Revision History


One normal exam is required from each exam type performed at the site:

  • Peripheral (Arterial or Venous)

  • Cerebrovascular

  • Abdominal (Liver or Renal), and/or

  • Deep Abdominal

Diagnostic and physiologic criteria for interpretation must be submitted with vascular exams. Diagnostic criteria should consist of a brief summary of the criteria the physician(s) at the facility use to determine normal vs. abnormal exams. For Duplex carotid exams the velocity table should be included.


Exam Requirements: Peripheral Ultrasound Accreditation

Choose one exam: Arterial OR Venous

Arterial

Choose one of these

Arterial Occlusive Disease – Lower Extremities

  • Longitudinal grey scale images

    • Common femoral artery

    • Proximal profunda femoris artery

    • Superficial femoral artery - proximal, mid and distal

    • Popliteal artery - proximal and distal

  • Longitudinal color Doppler images

    • Common femoral artery

    • Proximal profunda femoris artery

    • Superficial femoral artery - proximal, mid and distal

    • Popliteal artery - proximal and distal

  • Longitudinal Spectral Doppler waveform with color Doppler evaluation

    • Common femoral artery

    • Proximal profunda femoris artery

    • Superficial femoral artery - proximal, mid and distal

    • Popliteal artery - proximal and distal

  • Anterior tibial, posterior tibial and peroneal arteries evaluated as clinical indicated

Bypass Graft/Stent

  • Longitudinal gray scale images of graft/stent and anastomoses

  • Longitudinal color Doppler images of graft/stent and anastomoses

  • Spectral Doppler waveforms to include peak systole and end diastole measurements

    • Proximal native vessel

    • Proximal anastomosis/edge of stent

    • Proximal, mid and distal segments of graft/stent (at a minimum)

    • Distal anastomosis/edge of stent

    • Distal native run-off vessel

  • Direction of flow documented in native run off vessel distal to graft

Venous

Choose one of these

Thrombosis – Lower Extremities 

  • A bilateral exam should be submitted

  • Transverse gray scale with & without compression images

    • Common femoral vein

    • Saphenofemoral junction

    • Proximal profunda femoris vein

    • Femoral vein – proximal, mid and distal

    • Popliteal vein

  • Longitudinal color and/or spectral Doppler waveform images

    • Saphenofemoral junction

    • Proximal profunda femoris vein

    • Femoral vein – proximal, mid and distal

  • Spectral Doppler wave form demonstrating spontaneous flow and respiratory phasicity

    • Common femoral vein or external iliac vein

    • Popliteal vein

  • Calf veins as clinically indicated

Vein mapping

Complete evaluation of appropriate superficial venous system using grey scale including axial diameter +/- distance from skin surface:

  • Great or small saphenous of leg



OR

  • Cephalic vein of upper arm/forearm and
  • Basilic vein of upper arm/forearm 

Images to note thrombus, wall thickening, calcification or branching should be obtained

Incompetence 

Perform a complete Thrombosis - Lower Extremities exam first, then add the reflux assessment below:


Documentation of direction of flow with color and spectral Doppler waveform following augmentation maneuvers or Valsalva (in the upper thigh) with the patient in the semi-upright or upright position. Length of time of reflux must be measured in at least one location within the superficial system.

  • Common femoral vein

  • Femoral vein

  • Popliteal vein

  • Great saphenous vein including SFJ and throughout thigh at a minimum

  • Additional imaging inferior to knee, if appropriate

    • GSV

    • Small saphenous vein including saphenopopliteal junction

  • Assess for perforators as clinically indicated

Thrombosis – Upper Extremities

  • Transverse gray scale without and with compression images

    • Internal jugular vein

    • Axillary vein

    • Brachial vein

    • Basilic vein to the level of the antecubital fossa

    • Cephalic vein to the level of the antecubital fossa

  • Longitudinal gray scale images

    • Internal jugular vein

    • Subclavian vein

    • Axillary vein

    • Brachial veins

  • Longitudinal color Doppler images

    • Internal jugular vein

    • Subclavian vein

    • Axillary vein

    • Brachial veins

  • Spectral Doppler wave form images

    • Internal jugular vein - bilaterally

    • Subclavian vein - bilaterally

    • Axillary vein

    • Brachial veins


Exam Requirements: Cerebrovascular Ultrasound Accreditation

(Bilateral Duplex Carotid Ultrasound)

  • Transverse gray scale images:

    • Common carotid artery – proximal and distal

    • Bifurcation

    • Any area of significant plaque

  • Longitudinal grey scale images:

    • Common carotid artery – proximal and distal

    • Internal carotid artery – proximal

    • External carotid artery – proximal

  • Longitudinal color Doppler images:

    • Common carotid artery – proximal and distal

    • Internal carotid artery – proximal

    • External carotid artery – proximal

  • Longitudinal spectral Doppler wave form with color Doppler evaluation:

