structures present in each cross-

sectional slice. These structures are then displayed

on a computer screen using shades of gray. The
shade of gray corresponds to the x-rayattenuating
ability of the tissue, similar to that of plain radiography. The most attenuating tissues (e.g., bone, teeth)
are displayed closest to white, whereas gas and fat are
displayed closer to black. Unlike radiography, the
contrast resolution is very good, allowing differentiation of blood from other fluids, and various soft
tissues. Windowing and leveling may be thought
of as adjusting the contrast and brightness levels of
the image, and allow the tissue of interest (e.g., bone
or lung) to be optimally displayed (Fig 2).
A major advantage of CT over plain radiography
is the ability to visualize internal anatomy without
superimposition of adjacent structures. For example,

Figure 2. Transverse plane images of the midcoelom of a normal green iguana (Iguana iguana). The same image has been windowed to
enhance different tissue types. (A) Using a bone window (window width 2500, window level 480), osseous structures are optimally
displayed. Note the bony detail of the vertebra (arrow). (B) Using a lung window (window width 1500, window level 600), visualization
of pulmonary structures is optimized. Note the conspicuity of the septae, which define the lobes of the posterior chamber of the lungs (arrows).
(C) Using a soft tissue window (window width 500, window level 0), soft tissue contrast resolution is maximized. Note the excellent
contrast between fat body (1) and liver (2).

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when evaluating the head, radiography results in
superimposition of the complex bones of the skull,
which often hinder evaluation of the teeth. CT allows for the examination of skull and dental structures without superimposition. Another important
benefit of CT is the ability to acquire postcontrast
images. Intravenous iodinated contrast media can be
injected to enhance certain tissues. Soft tissue structures with abnormal vascularity due to disease (e.g.,
neoplasia, inflamed tissue) will have an increased
uptake of the iodinated contrast media, allowing for

Mackey et al

differentiation from normal tissue. The imaging of

large vascular structures can also be performed by
administering contrast media before imaging. Another application of CT technology is the ability to
accurately place needles or biopsy instruments into
areas of interest for diagnostic sampling of tissue or
fluid. For this diagnostic sampling procedure, the
slice of interest is selected by the user, after which
the position of the preferred slice of the patient is
indicated by the CT scanner through the use of a
thin light or laser line. After placing the needle in

Figure 3. CT of the hindlimbs and tail base of a water monitor (Varanus salvator), scanned transversely at 130 kV, 83 mA, 5.0-mm slice
thickness, and 1.5 sec. This is the standard display for a CT series and provides multiple cross-sectional images. (A) Transverse plane image
at the level of the metatarsi demonstrating gross enlargement of the soft tissues of the left foot. (B) Dorsal view of a 3-dimensional
skin-surfacerendered reconstruction demonstrating the gross deformity of the left foot. (C) Dorsal view of a 3-dimensional bone-surface
rendered reconstruction demonstrating the caudal vertebrae (1), fibulas (2), tibias (3), and digits (4). (D) Magnified dorsal view of a
3-dimensional bone-surfacerendered reconstruction of the normal right and abnormal left hindfeet. Note the bone lysis (arrows) associated
with osteomyelitis of distal phalanx 1 and proximal phalanx 2 of digits 4 and 5.

CT in Zoological Medicine

the desired location, correct positioning of the needle can be verified by CT imaging before sampling.
Since its inception in the 1970s, CT has undergone a number of important improvements. Improved resolution, shorter scan times, and advanced
image manipulation are some of the advantages offered by modern CT and computer equipment. Helical CT involves scanning while the patient is continuously moved through the gantry, which allows
shorter acquisition times. Without helical CT, the
patient must be stopped for each slice. Another feature of many modern scanners is multiple slice technology, where thin rows of radiograph detectors
sandwiched together allow up to 256 slices to be
simultaneously acquired, although 2- to 16-slice scan-

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ners are the machines used most frequently at this
time. This allows further shortening of scan times
and reduces motion artifacts. Modern machines create a 3-dimensional volume of data and allow reconstruction of data into alternate planes (e.g., sagittal,
obliques). The data can be manipulated in multiple
ways by the user, including 3-dimensional volume
rendering. Multiple imageviewing software packages provide many of the same or, often, more advanced viewing options using CT images stored on
CD-ROM in standard Digital Imaging and Communications in Medicine (DICOM) format. One particular software package that has gained popularity is
Osirix (Osirix Foundation, Geneva, Switzerland) for
the Apple Macintosh (Apple Inc., Cupertino, CA USA)

