Vascular Technology Examination Prep PDF
Preview Vascular Technology Examination Prep
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Contents Preface Acknowledgments Chapter 1 Instrumentation, Hemodynamics, and Doppler Questions Answers and Explanations Chapter 2 Extracranial Cerebrovascular Questions Answers and Explanations Chapter 3 Intracranial Cerebrovascular Questions Answers and Explanations Chapter 4 Peripheral Arterial Questions Answers and Explanations Chapter 5 Peripheral Venous Questions Answers and Explanations Chapter 6 Abdominal Vascular Studies Questions Answers and Explanations Chapter 7 Quality Assurance and Statistics Questions Answers and Explanations Practice Examination Questions Answers and Explanations Index Preface Through the many years we’ve spent educating inspiring vascular technologists, we have answered a very simple question numerous times: “What is a good resource to use to help me pass the vascular technology boards?” Our answer would always jokingly be, “Just study my notes from class and you should pass with no problem.” Of course we would always follow with some of our favorite review materials that have previously been published. It wasn’t until a couple of years ago that we decided that our initial answer to that repeated question was not that far-fetched. Traci Fox and I share the same passion for educating, and it was at that time we decided to take our combined years of clinical and teaching experience and create a comprehensive review for vascular technologists and students. The purpose of this book is to provide a comprehensive yet concise review of all aspects of vascular disease and testing for sonographers at any level of their career. It can serve as a point of reference for practicing technologists in any laboratory as well as a systematic, well-organized review for new technologists preparing for the ARDMS (VT) or CCI (RVS) examinations. It can also be used by interpreting physicians, residents and fellows as a reference as well as a resource of review material for the RPVI examination. With over 40 images per chapter, this text offers an extensive review of vascular testing presented in a clear and thorough manner that is easy to read and understand. The chapter outline follows the outline for the ARDMS vascular technology examination which covers hemodynamics and vascular anatomy, pathology, patient assessment and integration of data, protocols, interpretation of results, treatments, and other related testing for each of the vascular systems in the body. Each section is explained in a way that can be understood and applied to every aspect of a vascular technologist’s duties. For the novice sonographer, this book provides the knowledge necessary to practice as well as to become a registered vascular technologist. The key feature of this text is that it is an all-encompassing, comprehensive review book focused on vascular principles that includes both the content as well as review questions for each chapter. When studying, knowing what you do not know is an important part of studying. Therefore, each chapter has the relevant content for each vascular topic as well as a complete list of questions followed by the answers and explanations. In addition to the review questions at the end of each chapter there is a full practice examination with an additional 120 questions also followed by answers and explanations designed to mimic the ARDMS national registry examination for vascular technology. Additionally, McGraw-Hill has created an online test bank at VascularTechExamPREP.com, featuring 700+ questions from the book where users can create customized practice tests and track their results. We are very pleased to be able to share this text with you. We wrote this text with the intent to help expand the knowledge of vascular technology for those currently practicing while providing the foundation of knowledge for others just getting started. We really enjoyed writing this text and hope that you find it to be a valuable resource throughout your career. Sincerely Ray Gaiser, MS, RDMS, RVT Traci Fox, EdD, RT(R), RDMS, RVT Acknowledgments Obviously I could not have accomplished such a task as writing this text without the help of some of my colleagues and friends. I would like to acknowledge Adam Olsen and Rita Brooks who took time out of their personal lives by providing the editing and suggestion for us throughout this process. I would also like to express an additional gratitude to Adam Olsen for providing the great illustrations in several of the chapters. In addition my appreciation goes out to the many people who volunteered their time and anatomy which help provide great images throughout the text, especially Rachel Lucchese and Katie Nahill. I would also like to make my gratitude known to all the vascular technologists at Capital Health Medical Center in New Jersey for their contributions to this text. Their commitment to quality and skill level made it possible for us to provide you with such amazing images. Without their expertise this book would not be possible. I would like to thank my family and friends, especially my wife Diana for her constant support and encouragement throughout this journey and to my three beautiful daughters Ava, Mia, and Alina, I love you more than life itself and will always be proud of everything you accomplish in life. Finally but certainly not least I would like to personally thank my esteemed partner in crime