Lower Extremity Venous Competency

Student Name: Kristen Cherry

Date Written Comp submitted: 03/31/2014

Directions:
Students are required to complete each area to receive maximum points
There are 10 sections, each section is worth a maximum of 5 points
Answers provided must relate to specific information requested. Additional information
including non-applicable information will result in point deduction.
Answer formatting:
Reflective writing: describes what you did during the examination
Technical writing: describes what can be found in the literature
Bullet format is preferred for most sections (complete sentences are not required)
Narrative format is identified for specific sections. The narrative should be written in a
format that is easy to follow and understand.

Clinical Site:
Sonographer
Providing Scan
Comp Grade:
Identify the
Sonographers
Credentials:

1st Attempt
BMH Memphis
Tracy Sparks

2nd Attempt
Patient MRN:
Exam Ordered on
Request:

RDMS (AB,
OB/GYN) &
RVT (VT)

Performance date of
Final Scan
Competency

1st Attempt 2nd Attempt

1C10312964
Ultrasound
leg bilateral
venous
03/19/2014

Section I: Patient Care, Patient Identification, and Universal Precautions

Complete the table below by providing a self-reflection of each component as it relates to the patient
examination you performed.
Some components contain several elements. For maximum score each element must
be answered.
Reflective writing will be used for this section.
Answers should be written in a narrative form
Examination preparation
Describe the patient set up and
include reasoning for set up used

Explanation
Patient supine on stretcher
Head elevated
o Causes blood to better fill lower extremity veins
Right leg exposed with towel tucked into underwear at groin
area
o Prevent gel from getting on patient clothing

Lower Extremity Venous Competency

Describe how the patient was

identified

Identify how patient allergies were

determined (chart and patient
interview)
Describe how you educated the
patient about the examination you
performed (must include specifics
about organs involved in the
competency performed)

Describe universal precautions

utilized at the beginning and end
of exam regarding handwashing
and transducer cleaning as well as
other applicable techniques

No known allergies listed in chart

Patient reported no known allergies in patient interview

I introduced myself to the patient when she entered the exam

room. I told her I was a student sonographer and if she had no
objections, I would be performing her exam. I said that one of the
sonographers would check the images when I was finished with her
exam. I explained that the doctor had ordered a lower extremity
venous ultrasound to evaluate the veins in her right leg. I told her that
I would have to start very high in her groin area, and scan all the way
down to her ankle. I explained that to properly perform the exam I
was going to be applying pressure to compress the veins, and also
squeezing her legs as we went. I also informed her that she would be
hearing some noise while the exam was being performed and that
this was simply the blood flow within the veins. I explained that warm
gel would be applied to her leg, and a transducer would be used to
image and take pictures. I explained that sound waves were used to
produce the images, and she would not be exposed to any radiation.
I also asked the patient if she would allow me to use the images and
patient information for a grade at school, and she said that was not a
problem.

Grade:

Left leg fully covered

o Patient comfort
o Warmth helps keep veins from vasoconstricting and
allows for better visualization of small calf veins
Patient name and date of birth on arm band checked against
the name and date of birth on request form
Asked the patient to verbally verify her full name and date of
birth and checked against request form

Probe was cleaned with the correct type of sanitary wipe

before exam
Hands were washed thoroughly using the proper hand rub
technique before scanning
New gloves were donned
Transducer cleaned with correct type of sanitary wipe after
exam
Gloves placed in the trash
Hands were washed thoroughly using the proper hand rub
technique

