UVMFLOWNET List

Re: [External] CW Doppler of the the superficial femoral artery

Butler, Derek — 2026-05-12T21:29:16+00:00

Hi Andy ,

We as well perform ankle pressures bilaterally directly after arm pressures as you have stated.

Derek Butler BS, RVT, RDCS, RDMS, RT(R)
Non-Invasive Vascular Lab Technical Director
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Re: When does ectasia become an aneurysm?

Deidre Harpster — 2026-05-09T00:32:59+00:00

I actually wish we had more criteria to base calling an aneurysm an aneurysm off of. If a patient is big in general and everything is uniformly big , is it truly an aneurysm? I think not.
I believe Echo has something like that for patients. Why have we never really taken time to evaluate the efficacy of our magic number in relation to patient height, weight, etc.
Maybe some sort of sliding scale could be developed.
AAA size of 3cm or > is one of the only measurements over my career that I've found to be consistent anywhere. Iliacs [...]

Re: [External] CW Doppler of the the superficial femoral artery

KIRK BEACH — 2026-05-08T14:19:47-07:00

Thanks Steve,

I've attached the paper for your amusement.
The reason that we returned to the Right arm
was to check whether the systemic BP changed during the measurements.
The reason that we took pressures from both the posterior tibial artery
and the anterior tibial artery is that we believed that people with
diabetes (both type I and type II) had a higher prevalence of
below knee stenosis than femoral artery stenosis.
With the Doppler, we only measured systolic pressures. [...]

When does ectasia become an aneurysm?

Steve Knight — 2026-05-08T16:16:42-04:00

I had a patient this morning with an essentially uniformly ectatic aorta
that measured 3.5 cm at the level of the renal arteries (slightly smaller
at the level of the bifurction). The iliacs were also ectatic.
I would love it if some physicians would weigh in here on the significance
of language used in a preliminary finding. [...]

Re: [External] CW Doppler of the the superficial femoral artery

Steve Knight — 2026-05-08T15:50:15-04:00

Kirk,
Is that raw data still available for further analysis?
I'm curious to learn how taking a blood pressure anywhere affects blood
pressure measurementin different locations. If we take it in the arms
first, does it affect the measured pressure in the lower extremities?
Do you recall if your data revealed anything about this?

Steve Knight [...]

Re: [External] CW Doppler of the the superficial femoral artery

KIRK BEACH — 2026-05-08T09:28:33-07:00

Dear Friends

Half a century ago, for a supine research subject
we applied cuffs over both brachial arteries and both ankles.
The ankle cuffs were secured with tape reinforcements on the loose ends of the
cuffs.
Then with a CW 5 MHz Doppler the pressure was measured on the
Right Arm (Doppler on the antecubital artery)
Right Ankle (posterior tibial artery)
Right Ankle (anterior tibial artery)
Left Ankle (anterior tibial artery)
Left Arm (Doppler on the antecubital artery)
Right Arm (Doppler on the antecubital artery)
Then the research subject, with cuffs in place stood up.
and walked for 5 minutes [...]

Re: [External] CW Doppler of the the superficial femoral artery

Nicole Ball — 2026-05-08T15:18:59+00:00

Hi all.

For pressures....I do the arms and ankles / toes first , if ABI is normal then stop, if abnormal then start moving up the legs until a normal index is reached per leg.

I actually do my pressures differently than anyone I know, lol. I do both ankle PTA pressures, then arms, then DPA/ATA pressures. This gives the ankle a rest before taking the next pressure on the same ankle and then the arms are close to both PTA and DPA pressures. Most people think I am nuts for doing it this way but it works for me [...]

Re: CW Doppler of the the superficial femoral artery

Bill Schroedter — 2026-05-03T12:50:13-04:00

Sorry for the slow reply Steve. Some good questions.

First, I must claim ignorance of the CW waveforms, especially the SFA and popliteal because we never really did much of that. I always stress that perform CW Doppler waveforms appears very easy and straightforward, it is actually rather difficult and requires immense skill. And honestly, while we did perform segmental pressures, I never liked doing them as most patients would complain of the discomfort from that. If there is disease confirmed by the ankle measurements, we should also have an idea of the relative severity based on the CW waveform [...]

