Noninvasive vascular ultrasound is a crucial tool for diagnosing vascular diseases, including (but not limited to) atherosclerosis, abdominal aortic aneurysm, deep vein thrombosis, arterial compression, and varicose veins. Vascular imaging uses Doppler technology to determine the speed and direction of blood flow. High quality vascular ultrasound exams are typically performed in a dedicated vascular ultrasound laboratory by Registered Vascular Technologists (RVTs).
A noninvasive vascular laboratory is a specialized lab dedicated to providing vascular ultrasound exams. Not all hospitals have a dedicated vascular laboratory, however these labs can often provide higher quality ultrasound studies with a quicker turnaround time than non-vascular ultrasound labs. These quality studies are the result of adherence to specific guidelines for noninvasive vascular testing.
Medical guidelines and standards are often set forth by independent societies or accrediting organizations. For vascular medicine, these include the American Registry for Diagnostic Medical Sonography (ARDMS), the Society for Vascular Medicine (SVM), and the Intersocietal Accreditation Commission (IAC), among others. The ARDMS provides certification for Registered Vascular Technologists, the SVM publishes the Vascular Medicine Journal, and the IAC provides accreditation for vascular labs.
Guidelines and Best Practices
In order to achieve accreditation, vascular laboratories must meet certain standards. In addition, there are some best practices for providing the highest quality of vascular care. The following guidelines for vascular testing are from both the IAC and SVM.
Certified Vascular Testing Personnel
Certified and trained personnel are critical for vascular laboratory testing. The SVM clearly states that “assessment of peripheral vascular disease is largely dependent on the functioning of the equipment and skill of the operator.”1 The Medical Director should be a licensed physician who can interpret vascular ultrasound exams. 2 They may qualify as an interpreting physician in one or more of the following ways:
- Be a Registered Physician in Vascular Interpretation (RPVI credential)
- Completion of residency or fellowship that includes vascular testing experience
- Completion of Continuing Medical Education (CME) alongside supervised vascular interpretation experience
The laboratory should also have a technical director who holds a credential in vascular testing and has completed a minimum number of studies in multiple areas. Technical staff should be certified to perform vascular ultrasound exams by holding an RVT or similar credential. All medical and technical staff should also complete regular CME courses. For more detailed information on personnel requirements, please refer to IAC Vascular Testing Standards and Guidelines.
Detailed Documentation and Reporting
It is important to create a documentation and reporting process for vascular labs to maintain high standards. The IAC requires specific recordkeeping to achieve and maintain accreditation. Accurate and detailed reports of all exams must be maintained according to federal guidelines for medical records (5-7 years).2 In addition to exam reports, thorough documentation should be maintained on all lab equipment and procedures. The vascular ultrasound exam protocol also be appropriate for the area being imaged.1 Clear standards regarding documentation, equipment, and protocols for all vascular testing are available via the IAC website.
Commitment to Quality Improvement
Vascular labs should have a quality improvement (QI) policy in place to “evaluate all types of procedures performed in the facility on an ongoing basis”, according to the IAC.2 Quality improvement policies demonstrate a commitment to ongoing review and improvement of an organization’s processes. When employed at health care organizations, these policies can help ensure that patients receive the highest standard of care.
Accredited vascular laboratories must have QI policies in place that evaluate vascular testing, technical and interpretative quality, report completion and timeliness, and case reviews. For full details on these standards, please review the IAC Vascular Testing Standards and Guidelines.
Collaboration with Vascular Surgery
Collaboration with vascular surgery departments in some form is important for vascular labs to provide high quality care. Vascular surgeons are often the ones who order vascular testing for their patients and make diagnoses based on the results. When vascular lab teams and vascular surgeons work together to review results, patients have a more integrated health care experience. Although this is not a specific society guideline, it is a best practice. Ideally, dedicated vascular labs will be housed within the vascular surgery department of a hospital to promote this collaborative environment and minimize any delay in results.
Mint Medical Vascular Laboratory Services
Mint Medical is a leader in noninvasive vascular laboratory services including testing, accreditation, and administrative services. In addition to the guidelines and best practices listed above, Mint Medical labs go above and beyond to provide high quality vascular studies performed by RVTs and interpreted by RPVIs. Vice President of Operations, CC Todd-Edwards, gives an example: “We run the quality assurance and quality improvement meeting with [our partners]. Only two per year are required for accreditation, but we do these quarterly and sometimes monthly depending on the lab,” she says.
Guidelines, standards, and best practices are crucial for vascular labs to meet patient needs and maintain excellence. Mint Medical is committed to exceeding these standards to provide the highest level of care for patients and the best experience for our partners.
Guest Contributor: Jordan Galerkin
Sources:
- Guidelines for Noninvasive Vascular Laboratory Testing: A Report from the American Society of Echocardiography and the Society for Vascular Medicine and Biology. Vascular Medicine Journal. https://www.asecho.org/guideline/guidelines-for-noninvasive-vascular-laboratory-testing-a-report-frorm-the-ase-and-the-svmb/
- Vascular Testing Standards & Guidelines. Intersocietal Accreditation Commission. https://intersocietal.org/programs/vascular-testing/standards/