Lower Extremity Venous Competency

Section II: Patient History

Complete the table below by providing a self-reflection of each component as it relates to the patient
examination you performed
Some components contain several elements. For maximum score each element must
be answered correctly.
Reflective writing will be used for this section.
Answers written in a bullet format are preferred
Patient interview includes questions asked of the patient regarding including answers
given
Required
Discussion
(Must include specifics regarding exam ordered and organs
included in the Lower Extremity Venous protocol)
Identify the patients age, race, sex and
63 years old
weight
Caucasian
Female
140 lbs
Identify why the examination ordered
Swelling of limb
(see request form or scheduling sheet for
reason exam was ordered) If this different
from admitting diagnosis for an inpatient,
explain?
Identify previous imaging examinations
No previous exams related to this competency were listed
and exam results the patient had that are
in the patient chart
related to the competency as discovered
No previous exams related to this competency were listed
in patient chart, PACS, and patient
in PACS
interview.
No previous exams related to this competency were made
known by the patient in the patient interview
Identify pertinent lab tests and lab results
No lab tests were identified in the patient chart or during
that are relevant to the competency made
the patient interview
available in patient chart and from patient
Labs to be reviewed:
interview. (If none are identified in chart or
o D-dimerif increased my indicate thrombus
from interview, note none were available and
formation
identify lab tests should be reviewed and
why)
Identify medical history that is relevant to
There is a previous history of metastatic lung cancer to the
the competency or reason for exam. This
brain and thyroid gland, as well as esophageal cancer
history was gathered from the patient
Radiation and chemo were used to treat the cancers, and
chart and patient interview. (Include
the patient is in remission
previous surgery, hospital admission,
o Dates not available in chart
previous history of similar condition, known
disease, and other applicable historical
information)
Identify the patients presenting clinical
Presenting clinical symptoms from chart indicate swelling

Lower Extremity Venous Competency

symptoms from chart and patient
interview. This includes questions asked
of the patient regarding presenting
symptoms
(This reflects only current information)
Grade:

of right lower limb

Patient indicated in the patient interview that she had a
small amount of pain and swelling in her right leg for about
a day

Lower Extremity Venous Competency

Section III: Analyze Patient Information

Using information gathered from section II complete the table below to determine an applicable
pathology that should be considered when performing the examination.
In order determine the applicable pathology, consider the following:
What was the pathology you were prompted to rule out first?
Having trouble identifying priority pathology to rule out first?
Do the current clinical symptoms including labs help you identify an
abdominal pathology to consider?
Are the clinical symptoms too vague, if so what other clinical/medical
history (previous surgery, test results, etc.) help you identify an abdominal
pathology to consider?
If you unable to determine a pathology, contact grading instructor for
assistance.
Reflective and technical writing will be used in this section
Reflective writing is use for the section labeled reason for selecting the pathology
All other sections will require technical writing and bullet format is preferred.
Pathology (Must relate to the lower extremity venous competency)

Describe the reason for selecting

pathology (use information from
section 2)
Identify the name of a pathology to
be considered and list applicable
synonym(s)
Provide a definition of the pathology
Identify common clinical findings
associated with the pathology
(symptoms, labs, occurrence,
associations, etc.)

Swelling of right lower limb

Acute thrombus

Newly formed clotted blood within a vein, usually less than 14

days old
Symptoms:
Asymptomatic
Extremity pain
Tenderness
Swelling
Venous distention
Discoloration
A palpable cord
Tachypnea
Chest pain
Tachycardia
Labs:
D-dimerif increased may indicate thrombus formation
Occurrence:
More common with increased age
Can occur after surgery trauma, immobilization

Lower Extremity Venous Competency

Identify main sonographic

appearance of the pathology
(use of proper terminology is required)
Identify one additional area to be
evaluated and explain why it would
be evaluated
(other organ/systems could be involved
or affected- scan through of the organ
involved is not acceptable)
Identify and explain one pitfall that
should be considered (why the
diagnosis of the pathology may be
incorrect. The pitfall may relate to a
differential or technique (scan through
is not acceptable)
Grade:

More common when a previous DVT has occurred

Common is patients with coagulation disorders
Increased risk with malignancy, septicemia, use of oral
contraceptives, hormone replacement therapy,
pregnancy, obesity, stroke, congestive heart failure, long
distance travel, inflammatory bowel disease, and varicose
veins
Associations:
Venous stasis
Vessel wall injury
Hypercoaguable state
Pulmonary embolism
Hypoechoic to lightly echogenic
Spongy texture
Loosely attached to vein wall
Dilated vein
CTV along with computed tomography may be used to
evaluate the lungs for pulmonary embolism that is caused by DVT

Compression of the femoral vein at the level of the adductor

canal can be difficult, and if not correctly done can lead to a false
positive finding of DVT

Section IV: Diagnostic Image Quality- Acquired Images

Complete the table below by providing a self-reflection of each component as it relates to the images
taken in the patient examination you performed
Students are required to image each structure of the required competency, if a
situation occurs that this cannot be completed due to clinical site instructions, contact
the clinical coordinator immediately.
If additional images are taken of structures required for the competency, you may add
additional rows below the last image identified.
Reflective writing will be used for this section.
Answers written in a bullet format are preferred (complete sentences not required)
Structure
(Add rows if
exam was

