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Hi Ann,

Same here, that is the approach we are trying to do more TCI if we are questioning a stenosis or any pathology. The sensitivity and specificity of TCD in the posterior circulation is lower than in the anterior circulation and I am hoping using TCI as an adjunct might help.

No bone to go through so with practice you can usually at least get the VB junction. 


  
         
 
Larry N. Raber  RDMS, RVT, RT(R)
Neurovascular Laboratory Manager  / Imaging Institute
Cleveland Clinic  |  9500 Euclid Ave. S80   |  Cleveland, OH 44195  | (216) 444-9129
[log in to unmask] / Fax (216) 636-0120

 
 


-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Anne E Moore
Sent: Thursday, April 14, 2016 4:05 PM
To: [log in to unmask]
Subject: Re: TCD machines

In our institution we have found that imaging the basilar can be challenging and we would miss about 25% of vasospasm.  We use the Sonoras and adjunct with TCI when needed.  
Anne Moore BSN, RVT
Supervisor Cerebrovascular Laboratory
Harborview Medical Center
206-744-3592, Box 359970

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On Thu, 14 Apr 2016, Raber, Larry wrote:

> 
> You will find a lower success rate of finding temporal windows with 
> imaging (TCI) compared to the using the dedicated blind TCD units. 
> There are studies that have put the success of finding temporal 
> windows with imaging 50-70% and the dedicated blind TCD units up to 90%.  We have had many patients where we completed the blind TCD got a diagnostic exam and wanted to get some TCI images for teaching and could not penetrate the skull. We did close to 4,000 TCDs in 2015. We have 6 Sonaras in our Labs plus one companion III. For imaging we use have a new GE E9 with the M5S probe.
> 
>  
> 
> On patients with intracranial stenosis and vasospasm that we have done 
> TCD and TCI on we find a good correlation in the MFVs.  But you have to remember that with the TCI you do not angle correct, keep the angle at 0 degrees since all the criteria for stenosis and vasospasm are based on blind imaging.
> 
>  
> 
> Also you have to remember that that the power setting to scan through 
> the eye have to be reduced. The FDA are commends the Mechanical Index to be <.23, as far as I know only the blind TCD is recommend for transorbital TCD.
> 
>  
> 
> cid:[log in to unmask]
> 
>  
> 
>         
> 
>  
> 
> Larry N. Raber  RDMS, RVT, RT(R)
> 
> Neurovascular Laboratory Manager  / Imaging Institute
> 
> Cleveland Clinic  |  9500 Euclid Ave. S80   |  Cleveland, OH 44195  | 
> (216) 444-9129
> 
> [log in to unmask] / Fax (216) 636-0120
> 
>  
> 
>  
> 
>  
> 
>  
> 
>  
> 
> From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of 
> Christopher Walters
> Sent: Thursday, April 14, 2016 12:43 PM
> To: [log in to unmask]
> Subject: Re: TCD machines
> 
>  
> 
> That’s fantastic to hear. We already use CX-50’s and Epiq’s for our 
> duplex exams along with IE-33s. Do you know of any studies that correlate TCD with TCD-i? I’d like to know the validity of TCD-I before we make a switch.
> 
>  
> 
> C. Alan Walters, RVT, RDCS
> 
> Vascular Quality Assurance Coordinator, Cardiac Diagnostics
> 
> Palmetto Health
> 
> 6 Richland Medical Park Drive, Columbia, SC 29203
> 
> Office: 803-434-5303
> 
> Fax: 803-434-5957
> [IMAGE]
> 
>  
> 
> From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Calli 
> opsis
> Sent: Thursday, April 14, 2016 9:32 AM
> To: [log in to unmask]
> Subject: Re: TCD machines
> 
>  
> 
> We also use a Sonara for embolic monitoring.  For Vasospasm and 
> stenosis, we use a Philips CX50 with Purewave S5 probe.  The Philips Purewave S5 has been the best penetration I've found in many years.   There are a few older patients with poor windows, but those also cannot be performed with the Sonara monitoring machine either.
> 
>  
> 
> We average 5-7 vasospasm exams daily. Once or twice a year we get an order on a patient that has inadequate temporal windows.
> 
> I love imaging versus blind studies.   As far as documenting trends, 
> we take velocities daily and report them...and the studies are compared to the prior study in the final interpretation.
> 
> However, there is no trend curve/graph/data table from day to day.
> 
> Good Luck !
> 
> Amanda
> 
>  
> 
> On Thu, Apr 14, 2016 at 8:42 AM, Christopher Walters <[log in to unmask]> wrote:
> 
> Does anyone have a favorite brand of TCD Machine? Our Neurosurgical 
> ICU is ramping up and our TCD volumes are going through the roof! We 
> are looking to invest in a new machine
> (machineS?) for monitoring vasospasm in subarachnoid hemorrhage 
> patients. Important to this end is the ability to create trends. 
> Something that could trend from the cloud would be ideal. We are currently using Sonora/Viasys machines that can only trend studies that are logged directly on the machine. They are also somewhat glitchy… We’ve thought about looking at TCD-imaging, but the last I read it was for the most part inferior – fewer scannable patients. Is this still the case?
> 
>  
> 
> Any suggestions?
> 
>  
> 
> Best,
> 
>  
> 
> C. Alan Walters, RVT, RDCS
> 
> Vascular Quality Assurance Coordinator, Cardiac Diagnostics
> 
> Palmetto Health
> 
> 6 Richland Medical Park Drive, Columbia, SC 29203
> 
> Office: 803-434-5303
> 
> Fax: 803-434-5957
> cid:[log in to unmask]
> 
> 
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Visit us online at http://www.clevelandclinic.org for a complete listing of our services, staff and locations.


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