Introduction: Vascular laboratories need to improve efficiency while maintaining examination qual... more Introduction: Vascular laboratories need to improve efficiency while maintaining examination quality. Vascular ultrasound examinations were retrospectively evaluated using the Intersocietal Accreditation Commission (IAC) Quality Improvement (QI) Self-Assessment Tool to evaluate the quality of the examinations and to determine inter-rater and intra-rater agreement between groups of vascular technologists and interpreting physicians. Methods: Vascular technologists and attending interpreting physicians evaluated 100 carotid Doppler and 100 lower extremity venous Doppler examinations utilizing the IAC QI Self-Assessment Tool. Gwet’s First-Order Agreement Coefficient (AC1) statistic and 95% confidence intervals were calculated to determine both inter-rater and intra-rater agreement. Results: The inter-rater agreement for 91% of all questions ranged from substantial (AC1 = 0.6) to almost perfect (AC1 = 1) for both examination types across all reviewers. Agreement on 2 questions was subop...
Abstract Despite formal ultrasound training becoming prevalent in preclinical medical student edu... more Abstract Despite formal ultrasound training becoming prevalent in preclinical medical student education, significant barriers remain to the continuation of this training during clinical years. We sought to develop a program for third-year medical students to continue ultrasound training after an already robust preclinical ultrasound curriculum and evaluate their scanning confidence after participation. We developed a program to facilitate bedside ultrasound scanning of patients being cared for by third-year students. Students identified appropriate patients to be scanned, obtained consent for scanning, and determined which scans were most appropriate given the patient's clinical problems. Trained facilitators met with students at the bedside in 1-hour sessions called Gel Rounds to observe and direct the students' scans of their patients. Fifty-one students were surveyed after completing Gel Rounds. Students were significantly more likely to feel comfortable with independently acquiring and interpreting images after Gel Rounds than before completing the activity. Approximately 67% of students felt that ultrasound had utility in assisting bedside clinical reasoning, and this proportion did not change significantly after completing Gel Rounds. Gel Rounds was a positive continuation of the ultrasound curriculum into the third-year clerkship environment. A minority of students reported prior ultrasound exposure in their third year, reflecting difficulty with developing a longitudinal curriculum. The activity helped students to independently acquire and interpret images in patients. Because Gel Rounds can be performed at the discretion of students and faculty, it fits naturally in a variety of existing longitudinal curricula.
Diagnostic criteria to classify severity of internal carotid artery (ICA) stenosis vary across va... more Diagnostic criteria to classify severity of internal carotid artery (ICA) stenosis vary across vascular laboratories. Consensus-based criteria, proposed by the Society of Radiologists in Ultrasound in 2003 (SRUCC), have been broadly implemented but have not been adequately validated. We conducted a multicentered, retrospective correlative imaging study of duplex ultrasound versus catheter angiography for evaluation of severity of ICA stenosis. Velocity data were abstracted from bilateral duplex studies performed between 1/1/2009 and 12/31/2015 and studies were interpreted using SRUCC. Percentage ICA stenosis was determined using North American Symptomatic Carotid Endarterectomy Trial (NASCET) methodology. Receiver operating characteristic analysis evaluated the performance of SRUCC parameters compared with angiography. Of 448 ICA sides (from 224 patients), 299 ICA sides (from 167 patients) were included. Agreement between duplex ultrasound and angiography was moderate (κ = 0.42), wi...
ObjectivesRetrograde vertebral artery flow, the steal phenomenon, is most frequently caused by a ... more ObjectivesRetrograde vertebral artery flow, the steal phenomenon, is most frequently caused by a flow‐limiting stenosis of the proximal subclavian artery. The reversal of flow can be incomplete, resulting in bidirectional flow: retrograde in systole and antegrade in diastole. Less often, retrograde vertebral artery flow is the consequence of increased subclavian flow, as might occur with a well‐functioning dialysis access fistula. Our objective was to evaluate bidirectional vertebral artery flow associated with dialysis access fistulas.MethodsWe retrospectively reviewed the direction of flow through the vertebral artery in systole and diastole of 335 patients with dialysis fistulas who had undergone extracranial cerebral vascular Doppler examinations.ResultsFifteen patients had retrograde flow in their vertebral artery ipsilateral with the side of their fistula. There was completely reversed flow in 1 patient and bidirectional flow in the other 14. For each of these 14, the flow was...
The first purpose was to test the assumption that ultrasound (US) examination of the asymptomatic... more The first purpose was to test the assumption that ultrasound (US) examination of the asymptomatic leg was unnecessary. The second was to confirm the absence of deep venous thrombosis (DVT) in patients with bilateral symptoms. Four hundred eighty-eight patients were evaluated at a peripheral vascular laboratory for signs and symptoms of DVT. All patients then underwent bilateral color Doppler US of their leg veins. Ninety-four patients had no lower extremity symptoms. Of these, 73 had no DVT, 11 had unilateral DVT, and 10 had bilateral DVT. Of 245 patients with unilateral symptoms, 180 had no DVT, 44 had ipsilateral DVT, three had contralateral DVT, and 18 had bilateral DVT. Of 149 patients with bilateral symptoms, 114 had no DVT, 10 had unilateral DVT, and 25 had bilateral DVT. The frequent finding of bilateral DVT and unsuspected contralateral DVT in patients with unilateral symptoms, and the even more frequent finding of DVT in patients with bilateral symptoms, clearly indicates t...
