On Fri, 7 Sep 2007 13:10:35 -0400, Macclellan <NJMacclellan@COLLINS-
>I HAVE JUST STARTED FILLING IN FOR A VASCULAR SURGEON PERFORMING
VASCULAR SONOGRAPHY. HE IS REQUESTING DIAMETER REDUCTION
CALCULATIONS THROUGHOUT THE EXTRACEREBRAL VASCULAR EXAMINATION.
I HAVE AN OPINION, HOWEVER, I WOULD LIKE TO KNOW IF ANYONE IS
PERFORMING THIS ROUTINELY, ARE YOU PERFOMING THIS CALCULATION IN
LONG OR TRANS. THANKS FOR ALL RESPONSES.
>Nancy MacClellan BA, RDMS, RVT
>Program Director, DMS
>Collins Career Center
>740-867-6641, extension 526
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Forget the longitudinal part! That is way too much to think that any
sonographer with any spacial relationship skills would EVER depend on, let
alone a fairly intelligent surgical group! Yikes!
What possibly could the physician's rationale be for attempting to determine %
stenosis calculations via diameter reduction measurements when this is so
blasted outdated? (Dr. Strandness, RIP and hang in there friend. No need to
roll over) :O)
So many vessels are often calcified in this target population age, and even
with rotational, window-searching scanning approach, valsalva to distend the
jugular window techniques..... calcification's often "beat" ultrasound regarding
penetrability. Give me a soft plaque anytime, and I'll build you a case. MRA's
often end up kissing my butt come post-angio and post-surg because they
can and do mislead Radiologists. We can do better with ultrasound! Remember
folks, we are examining a fairly simple tube with fluid dynamics. Velocities RULE
for % stenosis in the mod to critical range.
In 3 decades of scanning, I have noted many times velocities are WNL, but
there is a nasty, irregular or smooth annular plaque that can appear to
stenose an ICA bulb by 60% on transverse views. Sure, the complex
hemodynamics in the bulb get modified and streamlined, but still less than
twice a distal CCA velocity measurement, right?
THINKING::::Gee, do ya think the rest of the arterial system has the same
atherosclerotic burden? Is that more important than silly calcifications with
minimal diameter reductions? NAH!!::::
Longitudinal views for % stenosis? Lawdy, tell me these guys are NOT serious!!
Other than plaque pathology and Intima-media thickness, VELOCITIES and
ratios, judiciouisly appled, are the only way to go to accurately gauge a
stenosis, using color doppler as your guide with the correct PRF threshold
initially to broadly "check out the whole tube", and then to be used to find max
jet velocities by increasing the PRF till the location of max velocity is revealed.
If one has not spent following up NIC exams and correlating them with
subsequent angiograms, MRA's, digi-subtr, or whatever, (are you out there?)
then Mr./Mrs. Sonographer will never learn from his/her mistakes or judgement
errors. Nor do many WANT to learn. They know it all, you know. :O/
And did I mention it's a marvelous idea to keep your insonation angle at 60%
ALWAYS, and heel/toe and use colorbox/insonation angle changes to your
advantage. Consistancy, scanning acuity and agressiveness RULES and will
make you a prized sniper for your docs, and ultimately the patients you help
them to initially diagnose.
"I WOULD LIKE TO KNOW IF ANYONE IS PERFORMING THIS ROUTINELY, ARE
YOU PERFOMING THIS CALCULATION IN LONG OR TRANS. THANKS FOR ALL
No, and neither. I wish you the best of luck and let us know what in god's
name these docs want with the technology we have at hand here, ok Nancy?
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