|
The IAC Standards
and Guidelines |
Click here for a printer-friendly PDF of the Vascular
Testing Standards |
5.1B Visceral
vascular testing must be performed for appropriate clinical indications.
5.1.1B The
indication for testing must be documented prior to performing the examination.
(See Guidelines below for further recommendations.)
5.2B Equipment
must provide accurate data.
5.2.1B Imaging
Equipment – Duplex ultrasound with color flow Doppler must be
provided with:
5.2.1.1B imaging
frequencies appropriate for the structures evaluated;
5.2.1.2B Doppler
frequencies appropriate for the vessels evaluated;
5.2.1.3B range-gated
spectral Doppler with the ability to adjust the depth and position of the range
gate within the area of interest;
5.2.1.4B a
Doppler angle which is measurable and adjustable;
5.2.1.5B a
visual display and a permanent recording of the image; and
5.2.1.6B a
visual display, an audible output, and a permanent recording of the Doppler
waveform and corresponding image which includes the Doppler angle.
5.2.2B Equipment
Quality Control
5.2.2.1B Equipment
used for diagnostic testing must be maintained in good operating condition.
5.2.2.2B 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; and
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.)
5.3B
Each examination performed in the facility must have a written protocol. The
protocol must include:
5.3.1B
the equipment to be used for each examination;
5.3.2B
the elements of proper technique (also see STANDARD
– Techniques);
5.3.3B
anatomic extent that constitutes a complete examination includes evaluation of
the entire course of the accessible portion of each vessel:
5.3.3.1B
variations in technique following vascular intervention;
5.3.3.2B
variations in technique and documentation for limited examinations must be
described.
Comment: A complete examination includes
evaluation of the entire course of the accessible portions of each vessel. A
limited examination is a subset of the complete examination. There may be
recurring indications for a limited examination.
5.3.4B
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);
5.3.5B
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.
(See Guidelines below for further recommendations.)
5.4B
Visceral vascular examinations comprise the following visceral vascular
systems:
5.4.1B
mesenteric arterial system;
5.5B
Visceral vascular testing comprises several distinct examinations because
different indications require specific vascular systems to be evaluated.
5.5.1B
Each visceral vascular system requires several vessels to be examined.
5.5.2B
Some examinations also require grayscale imaging of the appropriate organ.
5.6B Appropriate
techniques must be used for the evaluation of each visceral vascular system to
assess for the presence of any abnormalities and to document their severity,
location, extent and whenever possible etiology.
5.6.1B
Elements of proper technique include, but are not limited to:
5.6.1.1B
performance of an examination according to the facility specific, written
protocol;
5.6.1.2B
proper patient positioning;
5.6.1.4B
appropriate equipment and transducer selection;
5.6.1.5B
appropriate transducer positioning;
5.6.1.6B
proper sample volume size and positioning;
5.6.1.7B
optimization of equipment gain and display settings;
5.6.1.8B
a spectral Doppler angle of 60 degrees or less with respect to the vessel wall
and/or direction of blood flow when measuring velocities;
5.6.1.9B
proper measurement of spectral velocities as required by the protocol;
5.6.1.10B
identification of vessels by imaging and Doppler.
5.7B 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:
5.7.5B other
images and waveforms as required by the protocol;
5.7.6B other
measurements as required by the protocol.
5.8B
Abnormalities will require additional images and waveforms that demonstrate the
severity, location, extent and whenever possible etiology of the abnormality
present.
5.8.1B
Documentation areas of suspected stenosis or obstruction must include
representative Doppler waveforms and velocity measurements recorded at and
distal to the stenosis or obstruction.
5.9B
Visceral Vascular Documentation
5.9.1B
Mesenteric Arterial System
5.9.1.1B
Grayscale and/or color Doppler images must be documented as required by the
protocol and must include at a minimum:
i.
adjacent aorta to celiac or superior mesenteric artery;
ii.
celiac artery;
iii.
superior mesenteric artery;
iv.
inferior mesenteric artery;
v.
stent(s) when present,
including proximal and distal ends.
5.9.1.2B
Spectral Doppler waveforms and velocity measurements must be documented as
required by the protocol and must include at a minimum:
i.
adjacent aorta;
ii.
celiac artery origin;
iii.
hepatic artery (does not require velocity measurements);
iv.
superior mesenteric artery origin;
v.
proximal superior mesenteric artery (beyond the origin);
vi.
inferior mesenteric artery;
vii.
stent(s) when present.
· native artery at the proximal end of
the stent;
· proximal stent;
· mid stent;
· distal stent;
· native artery at the distal end of the
stent.
5.9.2.1B
Grayscale and/or color Doppler images must be documented as required by the
protocol and must include at a minimum:
i.
intrahepatic portal vein;
ii.
extrahepatic portal vein;
iii.
hepatic veins;
iv.
inferior vena cava;
v.
adjacent liver parenchyma;
vi.
portosystemic shunts or collateral pathways (when present).
5.9.2.2B
Spectral Doppler waveforms must be documented as required by the protocol and
must include at a minimum:
i.
common portal vein;
ii.
right portal vein;
iii.
left portal vein;
iv.
superior mesenteric vein;
v.
splenic vein;
vi.
right, left and middle hepatic veins;
vii.
inferior vena cava;
viii.
portosystemic shunts (when present).