Figure 4. CT of the head of a normal rabbit, scanned transversely at 130 kV, 83 mA, 2.0-mm slice thickness, and 1.9 sec. This is the standard
display for a CT series and provides multiple cross-sectional images. (A) Transverse plane image at the level of the upper incisors
demonstrating the rostral rhinarium (1) and upper incisors (2). (B) Transverse plane image at the level of the mid-diastema demonstrating the
2 mandibular rami (1), tongue (2), and maxilla (3) containing the midline vomer bone and turbinate structures (arrows). (C) Transverse plane
image at the level of the first molar teeth demonstrating the mandible (1), tongue (2), hard palate (3), nasopharynx (4), ethmoid bone and
endoturbinates (arrows), maxilla and zygomactic arch (5), first molars (6), and nasal bone (7). (D) Transverse cross-sectional slice at the level
of the orbits demonstrating the mandible (1), oropharynx (2), nasopharynx (3), orbits (4), olfactory bulb of brain (5), frontal bone (6), zygomatic
arches (7), perpendicular plates (8), and presphenoid bone (arrow).

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computer. The ability to see the images in a 3-dimensional field is beneficial in communicating with owners and curators, students, and other veterinarians,
and, although no studies have substantiated an improvement in diagnostic ability, clinically, these manipulations appear to be very useful.

Protocol
CT is a noninvasive procedure that is of short duration.
It is imperative that the patient remains immobilized
during the scanning period. General anesthesia is
typically required to achieve appropriate positioning
and prevent movement between scans for all mammals, birds, and fish.1-3 The appropriate protocol
must be selected based on the species, the health of
the patient, and the estimated duration of the procedure. Some reptiles may be immobilized with physical techniques including vasovagal response in lizards and taping the limbs of chelonians inside their

Mackey et al

shells.4-7 If the head, neck, or appendages need to be

scanned, anesthesia is required.2 To maintain their
body position during the scanning procedure,
snakes must be maintained under general anesthesia.8 It is essential that a radiologist is consulted
before the imaging procedure to ensure that optimal
results are obtained and diagnostic questions are
adequately answered.
The endotracheal tube does not present problems of superimposition in CT images as in patients
when standard radiography is used.1 Animals are
typically placed in dorsal or ventral recumbency
during the procedure. Imaging of the reptilian
coelom in lateral recumbency may result in organ
displacement, which has led to misinterpretation.2
The size and body conformation of the patient is
an important consideration when determining
whether sagittal or transverse images are obtained
for patient evaluation. To completely scan a lizard
or bird, fewer slices are required if the sections

Figure 5. CT images of a rabbit with a dental abscess associated with right maxillary premolar 2, scanned at 130 kV, 83 mA, 2.0-mm slice
thickness, and 1.9 sec. (A) Craniodorsal view of a 3-dimensional skin-surfacerendered image demonstrating the gross swelling associated
with the right maxilla (arrow). (B) Dorsal view of a 3-dimensional volumerendered image demonstrating the severe soft tissue swelling
associated with an abscess (white arrow) and the loss of mineralized bone due to osteomyelitis of the right maxilla and nasal bone (black
arrow). (C) Right craniolateral view of a 3-dimensional bone-surfacerendered image demonstrating the loss of bone associated with the right
maxilla and nasal bone (red arrows). (D) View of a 3-dimensional mucosal-surfacerendered image from within the caudal dorsal nasal meatus
demonstrating the abscess (1) extending into the nasal cavity.

CT in Zoological Medicine

are scanned sagittally than if they are taken in

transverse.2

Practical Applications
Reptiles
Clinical presentations of sick reptiles are often
nonspecific, making lesion localization difficult. Although high-quality radiographs are often useful,
interpretation can be challenging because of the
superimposition of bone and various soft tissues.
The chelonian shell and osteoderms within the skin
of crocodilians and some lizards can create artifacts
and reduce imaging sensitivity. In addition, reptiles
lack diffuse fat around their visceral organs, which
also reduces soft tissue contrast and appreciation.