Introduction: Vascular laboratories need to improve efficiency while maintaining examination qual... more Introduction: Vascular laboratories need to improve efficiency while maintaining examination quality. Vascular ultrasound examinations were retrospectively evaluated using the Intersocietal Accreditation Commission (IAC) Quality Improvement (QI) Self-Assessment Tool to evaluate the quality of the examinations and to determine inter-rater and intra-rater agreement between groups of vascular technologists and interpreting physicians. Methods: Vascular technologists and attending interpreting physicians evaluated 100 carotid Doppler and 100 lower extremity venous Doppler examinations utilizing the IAC QI Self-Assessment Tool. Gwet’s First-Order Agreement Coefficient (AC1) statistic and 95% confidence intervals were calculated to determine both inter-rater and intra-rater agreement. Results: The inter-rater agreement for 91% of all questions ranged from substantial (AC1 = 0.6) to almost perfect (AC1 = 1) for both examination types across all reviewers. Agreement on 2 questions was subop...
Abstract Despite formal ultrasound training becoming prevalent in preclinical medical student edu... more Abstract Despite formal ultrasound training becoming prevalent in preclinical medical student education, significant barriers remain to the continuation of this training during clinical years. We sought to develop a program for third-year medical students to continue ultrasound training after an already robust preclinical ultrasound curriculum and evaluate their scanning confidence after participation. We developed a program to facilitate bedside ultrasound scanning of patients being cared for by third-year students. Students identified appropriate patients to be scanned, obtained consent for scanning, and determined which scans were most appropriate given the patient's clinical problems. Trained facilitators met with students at the bedside in 1-hour sessions called Gel Rounds to observe and direct the students' scans of their patients. Fifty-one students were surveyed after completing Gel Rounds. Students were significantly more likely to feel comfortable with independently acquiring and interpreting images after Gel Rounds than before completing the activity. Approximately 67% of students felt that ultrasound had utility in assisting bedside clinical reasoning, and this proportion did not change significantly after completing Gel Rounds. Gel Rounds was a positive continuation of the ultrasound curriculum into the third-year clerkship environment. A minority of students reported prior ultrasound exposure in their third year, reflecting difficulty with developing a longitudinal curriculum. The activity helped students to independently acquire and interpret images in patients. Because Gel Rounds can be performed at the discretion of students and faculty, it fits naturally in a variety of existing longitudinal curricula.
Diagnostic criteria to classify severity of internal carotid artery (ICA) stenosis vary across va... more Diagnostic criteria to classify severity of internal carotid artery (ICA) stenosis vary across vascular laboratories. Consensus-based criteria, proposed by the Society of Radiologists in Ultrasound in 2003 (SRUCC), have been broadly implemented but have not been adequately validated. We conducted a multicentered, retrospective correlative imaging study of duplex ultrasound versus catheter angiography for evaluation of severity of ICA stenosis. Velocity data were abstracted from bilateral duplex studies performed between 1/1/2009 and 12/31/2015 and studies were interpreted using SRUCC. Percentage ICA stenosis was determined using North American Symptomatic Carotid Endarterectomy Trial (NASCET) methodology. Receiver operating characteristic analysis evaluated the performance of SRUCC parameters compared with angiography. Of 448 ICA sides (from 224 patients), 299 ICA sides (from 167 patients) were included. Agreement between duplex ultrasound and angiography was moderate (κ = 0.42), wi...
ObjectivesRetrograde vertebral artery flow, the steal phenomenon, is most frequently caused by a ... more ObjectivesRetrograde vertebral artery flow, the steal phenomenon, is most frequently caused by a flow‐limiting stenosis of the proximal subclavian artery. The reversal of flow can be incomplete, resulting in bidirectional flow: retrograde in systole and antegrade in diastole. Less often, retrograde vertebral artery flow is the consequence of increased subclavian flow, as might occur with a well‐functioning dialysis access fistula. Our objective was to evaluate bidirectional vertebral artery flow associated with dialysis access fistulas.MethodsWe retrospectively reviewed the direction of flow through the vertebral artery in systole and diastole of 335 patients with dialysis fistulas who had undergone extracranial cerebral vascular Doppler examinations.ResultsFifteen patients had retrograde flow in their vertebral artery ipsilateral with the side of their fistula. There was completely reversed flow in 1 patient and bidirectional flow in the other 14. For each of these 14, the flow was...
The first purpose was to test the assumption that ultrasound (US) examination of the asymptomatic... more The first purpose was to test the assumption that ultrasound (US) examination of the asymptomatic leg was unnecessary. The second was to confirm the absence of deep venous thrombosis (DVT) in patients with bilateral symptoms. Four hundred eighty-eight patients were evaluated at a peripheral vascular laboratory for signs and symptoms of DVT. All patients then underwent bilateral color Doppler US of their leg veins. Ninety-four patients had no lower extremity symptoms. Of these, 73 had no DVT, 11 had unilateral DVT, and 10 had bilateral DVT. Of 245 patients with unilateral symptoms, 180 had no DVT, 44 had ipsilateral DVT, three had contralateral DVT, and 18 had bilateral DVT. Of 149 patients with bilateral symptoms, 114 had no DVT, 10 had unilateral DVT, and 25 had bilateral DVT. The frequent finding of bilateral DVT and unsuspected contralateral DVT in patients with unilateral symptoms, and the even more frequent finding of DVT in patients with bilateral symptoms, clearly indicates t...
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