5.9.2.3B
Transjugular Intrahepatic Portosystemic Shunt (TIPS) require angle corrected
waveforms and velocity measurements, must be documented as required by the
protocol and must include at a minimum:
i.
portal vein inflow;
ii. left
and right portal veins (does not require velocity measurements);
iii.
portal end stent;
iv.
mid stent;
v.
hepatic end stent;
vi.
hepatic vein outflow (does not require velocity measurements).
5.9.3.1B
Grayscale and/or color
Doppler images must be documented as required by the protocol and must
include at a minimum:
i.
aorta at the level of the renal arteries;
ii.
renal arteries;
iii.
renal artery and vein at the hilum;
iv.
grayscale pole to pole renal length measurements.
v.
stent(s) when present,
including proximal and distal ends.
5.9.3.2B
Spectral Doppler waveforms and velocity measurements must be documented as
required by the protocol and must include at a minimum:
i.
aorta at the level of the renal arteries;
ii.
origin/ostia of the renal artery;
iii.
proximal main renal artery;
iv.
mid main renal artery;
v.
distal main renal artery;
vi.
parenchymal/hilar arteries (when appropriate);
vii.
accessory renal artery (when present);
viii.
renal veins, when appropriate (does not require velocity measurements).
ix.
stent(s) when visualized,
must include:
· native artery at the proximal end of
the stent;
· proximal stent;
· mid stent;
· distal stent;
· native artery at the distal end of the
stent.
Comment: Limitations of the study must be documented in
the final report.
Comment: A complete renal vasculature
examination includes a bilateral evaluation.
5.9.4.1B
Grayscale and/or color Doppler images must be documented as required by the
protocol and must include at a minimum:
i.
transplant renal artery;
ii.
transplant renal vein;
iii.
grayscale images of transplant kidney and peri-transplant region.
5.9.4.2B
Spectral Doppler waveforms and velocity measurements must be documented as
required by the protocol and must include at a minimum:
i.
donor artery;
ii.
region of arterial anastomosis;
iii.
proximal transplant renal artery;
iv.
distal transplant renal artery;
v.
parenchyma/hilar arteries;
vi.
transplant renal vein (does not require velocity measurements);
vii.
renal vein at or near anastomosis (does not require velocity measurements).
5.9.5.1B
Grayscale and/or color Doppler images must be documented as required by the
protocol and must include at a minimum:
i.
color Doppler of intrahepatic portal vein;
ii. color
Doppler of extrahepatic portal vein;
iii. color
Doppler of hepatic veins;
iv. color
Doppler of the left and right portal veins;
v. hepatic
artery;
vi.
inferior vena cava;
vii.
grayscale images of transplant liver and peri-transplant region.
5.9.5.2B
Spectral Doppler waveforms and velocity measurements must be documented as
required by the protocol and must include at a minimum:
i.
donor hepatic artery in the region of the anastomosis;
ii.
hepatic artery;
iii.
left and right hepatic arteries (does not require
velocity measurements);
iv.
hepatic veins (does not require velocity measurements);
v.
portal vein anastomosis;
vi.
portal vein;
vii.
inferior vena cava (does not require velocity measurements).
5.9.6B
Abdominal aorta examinations (if performed) must be documented as required by the
protocol and must include at a minimum.
Comment: The facility can include
abdominal aorta examinations as part of the peripheral arterial application
only if the facility performs other peripheral arterial examinations. If the
facility does not perform any other peripheral arterial examinations, abdominal
aorta examinations can be included in the visceral vascular testing
section.
5.9.6.1B
Transverse view (defined as perpendicular to the long axis of the aorta)
grayscale images with the single widest outer wall to outer wall diameter
measurement must be documented as required by the protocol and must include at
a minimum:
i.
proximal aorta;
ii.
mid aorta;
iii.
distal aorta;
iv.
common iliac arteries at the bifurcation.
5.9.6.2B
Long axis grayscale images must be documented as required by the protocol and
must include at a minimum:
i.
proximal aorta;
ii.
mid aorta;
iii.
distal aorta;
iv.
documentation of aneurysms (if present) must include the widest size of the
aorta measured outer wall to outer wall. Additional images proximal and distal
to the aneurysm must be recorded.
5.9.6.3B
Spectral Doppler waveforms and velocity measurements must be documented as
required by the protocol and must include at a minimum:
i.
aorta at/or proximal to the renal artery origins;
ii.
mid aorta;
iii.
distal aorta;
iv.
right common iliac artery;
v.
left common iliac artery.
(See Guidelines below for further recommendations.)
5.10B Records
must be maintained that permit evaluation of annual procedure volumes. These records
must include:
5.10.1B
indication for the examination;
5.10.2B
technologist performing the examination;
5.10.3B
examination(s) performed;
5.10.5B
the physician interpreting the examination.
(See Guidelines below for further recommendations.)
5.1B
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.
5.2.2.2B
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.
5.3B
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.
5.9.6.3B
Color Doppler images may supplement grayscale imaging but does not substitute
for it.
5.10B
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.