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CT has been used to describe the normal anatomy
of several reptiles, and this knowledge may be used
as a baseline for the clinical evaluation of unhealthy animals.8-10 Although plain radiography is
commonly used to evaluate the musculoskeletal
system, CT can provide better detail. The greater
detail achieved with CT imaging may be useful for
confirmation of a lesion, a more accurate description of location and extent, and therefore, a more
accurate prognosis (Fig 3).11 In one study evaluating skeletal injuries of chelonians, CT was able to
reveal fractures that were not apparent on plain
radiographic images.6 CT has been used for evaluating metastases in a yellow-belly racer (Coluber
constrictor flaviventris), thus providing prognostic
information.12

Figure 6. CT images of a rabbit with a left mandibular dental abscess associated with premolar 2, scanned at 130 kV, 83 mA, 2.0-mm
slice thickness, and 1.9 sec. Left caudolateral (A) and caudomedial (B) 3-dimensional volumerendered views of a mandibular abscess
(arrows) demonstrating both bony proliferation and destruction typical of a dental abscess. (C) Left lateral view of a 3-dimensionalvolumerendered image demonstrating vascular (inflammatory) tissue surrounding the infected area (arrow).

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Radiography and ultrasonography of the chelonian reproductive tract may reveal the presence of
eggs or follicles but are often inaccurate for determining the precise number present. CT studies have
demonstrated 4 to 6 times more accuracy in determining the precise number of eggs present in reptile
species when compared with ultrasonography.2 With
CT, the number can be accurately assessed along
with providing information about their size, shape,
and density. Shell density measurements may even
provide an estimation of an eggs age.7
The slow respiratory rate, together with the enhanced contrast between lung parenchyma and air
has resulted in exceptional CT images of chelonian
and snake respiratory tracts.2,9 These quality images
have the potential to detect numerous pulmonary
disease conditions.9 The CT scans were particularly
informative in one study in which the majority of
snakes with pneumonia, even those with severe respiratory tract disease, were not detected on radiographic evaluation.8

Small Exotic Mammals

Small mammals, including insectivores, rodents, and
lagomorphs, have become increasingly popular as
pets; the rabbit (Oryctolagus cuniculus) is now ranked

Mackey et al

as the third most common pet mammal in the

United States.13 Although overgrowth of teeth is a
common problem for many small mammals with
open-rooted incisors, it is particularly significant in
those animals that also have open-rooted cheek
teeth (e.g., lagomorpha, caviidae), because changes
in the cheek teeth can develop into a more serious
disease presentation.4,14
Evaluating lagomorph and rodent dentition can
be particularly challenging. Oral examination is limited because of the small mouth, extensive buccal
soft tissue, and structure of the temporomandibular
joint, which limits gape.4,15,16 Oral examinations may
reveal ulcers, foreign bodies, or supragingival spurs,
but many dental diseases are subgingival. Standard
radiography allows for visualization of the underlying regions, but distortion from naturally occurring
curvature of the cheek teeth along with superimposition with the other teeth, maxilla, and mandible
make radiographs challenging to interpret.16,17 Radiographs of the skulls of rabbits with clinical signs
attributable to dental disease may reveal severe deformity of teeth and evidence of osteomyelitis. However, radiographs are not always able to identify the
specific tooth or teeth responsible for an abscess,
and they cannot definitively exclude dental disease.17

Figure 7. CT images of a rabbit that presented with mild right exophthalmia, scanned at 130 kV, 83 mA, 2.0-mm slice thickness, and 1.9
sec. (A) Radiography was unremarkable, and only mild asymmetry of the ocular and retrobulbar spaces were evident on transverse CT images.
Images B and C are 3-dimensional bone-surfacereconstructed views of the alveolar bullae of the maxilla, as seen from within the left (B) and right
(C) orbital spaces. Note the 2 normal nutrient foramina in both the left and right alveolar bullae (white arrows). However, also note the abnormal
nutrient foramen (black arrow) and the fistula (red arrow) associated with root abscessation of right maxillary molar 2. In this case, 3-dimensional
reconstruction enabled a diagnosis that was impossible with radiography or standard transverse CT imaging, and also aided surgical planning.

