DVT Protocols The following provides details of Upper and Lower Limb DVT protocols used in our practice. Paige Fabre 13654584
Lower Limb DVT
Anatomy of the Lower Limb Deep Venous System In our practice lower limb DVT studies will standardly examine: Distal portion of the Common Femoral Vein Saphenofemoral Junction Long Saphenous Vein Proximal Deep Femoral Vein Superficial Femoral Vein Popliteal Vein Medical Gastrocnemious Veins Lateral Gastrocnemious Veins Soleal Veins Peroneal Veins Posterior Tibial Veins
Anatomy of the Lower Limb Deep Venous System
Lower Limb DVT Study Protocol Compress throughout follow in colour etc
Lower Limb DVT Study Protocol The following protocol is as dictated in our practice protocol manual: Image 1 to 5 completed in a duel screen format. These images are taken in the transverse plane in B mode. Common Femoral Vein (non compressed and compressed) Common Femoral Vein and Long Saphenous Vein Junction (non compressed and compressed) Femoral Vein Proximal (non compressed and compressed) Femoral Vein Mid (non compressed and compressed) Femoral Vein Distal (non compressed and compressed)
1. Common Femoral Vein
2. Common Femoral Vein and Long Saphenous Vein Junction
3. Femoral Vein Proximal
4. Femoral Vein Mid
5. Femoral Vein Distal
Lower Limb DVT Study Protocol Images 6 through 13 are taken in single screen format. Spectral trace of the Common Femoral Vein Colour Doppler image of the Common Femoral Vein and Long Saphenous Vein Colour Doppler Image of the Common Femoral Vein and Femoral Vein Spectral trace of the Deep Femoral Vein Spectral trace of the Proximal Femoral Vein Spectral trace of the Mid Femoral Vein Spectral trace of the Distal Femoral Vein Spectral trace of the Distal Femoral Vein with augmentation
6. Spectral Trace of the Common Femoral Vein
7. Colour Doppler of the Common Femoral Vein and Long Saphenous Vein
8. Colour Doppler of the Common Femoral Vein, Deep Femoral Vein and the Femoral Vein
9. Spectral Trace of the Deep Femoral Vein
10. Spectral Trace of the Proximal Femoral Vein
11. Spectral Trace of the Mid Femoral Vein
12. Spectral Trace of the Distal Femoral Vein
13. Spectral trace of the Distal Femoral Vein with Augmentation
Lower Limb DVT Study Protocol Imaging of the limb below the knee is variable and is dependant on the individual sonographers preference as well as reporting radiologist preference. Imaging must contain: Compression of the Popliteal Vein in duel screen format Colour Doppler Image of the Popliteal Vein Spectral trace of the Popliteal Vein Duel screen compression images of the calf veins either singly or as a group – most of the variation between studies occurs in these images
14. Compression of the Popliteal Vein
15. Colour Doppler Image of the Popliteal Vein
16. Spectral trace of the Popliteal Vein
Calf Veins Protocol for the Calf Veins is variable between sonographers. The protocol that I have encountered most often through different trainers includes: Medial Gastrocnemious Veins (Duel screen - non compressed and compressed) Lateral Gastrocnemious Veins (Duel screen - non compressed and compressed) Short Saphenous Vein (Duel screen - non compressed and compressed) Long Saphenous Vein (Duel screen - non compressed and compressed) Soleal Veins (Duel screen - non compressed and compressed)
Calf Veins Continued Either: OR Posterior Tibial Veins (Duel screen - non compressed and compressed) Peroneal Veins (Duel screen - non compressed and compressed) OR Posterior Tibial Veins and Peroneal Veins (Duel screen - non compressed and compressed, Prox, Mid And Dist) In addition, some radiologists also like a transverse colour Doppler image of Peroneal and Posterior Tibial Veins with augmentation to demonstrate colour filling
Medial Gastrocnemious Veins
Lateral Gastrocnemious Veins
Short Saphenous Vein
Long Saphenous Vein
Soleal Veins
Posterior Tibial Veins and Peroneal Veins
Posterior Tibial Veins and Peroneal Veins
Work Sheet for Examination At our practice the adjacent worksheet is used to document the study. This is to allow better understanding of any thrombosis by the reporting radiologist as well as aid in reproducibility when the patient returns for a follow up scan.
Upper Limb DVT
Anatomy of the Upper Limb Deep Venous System A DVT study of the Upper Limb will examine: Jugular Vein from the mastoid to the base of the neck Subclavian Vein Axillary Vein Brachial Vein Basilic Vein Cephalic Vein Radial and Ulnar Veins
Anatomy of the Upper Limb Deep Venous System
Upper Limb DVT Study Protocol Compress throughout follow in colour etc
Upper Limb DVT Study Protocol Jugular Vein Transverse (Duel screen - non compressed and compressed) Jugular Vein Long with Colour and Spectral Trace External Jugular Vein and Subclavian Junction in Colour Subclavian Vein Long B-mode Colour flow with spectral trace Prox Mid Distal Axillary Vein Transverse (Duel screen - non compressed and compressed) Axillary Vein Long with Colour and Spectral trace proximally and distally
Upper Limb DVT Study Protocol Basilic Vein, Brachial Veins, Cephalic Vein, Radial Veins, Ulnar Veins Transverse (Duel screen - non compressed and compressed) Longitudinal Colour and Spectral Trace - Prox, Mid, Distal if possible Augmentation can be used if needed but should be documented
1. Jugular Vein
2. Jugular Vein
3. External Jugular Vein and Subclavian Junction in Colour
4. Subclavian Vein Long B-mode
5. Subclavian Vein Prox
6. Subclavian Vein Mid
7. Subclavian Vein Distal
8. Axillary Vein
9. Axillary Vein Spectral Trace
10. Basilic Vein Transverse Longitudinal
11. Brachial Vein Transverse Longitudinal
12. Cephalic Vein Transverse Longitudinal
13. Radial Vein Transverse Longitudinal
14. Ulnar Vein Transverse Longitudinal
Worksheet for Examination
Examination Extension If abnormal flow is indicated at the common femoral vein distally, then the examination is extended superiorly into the abdomen to determine a cause The region of interest should be examined. If the patient presents with leg swelling and extensive oedema is seen this should be imaged If the patient has a tender area for investigation this should be imaged. If there is thrombophlebitis in the patients ROI then this should be documented as well are the vein that it drains to and apparent proximity to veins If the patient has popliteal fossa pain (in the absence of a DVT) the fossa and calf should be examined for the presence of a Baker’s cyst. If a duplication of vessels is noted i.e. two femoral veins, then both should be examined and the dupliation drawn on to diagram.