Exam Requirements: Vascular Ultrasound (Revised 8-23-2024)

Exam Requirements: Peripheral Arterial

Lower Extremities - Arterial Duplex

*A bilateral exam should be submitted

Longitudinal gray scale images 

• Common femoral artery

• Proximal profunda femoris artery

• Superficial femoral artery - proximal, mid, and distal

• Popliteal artery - proximal and distal

• Anterior tibial artery

• Posterior tibial artery - distal 

• Dorsalis pedis artery

Longitudinal stand-alone color Doppler images

• Common femoral artery

• Proximal profunda femoris artery

• Superficial femoral artery - proximal, mid, and distal

• Popliteal artery - proximal and distal

• Anterior tibial artery

• Posterior tibial artery - distal

• Dorsalis pedis artery

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 artery

• Posterior tibial artery - distal

• Dorsalis pedis artery

Exam Requirements: Peripheral Venous

Lower Extremities - Venous

Lower Extremities - Venous Insufficiency

A bilateral exam should be submitted

Static transverse gray scale images without and with compression OR transverse gray scale cine clips without and with compression

• Common femoral vein - superior to and separate from the saphenofemoral junction

• 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

Static transverse gray scale images without and with compression OR transverse gray scale cine clips without and with compression. 

• Common femoral vein - superior to and separate from the saphenofemoral junction

• Saphenofemoral junction

• Proximal profunda femoris vein

• Femoral vein - proximal, mid, and distal

• Popliteal vein

Documentation of direction of flow with longitudinal 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

• Saphenofemoral junction

• Proximal profunda femoris vein

• Femoral vein - proximal, mid, and distal

• Popliteal vein

• Great saphenous vein including saphenofemoral junction and throughout thigh at a minimum (proximal, mid and distal)

• Inferior to knee

  • Great saphenous vein - below the knee

  • Small saphenous vein

Exam Requirements: Cerebrovascular

Extracranial 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 stand-alone 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

Exam Requirements: Liver Vasculature

Complete gray scale documentation in longitudinal

• At least three gray scale images of the left lobe to include lateral, mid, medial

• At least three gray scale images of the right lobe to include lateral, mid, medial  

Complete gray scale documentation in transverse

• At least three gray scale images of the left lobe to include superior, mid, inferior

• At least three gray scale images of the right lobe to include superior, mid, inferior

Gray scale images of vascular anatomy including vessel labeling

• Portal veins – main, right, and left

• Hepatic veins – right, middle, and left

• Inferior vena cava

• Splenic vein – posterior to pancreas

Longitudinal stand-alone color or power Doppler images

• Portal veins - main, right, and left

• Hepatic veins – right, middle, and left

• Hepatic artery

• Inferior vena cava

• Splenic vein - posterior to pancreas

Spectral Doppler waveform with color Doppler evaluation

• Portal veins – main (angle correction required), right, and left

• Hepatic veins - right, middle, and left

• Hepatic artery (angle correction required)

• Inferior vena cava

• Splenic vein – posterior to pancreas

Exam Requirements: Renal Vasculature

Renal Artery Stenosis

*Both kidneys MUST be present

Complete gray scale documentation of kidneys in longitudinal 

• At least three gray scale images to include lateral, mid without measurement, medial

Complete gray scale documentation of kidneys in transverse 

• At least three gray scale images to include upper pole, mid without measurement, lower pole

Renal length

Spectral Doppler waveform with color Doppler evaluation 

• Aorta (angle correction required) - at or just above the origin of the renal arteries

• Main renal artery (angle correction required) - proximal, mid, and distal

• Main renal vein

• Upper and lower pole segmental or interlobar arteries documenting RI or AI/AT

Exam Requirements: Aorta

Longitudinal gray scale images without and with AP measurements

• Aorta – proximal, mid, and distal

• Right common iliac artery

• Left common iliac artery

Transverse gray scale images without and with transverse measurements

• Aorta – proximal, mid, and distal

• Proximal common iliac arteries

Longitudinal color and/or spectral Doppler waveform of the distal aorta

10-13-2023

Peripheral Venous

Clarified lower extremities-venous insufficiency needs documentation of direction of flow with longitudinal color and spectral Doppler waveform

8-23-2024

Added link to the Modalities with Low Volume or Emergency Use article

Lower Extremity-Venous Insufficiency

Added proximal, mid and distal description for the great saphenous vein