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CT in Zoological Medicine

CT scans of normal animals can be used as comparisons with those of clinically ill individuals (Figs 4,
5, 6, and 7).
CT has been used to reveal a tooth root abscess and
associated osteomyelitis in a guinea pig (Cavia porcellus) in which no radiographic abnormalities were
evident.18 In another case involving a woodchuck (Marmota monax) with unilateral nasal discharge, reconstructed 3-dimensional CT images were able to demonstrate the loss of turbinates and pinpoint the
source of infection as the left upper incisor root (S. J.
Hernandez-Divers, unpublished case report) (Fig 8).
With the use of CT, excellent detail is provided for
the fine bone structure of the skull and adjacent soft
tissue, allowing for the detection of minor pathological changes. This provides an opportunity for early
intervention and thus more effective treatment.4,16
Although CT is an excellent diagnostic tool for
the evaluation of dental disease, it has also been used
in the evaluation of exotic mammals with neoplasia.
Multiple plane scans can provide information regarding the size and local distribution of a tumor,

effects on surrounding tissues, and evaluation for

possible metastases.19-21 This information can then
be used to establish a prognosis, determine a surgical
plan, and monitor response to therapy. In other
cases, loss of normal architecture in the nasal cavity
of a rabbit due to mycobacteriosis can be fully appreciated by using CT imaging (unpublished case
report) (Fig 9). The application of CT is not limited
to small mammals, and has been shown to be valuable in the evaluation of other zoological species
including nonhuman primates and small cetaceans
(Figs 10 and 11).11

Avian
Although radiography can provide quality information about the skeletal system of avian species, it is
unable to provide the detail of CT in areas of significant bone superimposition (e.g., avian head). Several studies have shown the relevance and practical
applications for the use of CT in evaluating the avian
head.2,22,23 In a study comparing CT with conven-

Figure 8. CT of the head of a woodchuck that presented with left unilateral nasal discharge poorly responsive to antibiotics, scanned
transversely at 130 kV, 83 mA, 3.0-mm slice thickness, and 1.9 sec. (A) Transverse plane image at the level of the upper incisors
demonstrating an increased soft tissue density within the left nasal cavity (black arrow), and fracture of the left upper incisor (white arrow).
(B) Transverse plane image at the level of the caudal diastema demonstrating loss of mineralized tissue associated with the zygomatic process
and lacrimal bones (white arrow) and increased soft tissue density within the ventral nasal meatus (black arrow). (C) Left lateral view of a
3-dimensional surfacerendered reconstruction demonstrating loss of the zygomatic process and lacrimal bones (arrows). (D) Caudorostral
intranasal view of a 3-dimensional surfacerendered reconstruction demonstrating the nasal opening (1), vomer bone (2), nasal bone (3), and
normal medial surface of the maxilla on the right side (4). On the left side, the root of the upper incisor has abscessed through the maxilla
into the nasal cavity (5).

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Figure 9. CT of the nasal cavity of 2 rabbits; a normal control animal (A-C) (performed under an institutional animal care and use permit) and
a clinical case of nasal mycobacteriosis (D-F), both scanned at 130 kV, 83 mA, 2.0-mm slice thickness, and 1.9 sec, with computer rendering
to demonstrate bone and soft tissue-air interfaces. (A) Rostrocaudal view of a normal rabbit demonstrating the opening to the nasal cavity.
(B) Close-up demonstrating an air cast within the nasal cavity. The dorsal (1), medial (2), and ventral (3) meati are clearly visible, while the
vomer bone (4) and turbinates (5) have been digitally removed. (C) View of an air cast from within the caudal nasal cavity demonstrating the
nasopharynx (1) continuous with the trachea (2). (D) Rostrocaudal view of a rabbit demonstrating an asymmetrical air cast within the nasal
cavity (arrow) due to nasal mycobacteriosis. (E) Close-up rostrocaudal view of an air cast of the nasal cavity demonstrating the replacement
of normal meati with a large asymmetrical cavity (arrow) due to destruction of the vomer bone and turbinates. (F) Caudorostral view of the
same area as seen from within the nasal cavity. The asymmetrical air space (arrow), ventral surface of the dorsal nasal bone (1), and nostril
openings (2) are visible.