    • Common carotid artery – proximal and distal

    • Internal carotid artery – proximal, mid and distal 

    • External carotid artery – proximal

    • Vertebral artery


Exam Requirements: Abdominal Ultrasound Accreditation

 Choose one exam: Liver or Renal

Liver

 Choose one of these

Liver Vasculature

  • Complete gray scale survey of liver parenchyma in longitudinal and transverse

  • Gray scale images of vascular anatomy including vessel labeling

    • Main portal vein

    • Hepatic veins – right, middle and left

    • Inferior vena cava

    • Splenic vein – posterior to pancreas

  • Color or power Doppler images

    • Portal veins - main, right and left

    • Hepatic veins – right, middle and left

    • Hepatic artery

    • Inferior vena cava

    • Splenic vein - posterior to pancreas

  • Spectral Doppler waveform images

    • Portal veins – main (angle correction required), right and left

    • Hepatic veins - right, middle and left

    • Hepatic artery (angle correction required)

    • Inferior vena cava

    • Splenic vein – posterior to pancreas

Liver Transplantation

  • Complete gray scale survey of liver parenchyma in longitudinal and transverse

  • Gray scale images of vascular anatomy including vessel labeling

    • Main portal vein and anastomosis

    • Hepatic veins – right, middle and left

    • Inferior vena cava

    • Splenic vein – posterior to pancreas

  • Color or power Doppler images

    • Portal veins - main, right, left and site of anastomosis

    • Hepatic veins – right, middle and left

    • Hepatic artery – main, right, left and site of anastomosis

    • Inferior vena cava

    • Splenic vein - posterior to pancreas

  • Spectral Doppler waveform images

    • Portal veins – main (angle correction required), right, left and site of anastomosis

    • Hepatic arteries (angle correction required) - main, right, left and site of anastomosis

    • Hepatic veins - right, middle and left

    • Inferior vena cava

    • Splenic vein – posterior to pancreas

TIPS

  • Complete gray scale survey of liver parenchyma in longitudinal and transverse

  • Gray scale images of vascular anatomy including vessel labeling

    • Main portal vein

    • Hepatic veins – right, middle and left

    • Inferior vena cava

    • Splenic vein – posterior to pancreas

    • TIPS

  • Color or power Doppler images

    • Portal veins - main, right and left

    • Hepatic veins – right, middle and left

    • Hepatic artery

    • Inferior vena cava

    • Splenic vein - posterior to pancreas

    • TIPS

  • Spectral Doppler waveform images

    • Portal veins (angle correction required) – main, right, left and proximal to TIPS

    • Hepatic veins - right, middle, left and distal to TIPS

    • Hepatic artery (angle correction required)

    • Inferior vena cava

    • Splenic vein – posterior to pancreas

    • TIPS (angle correction required) – proximal, mid and distal

Renal 

Choose one of these

Renal Artery Stenosis

  • Complete gray scale documentation of kidneys in longitudinal and transverse

  • Renal length

  • Spectral Doppler waveform images

    • Aorta (angle correction required) - at or just above the origin of the renal arteries

    • Main renal artery (angle correction required) - proximal, mid and distal

    • Main renal vein

    • Upper and lower pole segmental or interlobar arteries documenting RI or AI/AT

Renal Vein Thrombosis

  • Complete gray scale documentation of kidneys in longitudinal and transverse

  • Renal length

  • Gray scale images

    • Renal veins

    • Inferior vena cava

  • Color Doppler images

    • Main renal arteries

    • Renal veins

    • Inferior vena cava

  • Spectral Doppler waveform images

    • Main renal artery (angle correction required)

    • Main renal vein

    • Intrarenal artery – upper and lower pole

    • Inferior vena cava

Renal Transplant

  • Complete gray scale documentation of kidneys in longitudinal and transverse

  • Renal length

  • Color Doppler images

    • Main renal arteries

    • Main renal vein

    • Proximal iliac artery

    • Draining iliac vein

  • Spectral Doppler waveform images

    • Renal artery (angle correction required) - anastomosis, proximal, mid and distal

    • Renal vein – anastomosis and proximal

    • Proximal iliac artery (angle correction required)

    • Draining iliac vein

    • Upper and lower pole segmental or interlobar arteries documenting RI or AI/AT


Exam Requirements: Deep Abdominal Ultrasound Accreditation

Choose One Exam: Aorta OR Inferior Vena Cava/Draining Veins

Aorta

  • Longitudinal gray scale images without and with measurements

    • Aorta – proximal, mid and distal

    • Right common iliac artery

    • Left common iliac artery

  • Transverse gray scale images without and with measurements

    • Aorta – proximal, mid and distal

    • Bifurcation into proximal common iliac arteries

  • Color and/or spectral Doppler waveform of the distal aorta

Inferior Vena Cava and Draining Veins

  • Longitudinal gray scale images without and with measurements

    • Inferior vena cava – proximal, mid and distal

    • Right common iliac vein

    • Left common iliac vein

  • Transverse gray scale images

    • Inferior vena cava – proximal, mid and distal

    • Bifurcation into proximal common iliac veins

  • Color and/or spectral Doppler waveform



Revision History for this Article

Date

Section

Description of Revision(s)

12-12-19

All

Article created; FAQs incorporated; No criteria changes




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