renal artey doppler exam for RAS studies

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Comments (6)

dbaryosef in Las Vegas, Nevada

20 months ago

Hello,

I have a question to anyone who has experience with scanning this type of exam. My job wants to me to start doing this exam and I'd like to get feedback from someone with experience in this. What is the exact protocol? How much time are you given to complete this exam? If anyone can reply, i would greatly appreciate this.
Thank you

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Roger in Oakland, California

20 months ago

IMO, renal exams are the most difficult of vascular.
Protocols vary, but starting from abdominal cross sectional, doppler under the sma, rotate probe and you start to see the renal arteries. follow them to the kidneys by having patients lay on their side. Doppler hilu, and some of the arcuate vessels, and measure cortical thinning.

renal is a hands on deal as body habitus plays a role.

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dbaryosef in Las Vegas, Nevada

20 months ago

Roger in Oakland, California said: IMO, renal exams are the most difficult of vascular.
Protocols vary, but starting from abdominal cross sectional, doppler under the sma, rotate probe and you start to see the renal arteries. follow them to the kidneys by having patients lay on their side. Doppler hilu, and some of the arcuate vessels, and measure cortical thinning.

renal is a hands on deal as body habitus plays a role.

so the place that i'm working at is giving me 30 minutes to do this exam with NO patient prep...ALL DAY LONG... we need to doppler the ao, doppler the renal arteries as well as measuring the kidneys, measure RI's on 3 locations of each kidney... Don't believe it is feasable to do this in 30 minutes and no pt prep... what do you think?

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Roger in San Francisco, California

19 months ago

dbaryosef in Las Vegas, Nevada said: so the place that i'm working at is giving me 30 minutes to do this exam with NO patient prep...ALL DAY LONG... we need to doppler the ao, doppler the renal arteries as well as measuring the kidneys, measure RI's on 3 locations of each kidney... Don't believe it is feasable to do this in 30 minutes and no pt prep... what do you think?

That is generally about the right time.. The lab that I trained in, they were not really into micro managing and also the manager knew that Renal studies can be difficult due to body habitius. But again, every place is different and some labs want every tech to be fast, yet have a good study... sometimes it dont happen like that.

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Dontbelieveit in Crazyhorse, Indiana

19 months ago

dbaryosef in Las Vegas, Nevada said: so the place that i'm working at is giving me 30 minutes to do this exam with NO patient prep...ALL DAY LONG... we need to doppler the ao, doppler the renal arteries as well as measuring the kidneys, measure RI's on 3 locations of each kidney... Don't believe it is feasable to do this in 30 minutes and no pt prep... what do you think?

That's because business majors think if you can do something in an hour, you should be able to do it in a half hour. They have no clue what we are doing, but they make the decisions.

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M.Cowan,MBA,RT,RDMS,RVT,RDCS in Houston, Texas

18 months ago

I agree that RAS studies are one of the most difficult studies to perform with accuracy....if assessing the RAs with the "direct method". Unless you have that perfect person and manage to hit that jet just right, you will have a high incidence of underestimating the disease. This is why statistically speaking RAS have a very poor Negative Prediction Value AND Specifity. In other words lots of false negatives.

I am a strong believer in the "indirect method" because I worship at the alter of physics, hemodynamics in this case. Here is my take, some degree of stenosis is acceptable. RAs are not considered worrisome until they have a diameter reduction of 60% or greater. Thus, are objective is not really to determine if the patient has RAS, but to determine if the patient has RAS greater than 60% (which is hemodynamically signifigant).

The laws of hemodynamics tells us that a proximal hemodynamic signifigant stenosis will alter the flow down stream.(Good ole Tardus Parvus) Thus if the RAs are truly stenosed to the point of comprimise, then the flow in the segmentals, interlobars, arcuates, ect...will display the effects of the stenosis. They will have a dampened systolic peak, but more importantly the systolic acceleration time will be greater than 100 msec. Its easy to do and much quicker. If you get a positive exam, then you simply recommend MRI angio.

My $.02

Ciao

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