1. DVT Protocols
The following provides details of Upper and Lower Limb DVT protocols used in our practice.
Paige Fabre

2. Lower Limb DVT

3. 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

4. Anatomy of the Lower Limb Deep Venous System

5. Lower Limb DVT Study Protocol
Compress throughout follow in colour etc

6. 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)

7. 1. Common Femoral Vein

8. 2. Common Femoral Vein and Long Saphenous Vein Junction

9. 3. Femoral Vein Proximal

10. 4. Femoral Vein Mid

11. 5. Femoral Vein Distal

12. 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

13. 6. Spectral Trace of the Common Femoral Vein

14. 7. Colour Doppler of the Common Femoral Vein and Long Saphenous Vein

15. 8. Colour Doppler of the Common Femoral Vein, Deep Femoral Vein and the Femoral Vein

16. 9. Spectral Trace of the Deep Femoral Vein

17. 10. Spectral Trace of the Proximal Femoral Vein

18. 11. Spectral Trace of the Mid Femoral Vein

19. 12. Spectral Trace of the Distal Femoral Vein

20. 13. Spectral trace of the Distal Femoral Vein with Augmentation

21. 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

22. 14. Compression of the Popliteal Vein

23. 15. Colour Doppler Image of the Popliteal Vein

24. 16. Spectral trace of the Popliteal Vein

25. 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)

26. 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

27. Medial Gastrocnemious Veins

28. Lateral Gastrocnemious Veins

29. Short Saphenous Vein

30. Long Saphenous Vein

31. Soleal Veins

32. Posterior Tibial Veins and Peroneal Veins

33. Posterior Tibial Veins and Peroneal Veins

34. 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.

35. Upper Limb DVT

36. 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

37. Anatomy of the Upper Limb Deep Venous System

38. Upper Limb DVT Study Protocol
Compress throughout follow in colour etc

39. 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

40. 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

41. 1. Jugular Vein

42. 2. Jugular Vein

43. 3. External Jugular Vein and Subclavian Junction in Colour

44. 4. Subclavian Vein Long B-mode

45. 5. Subclavian Vein Prox

46. 6. Subclavian Vein Mid

47. 7. Subclavian Vein Distal

48. 8. Axillary Vein

49. 9. Axillary Vein Spectral Trace

50. 10. Basilic Vein
Transverse
Longitudinal

51. 11. Brachial Vein
Transverse
Longitudinal

52. 12. Cephalic Vein
Transverse
Longitudinal

53. 13. Radial Vein
Transverse
Longitudinal

54. 14. Ulnar Vein
Transverse
Longitudinal

55. Worksheet for Examination

56. 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.