Re: [External] CW Doppler of the the superficial femoral artery

Andrew Bebry — 2026-04-30T18:43:56-04:00

Derek. I agree that arm pressures are taken first. What about B/L ankles
immediately after the arms? Life Sciences protocol was just that,
brachial then both ankles before the remainder of both legs. The idea
was, I believe, that going from arms to entire right leg next, may cause
some pt stress causing the left leg pressures to possibly be falsely
elevated. Any thoughts?
Andy Bebry, RVT, RCS [...]

Re: [External] CW Doppler of the the superficial femoral artery

Steve Knight — 2026-04-30T17:58:56-04:00

Great feedback Derek! Thanks.

Steve Knight

On Thu, Apr 30, 2026, 5:49 PM Butler, Derek <
00001106e4b07dad-dmarc-request@list.uvm.edu> wrote:

> Hey Steve –
>
>
>
> Regarding PPG – these are my thoughts:
>
> - Obtain PPG waveforms at maximum gain to reflect the vaso motor tone
> – amplitude means nothing on these according to literature, textbooks I
> have in the dept – we analyze the tone of the waveform, Anacrotic vs.
> Dicrotic notch, normal , widened etc – though the clinicians are only
> concerned with mmHg and TBI values. Having the gain at maximum may [...]

Re: [External] CW Doppler of the the superficial femoral artery

Butler, Derek — 2026-04-30T21:39:30+00:00

Hey Steve –

Regarding PPG – these are my thoughts:

* Obtain PPG waveforms at maximum gain to reflect the vaso motor tone – amplitude means nothing on these according to literature, textbooks I have in the dept – we analyze the tone of the waveform, Anacrotic vs. Dicrotic notch, normal , widened etc – though the clinicians are only concerned with mmHg and TBI values. Having the gain at maximum may be a subjective position, but if I have it too low I will mask any morphological changes, also – if the TBI is low and waveforms dampened at [...]

Re: CW Doppler of the the superficial femoral artery

Andrew Bebry — 2026-04-30T17:26:51-04:00

John. Prednisone BID she will not be able to sleep and her anxiety would
be through the roof. She'll probably be up throughout the night asking for
help. Same as previous.

On Thu, Apr 30, 2026, 4:45 PM Steve Knight <steveknightvt@gmail.com> wrote:

> I'm involved with the SVU writing group that is updating the professional
> performance guidelines PPGs). I'm looking at the peripheral arterial
> physiologic section and I'm wondering what your practices and rationales
> are for a few things.
> The first one is obtaining a CW waveform of the SFA. If you do it, at what
> [...]

CW Doppler of the the superficial femoral artery

Steve Knight — 2026-04-30T16:44:48-04:00

I'm involved with the SVU writing group that is updating the professional
performance guidelines PPGs). I'm looking at the peripheral arterial
physiologic section and I'm wondering what your practices and rationales
are for a few things.
The first one is obtaining a CW waveform of the SFA. If you do it, at what
location? How do you avoid interrogating the profunda accidentally?
The second one is the order of pressure measurements. I like to take arms
last because 1. I get cozy at the patients ankles and get all of the leg
values then relocate. 2. I worry that getting [...]

Re: Down the rabbit hole

Carolyn Semrow — 2026-04-18T21:43:39+00:00

I remember those days in my 1st intro to computer programming. Boy I was happy when we switched to keyboards & Fortran, then Basic on the mainframe.

Sent from AT&T Yahoo Mail on Android

On Thu, Apr 16, 2026 at 9:49 AM, Bill Schroedter<bschroedter@QUALITYVASCULAR.COM> wrote: 
So Steve, I read your post and thanks Audrey for wonderfully answering the questions. As long as you have her email, you don’t need to go [...]

Re: Down the rabbit hole

Bill Schroedter — 2026-04-18T09:44:38-04:00

Morning Sarah,

As we did point out, many of us old(er) folks reminisce about days gone by. So please take many of the diversions as such, just off on a tangent. That said, the true value of this forum is the vast amount of information and knowledge that it can provide. The members can very likely help answer some questions that you may not be able to find readily when searching for a specific topic or issue. As we know, one of the greatest things about ultrasound, is that we never know it all. Always something new to learn. The [...]