Scan Plane

Label

Sonographic Features
(Identify and describe the sonographic appearance of each
structure seen in the image)

Lower Extremity Venous Competency

bilateral)
ILIAC V

Transverse
Dual Screen

ILIAC V

Transverse
Dual Screen

ILIAC V

Sagittal

ILIAC V

Sagittal

CFV/GSV

Transverse
Dual Screen

CFV/GSV

Transverse
Dual Screen

CFV/GSV

Sagittal

CFV/GSV

Sagittal

CFV/GSV

Sagittal

FV
CENTRAL/
PROFUNDA
FV
CENTRAL/
PROFUNDA

Transverse
Dual Screen

FV
CENTRAL/
PROFUNDA

Sagittal

FA
CENTRAL/
PROFUNDA

Sagittal

FA
CENTRAL/

Sagittal

Transverse
Dual Screen

Right external iliac vein & right external iliac artery

anechoic lumen with echogenic walls
W/COMP
Right external iliac arteryanechoic lumen with echogenic
walls
Right external iliac veinechogenic walls seen compressed
together with no anechoic lumen being visualized
RIGHT EIV
Right external iliac vein & right common femoral vein
complete color fill in of vessel lumens between echogenic walls,
with flow going away from transducer
RIGHT EIV
Right external iliac veinrespiratory phasicity with increased
W/AUG
flow during distal augmentation, unidirectional toward the right
atrium
RIGHT
Right superficial femoral artery, right common femoral vein,
CFV/GSV
& right greater saphenous veinanechoic lumen with echogenic
walls
W/COMP
Right superficial femoral arteryanechoic lumen with
echogenic walls
Right common femoral vein & right greater saphenous vein
echogenic walls seen compressed together with no anechoic
lumen being visualized
RIGHT
Right common femoral vein & right greater saphenous vein
CFV/GSV
complete color fill in of vessel lumens between echogenic
walls, with flow going away from transducer
RIGHT CFV
Right common femoral veinrespiratory phasicity with
W/AUG
increased flow during distal augmentation, unidirectional toward
the right atrium
RIGHT GSV
Right greater saphenous veinrespiratory phasicity with
W/AUG
increased flow during distal augmentation, unidirectional toward
the right atrium
RIGHT FV
Right femoral vein central, right deep femoral vein, right
CENTRAL/DFV superficial femoral artery anechoic lumen with echogenic walls
RIGHT EIV

Right femoral vein central & right deep femoral vein

echogenic walls seen compressed together with no anechoic
lumen being visualized
Right superficial femoral arteryanechoic lumen with
echogenic walls
RIGHT FV
Right femoral vein central & right deep femoral vein
CENTRAL/DFV complete color fill in of vessel lumens between echogenic walls,
with flow going away from transducer
RIGHT FV
Right femoral vein respiratory phasicity with increased
W/AUG
flow during distal augmentation, unidirectional toward the right
atrium
RIGHT DFV
Right deep femoral vein respiratory phasicity with
W/AUG
increased flow during distal augmentation, unidirectional toward
W/COMP

