Tests prior to October 1, 2021:
(Outline Summary)
| # | Domain | Subdomain | Percentage |
| 1 | Cerebrovascular | Extracranial Carotid Intracranial Carotid |
15% |
| 2 | Abdominal | Aortoiliac Liver Mesenteric Renal |
15% |
| 3 | Peripheral Arterial – Duplex Imaging | Bypass Graft Dialysis Access Interpretation of Duplex Imaging Postoperative Endovascular Intervention |
15% |
| 4 | Peripheral Arterial – Physiologic | Ankle Brachial Index/Pulse Volume Recording Digital Evaluation |
20% |
| 5 | Peripheral Venous | Vein Mapping Venous Thrombosis/Obstruction Venous Insufficiency Testing |
20% |
| 6 | Laboratory Technology and Operations | Patient Care Physics and Instrumentation Quality Assurance |
15% |
(Detailed Outline)
| 1. | Cerebrovascular 15% | Knowledge and/or skill of the cerebrovascular system |
| 1.A. | Extracranial Carotid | |
| 1.A.1. | Interpret extracranial carotid exams | Knowledge of normal vascular anatomy Knowledge of blood pressure, flow, and regulation of vascular resistance Knowledge of fluid dynamics, laminar and turbulent flow, fluid energy, and effects of stenosis Knowledge of anatomic variants Knowledge of incidental findings Knowledge of pathologic anatomy Apply velocity criteria for grading stenosis of the extracranial and intracranial portions of the cerebrovascular circulation Understand the physiology of the cerebral vascular bed Incorporate patient-specific anatomy and understand its impact on diagnostic conclusion Apply transcranial Doppler diagnostic criteria for brain death, vasospasm, arterial venous malformation, and emboli detection Modify diagnosis of vertebral artery disease based on waveform analysis Identify findings for planning operations or interventions Recognize nonatherosclerotic vascular disease Discriminate normal post-operative/intervention changes Knowledge of sickle cell anemia diagnostic criteria |
| 1.A.2. | Assess carotid vessels after intervention, (i.e., carotid endarterectomy or stent) |
|
| 1.A.3. | Assess the effect of contralateral disease | |
| 1.A.4. | Include plaque description when interpreting exams |
|
| 1.A.5 | Grade stenosis other than bulb/internal carotid artery, (i.e., common carotid artery, external carotid artery, vertebral artery and subclavian artery) |
|
| 1.A.6. | Comment on incidental findings | |
| 1.A.7. | Incorporate cardiac disease impact on carotid waveforms |
|
| 1.A.8. | Assess nonatherosclerotic vascular disease | |
| 1.B. | Intracranial Carotid | |
| 1.B.1. | Interpret intracranial carotid exams | |
| 2. | Abdominal 15% | Knowledge and /or skill of the abdominal system |
| 2.A. | Aortoiliac | |
| 2.A.1. | Evaluate aneurysmal disease | Knowledge of normal vascular anatomy Knowledge of blood pressure, flow, and regulation of vascular resistance Knowledge of fluid dynamics, laminar and turbulent flow, fluid energy, and effects of stenosis Modify interpretation post-intervention Knowledge of anatomic variants Knowledge of incidental findings Knowledge of pathologic anatomy Knowledge of the effects of fasting on superior mesenteric artery stenosis Recognize nonatherosclerotic vascular disease Recognize abnormal blood flow patterns using waveform analysis Understand Doppler principles Understand the physiology of the internal organ circulation and hepatoportal venous system Apply velocity criteria for grading stenosis Calculate and understand waveform indices, e.g., resistive indices Modify diagnosis based on patient comorbidities Understand the role and limitations of contrast agents Understand the normal and abnormal flow patterns associated with renal allografts |
| 2.A.2. | Interpret aortoiliac ultrasound studies | |
| 2.A.3. | Evaluate occlusive disease | |
| 2.A.4. | Interpret post-endovascular aneurysm repair ultrasound studies | |
| 2.A.5. | Use color Doppler for evaluation of endoleaks | |
| 2.A.6. | Use power Doppler for evaluation of endoleaks | |
| 2.B. | Liver | |
| 2.B.1. | Interpret hepatoportal studies | |
