Documenting Your Laboratory's Commitment To Quality Patient CARE: Complete Accurate Reproducible Examinations

Though all portions of the ICAVL Standards and application are important in demonstrating quality patient care, it is often cited that the most important aspect of a laboratory's accreditation application lies with the case studies. Integrating all aspects of the Standards from equipment, to technical protocols, to final reports and quality assurance on a continual basis assists in ensuring optimum case study production, resulting in the best possible patient care.

COMPLETE

The technical quality and completeness of exam findings is vital in an interpreting physician's ability to compile a report and formulate a final diagnosis. The ICAVL Standards for each type of testing are organized in identical formats. Each area is divided into six sections, and the minimum required hardcopy documentation (images and waveforms) for each type of testing is located in Section 3 - Techniques and Documentation of Examination Performance. Following are the hardcopy documentation requirements for the primary testing procedures for the three testing areas most frequently applied for: Extracranial Cerebrovascular, Peripheral Arterial, and Peripheral Venous. Keep in mind that these are considered the minimum requirements, and laboratories may choose to include documentation beyond the requirements of the Standards that are often needed and warranted for patients with difficult anatomy or abnormal findings.

EXTRACRANIAL CEREBROVASCULAR Representative gray scale images (figure 1): CCA ICA carotid bifurcation Representative spectral Doppler waveforms: two (2) sites in the CCA two (2) sites in the ICA one (1) site in the ECA one (1) site in the vertebral mid and distal to stenosis

Figure 1. Gray scale image: Distal CCA, bifurcation and ICA (image courtesy of Boston Medical Center Vascular Laboratory, Boston, MA) +VIEW LARGER IMAGE+

PERIPHERAL ARTERIAL (Lower Extremities)

A complete lower extremity examination includes bilateral waveform sampling from three or more levels in conjunction with a minimum of ankle/brachial index (ABI) or segmental pressures.

• common femoral artery
• popliteal artery
• distal tibial arteries at the level of the ankle

If plethysmographic waveforms (PVR) are obtained, they must be documented from a minimum of the:

• thigh
• calf
• ankle

If arterial duplex is performed, the following hardcopy documentation is required in conjunction with ABI measurements.

Representative gray scale images:

• common femoral artery
• superficial femoral artery
• proximal deep femoral artery
• popliteal artery
• aorta, common and external iliac arteries and tibial arteries when appropriate
• bypass graft(s) when present, including anastomoses, inflow and outflow arteries

Representative spectral Doppler waveforms:

• common femoral artery
• superficial femoral artery
• proximal deep femoral artery
• popliteal artery
• tibial arteries
• aorta, common and external iliac arteries when appropriate
• bypass graft when present, including proximal and distal anastomoses, inflow and outflow arteries
• mid and distal to stenosis

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