Changes: The Latest Revisions To The ICAVL Standards [continued]

Extracranial Cerebrovascular Testing

The required characteristics for extracranial duplex ultrasound examinations have been expanded to include a statement mandating that "The entire course of the accessible portions of the CCA and ICA must be evaluated."

Related to the documentation of representative spectral Doppler waveforms, the minimum waveforms have been expanded:

3.2.1.1 Representative spectral Doppler waveforms must be documented as required by the protocol and must include at a minimum waveforms taken from:

• Proximal CCA
• Mid/distal CCA
• Proximal ICA
• Distal ICA, sampling as distally as possible
• One site in the ECA
• One site in the vertebral

Intracranial Cerebrovascular Testing

The instrumentation standard was expanded by the addition of Transcranial Duplex:

1.1 Transcranial Doppler (TCD) or Transcranial Duplex must be provided as instrumentation.

The listing of appropriate indications for TCD examination has been expanded and now includes occlusion, vasomotor reactivity, right-to-left shunt detection, peri-procedural or surgical monitoring, cerebral circulatory arrest.

Related to techniques for examination performance, specific emitted power specifications have been added:

3.1.1.2 The laboratory protocol must define the extent of power reduction to be used for transorbital examinations. For patient safety, the output power must not exceed 10% of maximum emitted power or 17mW per cm2 or equivalent measurements.

In the required documentation of examination standard, the requirements for written protocols are now more specific:

3.2.1.1 As a minimum, the written protocol for complete examination requires the spectral Doppler sampling of the following segments:

• Intracranial internal carotid arteries
• A1 segment of the Anterior cerebral arteries
• M1-proximal M2 Middle cerebral arteries
• P1 or P2 Posterior cerebral arteries
• Ophthalmic artery
• Internal carotid artery siphon
• Distal internal carotid artery on the neck (when appropriate)
• Distal vertebral arteries
• Proximal and distal Basilar artery

Within the Quality Assurance section, the standard related to correlation and confirmation of results now requires a higher number of correlations, including a greater number of abnormal studies:

6.1.2 A minimum of 30 separate examinations, including normal and abnormal intracranial studies, must be correlated every three years. A minimum of 10 of the correlating studies must include abnormal intracranial findings. These studies must have been done within the three years preceding the submission of the application.

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