Re: Down the rabbit hole

KIRK BEACH — 2026-04-17T12:48:33-07:00

Dear Friends,

As and olde retired (tired) guy, here is my advice to those following on:
1. If you have the financial resources, attend meetings and conferences
so that you can meet colleagues to share information.
2. Keep an easily accessible record of your examination results.
I like a spread sheet with rows for examinations and columns for measurement
values.
If the exams and patients are identified by an unbreakable code (anonymized),
I think that you will avoid criticism about medical records confidentiality.
3. If possible, while keeping confidence, if you can find the outcome of each
case
(did the [...]

Re: Down the rabbit hole

Audrey Fleming — 2026-04-17T18:41:49+00:00

Sarah,
Don't feel bad. If you look at the UVMFlownet archives there will be hundreds of threads from 15-20 years ago. Us old 'ems occasionally slip back into the days when there were only 20 1/2 vascular techs and we all ate lunch together....LOL That really was a joke, we didn't eat lunch together because we were too busy wondering why someone didn't find a way to add color to these dang images.
We keep the fires burning by constantly learning and questioning. If you have a question, ask. If you have an idea, act. If you can take a [...]

Re: Down the rabbit hole

Andrew Bebry — 2026-04-16T22:53:53-04:00

Sarah. What would you like to see happen? Do you need ideas? References?
Connections? Are you interested in rare or special cases? Do you like
statistical analyzes of a group of patients? You name it. Andy Bebry

On Thu, Apr 16, 2026, 10:21 PM Sarah Sarlo <s.kent07@gmail.com> wrote:

> Guys, I’m lost. I graduated in 2007 and have been working dedicated
> vascular since 2013. How do we incorporate us “young folk” into the mix?
> Love this forum but the references are often lost on me. How do we keep the
> flame alive!
> Sent from my iPhone
>
[...]

Re: Down the rabbit hole

Sarah Sarlo — 2026-04-16T20:04:16-06:00

Full message available at: Re: Down the rabbit hole

Re: Down the rabbit hole

Andrew Bebry — 2026-04-16T20:05:05-04:00

Easy fix, rotate speakers! Andy Bebry

On Thu, Apr 16, 2026, 8:03 PM Denise Levy <sisdenise@gmail.com> wrote:

> YES Bill, I recall handing the slide carousels to the projectionist, and
> often there were two screens projecting, so you had to do the right and the
> left.
> The AIUM in New Orleans 1990 I was in the Superdome and the stage was on a
> flatbed truck ! The rwo screens were as large as a movie theater size. I
> can't imagine the lock failing and loosing your slides, I think I would die
> on the spot. [...]

Re: Down the rabbit hole

Denise Levy — 2026-04-16T17:03:06-07:00

YES Bill, I recall handing the slide carousels to the projectionist, and
often there were two screens projecting, so you had to do the right and the
left.
The AIUM in New Orleans 1990 I was in the Superdome and the stage was on a
flatbed truck ! The rwo screens were as large as a movie theater size. I
can't imagine the lock failing and loosing your slides, I think I would die
on the spot. Lecture anxiety no more. My best, Denise [...]

Re: Down the rabbit hole

Bill Schroedter — 2026-04-16T17:24:54-04:00

One more reminiscence as we digress Audrey

I presented at an AIUM meeting way back when. We used the 35 mm slides that we would carry in a plastic sheave, and then load the slides into the carousel prior to the presentation session in a separate adjacent room. Making sure each slide was placed into the carousel the right side up, forward, and in precise order was a big concern. The carousel was then carried up and given to the slide person who then loaded it onto the projector as you were on the way to the podium. These carousels [...]

Re: Down the rabbit hole

Steve Knight — 2026-04-16T12:13:09-04:00

Great Ajay! Thank you so much!

