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Scary!!

________________________________

From: UVM Flownet on behalf of Terry Zwakenberg
Sent: Thu 2/3/2011 3:44 PM
To: [log in to unmask]
Subject: Re: Arterial Journals



Amplitude of the waveform is for all practical purposes meaningless without a means to calibrate the system.  As far as I know there has not been a system capable of calibration since the old life science systems of the 80s.  Waveform analysis is the current standard.  So maniuplation of the gain to better visualize subtle changes is always indicated.

On Feb 3, 2011 2:32 PM, "Mican, Lisa" <[log in to unmask]> wrote:
> Amplitude of PVR waveforms can be adjusted according to size at the BEGINNING of the exam ONLY....and not changed during exam (with the exception of the PPGs).
> 
> ________________________________
> 
> From: UVM Flownet on behalf of JASON r
> Sent: Thu 2/3/2011 3:19 PM
> To: [log in to unmask]
> Subject: Re: Arterial Journals
> 
> 
> 
> I do not see a problem with increasing or decreasing the gain on a PVR amplitude. I do agree that there should be a standard setting. However, if a PVR waveform has a upstroke, downstroke, and dicrotic notch its technicall normal...right.. So is one extremity waveform is smaller than the other cuff placement may be the issue. Given that limbs are not created equal, one limb will always be bigger than the other, thus, the issue of dissimilar PVR amplitudes. With this said, there should be not reason the gain cannot be adjusted within reason to accentuate the waveform. Think about this, a doppler waveform is Triphasic, who cares if it looks bigger or smaller on the screen. Also, a physiologic test encompasses many other inforamtics as well. 
> While i am constantly looking a research data, the referenced data in many of these thoughts is old >10years, and should be revised. Does turning up the spectral doppler a little bit overly increase the velocities, yes and no. It could but, it will never degredate the the overall look of the spectral envelope. 
> 
> I thinks this topic should be revised, and the original data be revisited as well. I believe in standards modes of measures, but alittle bit of a skew will not hurt the overall test. Besides its a quantitative test. :)
> 
> 
> 
> 
> 
> Jason 
> 
> ________________________________
> 
> 
> Date: Thu, 3 Feb 2011 11:43:46 -0800
> From: [log in to unmask]
> Subject: Re: Arterial Journals
> To: [log in to unmask]
> 
> 
> 
> 
> I am old school and we were taught not to change the size of the waveform (if you do, then if makes it more difficult to compare from previous-think about it)
> 
> I keep all my waveforms on the Parks the same on all studies. Occasionally my per diem will change the PPG size for a pressure or ? and not reset it-not happy with that. 
> 
> My reading docs count on the standard sizing and if they are questioning a waveform the size of percentage will be the first thing I will check. 
> 
> I read an article or heard a talk a while back and they said it was okay to change the size-I disagree. Some of the new techs have said the same thing, I think somethings should not be changed. 
> 
> The output filter should also remain the same for whatever the lab is using. I have worked in places that the 3.5 was the standard and others that insist on 7. If the readers are in agreement, then keep 
> 
> the same. Correlations are easier. I heard someone once say they like them to all look uniform---I was thinking-whatthe???(the older the I get the more I just walk away.)
> 
> That said, the size is not the only characteristic we look at in the signals and not every person will get the same angle and placement on the same patient, but why give yourself another variable/
> 
> 
> 
> My Gerlock (1988) states the cuff is more accurate when the width of the cuff is 20% greater than the diameter of the limb. (that would be the bladder)
> 
> 
> 
> Lisa in sunny San Diego ( okay, we do have wild fires and earthquakes too-you don't want to live here, really)
> 
> ________________________________
> 
> From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Nicole Ball
> Sent: Thursday, February 03, 2011 10:40 AM
> To: [log in to unmask]
> Subject: Arterial Journals
> 
> 
> 
> 
> I am putting together some ABI / Arterial QA info together and I am wondering if anyone knows of any journals on ABI with reference to cuff size (measuring width of ankle / arm to know what size cuff to use). Also, when we do physiological waveforms we keep all the wavefoms the same size (including the PPG), Is this the standard? Articles? 
> 
> Thanks, 
> 
> Nicole Ball, BS, RVT
> President for NNEVS
> Frisbie Memorial Hospital
> Vascular Lab
> Rochester, NH
> (w) 603-692-9981
> 
> 
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Visit us online at http://www.clevelandclinic.org for
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