Lower Extremity Venous Competency

PROFUNDA
FV MID

Transverse
Dual Screen

FV MID

Transverse
Dual Screen

FV MID

Sagittal

FV MID

Sagittal

FV PERIPH

Transverse
Dual Screen

FV PERIPH

Transverse

FV PERIPH

Sagittal

FV PERIPH

Sagittal

POP V

Transverse
Dual Screen

POP V

Transverse
Dual Screen

POP V

Sagittal

POP V

Sagittal

PTV

Transverse
Dual Screen

the right atrium

RIGHT FV MID Right femoral vein mid & rig superficial femoral artery
anechoic lumen with echogenic walls
W/COMP
Right femoral vein mid echogenic walls seen compressed
together with no anechoic lumen being visualized
Right superficial femoral arteryanechoic lumen with
echogenic walls
RIGHT FV MID Right femoral vein mid complete color fill in of vessel
lumen between echogenic walls, with flow going away from
transducer
Right superficial femoral artery complete color fill in of
vessel lumen between echogenic walls, with flow going toward
transducer
RIGHT FV MID Right femoral vein midrespiratory phasicity with increased
W/AUG
flow during distal augmentation, unidirectional toward the right
atrium
RIGHT FV
Right femoral vein peripheral & right superficial femoral
PERIPH
arteryanechoic lumen with echogenic walls
W/COMP
Right femoral vein peripheral echogenic walls seen
compressed together with no anechoic lumen being visualized
Right superficial femoral arteryanechoic lumen with
echogenic walls
RIGHT FV
Right femoral vein peripheralcomplete color fill in of vessel
PERIPH
lumen between echogenic walls, with flow going away from
transducer
Right superficial femoral arterycomplete color fill in of
vessel lumen between echogenic walls, with flow going toward
transducer
RIGHT FV
Right femoral vein peripheralrespiratory phasicity with
PERIPH
increased flow during distal augmentation, unidirectional toward
W/AUG
the right atrium
RIGHT POP V Right popliteal vein & right popliteal arteryanechoic lumen
with echogenic walls
W/COMP
Right popliteal veinechogenic walls seen compressed
together with no anechoic lumen being visualized
Right popliteal arteryanechoic lumen with echogenic walls
RIGHT POP V Right popliteal veincomplete color fill in of vessel lumen
between echogenic walls, with flow going away from transducer
Right popliteal arterycomplete color fill in of vessel lumen
between echogenic walls, with flow going toward transducer
RIGHT POP V Right popliteal vein respiratory phasicity with increased
W/AUG
flow during distal augmentation, unidirectional toward the right
atrium
RIGHT PTV
Right posterior tibial veins, right posterior tibial artery, right
peroneal veins, & right peroneal arteryanechoic lumen with
echogenic walls

Lower Extremity Venous Competency

PTV

Transverse
Dual Screen

W/COMP

PTV

Sagittal

RIGHT PTV

PTV

Sagittal

RIGHT PTV
W/AUG

PERONEAL

Transverse
Dual Screen

RIGHT
PERONEAL V

PERONEAL

Transverse
Dual Screen

W/COMP

PERONEAL

Sagittal

RIGHT
PERONEAL V

PERONEAL

Sagittal

RIGHT
PERONEAL V
W/AUG

Right posterior tibial veins & right peroneal veins

echogenic walls seen compressed together with no anechoic
lumen being visualized
Right posterior tibial artery & right peroneal arteryanechoic
lumen with echogenic walls
Right posterior tibial veinscomplete color fill in of vessel
lumens between echogenic walls, with flow going away from
transducer
Right posterior tibial arterycomplete color fill in of vessel
lumen between echogenic walls, with flow going toward the
transducer
Right posterior tibial veinphasic flow with increased flow
during distal augmentation, unidirectional toward right atrium
Right posterior tibial veins, right posterior tibial artery, right
peroneal veins, & right peroneal arteryanechoic lumen with
echogenic walls
Right posterior tibial veins & right peroneal veins
echogenic walls seen compressed together with no anechoic
lumen being visualized
Right posterior tibial artery & right peroneal arteryanechoic
lumen with echogenic walls
Right peroneal veinscomplete color fill in of the vessel
lumens between echogenic walls, with flow going away from the
transducer
Right peroneal veinphasic flow with increased flow during
distal augmentation, unidirectional flow toward right atrium

Grade:

Section V: Diagnostic Image Quality- Augmentation

Complete the table below by providing a self-reflection of each component as it relates to the
patient examination you performed
Note-explanation of how you augmented or why you didnt is related to technical writing
Reflective and technical writing will be used in this section
Answers written in a bullet format are preferred
Reflective writing is used for measurement recorded and description of caliper placement.
Technical writing is used for normal or abnormal and explanation of why measurement is
considered normal or abnormal

Image
(Identify one vessel
that compressed and
complete the chart.)