On Thu, Apr 16, 2026 at 11:31 AM Ajay <ajayzach@gmail.com> wrote:

> Hi Steve,
>
> I do have the original publication. I was fortunate to work with Dr.
> Spencer when he did the work to develop his Logarithmic Scale, and I’ve
> attached it here.
>
> Ajay
>
> On Thu, Apr 16, 2026 at 6:24 AM Steve Knight <steveknightvt@gmail.com>
> wrote:
>
>> I'm trying to find the original publication of the Spencer Logarithmic
>> Scale for grading right to left intracardiac shunting with TCD. When I go
>> to references listed [...]

Re: Down the rabbit hole

Audrey Fleming — 2026-04-16T15:41:21+00:00

Bill,
Reminds me of a story Dr Jeanty, a renowned obstetric pioneer, told. He was Belgian and was doing his research on obstetric measurements using ultrasound. His book co-authored with Romero is still considered a gold standard today.
He meticulously measured hundreds of fetuses and bones, organs, anything he could see and measure. Then he created his punch cards to run through the university computer. He had to request time to run the punch cards.
While walking up the stairs with shoeboxes of punch cards all in their specific order, he dropped them. The cards were scattered all over. He [...]

Re: Down the rabbit hole

Ajay — 2026-04-16T08:27:52-07:00

Hi Steve,

I do have the original publication. I was fortunate to work with Dr.
Spencer when he did the work to develop his Logarithmic Scale, and I’ve
attached it here.

Ajay

On Thu, Apr 16, 2026 at 6:24 AM Steve Knight <steveknightvt@gmail.com>
wrote:

> I'm trying to find the original publication of the Spencer Logarithmic
> Scale for grading right to left intracardiac shunting with TCD. When I go
> to references listed in various articles discussing the scale, they all
> point to other publications with no hint of Spencer in the author list.
> Surely something named for [...]

Re: Down the rabbit hole

Bill Schroedter — 2026-04-16T10:48:57-04:00

So Steve, I read your post and thanks Audrey for wonderfully answering the questions. As long as you have her email, you don’t need to go to the library and sort through the card catalogue – 😉

Sorry but I digress. I won’t comment on your “stack of Matryoshka nesting dolls” but your how did we ever get to the moon question intrigued me. Reminded me of one of the best books I ever read was by Michael Collins, the command module pilot on Apollo 11. He stayed in the module while Neil Armstrong and Buzz Aldrin landed on the [...]

Fw: Down the rabbit hole

Audrey Fleming — 2026-04-16T14:08:11+00:00

https://www.ahajournals.org/doi/10.1161/01.STR.10.3.326
----- Forwarded Message ----- From: Audrey Fleming <0000004a763a832b-dmarc-request@list.uvm.edu>To: "uvmflownet@list.uvm.edu" <uvmflownet@list.uvm.edu>Sent: Thursday, April 16, 2026 at 09:53:23 AM EDTSubject: Fw: Down the rabbit hole
Sorry forgot this part https://onlinelibrary.wiley.com/doi/10.1111/j.1552-6569.2006.00083.x

ABSTRACT

Merrill P Spencer and John M Reid applied the Hagen-Poiseuille law, continuity principle, and cerebrovascular resistance to describe a theoretical model of the relationship between the flowvelocity, flowvolume, and decreasing size of the residual vessel lumen. The model was plotted in a graph that became widely known as the Spencer's curve. Although derived for a smooth and axis-symmetric arterial stenosis of a short length in a segment with no bifurcations being [...]

Re: Fw: Down the rabbit hole

Steve Knight — 2026-04-16T10:07:14-04:00

Thanks Audrey. Unfortunately that's not the work I was trying to get the
original source of.

Steve Knight

On Thu, Apr 16, 2026, 9:53 AM Audrey Fleming <
0000004a763a832b-dmarc-request@list.uvm.edu> wrote:

> Sorry forgot this part
> https://onlinelibrary.wiley.com/doi/10.1111/j.1552-6569.2006.00083.x
>
> ABSTRACT
>
> Merrill P Spencer and John M Reid applied the Hagen-Poiseuille law,
> continuity principle, and cerebrovascular resistance to describe a
> theoretical model of the relationship between the flowvelocity, flowvolume,
> and decreasing size of the residual vessel lumen. The model was plotted in
> a graph that became widely known as the Spencer's curve. Although derived
> for [...]

