Normal Anatomy Perfusion Function
21%of exam
AortoiliacCarotid VertebralPeripheral ArteriesPeripheral VeinsVisceral Vessels
Pathology Perfusion Function
32%of exam
Carotid StenosisDVTPADAAAVisceral Disease
Surgically Altered Anatomy
6%of exam
Bypass GraftsStentsDialysis AccessEVARTIPS
Physiologic Exams
12%of exam
ABISegmentalsPVRPPGExercise Testing
Guided Procedures
7%of exam
PseudoaneurysmThrombinVenous AblationAccess Guidance
QA Safety Physics
14%of exam
Preparation Documentation Communication
8%of exam
IndicationsHistoryPatient IDReportingCritical Findings
Quick Facts
- Credential
- RVT
- Exam
- Vascular Technology
- Body
- ARDMS
- Questions
- About 170
- Items
- MCQ plus hotspots
- Time
- 3 hours
- Pass
- 555 scaled
- Scale
- 300-700
- Fee
- $300 USD
- Delivery
- Pearson VUE
- Rule
- SPI plus VT
- Window
- 90-day ECL
ICA vs ECA
ICA
- Low resistance
- No neck branches
- Brain flow
ECA
- High resistance
- Neck branches
- Temporal tap
Brain vs face
Cerebrovascular Map
- R CCA
- Brachiocephalic branch
- L CCA
- Aortic arch branch
- ICA
- Low resistance
- ECA
- High resistance
- Vertebral
- Antegrade cephalad flow
- Subclavian
- Upper extremity inflow
- Carotid bulb
- Common plaque site
- Temporal tap
- ECA clue
Carotid Order
Plaque, PSV, EDV, ratio, waveform.
Plaque firstVelocity nextRatios support
Acute vs Chronic DVT
Acute
- Soft thrombus
- Distended vein
- Hypoechoic
Chronic
- Echogenic thrombus
- Small vein
- Wall adherent
Fresh vs organized
Carotid Read
- No plaque→Normal ICA(PSV below 125)
- Plaque, PSV low→Below 50(Ratio supports)
- PSV 125-230→50-69(Check EDV)
- PSV above 230→70 plus(High grade)
- String flow→Near occlusion(Variable velocity)
- No lumen flow→Occlusion(Confirm settings)
Carotid Criteria
- Normal ICA
- PSV below 125
- ICA below 50
- Plaque, PSV below 125
- ICA 50-69
- PSV 125-230
- ICA 70+
- PSV above 230
- EDV clue
- Rises with severity
- ICA/CCA ratio
- Supports category
- Near occlusion
- Variable low flow
- Occlusion
- No detectable lumen
DVT Core
Compress, color, spectral, document extent.
Compression primaryColor supportsSpectral proximal
Stenosis vs Occlusion
Stenosis
- Residual lumen
- Velocity rises
- Turbulence distal
Occlusion
- No lumen flow
- Collateral clues
- Low distal flow
Narrowed vs closed
Venous Read
- Vein compresses→No acute DVT(At segment)
- Noncompressible→DVT present(Document extent)
- Soft hypoechoic→Acute DVT(Distended vein)
- Echogenic small→Chronic change(Wall adherent)
- Continuous flow→Proximal obstruction(Check pelvis)
- Reverse with stress→Reflux(Time threshold)
Venous Duplex
- Compressibility
- Primary DVT test
- Acute DVT
- Soft distended vein
- Chronic DVT
- Echogenic wall-adherent
- Phasicity
- Central patency clue
- Augmentation
- Distal flow response
- Reflux
- Valve incompetence
- Valsalva
- Proximal reflux stress
- Calf veins
- Paired compressions
Arterial Duplex
- Triphasic
- Normal high resistance
- Biphasic
- Often acceptable
- Monophasic
- Disease suspected
- Tardus-parvus
- Proximal obstruction
- Spectral broadening
- Turbulent flow
- Velocity ratio
- Stenosis estimate
- Collateral flow
- Chronic occlusion clue
- Post-stenotic turbulence
- Distal disturbance
Abdominal Visceral
- AAA
- Aorta 3 cm
- Iliac aneurysm
- Segmental dilation
- Renal stenosis
- High PSV/RAR
- RAR
- Renal-aortic ratio
- SMA stenosis
- High fasting PSV
- Celiac stenosis
- Respiratory variation
- Portal vein
- Hepatopetal flow
- TIPS
- Portal-systemic shunt
Surgical Surveillance
- Bypass graft
- Inflow conduit outflow
- Graft stenosis
- Focal velocity rise
- Stent restenosis
- In-stent velocity rise
- EVAR
- Endograft leak check
- Endoleak
- Sac flow persists
- AV fistula
- Native access
- AV graft
- Prosthetic access
- Steal syndrome
- Distal ischemia
ABI Rule
Ankle over arm; high means calcified.
