Accreditation Support

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