ULTRASOUND REGISTRY REVIEW SIMPLIFIED



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Name:____________________________________________ Date:_____/_____/____ ID:_________________

DOB: _____/______/______ Age:______ Sex: M / F Referring Physician:_________________________

Indications:__________________________________________________________________ Tech:_________

Height: _____________ Weight:______________

RIGHT: PSV/EDV

CCA prox: ____/____ cm/s

CCA dist: ____/____cm/s

ICA prox: ____/____cm/s

ICA dist: ____/____ cm/s

ECA: ____/____cm/s

SUBC: ____/____cm/s

VERT: ____/____cm/s

Antegrade / Retrograde

ICA/CCA ratio: ________

Brachial Pressure:______mmHg

LEFT: PSV/EDV

CCA prox: ____/____ cm/s

CCA dist: ____/____cm/s

ICA prox: ____/____cm/s

ICA dist: ____/____ cm/s

ECA: ____/____cm/s

SUBC: ____/____cm/s

VERT: ____/____cm/s

Antegrade / Retrograde

ICA/CCA ratio: ________

Brachial Pressure:______mmHg

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