on this project, Traci Fox. Without her knowledge and expertise none of this would have been possible. Sincerely Ray Gaiser, MS, RDMS, RVT I would like to thank Thresa for her unbelievable patience and understanding, and my friends and family for their everlasting support. I would also like to thank my colleagues who offered both images as well as their own anatomy for this project. Special thanks to Dr. Larry Needleman and the vascular ultrasound team at Thomas Jefferson University Hospital, who let me open their brains and peek inside at the amazing knowledge they all hold. I would especially like to thank my partner in this text, Ray Gaiser, for his knowledge, experience, and dedication to this project. We haven’t learned how to say “no” yet, but we’re trying. Sincerely Traci B. Fox, EdD, RT(R), RDMS, RVT We are grateful to be surrounded by so many talented and intelligent people who all made this possible. We hope you enjoy reading the text as much as we enjoyed writing it. 1 Instrumentation, Hemodynamics, and Doppler INSTRUMENTATION Transducers Modern ultrasound (US) transducer arrays use a row of piezoelectric elements made of a lead zirconate titanate (PZT) ceramic to create sound waves. Sound waves are generated by the transducer and sent into the patient when the piezoelectric elements are shocked by electricity. The sound waves are reflected by reflectors in the body, and the sound returns to the piezoelectric elements, which generate electricity. The electrical signals produced by the piezoelectric elements are sent to the US machine for processing, and an image is produced. Doppler is possible because red blood cells (RBCs) reflect sound. RBCs are a type of nonspecular reflector called a Rayleigh scatterer, which is a type of scattering that occurs from reflectors that are very small compared to the wavelength of the beam. Transducers can operate in pulsed-wave (PW) or continuous-wave (CW) operation, depending on their design (Fig. 1–1). In vascular sonography, CW transducers most commonly resemble a pencil probe with two separate piezoelectric elements (Fig. 1–2). The CW pencil probe is commonly used to insonate the distal arteries during non-invasive peripheral arterial examinations. CW transducers need to have two piezoelectric elements: one to continuously send and one to continuously receive. The constant transmission of the sound causes depth ambiguity. Depth ambiguity refers to the inability to know from where the echoes came. Therefore, dedicated CW transducers do not produce an image, only a spectral Doppler waveform. FIGURE 1–1. Pulsed-wave (PW) versus continuous-wave (CW) transducers. PW transducers need a minimum of one piezoelectric element to send and receive sound. Once the pulse is sent, the transducer must wait for that pulse to return before the next pulse is transmitted. CW transducers need a minimum of two elements: one to constantly send, and one to constantly receive. (Reproduced, with permission, from Fuster V, Walsh RA, Harrington RA. Hurst’s the Heart. 13th ed. New York, NY: McGraw-Hill Education, 2011. Figure 18-27.) FIGURE 1–2. CW transducer. Dedicated CW pencil probe. Note the two piezoelectric elements for sending and receiving. (Reproduced, with permission, from Parks Medical Electronics, Inc., Las Vegas, NV.) The curvilinear, linear, and sector transducers are PW transducers used for different purposes. The curvilinear (aka convex or curved) array is commonly used for abdominal work or for venous examinations on patients with a large body habitus. The linear array, which produces a rectangular- shaped image, is used for most peripheral and extracranial cerebrovascular work. The sector transducer, also called a phased array transducer, produces a pie slice–shaped image and is used for cardiac, transcranial, and some abdominal work (Fig. 1–3). FIGURE 1–3. Ultrasound transducers. From left to right: Sector, or phased array transducer; linear transducer; curvilinear (or convex) transducer. Although all modern PW transducers are arrays with multiple elements, technically a PW transducer only needs one piezoelectric element to send and receive sound. However, piezoelectric elements cannot send and receive simultaneously. Therefore, the PW transducer sends a pulse and then has to wait for it to return before sending the next pulse. Image Storage US images and data from other noninvasive testing devices must be archived in some fashion for future comparison and medico-legal purposes. US images may be stored either as a hard copy, meaning film or paper, or through digital storage, such as a hard drive or formal picture archiving and communication system (PACS). Although most newer equipment is compatible with PACS, older machines may not be compatible. The printouts from these studies must still be made part of the patient’s record for medico- legal purposes. Paper printouts may be part of the patient’s hard copy file, or may be scanned into a digital system. HEMODYNAMICS Principles of Flow The cardiac output of the heart is approximately 5–6 L/min, although that amount dramatically increases with exercise. Cardiac output, which helps to determine blood pressure, is equal to the stroke volume times the heart rate (CO = SV × HR). The stroke volume is the amount of blood (in mL) pumped by the heart’s every beat. Blood flow (Q) is defined as volume flow per unit time (e.g., L/min). Blood, like all liquids, moves
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