Compressed
or DNC
(If all vessels
compressed,

Explain how
you know if
the vein
compressed

Augmented or did
not augment

Explain your
augmentation
technique and what
this told you specific

Lower Extremity Venous Competency

(Identify one vessel

that DNC and
complete the chart)
Femoral vein mid

you are only

required to
complete the
first image in
this chart.)
Compressed

or DNC (be
specific with
your probe
technique)
Probe
transverse
on mid-thigh
Pressed
probe down
firmly on the
mid-thigh
until the
anterior and
posterior
vein walls
completely
compress
together
No
anechoic
area should
be seen in
between the
echogenic
vein walls

Augmented

to the image. (be

specific with the location
of your hand for the
augmentation)
If you did not augment,
explain why.
Vein in sagittal across
the screen with color
and spectral Doppler
turned on
Spectral gate placed in
the center of the vessel
Augment administered
distally to the mid-thigh,
close to the adductor
canal just above the
knee
Upon augment, the
blood flow increased,
causing a higher
spectral waveform that
then returned to normal,
phasic flow
This shows that the
vein is competent and
working properly, and
that there is no
obstruction present
within the vein lumen

DNC
Grade:
Section VI: Diagnostic Image Quality- Instrumentation

Complete the table below by provided information as it applies to sonographic principles and
instrumentation as it relates to the images taken in the patient examination you performed

Reflective and technical writing will be used in this section

Answers written in a bullet format are preferred
Reflective writing is used for the column labeled what was used
Reflective writing with the support of technical writing is used for the column labeled Why
its correct
Required Elements

What was used

Why its correct

Lower Extremity Venous Competency

(use information from only one
extremity)
Identify the transducer
selected for the examination
robe

Must be specific
7 L linear transducer

Identify the frequency(s)

used during examination

6.0 MHz

Color & Spectral Doppler FV

Central image

Color PRF1.2 kHz

Color gain41
Spectral PRF1.2 kHz

Color & Spectral Doppler FV

PERIPH image

Color PRF1.9 kHz

Color gain31
Spectral PRF2.0 kHz

Color & Spectral Doppler

Color PRF1.0 kHz

Explain in detail why each element was

used in the examination
Field of viewrectangular as to not cut
off any of the vessel
Frequencyranges from 5 to 6 MHz
Allows good penetration for deeper
vessels, while also maintaining the best
resolution possible for both deep and
superficial veins
Frequency at its highest for this
transducer may not penetrate far enough
into the body, but will have good resolution
in the near field
Frequency at its lowest for this
transducer will penetrate far into the body,
but will have worse resolution
Shapehas a flat, small footprint which
is good for scanning along the straight
parts of the legs
Penetration was adequate to visualize
just beyond the posterior walls of the
vessels, while also maintaining good
resolution
Color PRF is correct because it allowed
complete color fill all the way to the vessel
walls, without aliasing
Color gain is correct because it ensured
complete filling of the vessel, with no color
bleed or color flash artifacts
Spectral PRF is correct because it
allowed for a good sized spectral
waveform with no aliasing or the normal
flow or the increased flow during
augmentation
Color PRF is correct because it allowed
complete color fill all the way to the vessel
walls, without aliasing
Color gain is correct because it ensured
complete filling of the vessel, with no color
bleed or color flash artifacts
Spectral PRF is correct because it
allowed for a good sized spectral
waveform with no aliasing or the normal
flow or the increased flow during
augmentation
Color PRF is correct because it allowed

Lower Extremity Venous Competency

PTV image

Color gain33
Spectral PRF2.0 kHz

complete color fill all the way to the vessel

walls, without aliasing
Color gain is correct because it ensured
complete filling of the vessel, with no color
bleed or color flash artifacts
Spectral PRF is correct because it
allowed for a good sized spectral
waveform with no aliasing or the normal
flow or the increased flow during
augmentation

Grade

Section VII: Diagnostic Image Quality- Pathology Documentation

Complete the following table by describing the sonographic features of pathologies associated with
examination you performed
Reflective and technical writing will be used in this section
Answers written in a bullet format are preferred
Technical writing is used for the column labeled proper name
For the column labeled Sonographic features, technical writing if pathology is not seen,
reflective writing if pathology seen
Reflective writing is used for the column labeled identify or rule out pathology

Lower Extremity Venous Competency

Structure
Describe all
pathologies seen
or
If no pathology was seen,

describe 2 pathologies
that could be ruled out
Lower extremity deep
venous system

Identify the proper

name of the
pathology seen or
excluded
(Indicate if the
pathology was seen
or excluded)
Acute thrombus
excluded

