Characterizing Triphasic, Biphasic, and Monophasic Doppler Waveforms

Abstract

Doppler waveform analysis is a fundamental part of evaluating peripheral arterial disease. Waveform characteristics are traditionally defined as multiphasic (triphasic, biphasic) and monophasic. The purpose of this investigation is to evaluate whether sonography professionals correctly classify waveforms into these three categories. Thirty Doppler waveforms (15 continuous-wave [CW] and 15 pulsed-wave [PW] Doppler) were obtained from patients with previous noninvasive peripheral arterial evaluations. Participating readers were asked to interpret waveforms as triphasic, biphasic, or monophasic using standard definitions. “Other” was used to classify waveforms whose morphology could not be determined or accurately classified as triphasic, biphasic, or monophasic. Because multiphasic waveforms with pandiastolic flow have been associated with biphasic and monophasic waveform terminology, answer key responses were based on waveform descriptors used by interpreters of the originating noninvasive evaluation. There were a total of 97 participants, and of all Doppler waveforms, 73% were correctly identified (75% CW and 71% PW). Participants training or specializing in medical sonography misidentified an average of 27% triphasic, biphasic, or monophasic CW and PW Doppler waveforms and correctly interpreted more CW than PW waveforms. Because there is considerable variability among sonography professionals and educators in defining and classifying peripheral arterial waveforms, this issue deserves higher priority.

Doppler US of the Liver Made Simple

“…According to this approach, the flow pattern is described as "biphasic" if two sounds are heard during each cycle and as "triphasic" if three sounds are heard. More recently, sonologists have held that phase is defined in terms of discrete flow components in either direction (ie, portions on either side of the baseline) (8,11). This definition is based on observations of the spectral Doppler waveform.…”

Statement for Doppler waveforms analysis

“…Given the signifi cant variability in classifying arterial Doppler waveforms morphologies recorded using the Doppler technique [10], attention should be paid to the teaching methods. No specifi c teaching method has been proposed or validated for Doppler signals, even though analysis of the latter is a key element in vascular practice.…”

“…Regarding ABI, a certain number of measurements must be recorded to build up competence [6,39,40]. Studies conducted by Scissons highlight a better system for classifying Doppler waveform morphologies with the person gaining experience with every waveform analysis [8,10]. Studies should be carried out to establish the best way of teaching arterial waveform analysis and to improve practices for better patient management.…”

“…Intra-observer variability was assessed in a study that classifi ed arterial waveforms in three diff erent types, namely triphasic, biphasic, and monophasic [37]. A better waveform classifi cation appears to be generated when a continuous Doppler is used compared to a pulse-wave Doppler [10].…”

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“…It is observed that the transition from normal to abnormal is not always clear cut and the biphasic waveforms are associated with the most confusion and variability in their recognition by health care professionals. 48 Figure 1 is a simple illustration of the correlation between Doppler ultrasound waveforms, ABPIs, and the extent of occlusion. 49 Duplex ultrasound scanning.…”