Are pre-purchase X-rays for horses worthwhile or a can of worms? Vets have their say
Veterinary experts discuss how much is too much when it comes to pre-purchase X-rays and other imaging
“Shades of grey and nuance are signs of intelligence – being black and white is a sign of stupidity”.
This was the opinion of one expert, discussed during a debate on the value of X-rays and other imaging techniques at the 2026 British Equine Veterinary Association congress.
In a session titled “Pre-purchase imaging: how much is too much?” veterinary experts considered the different types of imaging and the value they might have.
Jane Boswell of the Veterinary Defence Society, an insurance mutual for vets, covered pre-purchase examination (PPE) X-rays of leisure horses. She stressed, as did the other speakers, that PPEs are not about passing or failing, they are risk assessments considering a horse’s fitness for the intended purpose.
“We don’t have a crystal ball, we’re not going to be able to give a guarantee of future soundness, nor find them the perfect horse,” she said. “Nor should we embark on the PPE thinking it’s going to be a diagnostic investigation. It’s all about assessment of risk and how we contextualise that risk, considering different factors.”
These include details of the horse and intended purpose, but also the buyer’s attitude to risk, aims to resell and of course insurance, all of which should be discussed when deciding whether to X-ray or not.
Pre-purchase X-rays benefits and disadvantages
“The benefits of X-rays: we can perhaps get more information about any abnormalities detected during a clinical examination,” she said. “You find a horse with joint effusion, you may recommend imaging to investigate further. We’re also looking at whether we can identify pathology where we haven’t found any associated clinical signs, to reveal lesions that might be associated with increased future risk.
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“Once we can advise purchasers about the risk, they may use that to consider whether they purchase the horse.”
A big disadvantage to X-rays is cost, but “the real challenge is the difficulty in determining the significance of the changes we identify”. She said X-rays must be reviewed carefully in an appropriate environment, rather than a quick look by the stable – but even then, vets can have very different opinions. And a vet reviewing an X-ray two years later, of a horse who has become lame, will have a very different viewpoint.
“Identifying a radiographic change does not necessarily mean it’s clinically relevant and the horse is not suitable for its intended use,” she said. “For many changes we see, particularly in a horse that is clinically asymptomatic and sound, it’s very difficult to give a robust idea of what the probability is of that becoming problematic in future.”
Ms Boswell also cited a study that found little evidence for the significance of neck X-rays in PPEs, pointing out that a thorough examination is likely to provide more information, and “certainly shouldn’t be a step omitted because you’ve got the comfort blanket of thinking, ‘I’m going to X-ray the neck anyway.’
“You’ve got to know, can you defend the decision not to take radiographs?” she said. “But probably most importantly, when you do, could you defend what you told the purchasers about the ones you did take at a future time?”
Changing international sales
Equine sports medicine specialist Jonathan McLellan covered international sales, in which “our reliance on radiography has changed the entire sales process”.
He explained that rather than buyers having the right to X-ray a horse bought at public auction, now sellers submit X-rays in advance, putting pressure, he said, on the vet who takes them and those who interpret them.
He added that there are still risks to the buyer. Not all joints are X-rayed and the assessing vet has to look at the images with no clinical context, not even seeing the horse move in a PPE.
“This quick summary is where we now are,” he said. “Dr [Larry] Bramlage, says it doesn’t matter if we say it’s not important. If there’s writing on the report, the industry doesn’t like it. Everybody wants clean radiographs.
“This becomes a new ethical problem, where we subject horses to multiple radiographs early in their career to make sure the radiographs are clean, so they can be sold. We’ve gone from no radiographs and everybody lining up to perform examinations, a welfare issue, to multiple radiographs to perform surgeries that maybe horses don’t need.
“The only way out of this situation is to try to continue to educate buyers and sellers. The radiograph is only part of this process, it shouldn’t be a massive hurdle to be cleared, and if we help clients understand that, it’ll take away our reliance on radiography.”
Pre-purchase MRI and CT scans
Equine imaging expert Filip Vandenberghe asked whether PPE MRI and CT scans were “worthwhile or a can of worms” – and concluded both options may well be the case. He cited horses who are sound, but may have been injected to make them so, or those who may not be entirely “sound”, but can be managed to be comfortable doing their job.
“An image tells you something, might help you look into the future,” he said, but he added: “Most athletes, including humans, need management. They occasionally go lame and have a gap in their career; does this make them not sustainable?
“But in a PPE, they want a sustainable, ever-healthy and sound horse. We can’t do that. What is the predictive value of these image findings? That’s the question but sometimes we can have a good idea of how they’re going to evolve, the question is when, and the severity of it, and how easy will it be to manage.
“In the real world, there’s more and more pathologies, so try not to use the exceptional as the standard.
“[A PPE] is not a pass or fail, just that risk assessment. Define clearly what is unclear. If things are not known, it’s OK to say we don’t know that, just make sure you’re not the only one who doesn’t know it. I invite you to introduce some grey into your interpretation because grey and nuance is a sign of intelligence. Being black and white is a sign of stupidity.”
● What are your thoughts on pre-purchase or routine X-rays? Let us know your thoughts at hhletters@futurenet.com, including your name, nearest town and county, for the chance to have your thoughts published in a future issue of Horse & Hound magazine
Eleanor is an experienced journalist who spent over eight years working for local and national newspapers before joining H&H as news editor in March 2016. Passionate about equine welfare and exposing the truth, Eleanor has reported on all aspects of the industry, from Brexit to anti-bullying campaigns, and from dressage rules to mules. Her sport of choice is showjumping, in which she competes her own horses, and she also enjoys reporting at local jumping shows through to international championships.