Non-Invasive Vascular Technology (NIVT)

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Anatomic Location and Physiology of:

I. Arterial

• Aorta Ascending, Descending and Branches
• Lower Extremity Arteries
• Upper Extremity Arteries
• Abdominal Vasculature
• Cerebral Extracranial Arteries

II. Venous

• Abdominal Venous System
  (Vena Cava, Portal, Mesenteric and Renal veins)
• Lower Extremity Veins (Deep, Superficial, and Perforators)
• Upper Extremity Veins (Deep and Superficial)

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I. Obtaining Patient History

• Chronic arterial occlusive disease
• Acute arterial occlusive disease
• Cold sensitivity
• Hypertension
• Ischemia
• Stroke
• Diabetes
• Hyperlipidemia
• Transient Symptoms
• Previous surgery
• Previous or related non-invasive testing
• Chronic venous insufficiency
• Acute vein thrombosis
• Related Medication
• Cardiac history and surgery

II. Obtaining Risk Factors

• Age
• Smoking
• Trauma
• Previous DVT
• Bedrest patient
• Carcinoma
• Diabetes
• Hypertension
• Hyperlipidemia
• Recent surgery
• Pregnancy
• Birth Control Pills
• Varicose Veins
• Obesity
• Cardiac disease

III. Indications for Arterial and Venous Non-Invasive Procedures

IV. Signs and Symptoms

V. Physical Examination

• Skin Changes
• Palpating for pulses and aneurysms
• Lymphedema
• Venous Ulcerations
• Auscultation for bruits
• Pulses

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I. Venous Disease

• Pathology of peripheral venous diseases
• Pathology of central venous diseases
• Preliminary information on acute deep vein thrombosis
• Preliminary information on chronic venous insufficiency
• Interpretation of venous disease with non-invasive testing
• Diagnostic criteria for venous disease with non-invasive testing
• Limitations of interpretation of venous disease with non-invasive testing
• Discerning pathology and artifacts
• Valvular disease
• Thrombosis (location and characteristic)
• Ambulatory hypertension
• AV Fistula

II. Arterial Disease

• Pathology of peripheral arterial disease
• Pathology of central arterial disease
• Preliminary information on chronic and acute arterial disease
• Interpretation of arterial disease with non-invasive testing
• Diagnostic criteria for arterial disease with non-invasive testing
• Limitations of interpretation of arterial disease with non-invasive testing
• Discerning pathology and artifact
• Atherosclerosis
• Hematomas
• Embolism
• Aneurysm
• Entrapment Syndromes
• Arteriovenous Fistulas
• Thoracic Outlet Syndrome
• Subclavian Steel
• Raynaud's Syndrome
• Arteritis

III. Cerebrovascular Disease

• Pathology of the cerebrovascular system
• Interpretation of cerebrovascular disease with non-invasive testing
• Diagnostic criteria for cerebrovascular disease with non-invasive testing
• Limitations of interpretation for cerebrovascular disease with non-invasive testing
• Discerning pathology and artifacts
• Atherosclerosis
• Hemorrhage
• Morphology
• Ulceration
• Masses and aneurysms
• Stenosis
• Embolism
• Subclavian Steal

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I. Venous

• Normal venous peripheral hemodynamics
• Normal central venous hemodynamics
• Normal portal vein flow
• Flow patterns in acute and chronic venous disease
• Interpretation of abnormal flow patterns
• Collateral Circulation
• Non-Invasive Venous Testing:
  1. Impedance Plethysmography
  2. Continuous wave Doppler
  3. Duplex Imaging (B-mode, Doppler, color)
• Patient positioning
• Transducer positioning

II. Arterial

• Normal arterial peripheral hemodynamics
• Normal abdominal and central hemodynamics
• Flow patterns in arterial disease
• Spectral waveforms
• Analog waveforms
• Pressures (upper extremity, lower extremity, penile)
• Interpretation of abnormal flow patterns
• Non-Invasive arterial testing:
  1. Continuous wave Doppler
  2. Duplex Imaging (B-mode, Doppler, color)
• Patient positioning
• Transducer positioning
• Criteria for diagnosis of hemodynamic disease

III. Cerebrovascular

• Normal cerebrovascular hemodynamics
• Abnormal flow for cerebrovascular disease
• Waveform analysis
• Systolic and diastolic velocities
• Criteria for the diagnosis of cerebrovascular disease
• Non-Invasive Cerebrovascular Testing:
  1. Continuous wave
  2. Duplex Imaging (B-mode, Doppler, color)
  3. Periorbital
• Patient positioning
• Transducer positioning

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I. Transcranial Doppler

• Techniques
• Indications
• Normal flow velocities in the intracranial arteries
• Abnormal flow velocities
• Direction of flow

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I. Carotid Endarterectomy

• Intraoperative survey
• Postoperative survey

II. Bypass Grafts

• Types
• Normal flow patterns
• Abnormal flow
• Preoperative assessment

Ill. Angioplasty

IV. Venography

• Methods
• Interpretation

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I. Transducers

• Characteristics
• Piezoelectric effect
• Beam focusing
• Near field
• Far field
• Mechanical transducers
• Phased array transducers
• Lateral resolution
• Axial resolution
• Elements
• Beam steering

II. Sound Propagation

• Speed of sound (tissue, air, blood)
• Reflection
• Refraction
• Absorption
• Attenuation
• Impedance
• Scattering
• Interfaces

Ill. Definitions

• Frequency
• Wavelength
• A-Mode
• B-Mode
• M-Mode
• Bandwidth
• Hertz
• Power
• Range
• Velocity

IV. Laws

• Ohm's Law
• Poiseuille's Law
• Bernoulli's

V. Instrumentation

• Pulsed wave
• Continuous wave
• Bidirectional and unidirectional Doppler
• Signal Processing:
  1. Arrival time analysis
  2. Decibel gain
  3. Digital signal
  4. Dynamic range
  5. Fast Fourier Transformation
  6. Post scan processing
  7. Pre scan processing
  8. Scan converter
  9. Time gain compensation
  10. Zero crossing detector

VI. Hemodynamics

• Venous resistance
• Arterial pressure
• Turbulent flow disturbances
• Velocity acceleration
• Diameter reduction
• Aliasing

VII. Artifacts

• Shadowing
• Reverberation

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I. Qualitative

II. Quantitative

III. Validity

• Sensitivity
• Specificity
• Accuracy

IV. Measurements

• Diameter reduction
• Lumen diameter
• Area reduction
• Maximum systolic velocities
• Maximum diastolic velocities

V. Safety

• Electrical Safety
• Patient Safety

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Instructor: David Hamments, RT(R), RDMS, RDCS, RVT

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