I had a similar experience temping. Intresting
situation: the Rads interpreted the Grey scale images
and % stenosis by area, then Vascular surgeons
interpreted color images and spectral analysis- one
exam, but 2 interpretations! Yikes.
--- Audrey Fleming <[log in to unmask]>
> I have worked in one or two places where the reading
> physician wants area reductions. No amount of
> persuasion ever changed their minds. You can give
> them all the articles you want, they have decided
> they know best. It doesn't happen as much as it used
> to, but it does still happen.
> The worst was when I was required to perform area
> measurments on all carotids that had any plaque. The
> reports read as "13% stenosis seen in the ICA".
> Yeah, what a disaster. I was a temp and agreed to
> work my already commited week, but just laughed when
> they wanted to extend me. This would have been 6-7
> years ago so don't know if this person is still
> Audrey Fleming RDMs, RVS
> "Ross, Diana" <[log in to unmask]> wrote:
> Hi, Linda
> Diameter reduction and area reduction are only
> useful when doppler doesn't correlate with something
> seen visually. Mostly this is only useful in a wide
> bulb or maybe in the CCA. I have found this useful
> in maybe 4 or 5 cases over the thousands I have
> OTHERWISE PULSED WAVE DOPPLER RULES...STRANDNESS
> OR OTHERWISE.
> I find it scary that this is what people are doing
> anywhere in the USA. Is anyone of these people an
> RVT? Or even RDMS? Angiography is not ultrasound.
> The RESULTS of angio should be compared with the
> RESULTS of doppler ultrasound, but they can not use
> the same methods...
> This is an old topic on these boards..... Always
> good for a few flames!
> From: UVM Flownet [mailto:[log in to unmask]]
> On Behalf Of linda sulzdorf
> Sent: Tuesday, June 05, 2007 1:07 PM
> To: [log in to unmask]
> Subject: Doppler vs measurement criteria for grading
> carotid disease.
> Dear flownetters;
> I'm teaching an online sonography program and as
> part of the coursework, I'm introducing the students
> to venous and carotid exams. My first discussion
> assignment asked what criteria the students'
> departments were using to grade carotid lesions and
> how the surgeons used this criteria for patient
> treatment decisions.
> One department is essentially using the Stavros
> Doppler criteria for grading the degree of the
> diameter-reducing stenosis, but added the ICA/CCA
> ratio of 4.0 (Moneta) to differentiate between
> greater or lesser than 70% diameter reduction.
> Then, if severe plaquing is identified, a transverse
> image is used to determine the percent of area
> stenosis. When I asked how these two criteria were
> integrated, these are the explanations I received
> from the clinical instructor and student:
> Clinical Instructor: "Area measurements are used
> at virtually every facility I have worked at, and as
> a traveler I have worked at many. With the advent
> of pdi obtaining transverse area measurements is
> more accurate and precise than older methods i.e.
> Diameter measurements which do no account for
> lateral plaques......I personally think that area
> measurements are more precise albeit more time
> consuming than diameter measurements. These
> measurements are more easily compared to cta/mra
> images which are measured in the same manner..... I
> am trying to help ****** understand that Doppler is
> a poor indicator of low grade stenosis and is not
> accurate in establishing a reasonable estimation of
> the actual percentage of stenosis. We currently use
> the criteria established by The society of
> Radiologist in ultrasound."
> Student: "The manner that these measurements are
> obtained is identical to that used in
> echocardiography and is also used in the cardiac
> cath lab to determine ejection fraction, I believe
> it is based on the Simpson's equation so I think
> that these measurements are accurate and my clinical
> instructor believes them to be more precise than
> velocity alone. He says that diminished cardiac
> output, aortic insufficiency and overall poor
> arterial health effect velocity but have no effect
> on the area stenosis. I am told it is one of the
> many tools used to a thorough carotid study.
> Diameter stenosis is much less involved and much
> more innaccurate because of lateral plaques not in
> the line of measurement.... makes little sense to me
> that what is an acceptable measurement in echo would
> be invalid in vascular ultrasound. According to my
> clinical instructor this is a common practice at
> several large nationally known vascular labs he has
> worked at.
> OK, so the question I have is obviously, what is
> common practice in vascular labs? I confess to have
> been brought up to use Doppler criteria for diameter
> reduction and essentially follow the Strandness
> criteria with the addition of Moneta's ICA/CCA ratio
> to select those patients with a greater than 70%
> diameter-reducing stenosis. When we were performing
> angios, we internally validated this criteria and
> realized the difficulties with trying to add the
> Moneta criteria to the Strandness criteria, because
> one measured one thing and one measured another.
> (i.e., at the site of stenosis as opposed to a
> comparison with a normal ICA at a site distal to the
> lesion). So, am I way behind the times and should
> be put out to pasture? Please feel free to flame
> me....I'd much rather be enlightened than ignorant.
> Thanks in advance and forgive me for my long post.
> Linda Sulzdorf, RDMS, RVT, BSVT
> Sonographer and Instructor
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Thomas J. Hargens, R.T.,R.V.T.
Pro Vascular Services, Inc.
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