This study highlights the difficulty in obtaining consistent velocity measurements from a subject. Despite the variability in absolute peak systolic velocity and end diastolic velocity, scientists were generally consistent in obtaining an optimal spectral Doppler trace. Some issues with consistency were, however, identified which were subsequently addressed.
Introduction There is currently little research regarding optimum patient position for venous insufficiency assessment although standing is considered the gold standard in many professional guidelines. Some patients are unable to stand for the examination and scanning patients in a standing position is physically challenging for the sonographer. This pilot study aimed to evaluate the effect of varying patient positioning on the duration of venous reflux. Method Venous reflux duration was measured in symptomatic participants with suspected venous insufficiency. Measurements were taken in the standing position (gold standard) and four alternative positions: 25° reverse-Trendelenburg (RT) tilt, sitting on the edge of the examination couch, 10° RT tilt and 0° RT tilt. The mean reflux duration measured in each different position was compared with the gold standard. Results Complete measurements were obtained from 16 patients (8 men and 8 women). For an incompetent vein, statistical analysis demonstrated a significant difference only between the standing position and the 0° position ( U = 19.0; exact P < 0.01 [2-tailed]). Conclusion Results suggest that several alternative positions could be used for assessing incompetent veins as long as the patient is not lying supine with 0° tilt. This would offer much greater flexibility, which may be of benefit to both patients and sonographers.
Recent studies investigating chronic cerebrospinal venous insufficiency highlighted that intracranial venous return has not yet been routinely investigated by ultrasound in the normal population. This creates an absence of a reference standard and raises concerns that the approach introduces variations into the results. The primary objective of this study was to develop reference standards for the assessment of the internal jugular vein in a normal population. A prospective small-scale study was conducted. Internal jugular veins of 31 normal candidates were examined using B-Mode and PW Doppler. Measurements at proximal and mid-point internal jugular vein were taken in sitting (90 ) and supine (0 ) positions. Area measurements were taken during passive respiration in cm 2 . Time average velocity measurements were taken during passive respiration over a 3-second period. Reflux measurements were taken after apnoea and reflux was recorded from any reversed flow. Measurements were taken three times; an average was calculated and statically analysed. Of the 31 participants, one was excluded from the study and 30 were suitable. The Mann-Whitney U test was used to analyse the results; all results (area, time average velocity and reflux) showed that there was a significant difference between the two positions with p < 0.05 (two-tailed). This pilot study does suggest that there is a significant difference in area, time average velocity and reflux measurements of the internal jugular vein when taken in the sitting and supine position, which could affect the outcome of chronic cerebrospinal venous insufficiency. A further largescale study is required to validate and standardise the assessment of the internal jugular vein.
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