• Revision History



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

    • Peripheral (Arterial or Venous)

    • Cerebrovascular

    • Abdominal (Liver or Renal)

    • Deep Abdominal

    Complete documentation/survey means a series of several images throughout the entire organ in two planes. For example, from one side of the organ to the other in the longitudinal plane and from superior to inferior in the transverse plane. 


    Anatomy should be intentionally imaged in an organized fashion and correctly labeled for clarity.


    Exam Requirements: Peripheral Ultrasound Accreditation

    Choose one exam: Arterial OR Venous

    Arterial

    Choose one of these

    Arterial Occlusive Disease – Lower Extremities

    A bilateral exam should be submitted

    • Longitudinal gray scale images

      • Common femoral artery

      • Proximal profunda femoris artery

      • Superficial femoral artery - proximal, mid, distal

      • Popliteal artery - proximal and distal

      • Anterior tibial artery

      • Posterior tibial artery - distal

      • Dorsalis pedis artery

    • Longitudinal stand-alone color Doppler images

      • Common femoral artery

      • Proximal profunda femoris artery

      • Superficial femoral artery - proximal, mid, distal

      • Popliteal artery - proximal and distal

      • Anterior tibial artery

      • Posterior tibial artery - distal

      • Dorsalis pedis artery

    • Longitudinal spectral Doppler waveform with color Doppler evaluation

      • Common femoral artery

      • Proximal profunda femoris artery

      • Superficial femoral artery - proximal, mid, distal

      • Popliteal artery - proximal and distal

      • Anterior tibial artery

      • Posterior tibial artery - distal

      • Dorsalis pedis artery

    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

    Static transverse gray scale images without and with compression OR transverse gray scale cine clips without and with compression

    • Common femoral vein - superior to and separate from the saphenofemoral junction

    • Saphenofemoral junction

    • Proximal profunda femoris vein

    • Femoral vein – proximal, mid, distal

    • Popliteal vein

    Longitudinal color and/or spectral Doppler waveform images

    • Saphenofemoral junction

    • Proximal profunda femoris vein

    • Femoral vein – proximal, mid, distal

    Spectral Doppler waveform demonstrating spontaneous flow and respiratory phasicity

    • Common femoral vein or external iliac vein

    • Popliteal vein

    Vein mapping

    Complete evaluation of appropriate superficial venous system using gray 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 

    Static transverse gray scale images without and with compression OR transverse gray scale cine clips without and with compression. 

    • Common femoral vein - superior to and separate from the saphenofemoral junction

    • Saphenofemoral junction

    • Proximal profunda femoris vein

    • Femoral vein - proximal, mid, distal

    • Popliteal vein

    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

    • Saphenofemoral junction

    • Proximal profunda femoris vein

    • Femoral vein - proximal, mid, distal

    • Popliteal vein

    • Great saphenous vein including saphenofemoral junction and throughout thigh at a minimum

    • Inferior to knee

      • Great saphenous vein - below the knee

      • Small saphenous vein

    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 stand-alone color Doppler images

    • Internal jugular vein

    • Subclavian vein

    • Axillary vein

    • Brachial veins

    Longitudinal spectral Doppler waveform with color Doppler evaluation

    • 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

    Longitudinal gray scale images

    • Common carotid artery – proximal and distal

    • Internal carotid artery – proximal

    • External carotid artery – proximal

    Longitudinal stand-alone color Doppler images

    • Common carotid artery – proximal and distal

    • Internal carotid artery – proximal

    • External carotid artery – proximal

    Longitudinal spectral Doppler waveform with color Doppler evaluation

    • Common carotid artery – proximal and distal

    • Internal carotid artery – proximal, mid, 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 documentation in longitudinal

    • At least three gray scale images of the left lobe to include lateral, mid, medial

    • At least three gray scale images of the right lobe to include lateral, mid, medial  

    Complete gray scale documentation in transverse

    • At least three gray scale images of the left lobe to include superior, mid, inferior

    • At least three gray scale images of the right lobe to include superior, mid, inferior

    Gray scale images of vascular anatomy including vessel labeling

    • Portal veins – main, right, and left

    • 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 documentation in longitudinal

    • At least three gray scale images of the left lobe to include lateral, mid, medial

    • At least three gray scale images of the right lobe to include lateral, mid, medial  

    Complete gray scale documentation in transverse

    • At least three gray scale images of the left lobe to include superior, mid, inferior

    • At least three gray scale images of the right lobe to include superior, mid, inferior

    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 documentation in longitudinal

    • At least three gray scale images of the left lobe to include lateral, mid, medial

    • At least three gray scale images of the right lobe to include lateral, mid, medial

    Complete gray scale documentation in transverse

    • At least three gray scale images of the left lobe to include superior, mid, inferior

    • At least three gray scale images of the right lobe to include superior, mid, inferior

    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

    Both kidneys MUST be present

    Complete gray scale documentation of kidneys in longitudinal 

    • At least three gray scale images to include lateral, mid without measurement, medial

    Complete gray scale documentation of kidneys in transverse 

    • At least three gray scale images to include upper pole, mid without measurement, lower pole

    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

    • At least three gray scale images to include lateral, mid without measurement, medial

    Complete gray scale documentation of kidneys in transverse 

    • At least three gray scale images to include upper pole, mid without measurement, lower pole

    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 

    (Renal Artery Thrombosis)

    Complete gray scale documentation of  kidneys in longitudinal 

    • At least three gray scale images to include lateral, mid without measurement, medial

    Complete gray scale documentation of  kidneys in transverse 

    • At least three gray scale images to include upper pole, mid without measurement, lower pole

    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 AP measurements

    • Aorta – proximal, mid, distal

    • Right common iliac artery

    • Left common iliac artery

    Transverse gray scale images without and with transverse measurements

    • Aorta – proximal, mid, distal

    • 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, distal

    • Right common iliac vein

    • Left common iliac vein

    Transverse gray scale images

    • Inferior vena cava – proximal, mid, 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

    3-13-2020Diagnostic CriteriaThe submission of diagnostic criteria has been removed and is no longer required.
    6-2-2020
    Added complete documentation description
    8-4-2020Exam Requirements: Abdominal UltrasoundAdditional documentation clarification for liver vasculature, liver transplantation, TIPS, renal artery stenosis, renal vein thrombosis and renal transplant (renal artery thrombosis) exams.
    10-15-2020
    Removed and/or after abdominal (Liver or Renal) for clarification purposes
    10-30-2020Liver VasculatureChanged main portal vein to portal veins- main, right and left
    2-16-21Aortalongitudinal gray scale images without and with AP measurements and transverse gray scale images without and with transverse measurements
    4-20-21Renal Transplant (Renal Artery Thrombosis)Changed kidneys to transplanted kidney
    1-21-2022
    Updated exam requirements
    5-10-2022Thrombosis- Upper ExtremitiesAligned all bullets under transverse gray scale without and with compression



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