Module - Extracranial Arterial Imaging (SPS129)

STP

Aim of this module

This module provides trainees with the knowledge that underpins the third year specialist module in Vascular Science. It will provide trainees with the knowledge, understanding and practical skills to safely contribute to the diagnosis of extracranial vascular disease and provides the knowledge that will underpin learning in the work base.

Work-based learning outcomes


1. Triage requests for investigation of patient with suspected carotid and vertebral artery disease and prepare the room and equipment.
2. Prepare patients and take their clinical histories.
3. Perform scans on patients with suspected carotid and vertebral artery disease.
4. Interpret, explain and report results.

Work-based Competencies


Learning outcome Title Knowledge
1 1

Triage requests for investigation of patients with suspected carotid and vertebral artery disease.

  • Presenting signs and symptoms of cerebrovascular disease.
  • Associated co-morbidity and risk factors.
  • The role of the vascular diagnostic service in the management of patients with cerebrovascular disease.
2 1

Set up equipment and room ready for extracranial investigation.

  • Settings for extracranial investigation.
  • Mobility of patients with symptoms of cerebrovascular disease.
  • Potential hazards and risks with carotid and vertebral artery investigations and the actions to be taken to minimise these.
3 2

Control infection risks associated with extracranial investigations in accordance with departmental protocols.

  • Protocols and requirements for hygiene and infection control related to extracranial investigation, including preparation, conduct and completion of investigation.
  • Protocol for hand washing and how effective hand washing contributes to control of infection.
4 2

Minimise risks and hazards during the extracranial investigation in compliance with health and safety policies.

  • The relevant health and safety regulations specific to extracranial investigations, the potential hazards and risks, and the actions to be taken to minimise these.
5 2

Explain the procedure to the patient, address any procedure-related questions they may have and provide information on how the patient will be informed of the results.

As related to carotid and vertebral disease

  • The pathophysiology of the extracranial arteries and the appropriate choice of investigation, considering the findings from the history and clinical examination.
  • Common questions and concerns of patients about procedures.
  • Risks and benefits of undertaking the investigation.
  • The information needs of patients following investigation.
  • The authority level for provision of information to patients.
  • The process of notifying patients of the results.
6 2

Gain informed consent for the extracranial investigation.

  • The importance of explaining the extracranial investigation to the patient and gaining informed consent.
  • The relevant procedures and requirements for patient conformance.
  • Clinical indications and contraindications.
  • Principles, guidance and law with respect to informed consent.
7 2

Obtain clinical history from the patient pertinent to the extracranial examination.

  • The features that should be present in an effective patient consultation for extracranial investigations.
  • Structure of a consultation model, e.g. the Calgary-Cambridge model.
8 3

Perform an ultrasound scan using B Mode to identify normal carotid and vertebral anatomy in the neck.

  • Anatomy of carotid and vertebral arteries.
  • Morphological variations of the anatomy.
  • Examination technique, patient positioning and scanning protocol.
9 3

Perform an ultrasound scan using colour Doppler and spectral Doppler to demonstrate the haemodynamics of normal carotid and vertebral arteries.

  • Haemodynamics and normal physiology of carotid and vertebral arteries.
10 3

Perform an ultrasound scan to identify significant carotid artery disease.

  • Carotid artery pathology and ultrasound characteristics.
  • Effect of disease on cerebrovascular haemodynamics.
  • Examination technique and patient positioning.
11 3

Perform an ultrasound scan to identify an incidental finding, e.g. vertebral artery stenosis, other unusual finding.

  • Other findings that may be discovered on an ultrasound examination of the neck.
12 4

Produce an interpretive report of investigations.

  • Interpretation and determination of disease severity.
  • Reporting criteria pertinent to carotid and vertebral artery investigations.
13 4

Recognise the pitfalls and limitations of the investigation.

  • Limitations and pitfalls of carotid and vertebral artery duplex investigations.
  • Consequences of a misdiagnosis.
14 4

Ensure extracranial results are given in a timely manner with appropriate action for urgent findings.

  • Local protocols for reports.
  • Urgent extracranial findings.

Work-based assessment


Complete 2 Case-Based Discussion(s)
Complete 2 of the following DOPS and/or OCEs
Type Title
DOPS Perform and analyse B Mode colour Doppler scan of the carotid arteries obtaining longitudinal and transverse images from the origin of the CCA to the distal ICA and distal ECA.
DOPS Perform and analyse B Mode colour Doppler scan of the carotid bifurcation using anterior, lateral and posterior approaches.
DOPS Obtain, measure, differentiate and analyse Doppler spectra from CCA, ICA and ECA
DOPS Obtain, measure and analyse Doppler spectra from vertebral and subclavian arteries.
DOPS Perform and interpret a complete diagnostic scan on a new TIA patient
DOPS Perform and interpret a complete diagnostic scan on a pre endarterectomy patient or follow up patient with known 70 percent diameter reduction stenosis.
DOPS Perform and interpret a complete follow up scan on a post endarterectomystent patient.
DOPS Perform and interpret a complete diagnostic scan on an immobile patient in a wheelchair
DOPS Perform and interpret a complete diagnostic scan on an immobile patient on a trolley bed.
DOPS Perform and interpret an emergency post endarectomy stent scan on a patient in recovery ICU using a portable system
OCE Introduce yourself to the patient and confirm their identity
OCE Explain the carotid scan procedure and purpose to the patient
OCE Obtain patient consent for the carotid scan
OCE Obtain the relevant clinic history and symptoms pertinent to the carotid scan.
OCE Prepare and position a mobile patient for the carotid scan
OCE Prepare and position a patient with mobility difficulties for the carotid scan
OCE Communicate with the patient during the scan to explain the practical aspects of the procedure e.g. head position.
OCE Explain temporal tap procedure to the patient.
OCE Explain the carotid scan findings to the patient
OCE Explain what happens with the carotid scan results