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

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. 


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

    • Anterior tibial artery

    • Posterior tibial artery

    • Dorsalis pedis artery

  • Longitudinal color Doppler images

    • Common femoral artery

    • Proximal profunda femoris artery

    • Superficial femoral artery - proximal, mid and distal

    • Popliteal artery - proximal and distal

    • Anterior tibial artery
    • Posterior tibial artery
    • Dorsalis pedis artery
  • 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 tibia artery

    • Posterior tibial artery

    • 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

  • 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

3-13-2020Diagnostic CriteriaThe submission of diagnostic criteria has been removed and is no longer required.
6-2-2020
Added complete documentation description



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