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Scan through each vessel prior to taking any images.StructureScan PlaneLabelImages Stored Common Carotid ArteryTransverseRT CCA PROXGray Scale-ProximalRT CCA MIDGray Scale-MidRT CCA DISTGray Scale-DistalBulbTransverseRT BULBGray Scale -BulbBifurcationTransverseRT BIFGray Scale-ICA and ECACommon Carotid Artery ProximalSagittalRT CCA PROXGray Scale-ProximalColor Doppler-ProximalColor & Spectral Doppler-Proximal measure peak systolic velocity & end diastolic velocityCommon Carotid ArteryMidSagittalRT CCA MIDGray Scale-MidColor Doppler-MidColor & Spectral Doppler-Proximal measure peak systolic velocity & end diastolic velocityCommon Carotid Artery DistalSagittalRT CCA DISTALGray Scale-Distal (1-2 cm from bulb)Gray Scale-Distal (1-2 cm from bulb) *Zoom in area with no plaqueGray Scale-Distal (1-2 cm from bulb)* Zoom in area with no plaque *measure IMT of posterior wallColor Doppler-Distal(1-2 cm from bulb)Color & Spectral Doppler-Distal(1-2 cm from bulb) measure peak systolic velocity & end diastolic velocityBifurcationSagittalRT BIFGray Scale- ECA, ICA and bulbExternal Carotid ArterySagittalRT ECAGray ScaleColor DopplerColor & Spectral Doppler-Proximal measure peak systolic velocity & end diastolic velocityInternal Carotid ArterySagittalRT ICA PROXGray Scale-ProximalColor Doppler-ProximalColor & Spectral Doppler-Proximal measure peak systolic velocity & end diastolic velocityRT ICA MIDGray Scale-MidColor Doppler-MidColor & Spectral Doppler-Proximal measure peak systolic velocity & end diastolic velocityRT ICA DISTALGray Scale-Distal (most distal achievable) Color Doppler-Distal (most distal achievable)Color & Spectral Doppler-Distal (most distal achievable) measure peak systolic velocity & end diastolic velocityCommon Carotid ArterySagittalRT CCAColor DopplerVertebralSagittalRT VERTGray ScaleColor DopplerColor & Spectral Doppler-Proximal measure peak systolic velocity & end diastolic velocityStructureScan PlaneLabelImages StoredCommon Carotid ArteryTransverseLT CCA PROXGray Scale-ProximalLT CCA MIDGray Scale-MidLT CCA DISTGray Scale-DistalBulbTransverseLT BULBGray Scale -BulbBifurcationTransverseLT BIFGray Scale-ICA and ECACommon Carotid Artery ProximalSagittalLT CCA PROXGray Scale-ProximalColor Doppler-ProximalColor & Spectral Doppler-Proximal measure peak systolic velocity & end diastolic velocityCommon Carotid ArteryMidSagittalLT CCA MIDGray Scale-MidColor Doppler-MidColor & Spectral Doppler-Proximal measure peak systolic velocity & end diastolic velocityCommon Carotid Artery DistalSagittalLT CCA DISTALGray Scale-Distal (1-2 cm from bulb)Gray Scale-Distal (1-2 cm from bulb) *Zoom in area with no plaqueGray Scale-Distal (1-2 cm from bulb)* Zoom in area with no plaque *measure IMT of posterior wallColor Doppler-Distal(1-2 cm from bulb)Color & Spectral Doppler-Distal(1-2 cm from bulb) measure peak systolic velocity & end diastolic velocityBifurcationSagittalLT BIFGray Scale- ECA, ICA and bulbExternal Carotid ArterySagittalLT ECAGray ScaleColor DopplerColor & Spectral Doppler-Proximal measure peak systolic velocity & end diastolic velocityInternal Carotid ArterySagittalLT ICA PROXGray Scale-ProximalColor Doppler-ProximalColor & Spectral Doppler-Proximal measure peak systolic velocity & end diastolic velocityLT ICA MIDGray Scale-MidColor Doppler-MidColor & Spectral Doppler-Proximal measure peak systolic velocity & end diastolic velocityLT ICA DISTALGray Scale-Distal (most distal achievable) Color Doppler-Distal (most distal achievable)Color & Spectral Doppler-Distal (most distal achievable) measure peak systolic velocity & end diastolic velocityCommon Carotid ArterySagittalLT CCAColor DopplerVertebralSagittalLT VERTGray ScaleColor DopplerColor & Spectral Doppler-Proximal measure peak systolic velocity & end diastolic velocityRT ECAAnatomy/Image CorrelationDistRT CCAProxMidDistProxMidRT ICA Color DopplerWill vary with the presence/absence of pathology & curvature of the vesselMake sure your color images relay the same information as your Gray scale & Spectral imagesUtilize preset Color PRF (scale) and adjust according to the type of blood flow (velocities) being imaged If flow is normal and the color is outside the vessel wall or blooming in center of vessel slowly increase PRF until color is no longer outside the vessel wall or blooming.If flow is normal and the color in the vessel is not filled in slowly decrease PRF until the color fills the vessel Color box should be steered (angled) with vessel directionSpectral DopplerMust use angle correctAngle correct must be less than 60 degreesGate (SV length) must be in center of vessel & small widthAdjust your PRF (scale) to display a large waveform that has a clear spectral window and measure the highest peak systolic velocitySet the PRF(scale) appropriately for the velocities imaged.? Plaque Present (surface irregularities)Document plaque in transverse & sagittal planesDo not adjust your gray scale (TGC) to display a complete anechoic vesselDemonstrate blood flow around plaque with Color DopplerIf there is a stenosis A mosaic of color will be displayedEvaluate stenosis with Spectral Doppler for highest velocity by placing cursor in the stenotic area Record and measure highest peak systolic velocity Record velocities in normal area of vessel approximately 2cm prior (prestenotic) and after (poststenotic) the area of stenosis Significant stenosis is considered if the flow in stenotic area is twice the velocity of an area just previous (prestenotic flow) to itRatiosICA to CCA RatioDegree of Stenosis1.0 or lessNormal1.1-1.8Plaque present/Normal <50%1.9-4.050%-69%>4.0> 70%Variable70%-99% ................
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