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UVMFLOWNET  September 2007

UVMFLOWNET September 2007

Subject:

Re: Those darn Doppler angles again

From:

Norma Vandenberghe <[log in to unmask]>

Reply-To:

UVM Flownet <[log in to unmask]>

Date:

Mon, 17 Sep 2007 15:24:49 -0700

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (112 lines)

Janette left PVI before that study was completed. The last she told me
was that it was looking like signals taken at a zero degree angle from
the flank (but still in the area of the stenosis; one can follow the
renal artery all the way back to the aorta with some effort) were
consistent with >60% diameter reduction when they reached 90 cm/sec.
This is 50% of the 180 cm/sec that the University of Washington criteria
call consistent with >60% diameter reduction. The preva8ling theory is
that the velocities do not change because of the angle, but that minor
angle measurement errors using a 60 degree angle on a curved renal
artery from the midline cause big errors in velocity calculation.
Problem is, the original criteria were determined using the 60 degree
angle and from the midline; No, we can't just rearrange the criteria to
suit ourselves. Until the study Janette was doing is completed, we do
not know for sure.
So... focal velocity increase, post-stenotic turbulence, get the
velocity increase from both directions and pay attention to the hilar
and parenchymal signals. It all has to match.

NormaV 


-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of
Card,Jason
Sent: Monday, September 17, 2007 1:59 PM
To: [log in to unmask]
Subject: Re: Those darn Doppler angles again

Jeannette Isaacson is, I believe, currently involved in collecting data
to adjust the Doppler criteria to match 0 degree velocities in renal
studies.  Maybe she or one of her collaborators in this study could shed
some more light.  I believe in the last presentation I saw from her that
there was initial data to support a correlation of approximately 180%
when adjusting 0 degree velocities to fit 60 degree criteria.

-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Norma
Vandenberghe
Sent: Monday, September 17, 2007 8:12 AM
To: [log in to unmask]
Subject: Re: Those darn Doppler angles again

I could give you the cosine values to prove it, but maybe we could get
Kirk Beach to do that. The closer you get to 0 degrees, the more
accurate the velocity measurement. But be cautious; velocities obtained
at 0 degrees in the distal renal arteries will often (usually) be about
50% of those taken at 60 degrees at the origins (probably due to angle
errors). There is no hard data to confirm this, but we may need new
criteria for using low angles of incidence. Verify what you get with it
being focal, post-stenotic turbulence and that you see evidence of
stenosis from both directions (midline and flank. 

Norma J. Vandenberghe, RN, RVT
Technical Director
Overlake Internal Medicine Associates
Diagnostic Vascular Laboratory
1135 116th Ave NE  #600
Bellevue, WA  98044
425 450-6192
[log in to unmask] 


-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Don
Ridgway
Sent: Friday, September 14, 2007 9:51 PM
To: [log in to unmask]
Subject: Those darn Doppler angles again

Okay, bear with me, please. A couple of techs are wrangling about proper
angles while doing renal Doppler: One says that you can't go below 45
degrees, even if the actual angle relative to vessel wall is zero
degrees. The other says it's better to use the actual angle (assuming
it's not possible to obtain a 50-60 degree angle).

I most certainly know what I think, but a few opinions from heavyweights
would be helpful. (These young folks think I'm half senile and don't
listen to me.)


Don Ridgway
Grossmont Hospital
Grossmont College

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