| 2.C. | Mesenteric | |
| 2.C.1. | Interpret mesenteric ultrasound studies | |
| 2.C.2. | Use modified criteria for post-stent evaluation | |
| 2.C.3. | Interpret testing for celiac compression | |
| 2.D. | Renal | |
| 2.D.1. | Use renal-aortic ratio to grade stenosis | |
| 2.D.2 | Use velocity criteria to grade stenosis | |
| 2.D.3 | Report on resistive indices | |
| 2.D.4. | Interpret renal ultrasound studies | |
| 2.D.5. | Assess renal allografts | |
| 3. | Peripheral Arterial - Duplex Imaging 15% | Knowledge and /or skill of the peripheral arterial system-duplex imaging |
| 3.A. | Bypass Graft | |
| 3.A.1. | Apply a criteria for evaluating stenosis | Knowledge of normal vascular anatomy Knowledge of blood pressure, flow, and regulation of vascular resistance Knowledge of fluid dynamics, laminar and turbulent flow, fluid energy, and effects of stenosis Knowledge of anatomic variants Knowledge of arterial steals Knowledge of bypass grafts, stents and percutaneous angioplasty Knowledge of incidental findings Knowledge of pathologic anatomy Understand the normal and abnormal flow patterns associated with dialysis access Knowledge of aneurysm and pseudoaneurysm Knowledge of ultrasound guidance during a procedure Knowledge velocity criteria for grading stenosis Understand Doppler principles Understand provocative maneuvers Understand entrapment syndromes |
| 3.A.2. | Image native circulation above and below bypass graft | |
| 3.A.3. | Interpret surveillance of bypass graft with vein conduit | |
| 3.A.4. | Interpret surveillance of stents | |
| 3.A.5. | Interpret surveillance of bypass graft with prosthetic conduit | |
| 3.B. | Dialysis Access |
|
| 3.B.1. | Interpret venous mapping for pre-dialysis access |
|
| 3.B.2. | Evaluate for access problems | |
| 3.B.3. | Interpret arterial exams for pre-dialysis access | |
| 3.B.4. | Evaluate existing access before and after intervention | |
| 3.B.5. | Evaluate central veins | |
| 3.B.6. | Evaluate arteriovenous access for aneurysms |
|
| 3.B.7. | Interpret access surveillance | |
| 3.B.8 | Use volume flow measurements | |
| 3.C. | Interpretation of Duplex Imaging | |
| 3.C.1. | Interpret peripheral arterial ultrasound studies |
|
| 3.C.2. | Apply velocity criteria to grade stenosis | |
| 3.C.3. | Assess for peripheral arterial aneurysms | |
| 3.C.4. | Treat pseudoaneurysms in the vascular laboratory | |
| 3.C.5. | Assess for arterial trauma | |
| 3.C.6. | Use a protocol for provocative maneuvers to assess for popliteal artery entrapment | |
| 3.D. | Postoperative Endovascular Intervention | |
| 3.D.1. | Image native circulation above and below intervention | |
| 3.D.2. | Apply velocity criteria for stenosis/restenosis | |
| 3.D.3. | Use protocols that are modified to assess the stented vessel | |
| 3.D.4. | Use ultrasound guidance during procedures |
|
| 3.D.5. | Assess for stent fracture | |
| 4. | Peripheral Arterial - Physiologic 20% | Knowledge and /or skill of the peripheral arterial system-physiologic |
| 4.A. | Ankle Brachial Index/Pulse Volume Recording | |
| 4.A.1. | Report the level of disease | Understand the use of photoplethysmography (PPG), plethysmography, and laser Doppler Knowledge of TcPo2 testing Knowledge of methods of pressure measurement and their limitations Understand entrapment syndromes Understand qualitative Doppler waveform analysis Understand quantitative Doppler waveform analysis Knowledge of arterial steals Modify interpretation based on patient comorbidities Knowledge of provocative maneuvers (i.e., exercise, thoracic outlet and cold immersion) |
| 4.A.2. | Interpret qualitative Doppler waveform analysis |
|
| 4.A.3. | Interpret segmental pressure studies | |
| 4.A.4. | Interpret quantitative Doppler waveform analysis |
|
| 4.A.5. | Interpret pulse volume recordings | |
| 4.A.6. | Interpret exercise studies | |
| 4.B. | Digital Evaluation |
|
| 4.B.1. | Interpret toe pressures | |
| 4.B.2. | Interpret finger pressures to evaluate for arterial steal |
