Preparation, Documentation, and Communication Flashcards

Which patient preparation instruction is MOST important before performing a mesenteric arterial duplex examination?

Answer: NPO (nothing by mouth) for at least 6–8 hours prior to the exam

Bowel gas from food or liquid intake significantly degrades visualization of the celiac axis and superior mesenteric artery. Fasting for 6–8 hours minimizes intraluminal gas and promotes mesenteric vasodilation, improving both image quality and the physiologic significance of post-prandial velocity changes.

A vascular technologist performing a surveillance duplex identifies a new, complete thrombotic occlusion of a previously patent femoral-popliteal bypass graft. What is the MOST appropriate immediate action?

Answer: Communicate the finding urgently to the ordering physician or on-call clinical team before the patient leaves

Acute graft occlusion is a limb-threatening emergency requiring immediate clinical decision-making (thrombectomy, thrombolysis, or revision). The technologist must notify the responsible physician or clinical team while the patient is still present so that timely intervention can be arranged. Documenting without communication causes dangerous treatment delays.

Which of the following is considered a REQUIRED component of a complete vascular duplex examination report?

Answer: Clinical indication, technical description of findings, and diagnostic impression

A complete vascular report must include the reason the study was ordered (indication), a description of the vascular findings with supporting measurements, and a diagnostic conclusion or impression. These elements ensure the referring clinician has the information needed for clinical management.

The peak systolic velocity ratio (PSVR) used to grade arterial stenosis severity is calculated as:

Answer: PSV at the stenosis divided by PSV in the adjacent proximal normal arterial segment

The PSVR compares the elevated velocity at the stenosis to the velocity in the proximal normal (pre-stenotic) segment. This ratio corrects for patient-to-patient variation in cardiac output and overall flow state, making it a more reliable indicator of stenosis severity than an absolute PSV value alone.

Which organization specifically accredits vascular ultrasound testing laboratories in the United States for quality standards compliance?

Answer: The Intersocietal Accreditation Commission (IAC)

The IAC (Intersocietal Accreditation Commission) operates an accreditation program specifically for vascular testing laboratories, evaluating protocols, equipment, personnel credentials, report quality, and QA processes. Many payers and hospitals require IAC accreditation as a condition of reimbursement. ARDMS credentials individuals, not laboratories.

When documenting a carotid duplex examination, which finding most accurately represents a 70–99% internal carotid artery stenosis by the Society of Radiologists in Ultrasound (SRU) criteria?

Answer: ICA PSV ≥ 230 cm/s with ICA/CCA PSV ratio ≥ 4.0

The SRU consensus criteria define ≥70% ICA stenosis as ICA PSV ≥230 cm/s AND an ICA/CCA PSV ratio ≥4.0, often accompanied by ICA EDV ≥100 cm/s. Using both absolute velocity and the ratio improves accuracy and accounts for hemodynamic variability between patients.