Sonographic Features
(If a pathology was seen
include measurements
taken (if applicable) of
the pathology as well as
the sonographic
features. If no pathology,
identify main
sonographic features)

Hypoechoic to
lightly echogenic
Spongy texture
Loosely attached
to vein wall
Dilated vein

Sonographic techniques used to

Identify
or
Rule out Pathology

Scanned through and completed

compression run from the right
external iliac vein down to the right
peripheral femoral vein before taking
any images
Imaged the right external iliac vein,
common femoral vein, greater
saphenous vein, femoral vein central,
mid and peripheral, and deep femoral
vein in transverse using dual screen
with and without compression in gray
scale
Had to place left hand behind the
thigh to help with compression image
for right femoral vein peripheral
Imaged the right external iliac vein,
common femoral vein, greater
saphenous vein, femoral vein central,
mid and peripheral, and deep femoral
vein in sagittal with color turned on and
the color box in the correct direction
Color gain and PRF were
optimized to so that the entire vessel
filled with color, while also preventing
aliasing, color bleed, and other
unwanted color artifacts
Imaged the right external iliac vein,
common femoral vein, greater
saphenous vein, femoral vein central,
mid and peripheral, and deep femoral
vein in sagittal utilizing spectral Doppler
Spectral gate placed in the center
of the vessel
Baseline set at a proper level and
PRF optimized to prevent aliasing of the
spectral waveform
Scanned through and completed
compression run of right popliteal vein,
posterior tibial veins, and peroneal
veins

Lower Extremity Venous Competency

Imaged the right popliteal vein,
posterior tibial veins, and peroneal
veins in transverse using dual screen
with and without compression in gray
scale
Imaged the right popliteal vein,
posterior tibial veins, and peroneal
veins in sagittal with color turned on and
the color box in the correct direction
Color gain and PRF were
optimized to so that the entire vessel
filled with color, while also preventing
aliasing, color bleed, and other
unwanted color artifacts
Had to squeeze distally to the
peroneal veins to get color fill in
Imaged the right popliteal vein,
posterior tibial veins, and peroneal
veins in sagittal utilizing spectral
Doppler
Spectral gate placed in the center
of the vessel
Baseline set at a proper level and
PRF optimized to prevent aliasing of the
spectral waveform
Lower extremity deep
venous system

Chronic thrombus
excluded

Echogenic
Firm attachment to
vein wall
Contracted vein

Scanned through and completed

compression run from the right
external iliac vein down to the right
peripheral femoral vein before taking
any images
Imaged the right external iliac vein,
common femoral vein, greater
saphenous vein, femoral vein central,
mid and peripheral, and deep femoral
vein in transverse using dual screen
with and without compression in gray
scale
Had to place left hand behind the
thigh to help with compression image
for right femoral vein peripheral
Imaged the right external iliac vein,
common femoral vein, greater
saphenous vein, femoral vein central,
mid and peripheral, and deep femoral
vein in sagittal with color turned on and
the color box in the correct direction
Color gain and PRF were
optimized to so that the entire vessel
filled with color, while also preventing

Lower Extremity Venous Competency

aliasing, color bleed, and other
unwanted color artifacts
Imaged the right external iliac vein,
common femoral vein, greater
saphenous vein, femoral vein central,
mid and peripheral, and deep femoral
vein in sagittal utilizing spectral Doppler
Spectral gate placed in the center
of the vessel
Baseline set at a proper level and
PRF optimized to prevent aliasing of the
spectral waveform
Scanned through and completed
compression run of right popliteal vein,
posterior tibial veins, and peroneal
veins
Imaged the right popliteal vein,
posterior tibial veins, and peroneal
veins in transverse using dual screen
with and without compression in gray
scale
Imaged the right popliteal vein,
posterior tibial veins, and peroneal
veins in sagittal with color turned on and
the color box in the correct direction
Color gain and PRF were
optimized to so that the entire vessel
filled with color, while also preventing
aliasing, color bleed, and other
unwanted color artifacts
Had to squeeze distally to the
peroneal veins to get color fill in
Imaged the right popliteal vein,
posterior tibial veins, and peroneal
veins in sagittal utilizing spectral
Doppler
Spectral gate placed in the center
of the vessel
Baseline set at a proper level and
PRF optimized to prevent aliasing of the
spectral waveform
Grade:

Section VIII: Interpretation of Exam Findings

Complete the following table as it relates to information given to the reviewing sonographer and the
physician for the examination you completed.

