ACR Ultrasound Accreditation Program Exam Requirements

Transcription

1 ACR Ultrasound Accreditation Program Exam Requirements OBSTETRICAL ULTRASOUND EXAMINATIONS... 3 First Trimester... 3 Second Trimester... 3 Third Trimester... 4 GYNECOLOGICAL ULTRASOUND EXAMINATIONS... 4 Female Pelvis... 4 GENERAL ULTRASOUND EXAMINATIONS... 5 Complete Upper Abdominal... 5 Renal... 5 Scrotum... 5 Thyroid... 6 Transrectal/Prostate... 6 Shoulder... 6 PEDIATRIC ULTRASOUND EXAMINATIONS... 6 Neurosonology... 6 Pyloric Stenosis... 7 Pediatric Hip... 7 Intussusception... 7 VASCULAR ULTRASOUND EXAMINATIONS... 8 Peripheral Venous... 8 Thrombosis Lower Extremities... 8 Incompetence... 8 Thrombosis Upper Extremities... 9 Vein Mapping... 9 Peripheral Arterial Arterial Occlusive Disease Lower Extremities Bypass Graft/Stent Cerebrovascular Bilateral Duplex Carotid Abdominal Vasculature - Liver Liver Vasculature Page 1 of 14 Revised 09/26/18

2 Liver Transplantation TIPS Abdominal Vasculature - Renal Renal Artery Stenosis Renal Vein Thrombosis Renal Transplant Deep Abdominal Vasculature Aorta Inferior Vena Cava and Draining Veins Page 2 of 14 Revised 09/26/18

3 OBSTETRICAL ULTRASOUND EXAMINATIONS First Trimester * First trimester submissions MUST be an endovaginal exam * First trimester exams MUST include an embryo/fetus with cardiac activity Documentation of the gestational sac Documentation of the yolk sac Documentation of the embryo/fetus without measurement CRL measurement Cardiac motion with M-mode Complete documentation of the uterus in longitudinal and transverse Complete documentation of both ovaries in longitudinal and transverse Second Trimester * Second trimester exams MUST be between 18 and 26 weeks Fetal presentation/position Amniotic fluid documentation Placental location Placental relation to the internal cervical os Fetal measurements Biparietal diameter Head circumference Abdominal circumference Femur length 4 chamber view of heart Right ventricular outflow tract (RVOT) Left ventricular outflow tract (LVOT) Cerebral ventricles Cerebellum Cisterna magna Nose/lips Stomach Kidneys Urinary bladder Umbilical cord insertion into fetal abdomen Umbilical cord vessel number Spine in longitudinal and transverse Cervical Thoracic Lumbar Sacral All 4 extremities Maternal anatomy Cervix with measurement Uterus Adnexa Page 3 of 14 Revised 09/26/18

4 Third Trimester * Third trimester exams MUST be > 26 weeks Fetal presentation/position AFI documentation Placental location Placental relation to the internal cervical os Fetal measurements Biparietal diameter Head circumference Abdominal circumference Femur length 4 chamber heart Stomach Kidneys Urinary bladder GYNECOLOGICAL ULTRASOUND EXAMINATIONS Female Pelvis * For the GYN module, at least one exam MUST be an endovaginal exam * Do NOT submit an examination with an IUD Uterus Complete documentation in longitudinal and transverse Size length, AP, width Myometrial texture Endometrium without and with measurement Cervix Ovaries Complete documentation in longitudinal and transverse Size length, AP, width Tissue texture Cul-de-Sac Page 4 of 14 Revised 09/26/18

5 GENERAL ULTRASOUND EXAMINATIONS Complete Upper Abdominal Liver Complete documentation in longitudinal and transverse Tissue texture Vascular and ductal anatomy Gallbladder and Biliary Duct Complete documentation in longitudinal and transverse in two different patient positions Measurement of the extra hepatic duct Pancreas Complete documentation to include head, body and tail Tissue texture Kidneys Complete documentation in longitudinal and transverse Tissue texture Renal length Spleen Complete documentation in longitudinal and transverse Tissue texture Aorta Longitudinal documentation proximal, mid and distal IVC Longitudinal documentation proximal Renal Complete documentation of both kidneys in longitudinal and transverse Tissue texture Renal length Scrotum Complete documentation of testes in longitudinal and transverse Measurement of testes length, AP, width Tissue texture Documentation of epididymis and other peritesticular structures Doppler utilized when indicated Page 5 of 14 Revised 09/26/18

