I agree with you.  Start simple and answer questions as they arrise.  More importantly - and something I try to drill into the head of students/residents -  apply the "So What?" factor.  You want a test result and you get it, SO WHAT? What are you prepared to do with the result?  If intervention isn't planned why the detailed study?  Imaging tests primarily document anatomy, ABI's document physiology.  If the question is "why do my patient's legs ache when he/she walks 200 yards", then knowing that there's a  focal step up in velocities in the SFA's isn't going to get you any further than an abnormal ABI.  Smoking cessation, exercise, diet and other life style modifications will be urged, medicines prescribed and follow ups scheduled in the vast majority of patients by vascular surgeons armed with physiological data and a good history and physical.  If the patient is going to have any kind of intervention then angiography will be used (still the Gold standard anatomical test) rendering the duplex study redundant.  Of course there are exceptions to everything (the standard CYA statement).
Keep this in mind:
Duplex studies reimburse at a higher rate than physiologic studies.
The majority of radiology departments are devoid of physiologyic testing equipment.
Radiologic interpretations tend to be wordy.  A duplex exam uses lots of words and numbers to dicatate.
The irony is that plethysmography is easier to train, more reproducible, less expensive to acquire faster (or as fast) to perform and easier to interpret than duplex studies.  Unfortunately, the field of vascular testing is becoming "technocentric" in favor of imaging over physiology.  Even the title of the role has changed from technologist to sonographer. 
(have stick, will poke)

On 10/18/05, Dianne Gruber <[log in to unmask]> wrote:
Back to poking sticks  (doing imaging as the primary test, and ABI's "if
needed"). Having just had a dialogue with a radiologist on this subject, I
would be interested to hear it addressed (ok, again). My position was
physiologic first, imaging if needed for clarification (this is the
protocol we observe here). His was imaging first, abi's if imaging shows
disease. Viewpoints?

Dianne Gruber RVT RDMS
Maryville, TN

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