Lower Extremity Venous Competency

This section will require both technical writing and reflective writing
Answers written in a bullet format are preferred
Technical writing is used for the column labeled description of findings to physician
Reflective writing is used for column labeled description of findings to sonographer and
all components in the self-reflection column.
The Self Reflection column must:
Describe the interaction you had with the sonographer and physician. At a minimum include at
least one of the following:
Sonographer:
Did the sonographer retake any of your images? How were they different?
Provide a detail summary
Did the sonographer take additional images? Provide a detail summary.
Would you have liked the interaction with the sonographer to be different?
Why? Provide a detail summary
Describe in detail if the sonographer taught you something new, ask you
to clarify an image or challenged your images or patient history.
Physician:
o If you were not allowed to write on the jot pad/report page or disagreed
with what was written. Explain what you would have done differently and
why.
o Would you have liked the interaction different with the physician? Why?
(must be detailed and specific)
o Describe in detail if the physician taught you something new, ask you to
clarify an image or challenged your images or patient history.
Person of Interest

Sonographer
(Describe at a
minimum sonographic
features and
measurements
reported to the
sonographer)

Description of Findings
Reported

All vessels appeared

anechoic with echogenic
walls
o No echogenic
debris within
vein lumens
Veins completely
compressed from the
right external iliac vein to
the popliteal vein, as well

Method used
Self-Reflection
to Report
(See details in instructions for this
Findings
section)
(Identify :
verbal, jot
pad, report
page, etc.)
Verbally
After this scan was completed,
the sonographer taught me
something new. I was having
trouble getting the peroneal veins
to fill in, and the patient was
unable to drop her legs off the
side of the stretcher. The head of
the bed was also already raised.
The sonographer told me that if I
have the patient bend their knees

Lower Extremity Venous Competency

Physician
(Identify exactly what
is written on the jot
pad, report and/or
verbally)
Grade:

as the posterior tibial

veins and peroneal veins
All veins imaged showed
an increase in flow with
augment, followed by a
return to normal phasic
flow
HX: Swelling of limb
Right lower extremity
veins appeared WNL
Negative for DVT

up in the stretcher, it helps the

posterior tibial veins and the
peroneal veins to fill better.

Jot pad

Section IX: Physicians Report

Complete one of the following tables with information gathered from the final report of the examination
you performed
This section will require both technical writing and reflective writing
Answers written in a bullet format are preferred
Technical writing used for description of sections labeled overall impression of the report
and in the structures and measurements components as applicable
Reflective writing and technical writing are both used for describing components in the
self-reflection column.
Self-reflection Component:
The summary must include why you agree or disagree with the findings normal or
abnormal findings. For why, be sure to demonstrate your knowledge of the structure
compared to the impression of the physician. Your critique needs to be accurate to the
examination findings and clinical history.
If the report is attached, Complete the Following

Overall Impression
on the Report
(Exact wording found
on report)
Self-Reflection
(refer to instructions
above)

Grade:

Lower Extremity Venous Competency

If no report attached: Complete Table and Provide and Overall Impression below the table
Structure

All Measurements
Reported

Normal vs Abnormal (If abnormal, describe

the abnormal findings)

Overall Impression
on report
(Exact wording found
on report)
Self Reflection
(refer to instructions
above)
Grade:

Section X: Pathology Diagnosed or Pathology Ruled Out

Using information gathered from physicians examination reports complete the table below to determine
an applicable pathology that should be considered when performing the examination.
Reflective and technical writing will be used in this section
Answers written in a bullet format are preferred
Reflective writing is use for the section labeled reason for selecting the pathology
All other sections require technical writing
Selecting the pathology: The report may indicate a possible diagnosis at the conclusion of the report.
In some reports more than one possible diagnosis is listed (differential diagnosis), for this section you
will be required to identify the diagnosis and 1 differential diagnosis. Your answer must be based on:
The pathology identified in the impression/findings made by the physician in the first table
and 1 differential diagnosis for the pathology identified in the 2 nd table.
In the event 2 or more pathologies are seen, complete the chart for 2 pathologies and no
differentials
In the event of a normal report, identify and define 2 sonographic pathologies that should
be considered.
Pathology

Lower Extremity Venous Competency

Describe the reason for selecting
pathology (see instructions)
Identify the name of a pathology to
be considered and list applicable
synonym(s)
Provide a definition of the pathology
Identify common clinical findings
associated with the pathology
(symptoms, labs, occurrence,
associations, etc.)

