Radiographic Positioning: Radiographic Positioning of Cardiovascular Studies
A. Perform as per corporate protocol. Do 2D, M-mode, doppler, and colorflow on every patient!
B. Follow guidelines as to where to drop off echoes to be interpreted.
C. For all INPATIENT echoes, make a copy of the worksheet and put in patient's chart.
II. CAROTID DUPLEX SCANS
A. Document transverse images on tape in black and white and with color on tape.
B. Document on tape sagittal views of CCA, bulb, ICA, and ECA.
C. Document on tape and prints systolic velocities from proximal and distal CCA; systolic and diastolic velocities from proximal and distal ICA; highest systolic velocity from ECA.
D. Calculate internal/common ratio using highest systolic velocities for common and internal vessels.
E. Estimate degree of stenosis using specified guidelines.
F. Note on tape and worksheet whether vertebral flow is antegrade or retrograde.
G. Obtain brachial blood pressures.
III. LOWER EXTREMITY ARTERIAL DOPPLERS
A. Document waveforms from DP, PT, POP, SFA, and CFA; also digital to waveforms if indicated.
B. Do segmental BP on above ankle, below knee, above knee, and high thigh; take above ankle pressure utilizing DP and PT pulses; do BIG TOE pressure if indicated.
C. Do arm pressures.
D. Do not exercise patient
E. Calculate ABI's for DP, PT, and toe/brachial indices if indicated.
IV. VENOUS DUPLEX - LOWER
Do imaging and doppler compression with augmentation on CFV, SFV, GSV, POPV, PTV, ATV, peroneal veins and saphenous in the lower leg; do transverse views.
V. VENOUS DUPLEX - UPPER
Do transverse imaging on subclavian, axillary, basilar, brachial, veins, and doppler augmentation; do radial and ulnar veins.
VI. UPPER EXTREMITY ARTERIAL
A. Document doppler signals from subclavian artery, axillary artery, brachial, radial, ulnar and palmar arteries; do digital PPG waveforms if indicated.
B. Do upper and lower arm pressures using radial artery signal.
C. Do index finger pressures using PPG.
D. If indicated do thoracic outlet syndrome maneuvers documenting waveforms from brachial artery.