|
| 4.B.3. | Evaluate for thoracic outlet syndrome | |
| 4.B.4. | Interpret Raynaud disease testing | |
| 4.B.5. | Interpret transcutaneous oxygen tension (TcPo2) testing |
|
| 5. | Peripheral Venous 20% | Knowledge and /or skill of the peripheral venous system |
| 5.A. | Vein Mapping |
|
| 5.A.1. | Comment on compressibility of the veins | Knowledge of normal vascular anatomy Knowledge of venous hemodynamics and flow, and effects of intravascular and extravascular processes Knowledge of anatomic variants Knowledge of incidental findings Knowledge of pathologic anatomy Knowledge of venous insufficiency and reflux Knowledge of photoplethysmography (PPG) to identify venous insufficiency Venous testing after intervention Knowledge of positioning to assess venous reflux Knowledge of superficial and deep venous systems perforating veins Knowledge of lymphatic system Knowledge of ultrasound guidance during a procedure Understand Doppler principles Understand provocative maneuvers Understand entrapment syndromes |
| 5.A.2. | Report on vein diameter | |
| 5.A.3. | Comment on anatomic variants | |
| 5.A.4. | Interpret venous ultrasound studies | |
| 5.B. | Venous Thrombosis/Obstruction | |
| 5.B.1. | Assess for deep vein thrombosis | |
| 5.B.2. | Assess for anatomic variants | |
| 5.B.3. | Examine for nonthrombotic venous compression |
|
| 5.B.4. | Assess waveforms for cardiac comorbidities |
|
| 5.B.5. | Assess waveforms for central venous obstruction |
|
| 5.B.6. | Routinely examine the inferior vena cava and iliac veins |
|
| 5.C. | Venous Insufficiency Testing | |
| 5.C.1. | Assess for superficial venous reflux | |
| 5.C.2. | Assess for deep venous incompetence | |
| 5.C.3. | Assess for perforating veins | |
| 5.C.4. | Assess for superficial venous thrombus | |
| 6. | Laboratory Technology and Operations 15% | Knowledge and /or skill of laboratory technology and operations |
| 6.A. | Patient Care | |
| 6.A.1. | Address patient safety issues | Ability to recognize artifacts Correlate information with previous tests Knowledge of advanced imaging techniques, (i.e., harmonics and spatial compounding) Knowledge of ALARA (as low as reasonably achievable) principles and bioeffects Knowledge of continuous wave, pulsed wave, and Bmode imaging Knowledge of contrast agents Knowledge of Doppler principles Knowledge of patient satisfaction surveys, reimbursement and hospital experience Knowledge of quality assurance programs Knowledge of ultrasound principles Ability to provide direct feedback to technical staff on the quality of images/data presented Knowledge to select the appropriate transducer for the exam Understand patient care, procedural planning, and outcome assessment Understand report generation and PACS Understand the indications for vascular lab testing and reporting standards Understand the use of specificity, sensitivity, predictive value, and accuracy calculations and comparison with a referenced standard Understand vascular lab accreditation and requirements Ensure appropriate indications Recognize and communicate critical findings to referring physician Assess agreement between preliminary and final reports |
| 6.A.2. | Collect and evaluate patient satisfaction scores |
|
| 6.B. | Physics and Instrumentation | |
| 6.B.1. | Identify Doppler waveform characteristics | |
| 6.B.2. | Recognize artifacts | |
| 6.B.3. | Apply color Doppler principles | |
| 6.B.4. | Apply pulsed wave Doppler principles | |
| 6.B.5. | Apply continuous wave Doppler principles | |
| 6.B.6. | Apply power Doppler principles | |
| 6.B.7. | Implement a preventative maintenance program |
|
| 6.B.8. | Interpret and obtain video images | |
| 6.B.9. | Use ultrasound contrast agents | |
| 6.C. | Quality Assurance | |
| 6.C.1. | Implement a quality assurance program | |
| 6.C.2. | Participate in regular quality assurance | |
| 6.C.3. | Determine percent accuracy | |
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