6 Thyroid Complete documentation of both lobes in longitudinal and transverse Measurement of both lobes length, AP, width Transverse isthmus with and without AP measurement Tissue texture Complete documentation in two planes Size obtained from three orthogonal planes Tissue Texture Documentation of periprostatic structures Transrectal/Prostate Shoulder Complete documentation in two planes Bicep tendon Subscapularis tendon Supraspinatus tendon Infraspinatus tendon Teres minor tendon Measurements of rotator cuff tear size, if appropriate Size obtained from three orthogonal planes PEDIATRIC ULTRASOUND EXAMINATIONS Neurosonology Coronal views Frontal lobes anterior to the frontal horns of the lateral ventricles Frontal horns or bodies of lateral ventricles and interhemispheric fissure Lateral ventricles at level of lateral and third ventricles Lateral ventricles slightly posterior to the foramina of Monro, where the lateral and third ventricles communicate Level of quadrigeminal plate, quadrigeminal cistern and cerebellum Echogenic glomi of choroid plexuses at posterior aspect of the lateral ventricles at level of trigones Posterior to occipital horns Sagittal views Midline sagittal views to include corpus callosum, cavum septi pellucidi, and cavum verge, if present Right and left parasagittal views of lateral ventricles including caudothalamic groove Right and left parasagittal views of lateral ventricles documenting choroid plexus Right and left parasagittal views of the insula Right and left parasagittal views of the Sylvian fissure and temporal lobe Page 6 of 14 Revised 09/26/18

7 Pyloric Stenosis Documentation of the pylorus with antrum and duodenal bulb in longitudinal Documentation of the pylorus in transverse Abnormal studies should have measurements of muscle thickness in both longitudinal and transverse planes Abnormal studies should have measurements of the length of the pyloric canal which is hypertrophied Normal studies should identify the distal antrum and duodenal bulb. Measurements are not necessary in normal studies. Pediatric Hip Flexed coronal view outlining anatomic structures, including evaluation of acetabular morphology by acetabular angles and femoral head coverage. The image should outline the ilium, transverse Y cartilage, ischium, labrum and gluteal muscles, as well as the femoral head. Flexed transverse views with and without stress. The view should show the ossified femoral shaft, the femoral head and underlying ischium. Stress views should not be done when the hip is abnormal (i.e., subluxated or dislocated, or already in a Pavlik harness). Flexed coronal view of the posterior lip of the acetabulum and transverse views of the hip in extension may supplement the examination. Intussusception Evaluation should include the entire abdomen, right, left, and centrally, beginning in the epigastric region and extending into the pelvis Documentation of bowel loops, ascites and lymph nodes, if present. Positive examinations should document location where the intussusception is encountered. Positive examinations should attempt to follow the intussusception to its termination, identifying lead points, such as ileal duplication cysts in infants, or lymphoma in older children, if present. Positive examinations should identify and document ascites, if present, and fluid-filled dilated loops of bowel, indicating bowel obstruction, if present. Color Doppler of the intussusception can be used to supplement the examination and assess degree of flow to the intussusceptum complex. Page 7 of 14 Revised 09/26/18

8 VASCULAR ULTRASOUND EXAMINATIONS Peripheral Venous Thrombosis Lower Extremities * A bilateral exam should be submitted Transverse gray scale without and with compression images Common femoral vein Saphenofemoral junction Proximal profunda femoris vein Femoral vein proximal, mid and distal Popliteal vein Longitudinal color and/or spectral Doppler waveform images Saphenofemoral junction Proximal profunda femoris vein Femoral vein proximal, mid and distal Spectral Doppler waveform demonstrating spontaneous flow and respiratory phasicity Common femoral vein or external iliac vein Popliteal vein Calf veins as clinically indicated Incompetence Perform a complete Thrombosis - Lower Extremities exam first, then add the reflux assessment below: Documentation of direction of flow with color and spectral Doppler waveform following augmentation maneuvers or Valsalva (in the upper thigh) with the patient in the semi-upright or upright position. Length of time of reflux must be measured in at least one location within the superficial system. Common femoral vein Femoral vein Popliteal vein Great saphenous vein including SFJ and throughout thigh at a minimum Additional imaging inferior to knee, if appropriate o GSV below knee o Small saphenous vein including saphenopopliteal junction o Assess for perforators as clinically indicated Page 8 of 14 Revised 09/26/18

9 Thrombosis Upper Extremities Transverse gray scale without and with compression images Internal jugular vein Axillary vein Brachial vein Basilic vein to the level of the antecubital fossa Cephalic vein to the level of the antecubital fossa Longitudinal gray scale images Internal jugular vein Subclavian vein Axillary vein Brachial veins Longitudinal color Doppler images Internal jugular vein Subclavian vein Axillary vein Brachial veins Spectral Doppler waveform images Internal jugular vein - bilaterally Subclavian vein - bilaterally Axillary vein Brachial veins Vein Mapping Complete evaluation of appropriate superficial venous system using gray scale, including axial diameter +/- distance from skin surface Great or small saphenous of leg OR Cephalic vein of upper arm/forearm AND Basilic vein of upper arm/forearm Images to note thrombus, wall thickening, calcification or branching should be obtained Page 9 of 14 Revised 09/26/18

