Dear Medical and Technical Directors,

Congratulations once again on acquiring accreditation by the Intersocietal Commission for the Accreditation of Vascular Laboratories. Your laboratory has been awarded accreditation in the areas of Extracranial Cerebrovascular, Peripheral Arterial and Peripheral Venous testing.

Although your laboratory was found to be in substantial compliance with the written Essentials and Standards, several areas of concern noted by the Board are described below. It would be in your best interest to address these concerns before seeking reaccreditation in three years. The areas of concern are outlined according to their listing within the Essentials and Standards. If you have any questions or concerns after reading the comments, please contact me.

COMMENTS:

	The quality of the case studies submitted for review was considered marginal. The cases are the best mechanism to assure that the technical protocols and diagnostic criteria have been applied to patient testing. It is in the best interest of the laboratory to provide complete and comprehensive studies, with full, high quality hard copy and radiographic or clinical correlation whenever possible. Although it is understood that original images cannot always be submitted for review, the copies should be of good quality, so that the reviewers can accurately and objectively assess the case studies.
	The report form provided with the case studies does not always include information on the indication for the procedure. It is required that the technical staff list and document patient history. Follow up reports must contain a history or indication for the study. This will be required for reaccreditation.
	The diagnostic criteria described for determining carotid artery stenosis by duplex ultrasound are appropriate. However, if they are not adhered to when making the diagnosis, it is essential to state the reason for the variance in the final report. You have submitted case studies in which there is variability in the application of the diagnostic criteria to the test results. It is necessary for the laboratory to have a consistent approach, so that the vascular examinations are interpreted in a standardized manner.
	The use of color flow Doppler imaging provides flow information. However, the exclusive use of color flow Doppler imaging for the assessment of venous physiology is insufficient. The Essentials and Standards require spectral Doppler waveform analysis as a component of the duplex assessment.

Thank you for participating in the process of accreditation. By voluntarily demonstrating substantial compliance to the requirements outlined in the Essentials and Standards, you have demonstrated a commitment to high quality patient care.

Sincerely,

ICAVL Technical Manager