|
The IAC Standards
and Guidelines |
Click here for a printer-friendly PDF of the Vascular
Testing Standards |
1.1B Extracranial
cerebrovascular testing must be performed for appropriate clinical indications
1.1.1B The
indication for testing must be documented prior to performing the examination.
(See Guidelines
below for further recommendations.)
1.2B Equipment
must provide accurate data.
1.2.1B Imaging
Equipment – Duplex ultrasound with color flow Doppler must be
provided with:
1.2.1.1B imaging
frequencies appropriate for the structures evaluated;
1.2.1.2B Doppler
frequencies appropriate for the vessels evaluated;
1.2.1.3B range-gated
spectral Doppler with the ability to adjust the depth and position of the range
gate within the area of interest;
1.2.1.4B a
Doppler angle which is measurable and adjustable;
1.2.1.5B a
visual display and a permanent recording of the image; and
1.2.1.6B a
visual display, an audible output, and a permanent recording of the Doppler
waveform and corresponding image which includes the Doppler angle.
1.2.2B Equipment
Quality Control
1.2.2.1B Equipment
used for diagnostic testing must be maintained in good operating condition.
1.2.2.2B Equipment
maintenance must include, but is not necessarily limited to:
i. recording
of the method and frequency of maintenance of all imaging equipment and
non-imaging equipment;
ii. establishment
of and adherence to a policy regarding routine safety inspections and testing
of all facility electrical equipment;
iii. establishment
of and adherence to an equipment cleaning schedule that includes routine
cleaning of equipment parts, including filters and transducers, according to
specifications of the manufacturer.
(See Guidelines
below for further recommendations.)
1.3B Each
examination performed in the facility must have a written protocol. The
protocol must include:
1.3.1B equipment
to be used for each examination;
1.3.2B elements
of proper technique (also see STANDARD –
Techniques);
1.3.3B anatomic
extent that constitutes a complete examination includes the evaluation of the
entire course of the acceptable portion of each vessel;
1.3.3.1B bilateral
testing is considered a complete examination.
1.3.3.2B variations
in technique following vascular intervention.
1.3.3.3B variations
in technique and documentation for limited examinations.
1.3.4B documentation
that must be acquired for normal examinations and the additional documentation
that must be acquired to describe abnormalities, if present (also see STANDARD – Documentation);
1.3.5B a
description of how color Doppler or other flow imaging modes (e.g., power Doppler)
are used to supplement grayscale imaging, spectral Doppler and velocity
measurements.
1.4B Appropriate
techniques must be used for the evaluation of the extracranial cerebrovascular
system to assess for the presence of any abnormalities and to document their
severity, location, extent and whenever possible etiology.
1.4.1B Elements
of proper technique include, but are not limited to:
1.4.1.1B performance
of an examination according to the written, facility specific protocol;
1.4.1.2B proper
patient positioning;
1.4.1.4B appropriate
equipment and transducer selection;
1.4.1.5B appropriate
transducer positioning;
1.4.1.6B proper
sample volume size and positioning;
1.4.1.7B optimization
of equipment gain and display settings;
1.4.1.8B a
spectral Doppler angle of 60 degrees or less with respect to the vessel wall
and/or direction of blood flow when measuring velocities;
1.4.1.9B proper
measurement of spectral velocities as required by the protocol;
1.4.1.10B identification
of vessels by imaging and Doppler.
1.5B Each
examination performed in the facility must provide documentation as required by
the protocol that is sufficient to allow proper interpretation, including but
not limited to:
1.5.5B other
images and waveforms as required by the protocol;
1.5.6B other
measurements as required by the protocol.
1.6B Abnormalities
will require additional images and waveforms that demonstrate the severity,
location, extent and whenever possible etiology of the abnormality present.
1.6.1B Areas
of suspected stenosis or obstruction must include representative Doppler
waveforms and velocity measurements recorded at and distal to the stenosis or
obstruction
1.7B Extracranial
Cerebrovascular Documentation
1.7.1B Long
axis grayscale images must be documented as required by the protocol and must
include at a minimum:
1.7.1.1B common
carotid artery;
1.7.1.2B carotid
artery bifurcation;
1.7.1.3B internal
carotid artery.
1.7.1.4B carotid artery stent (if
present) including proximal and distal ends.
1.7.2B Spectral Doppler waveforms and
velocity measurements must be documented as required by the protocol and
must include at a minimum:
1.7.2.1B proximal
common carotid artery;
1.7.2.2B mid/distal
common carotid artery;
1.7.2.3B proximal
internal carotid artery;
1.7.2.4B distal
internal carotid artery (as distal as possible);
1.7.2.5B one
site in the external carotid artery;
1.7.2.6B one
site in the vertebral artery.
1.7.2.7B carotid artery stent (if
present).
i. native
artery at the proximal end of the stent;
ii. proximal
stent;
iii. mid
stent;
iv. distal
stent;
v. native
artery at the distal end of the stent;
Comment: Limitations of the
study must be documented in the final report.
1.7.3B Abnormalities
require additional images, waveforms and velocity measurements.
1.8B The
annual procedure volume must be sufficient to maintain proficiency in
examination techniques and interpretation.
1.8.1B indication
for the examination;
1.8.2B technologist
performing the examination;
1.8.3B examination(s)
performed;
1.8.5B physician
interpreting the examination.
1.1B
When available, appropriateness criteria published by medical professional
organizations should be utilized.
Comment: An accepted indication is generally written by the referring health
care provider. In some instances it can only be assessed at the time of the
examination.
1.2.2.2B
The cleaning schedule for each system will depend on the degree of use and
should be frequent enough to allow for accurate collection of data.
1.3B
The protocol should include the indications for a limited examination and the
descriptions of the limited examination. Separate limited examination protocols
may also be written.
1.8B The
annual procedure volume should be sufficient to maintain proficiency in
examination techniques and interpretation.
• In general, a
facility should perform a minimum of 100 complete examinations annually.