10 Peripheral Arterial Arterial Occlusive Disease Lower Extremities Longitudinal gray scale images Common femoral artery Proximal profunda femoris artery Superficial femoral artery - proximal, mid and distal Popliteal artery - proximal and distal Longitudinal color Doppler images Common femoral artery Proximal profunda femoris artery Superficial femoral artery - proximal, mid and distal Popliteal artery - proximal and distal Longitudinal spectral Doppler waveform with color Doppler evaluation Common femoral artery Proximal profunda femoris artery Superficial femoral artery - proximal, mid and distal Popliteal artery - proximal and distal Anterior tibial, posterior tibial and peroneal arteries evaluated as clinically indicated Bypass Graft/Stent Longitudinal gray scale images of graft/stent and anastomoses Longitudinal color Doppler images of graft/stent and anastomoses Spectral Doppler waveforms to include peak systole and end diastole measurements Proximal native vessel Proximal anastomosis/edge of stent Proximal, mid and distal segments of graft/stent (at a minimum) Distal anastomosis/edge of stent Distal native run-off vessel Direction of flow documented in native run off vessel distal to graft Page 10 of 14 Revised 09/26/18

11 Cerebrovascular Bilateral Duplex Carotid Transverse gray scale images Common carotid artery proximal and distal Bifurcation Longitudinal gray scale images Common carotid artery proximal and distal Internal carotid artery - proximal External carotid artery - proximal Longitudinal color Doppler images Common carotid artery proximal and distal Internal carotid artery - proximal External carotid artery - proximal Longitudinal spectral Doppler waveform with color Doppler evaluation Common carotid artery proximal and distal Internal carotid artery - proximal, mid and distal External carotid artery proximal Vertebral artery Abdominal Vasculature - Liver Liver Vasculature Complete gray scale survey of liver parenchyma in longitudinal and transverse Gray scale images of vascular anatomy including vessel labeling Main portal vein Hepatic veins right, middle and left Splenic vein posterior to pancreas Color or power Doppler images Portal veins - main, right and left Hepatic veins right, middle and left Hepatic artery Splenic vein - posterior to pancreas Spectral Doppler waveform images Portal veins - main*, right and left Hepatic veins - right, middle and left Hepatic artery* Splenic vein posterior to pancreas * angle correction required Page 11 of 14 Revised 09/26/18

12 Liver Transplantation Complete gray scale survey of liver parenchyma in longitudinal and transverse Gray scale images of vascular anatomy including vessel labeling Main portal vein and anastomosis Hepatic veins right, middle and left Splenic vein posterior to pancreas Color or power Doppler images Portal veins - main, right and left and anastomosis Hepatic veins right, middle and left Hepatic artery main, right and left and anastomosis Splenic vein - posterior to pancreas Spectral Doppler waveform images Portal veins - main*, right and left and anastomosis Hepatic arteries* - main, right and left and anastomosis Hepatic veins - right, middle and left Splenic vein posterior to pancreas * angle correction required TIPS Complete gray scale survey of liver parenchyma in longitudinal and transverse Gray scale images of vascular anatomy including vessel labeling Main portal vein Hepatic veins right, middle and left Splenic vein posterior to pancreas TIPS Color or power Doppler images Portal veins - main, right and left Hepatic veins right, middle and left Hepatic artery Splenic vein - posterior to pancreas TIPS Spectral Doppler waveform images Portal veins* - main, right, left and proximal to TIPS Hepatic veins - right, middle, left and distal to TIPS Hepatic artery* Splenic vein posterior to pancreas TIPS* proximal, mid and distal * angle correction required Page 12 of 14 Revised 09/26/18

13 Abdominal Vasculature - Renal Renal Artery Stenosis Complete gray scale documentation of kidneys in longitudinal and transverse Renal length Spectral Doppler waveform images Aorta* - at or just above the origin of the renal arteries Main renal artery* - proximal, mid and distal Main renal vein Upper and lower pole segmental or interlobar arteries documenting RI or AI/AT * angle correction required Renal Vein Thrombosis Complete gray scale documentation of kidneys in longitudinal and transverse Renal length Gray scale images Renal veins Color Doppler images Main renal arteries Renal veins Spectral Doppler waveform images Main renal artery* Main renal vein Intrarenal artery upper and lower pole * angle correction required Page 13 of 14 Revised 09/26/18

14 Renal Transplant Complete gray scale documentation of kidneys in longitudinal and transverse Renal length Color Doppler images Main renal arteries Main renal vein Proximal iliac artery Draining iliac vein Spectral Doppler waveform images Renal artery* - anastomosis, proximal, mid and distal Renal vein anastomosis and proximal Proximal iliac artery* Draining iliac vein Upper and lower pole segmental or interlobar arteries documenting RI or AI/AT * angle correction required Deep Abdominal Vasculature Aorta Longitudinal gray scale images without and with measurements Aorta proximal, mid and distal Right common iliac artery Left common iliac artery Transverse gray scale images without and with measurements Aorta proximal, mid and distal Bifurcation into proximal common iliac arteries Color and/or spectral Doppler waveform of the distal aorta Inferior Vena Cava and Draining Veins Longitudinal gray scale images without and with measurements proximal, mid and distal Right common iliac vein Left common iliac vein Transverse gray scale images proximal, mid and distal Bifurcation into proximal common iliac veins Color and/or spectral Doppler waveform Page 14 of 14 Revised 09/26/18