tional radiography, quality radiographs were obtained for the bony parts of the head, but CT was
superior for evaluation of the nasal cavity and conchae. For birds that had clinical signs of upper airway
disease, CT allowed for the actual measurement of
the pneumatized area, thus providing information
relevant for treatment and prognosis. Although radiographs could detect changes in birds with severe
respiratory pathology, only CT was able to detect
early disease changes.22 Radiographs of a yellownaped Amazon (Amazona ochrocephala auropalliata)
with left-sided paresis were unremarkable; however,

CT revealed hemorrhage and displacement of the

right side of the patients brain.1 Although it is able
to provide information about the size and shape of
the avian eye, lens, and scleral rings, CT cannot
differentiate intraocular structures such as pectin
oculi and hemorrhage.23 Scans were able to determine the extent of a periorbital liposarcoma in an
African gray parrot (Psittacus erithacus)24 and a fibrosarcoma on the skull of a hyacinth macaw (Anodorhynchus hyacinthinus).11
A comparison study between radiography and CT
has shown that CT is more sensitive for the detection

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Figure 10. CT images of a white-faced capuchin (Cebus capucinus) that presented with persistent nasal discharge scanned at 130 kV, 83
mA, 2.0 mm-slice thickness, and 1.9 sec. (A) Rostrocaudal view of a 3-dimensional volume rendition of the head. (B) Anteroposterior view
of a 3-dimensional bone-surfacerendered image of the skull. (C) Anteroposterior 3-dimensional bone-surfacerendered image of the opening
to the nasal cavity demonstrating asymmetry of the vomer bone (1), and the palatine bones (2). (D) Caudorostral 3-dimensional
bone-surfacerendered image from within the nasal cavity demonstrating asymmetry of the vomer bone (1) and the palatine bones (2). Based
on the CT, as well as the cytologic and microbiologic findings, this animal was successfully treated for allergic rhinitis.

of lower respiratory tract disease in psittacines.25 In

the comparison study, changes associated with severe disease were observed in the conventional radiographic images, and subtle lesions were only
detected through the use of CT.25 Radiographic evaluation of coelomic distension in a blue and gold
macaw (Ara ararauna) demonstrated intestinal tract
displacement suggestive of a mass. Ultrasonography
confirmed a mass but was unable to determine the
origin or extent of the lesion. CT scans revealed
the distribution of the mass and that the liver was the
origin of growth. The liver tumor was eventually
identified histopathologically as cystic biliary carcinoma.11
CT studies have also been performed to develop
an understanding of the appearance of bone and
tissue in healthy avian subjects of various species.3,22,26 A detailed understanding of what is normal
in an avian species will improve our chances of detecting abnormalities that may be observed in clinically ill individuals and to assist clinicians in diagnosing and formulating treatment plans. Information

obtained through CT evaluation of different avian

species may also be used to support taxonomic classification and nomenclature.27

Conclusion
Curatorial staff and exotic pet owners expect the
same high-quality medicine as is available for domestic animals. The use of advanced imaging in diagnostic patient evaluations is increasing as well as the
availability of machines for veterinary practices.
These imaging modalities have the potential to become part of our standard diagnostic investigation
for anatomic regions previously difficult to evaluate.
Advanced imaging, including CT, may provide earlier detection of abnormalities and more accurate
evaluation of clinical disease. The application of 3-dimensional rendering software allows for optimal surgical planning and is an excellent educational resource for owners and veterinarians. Guidelines
need to be established for the evaluation and inter-

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Figure 11. CT images of a bottlenosed dolphin (Tursiops truncatus) presented for necropsy with severe head trauma, scanned at 130
kV, 83 mA, 5.0-mm slice thickness, and 1.9 sec. (A) Left anterolateral view of a 3-dimensional bone-surfacerendered image of the
skull. (B) Posterior-anterior view of a 3-dimensional bone-surfacerendered image of the skull looking into the cranium. Left
anterolateral (C) and anteroposterior (D) views of a 3-dimensional volume rendition of the skull demonstrating severe soft tissue trauma
to the left temple.

pretation of healthy zoological species, and it is imperative that the application of these tools be substantiated by evidence-based clinical research and
that board-certified radiologists are involved in the
collection and interpretation of the imaging data.

6.
7.
8.

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