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Vascular > Normal Duplex Exam > Flashcards

Normal Duplex Exam Flashcards

1
Q

label

A
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2
Q

label

A
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3
Q

what are the 3 types of exam used on carotid

A

2D

color doppler

spectral doppler

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4
Q

what type of exam

Identifies vessels
Identifies plaque or other pathology
Determines %stenosis if <50 or 60

aka identify vessels, % stenosis

A

2D

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5
Q

what type of exam

Helps locate the vessel in technically difficult exams
Determine direction of flow
Identify filling defects associated with soft/fibrous plaque
Identify jet to aid in placement of spectral Doppler

aka: identify filling defects, jets, don’t measure with calipers

A

color doppler

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6
Q

what type of exama

Analysis of waveform morphology (high resistence, low resistance, tardus parvus, etc.)
Measure peak systolic and end diastolic velocities
Identify turbulence

aka: velocities, resistance, turbulence

A

spectral doppler

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7
Q

why are all 3 types of imaging necessary?

A

to make summary of findings. The findings should correlate. If not, look for pitfalls.

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8
Q

what can you see with trans vs long?

A

Transverse imaging

Helps you identify vessels
Helps you understand bifurcation orientation
Helps you find the best window
Best for 2D measurements of percent stenosis

Longitudinal

Show extent of stenosis
Doppler

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9
Q

which window is b/t:

between trachea and SCM muscle

through SCM muscle

lateral - posterior to SCM muscle

A

ant

lateral

posterior

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10
Q

in what plane do the following apply?

posterior - lateral approach
diameter measurement of stenosis
ICA -ECA identification /differentiation

A

transverse

post – can be identified w/ posterior/lateral approach



diameter measure – use 2D diameter measurements

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11
Q

what is this?

what is the equation used in this type of imaging?

A

2D % stenosis measured in trans (measures diameter of plaque)

% stenosis = Vessel – Lumen / Vessel x 100

*secondary method to diagnose stenosis. used when we don’t 
see hemodynamic change which does not happen unless it is 50% stenosed. THIS EXAM IS DONE FO RMORE MILD

rarely see this done clinically b/c most patients have >50% stenosis

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12
Q

Longitudinal estimation of stenosis from B-mode image is ____________________________ .

A

usually unreliable, use transverse image.

*you can NEVER overestimate the plaque in transverse

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13
Q

This minor plaque can be made to appear ____ or _____ stenotic in longitudinal view

A

more, less

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14
Q

wht is this image demonstrating?

A

area vs diameter.

In “A”, Circumferential plaque, 75% Area = 50% Diameter
reduction (always bigger than diameter; not used)

In “B”, 50% area reduction is also a 50% Diameter
reduction

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15
Q

what are the benefits of getting an image in long?

A

anatomy - helps elongate
plaque characterization - shadows/mobile
Length of plaque
Doppler

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16
Q

what type of plaqe is this?

A

smooth CCA plaque

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17
Q

what type of plaque morphology is this?

A

irregular, complex

18
Q

how can you differentiate the ICA from the ECA by anatomy and in the waveforms?

A

Anatomy:

posterior position of ICA (usually 95% of the time)
branches of ECA - no one cares about this it never gets treated.
ICA size: not reliable when diseased

Doppler waveforms & sounds:

ICA = low resistance
ECA = high resistance

*first branch off of ICA is superior thyroid (cervical branches)

19
Q

which way shoudl the groove of your Td face?

A

always to the patients right

20
Q

on body view

A

on screen view

*pink bar represents the Td orientation marker

21
Q

ECA position, whether lateral, anterior or medial, is _____.

A

variable

22
Q

is it possible for the ICA to lie deep or superficial to the ECA?

A

yes.

23
Q

ICA is ____ resistance

ECA is ____ resistance

they both flow _____ the head

A

low

high

towards

24
Q

what vessel doe this look like?

what is the sonographer dong to the patient? is this reliable in this vessel?

A

ECA Temporal Tap can be a useful tool in identifying the ECA, but it is often unreliable. Oscillations can and do occur in the ICA as well. Understanding the anatomical position of the ECA-ICA is the best method.

*fast vibration like taps to get 2-3 in during diastole

25
Q

which beams are steered corectly?

A
26
Q

how might you improve depth penetration?

A

by not steering the doppler

*steered ok - parallel to vessel as possible
w/ this you can’t see flow b/c you aren’t able to penetrate deep enough. in this case, try a straight steer. turning gain up and changing the scale would not work in this.

straight steer penetrates better.

27
Q

what are some sample doppler locations?

A
28
Q

whats the difference b/t these waveforms

A

ICA - low resistance, mod/high distal flow

CCA - mid resistance

29
Q

what artery is this waveform from…possibly?

A

subclavian

30
Q

coratid protocol 2D trans and long

A

Trans

CCA
Bulb
Bif ICA/ECA
Distal ICA

Long

CCA – Prox/mid
CCA/Bulb – Distal and Bulb
ICA/Bulb – Prox ICA and Bulb
ICA – mid and distal
ECA/Bulb –proxECA and Bulb

31
Q

COLOR AND spectral protocol

A

CCA – Prox/mid waveform
CCA/Bulb – Distal CCA waveform
CCA/Bulb – Bulb waveform
ICA/Bulb – Prox ICA waveform
ICA – mid ICA waveform
ICA – distal ICA waveform
ECA/Bulb –proxECA waveform
Subclavian - waveform

32
Q

national standards

Of note: not all require subclavian. Some labs will do bilateral brachial pressures rather than subclavian waveforms.

A

AIUM practice guidelines,

http://www.aium.org/publications/clinical/extracranial.pdf

ICAVL standards,

www.icavl.org

ACR guidelines,

http://www.acr.org/SecondaryMainMenuCategories/qualit y_safety/guidelines/us/us_extracranial_cerebrovascular.asp x

33
Q

what discussion has been had about angels to use in exams? (2) what do you need to remember?

A

2 schools of thought

  1. Always use 60 degrees – so everyone does it the same
  2. Always use best angle – so look up previous exam and use same angle.

*ALWAYS use the same angle

34
Q

What is the scanning window located between the trachea and sternocleidomastoid muscle?

lateral

posterior

anterior

medial

A

anterior

35
Q

Which 2D scanning plane is best for assessment of percent stenosis?

coronal

oblique

transverse

longitudinal

A

trans

36
Q

What is the most reliable way using 2D to differentiate the ECA and ICA?

ECA is smaller

ECA is posterior

ECA has cervical branches

ECA does not develop plaque

A

ECA has cervical branches

37
Q

Which of the following describes the plaque morphology on this image?

smooth

fibrous

calcified

fatty streak

A

calcified

38
Q

What vessel does this waveform likely represent?

ICA

ECA

superior thyroid

subclavian

A

ICA

39
Q

match the folllowing images w/ td position

A

2

3

1

40
Q

which waveform corresponds to the vessel

A

a

41
Q

The transverse image of the carotid bifurcation was obtained from the anterior window. What window would yield the bifurcation image demonstrated?

inferior

posterior

anterior

lateral

A

lateral

Vascular (9 decks)

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