Practical implementation of lung ultrasound in
dairy calves
Brandon J. Debbink, DVM
Dairy Doctors Veterinary Services
Plymouth, WI 53073
Abstract Utilization of a 0 to 5 scoring technique described by Dr. Terri
Ollivett5 simplifies the description of severity of lung consoli-
Routine thoracic ultrasonography is a developing service of- dation on a numerical scale that is relatively easy to convey to
fered by veterinary practitioners that acts as an accurate, rapid, producers:
calf-side diagnostic tool to aid in calf health management. Bo-
vine practitioners competent in the technique can provide this Calves are ultrasound-scored using a 0 to 5-point scale:
service to progressive producers by way of client education,
0 and 1 = normal
demonstration and evidence of impact of bovine respiratory
2 = lesions > 1 cm, but < 1 lobe
disease (BRD) in pre-weaned dairy calves. Routine, strategic
3 = at least one lung lobe consolidated
scanning demonstrates trends in new infection rate, cure rates,
4 = at least two lung lobes consolidated
and severity of lesions in those affected. Utilizing the data to
5 = three or more lung lobes consolidated
establish benchmarks for individual calf programs allows prac-
titioners and producers to make prudent, evidence-based deci- Seventy percent isopropyl alcohol is applied to each side of the calf
sions on treatment and management changes to aid in preven- thorax as a contact medium, allowing the ultrasound to generate
tion. Routine thoracic ultrasound is a tremendous opportunity an image of the lung field as the probe is placed between each of
for new and recent veterinary graduates who are looking to the intercostal spaces 10th to 1st. Practitioners that develop compe-
expand clinic services and can be offered with little additional tency and confidence in scanning calves should be able to perform
overhead. Consistent veterinary involvement brings the practi- this technique in under 30 seconds per calf.
tioner to the forefront in calf management and consultation.
Key words: ultrasound, dairy calves, lung, thoracic Client education and marketing
Implementation of routine TUS on farms is primarily fueled by
Thoracic ultrasound technique demonstration and/or word-of-mouth referral from producer to
producer. That aside, educating producers on the long-term ef-
Utilization of ultrasonography for examination of the thorax
fects of BRD in pre-weaned calves and possible unknown preva-
of the pre-weaned calf is a rapid, non-invasive, calf-side diag-
lence is imperative to successful application of this service
nostic that allows the practitioner to gain insight on the respi-
on-farm. Producer outreach and education meetings allow for
ratory disease status of calves with no outward clinical signs.
dissemination of information to producers in a low-risk envi-
With a reported sensitivity of 79 to 94% and specificity of 94 to
ronment to market this service. Additionally, offering a trial of
100%,1,2,3 this diagnostic technique offers an untapped potential
the service as a “loss leader” can show the producer the impact
to both the veterinary practitioner and producer to maximize
that ultrasonography has on detecting subclinical calves that
detection of BRD in pre-weaned calves, reducing the negative-
would otherwise go undetected by the nature of the definition.
associated effects of BRD on replacement heifers during rearing
and their productive lifetimes. Studies that include the entire
lung field within the study design reported higher sensitivities Strategic scanning
(closer to the upper range noted above), indicating that thoracic Practitioners that have demonstrated the importance and im-
ultrasound (TUS) is an excellent screening and diagnostic tool. pact of subclinical BRD to producers are faced with the chal-
For reference, on-farm calf-side clinical scoring systems, which lenge of how to implement this diagnostic on farm as a cost-
have had a large impact on the detection of ill calves with re- effective and impactful tool to use in a calf rearing program.
spiratory disease, has reported screening sensitivities around Initial cursory scans should be done to determine the age of
46%, and specificities of approximately 90%.4 onset in each individual herd to customize a scanning plan to
maximize detection on that specific farm. Scanning at approx-
Familiarity with the technique of TUS by bovine practitioners is
imately 3 weeks of age is a good starting point since maternal
an obvious essential step in offering this service to progressive
antibody is waning at the same time active immunity is being
dairy clients. Numerous opportunities have been available for
developed by the calf. Additionally, a scan at 5 weeks of age
practitioners to learn this technique at American Association of
will straddle this timeframe in which the calf is most suscepti-
Bovine Practitioners preconference seminars and other univer-
ble to respiratory disease called the window of susceptibility.
sity outreach meetings, and a growing number of new or recent
Calves can additionally be evaluated at 7 weeks if they exhib-
veterinary graduates have good familiarity with the technique
ited lesions at 5 weeks to monitor treatment success. A 2 or
upon graduation. 3-scan system allows the producer and practitioner to monitor
disease incidence and treatment success. Alternatively, prac-
titioners may choose to scan to monitor post-treatment suc-
cess (improvement or resolution of lesions within 7 to 10 days)
or monitor prevalence of lesions at weaning or pre-grouping
(“exit scanning”). Regardless of the approach, practitioners
should be cognizant of how the data is going to be utilized.