Fw: Down the rabbit hole

Audrey Fleming — 2026-04-16T13:49:38+00:00

Sorry forgot this part https://onlinelibrary.wiley.com/doi/10.1111/j.1552-6569.2006.00083.x

ABSTRACT

Merrill P Spencer and John M Reid applied the Hagen-Poiseuille law, continuity principle, and cerebrovascular resistance to describe a theoretical model of the relationship between the flowvelocity, flowvolume, and decreasing size of the residual vessel lumen. The model was plotted in a graph that became widely known as the Spencer's curve. Although derived for a smooth and axis-symmetric arterial stenosis of a short length in a segment with no bifurcations being perfused at stable arterial pressures and viscosity, this model represents a milestone in understanding cerebral hemodynamics with long-lasting practical and research implications. This review [...]

Re: Down the rabbit hole

Audrey Fleming — 2026-04-16T13:46:11+00:00

Does this help?
1 Spencer MP, Reid JM. Quantitation of carotid stenosis with continuous wave Doppler ultrasound. Stroke 1979; 10: 326-330.

And....
The Spencer Logarithmic Scale (SLS), developed by Merrill P. Spencer, originated as a transcranial Doppler (TCD) grading system to quantify right-to-left shunts (RLS) by counting microbubbles (MBS). It measures shunt severity based on a 6-level scale (Grades I–V) based on bubble counts during rest and Valsalva, defining "shower" or "curtain" patterns [...]

Down the rabbit hole

Steve Knight — 2026-04-16T09:22:51-04:00

I'm trying to find the original publication of the Spencer Logarithmic
Scale for grading right to left intracardiac shunting with TCD. When I go
to references listed in various articles discussing the scale, they all
point to other publications with no hint of Spencer in the author list.
Surely something named for somebody was published by that person. Does
anybody know what the original source was? It may be in a book that I can't
unearth.
And why are these references incorrect? Are these errors that are
perpetuated or do they simply refer to a claim made in another publication
[...]

Re: portal vein

Denise Levy — 2026-04-15T10:56:22-07:00

Hello, It is amazing the amount of information on the web. I was so found
of the portal vein , a vein that acts like an artery with normal direction.
I would quiz students all the time. It brings back great memories of Yale
and Dr Taylor. My best Ann Mare. Denise

Denise Levy
sisdenise@gmail.com [...]

Re: portal vein

Ann Marie Kupinski — 2026-04-15T13:30:49-04:00

Thanks so much Denise!

On Wed, Apr 15, 2026 at 1:26 PM Denise Levy <sisdenise@gmail.com> wrote:

> Hello Ann Marie, I did a paper at Yale with Ken Taylor this is the area we
> measured. I did a Google search of portal vein diameter taken at levels.
>
>
> Portal vein diameter (PVD) is measured using ultrasound, typically at the
> extrahepatic portion of the main portal vein, just before it bifurcates at
> the hepatic hilum. The optimal location is often identified posteriorly,
> specifically 2 cm above the portovenous/portomesenteric confluence or where
> it crosses the hepatic [...]

Re: portal vein

Denise Levy — 2026-04-15T10:26:11-07:00

Hello Ann Marie, I did a paper at Yale with Ken Taylor this is the area we
measured. I did a Google search of portal vein diameter taken at levels.

Portal vein diameter (PVD) is measured using ultrasound, typically at the
extrahepatic portion of the main portal vein, just before it bifurcates at
the hepatic hilum. The optimal location is often identified posteriorly,
specifically 2 cm above the portovenous/portomesenteric confluence or where
it crosses the hepatic artery, usually during quiet respiration. [...]

portal vein

Ann Marie Kupinski — 2026-04-15T12:45:44-04:00

Hi everyone,

I have a question about measuring portal vein diameter. I'd love to hear
exactly where along the portal vein you measure its diameter and if any one
has a reference that speaks to where to measure. I did a quick literature
search and most everything recent either doesn't specify or is vague. [...]