0.90 abnormalAbove 1.40 calcifiedUse TBI
ABI vs TBI
ABI
- Ankle pressure
- PAD screen
- False high calcification
TBI
- Toe pressure
- Digital vessels
- Calcification workaround
Ankle vs toe
PAD Testing
- Rest pain→ABI plus waveforms(Baseline severity)
- ABI normal symptoms→Exercise ABI(Unmask PAD)
- ABI above 1.40→TBI(Calcified arteries)
- Segment drop→Localize level(Pressure gradient)
- Flat PVR→Severe disease(Poor pulsatility)
- Duplex needed→Map lesion(Velocity ratio)
Physiologic Testing
- ABI formula
- Ankle divided arm
- Normal ABI
- 1.00-1.40
- Borderline ABI
- 0.91-0.99
- Abnormal ABI
- 0.90 or less
- Noncompressible
- Above 1.40
- TBI
- Toe divided arm
- PVR
- Pulse volume contour
- Exercise ABI
- Unmasks claudication
Duplex vs Physiologic
Duplex
- Images vessel
- Measures velocity
- Maps lesion
Physiologic
- Measures perfusion
- Shows severity
- Localizes level
Anatomy vs function
Pseudoaneurysm vs Hematoma
Pseudoaneurysm
- Flowing sac
- Neck present
- To-and-fro
Hematoma
- No internal flow
- Clotted collection
- No neck
Flow vs clot
Guided Procedures
- Pseudoaneurysm
- Yin-yang sac
- Neck
- To-and-fro flow
- Compression
- Manual thrombosis
- Thrombin
- Sac injection
- Ablation
- Vein closure
- Access guidance
- Needle visualization
- Pre images
- Baseline anatomy
- Post images
- Complication check
Doppler Angle
Angle errors create velocity errors.
Parallel cursor60 or lessCenter stream
Aliasing vs Turbulence
Aliasing
- Scale too low
- Nyquist limit
- Wrap artifact
Turbulence
- Chaotic flow
- Spectral broadening
- Post stenosis
Artifact vs hemodynamics
Image Optimization
- Color aliases→Raise scale(Or lower baseline)
- Slow flow missed→Lower filter(Increase gain)
- Spectral noisy→Reduce gain(Clean window)
- Velocity inaccurate→Fix angle(60 or less)
- Deep vessel→Lower frequency(More penetration)
- Shadow hides lumen→Change window(Document limit)
Physics Knobs
- Angle
- Keep 60 or less
- Aliasing
- Nyquist exceeded
- Scale
- Raise for aliasing
- Wall filter
- Removes slow flow
- Gain
- Noise versus dropout
- Sample volume
- Gate size
- PRF
- Pulse repetition frequency
- Power Doppler
- Flow sensitivity
QA Safety
- ALARA
- Lowest reasonable output
- MI
- Mechanical bioeffect index
- TI
- Thermal bioeffect index
- Protocol
- Standardized acquisition
- Criteria
- Lab validated rules
- Correlation
- Compare prior imaging
- Ergonomics
- Prevent scanning injury
- Critical result
- Escalate promptly
RVT Weight
Pathology plus normal equals exam core.
Pathology 32%Normal 21%Together 53%
Prelim vs Final
Prelim
- Technical findings
- Protocol driven
- Escalate criticals
Final
- Physician interpretation
- Official report
- Clinical diagnosis
Acquire vs interpret
Exam Model
- VT
- Specialty exam
- RVT
- Credential earned
- SPI
- Physics requirement
- Five-year rule
- Pair SPI with VT
- Hotspot
- Image click item
- Score
- Scaled pass/fail
- ECL
- Scheduling authorization
- Retake
- 60-day wait
Domain Weights
- Pathology
- 32%
- Normal anatomy
- 21%
- QA physics
- 14%
- Physiologic
- 12%
- Prep documentation
- 8%
- Procedures
- 7%
- Surgical anatomy
- 6%
- Top two
- 53% total
Prep Documentation
- Patient ID
- Verify two identifiers
- Indication
- Reason for exam
- History
- Symptoms interventions meds
- Position
- Changes venous pressure
- Limitations
- Document incomplete areas
- Images
- Archive diagnostic proof
- Prelim
- Technical impression
- Communication
- Notify per protocol
Common Traps
RVT requirement
SPI plus VT ≠ Not VT alone
Content weights
Approximate distribution ≠ Not item guarantees
Carotid category
Use lab criteria ≠ Not PSV alone
ICA occlusion
Optimize low flow ≠ Do not assume absent
DVT diagnosis
Compression is primary ≠ Color is supportive
ABI false normal
Symptoms still matter ≠ Exercise may reveal
Calcified ABI
High is suspicious ≠ Not excellent perfusion
Pseudoaneurysm neck
To-and-fro flow ≠ Not simple hematoma
Doppler angle
60 or less ≠ Do not over-angle
Critical findings
Notify per protocol ≠ Document communication
Last Minute
- 1.Pathology is 32%
- 2.Normal anatomy is 21%
- 3.QA physics is 14%
- 4.Physiologic exams are 12%
- 5.SPI plus VT required
- 6.Pass is 555 scaled
- 7.VT has hotspot items
- 8.ICA low, ECA high
- 9.Carotid: plaque plus velocities
- 10.DVT: compression first
- 11.ABI = ankle/arm
- 12.ABI above 1.40 calcified
- 13.Angle 60 or less
- 14.Document technical limitations
- 15.Criticals follow protocol
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