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Anecdotally, calves typically do not exhibit lung lesions un- life. Further records analysis can include trends over time in
der 2 weeks of age unless processing of the newborn calf is pre- and post-weaned treatment rates, survival rates, culls and
performed incorrectly or the possibility of disease pressure is ability to make it to first and subsequent lactations. Monitoring
high, such as instances of consistent failure of passive transfer, these trends at or around the beginning of TUS implementa-
high prevalence of concurrent disease, ventilation inadequa- tion can demonstrate the benefits to the producer of detection
cies in barn-housed calves, subpar nutrition, etc. In these in- and intervention of subclinical BRD. Trends in completion rates
stances, treatment rates of clinical calves may be at an accept- of the pre-weaned phase may be noticed early (months), while
able rate. Working with producers to identify and correct these trends in post-weaned and first lactation completion rates will
problems can shift consultation toward the veterinarian, pro- take more time to observe (several months to years). Reporting
viding additional opportunities of business. these trends to producers is important to determine if a TUS
program is providing benefit.
Pairing TUS results with additional diagnostics such as deep
nasopharyngeal swabs for viral PCR (polymerase chain re-
action) and bacterial culture can direct treatment efforts or Opportunities for young practitioners
practical vaccination needs and schedules. Knowing and un- New and recent graduate practitioners generally strive to create
derstanding the current vaccination protocol can help direct a niche or aspect of veterinary medicine in which they thrive in.
scanning efforts toward logical timeframes to examine calves. Practice owners should be cognizant of this and allow flexibil-
It becomes obvious that detection is not prevention. That being ity to their associates to develop new skills and services for their
stated, detecting calves with subclinical BRD can aid in correct clientele. TUS is a developing and emerging skill that producers
treatment at the earliest onset of disease, allowing for better unknowingly crave and seek out. New hires generally are either 1)
treatment success which subsequently follows with better post- replacing an existing position within a practice, or 2) carving out a
transition performance until replacements enter the milking new position for themselves within the practice, attempting to ac-
string. It is important to consider the option of metaphylactic cumulate clientele that they consider their own.
treatment of all calves that fall into an at-risk age based on ul-
trasound guided determination of the highest risk age of onset. Regardless of either of these common scenarios, exploring new
Factors that should be considered are veterinary cost, anti- services to offer to producers falls, by nature, onto the younger
infective cost, possibility of infection after anti-infective effec- generation of veterinarian. Since rectal ultrasonography for
tiveness ceases, and the factor of increasing scrutiny of “blan- pregnancy diagnosis is commonly offered by many veterinary
ket dosing” antimicrobials. All these factors should be weighed practices, there is little overhead in offering TUS other than iso-
by both the producer and veterinarian to determine the most propyl alcohol and time. Additionally, developing this service
economic solution, whilst being cognizant of responsible anti- will naturally generate questions and concerns by producers
microbial stewardship. that will be funneled to the practitioner.
Historically, young-stock rearing on dairies functions com-
Data analysis and utilization monly in lieu of veterinary involvement other than maintain-
ing a valid veterinary client-patient relationship and when oc-
On a basic level, detection and treatment of subclinical BRD in
casional calf health issues arise. Producers, with increasing
calves is fairly straightforward – “this calf has subclinical BRD,
frequency, are looking to feed mill or pharmaceutical company
so let’s treat her”. TUS scores should be entered into on-farm
representatives due to their availability and perceived free-of-
software to tie the calf’s respiratory health to her “permanent
charge consultation. Shifting the focus to the veterinarian as
record”. Opportunities for practitioners with familiarity in on-
the forefront authority on calf health is imperative to not only
farm records software or Microsoft Excel to analyze data are
the success of the calf program, but also for the industry to
abundant, although reporting basic disease incidence and cure
garner consumer trust. Routine TUS assists in more concrete
rate data may be all that is needed. For simplicity’s sake, assign-
veterinary involvement in a calf program, using advanced diag-
ing calves as either positive (score ≥ 2) or negative (score < 2) aids
nostic capabilities to ensure calves are attaining their potential.
in generating new infection rate and cure rate data. Providing
producers with a list of subclinical calves to treat and visit-to-
visit key performance indicators offers producers a value-added Conclusions
service to track performance over time. The 3 most crucial indi- Routine TUS is an emerging service that can be offered by bo-
ces to monitor are: vine veterinarians to aid in calf health management. Compe-
1. New infection rate (goal < 25%) tency in the technique allows for rapid detection and diagnosis
2. New infection cure rate (i.e., excludes chronic calves of subclinical BRD in pre-weaned calves. Scheduled herd visits
(goal > 80%) with an intent to utilize the data collected allows for monitoring
3. Proportion of new infections with score ≥ 3 (goal < 30%) of management changes, as well as providing insight to each in-
dividual calf’s respiratory health prior to transition to a dry ra-
Monitoring these indices over time helps evaluate trends in calf tion. Providing the producer with key performance indicators
respiratory health, treatment success and severity of lesions after each visit strengthens the value of this service, in which
at first evaluation. For example, a recent decline in treatment focus of implementation should be toward progressive produc-
success may lead to the discovery of under-dosing antibiotic, ers. TUS allows for expansion of practice services, shifting the
inappropriate antibiotic choice, or other factors that attribute focus of calf consultation toward the veterinarian.
to high disease pressure that may decrease treatment cure rate,
elevate new infection rate, and the severity of those lesions.
The overarching goal is to generate an idea of pre-weaned
respiratory health of each calf going into weaning/group-
ing. Identification and treatment in the pre-weaned period
prevent relapses during the most stressful time in the calf’s
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