Identify main sonographic

appearance of the pathology
(use of proper terminology is required)
Identify one additional area to be
evaluated and explain why it would
be evaluated
(other organ/systems could be involved
or affected- scan through of the organ
involved is not acceptable)
Identify and explain one pitfall that

Swelling of right lower limb with slight pain

Acute thrombus

Newly formed clotted blood within a vein, usually less than 14

days old
Symptoms:
Asymptomatic
Extremity pain
Tenderness
Swelling
Venous distention
Discoloration
A palpable cord
Tachypnea
Chest pain
Tachycardia
Labs:
D-dimerif increased may indicate thrombus formation
Occurrence:
More common with increased age
Can occur after surgery trauma, immobilization
More common when a previous DVT has occurred
Common is patients with coagulation disorders
Increased risk with malignancy, septicemia, use of oral
contraceptives, hormone replacement therapy,
pregnancy, obesity, stroke, congestive heart failure, long
distance travel, inflammatory bowel disease, and varicose
veins
Associations:
Venous stasis
Vessel wall injury
Hypercoaguable state
Pulmonary embolism
Hypoechoic to lightly echogenic
Spongy texture
Loosely attached to vein wall
Dilated vein
CTV along with computed tomography may be used to
evaluate the lungs for pulmonary embolism that is caused by DVT

Compression of the femoral vein at the level of the adductor

Lower Extremity Venous Competency

should be considered (why the
diagnosis of the pathology may be
incorrect. The pitfall may relate to a
differential or technique (scan through
is not acceptable)
Grade:

canal can be difficult, and if not correctly done can lead to a false
positive finding of DVT

Pathology or Differential
Describe the reason for selecting
pathology (see instructions)
Identify the name of a pathology to
be considered and list applicable
synonym(s)
Provide a definition of the pathology
Identify common clinical findings
associated with the pathology
(symptoms, labs, occurrence,
associations, etc.)

Identify main sonographic

appearance of the pathology
(use of proper terminology is required)
Identify one additional area to be
evaluated and explain why it would
be evaluated
(other organ/systems could be involved
or affected- scan through of the organ
involved is not acceptable)
Identify and explain one pitfall that
should be considered (why the

Swelling of right lower limb

Venous valvular insufficiency
Inadequacy of venous valves with impairment of venous
drainage, resulting in edema
Symptoms:
Spider veins
Telangiectasias
Reticular veins
Varicose veins
Edema
Skin changes
Ulceration
Labs: no pertinent labs available for this pathology
Occurrence:
Both men and women
Chance increases with age
Associations:
Varicose veins
Edema
Restless leg syndrome
Enlarged vein diameter
Hypoechoic lumen
Enlarged valve sinuses
Flapping valve leaflets
Tortuous, varicosed, or aneurysmal veins
Checking leg areas around the veins for edema, which is
common with this pathology

High persistence may result in false-positive color flow findings

Lower Extremity Venous Competency

diagnosis of the pathology may be
incorrect. The pitfall may relate to a
differential or technique (scan through
is not acceptable)
Grade:
Grading
Points
5
4
3
2
1

50=100 49=98
40=88
39=86
30=75
29=74
20=60
19=57
10 or less = 0

Section
1
2
3
4
5
6
7
8
9
10
Total/Final score

Description

48=97
38=85
28=73
18=55

No errors were identified

One error was identified
Errors identified In less than the of the components required
Errors identified In up to s of the components required
Immediate action required
errors identified in more than s of the components required
evidence of an unsafe event (unsafe events may result in failure
of the competency)
required image not included

47=96
37=84
27=72
17=45

Point Value Conversion Chart

46=95 45=93 44=92
36=82 35=80 34=79
26=71 25=70 24=68
16=40 15=45 14=35

Points Received

43=91
33=78
23=66
13=30

42=90
32=77
22=64
12=25

41=89
31=76
21=61
11=20

Lower Extremity Venous Competency

Instructor:
Comments: