Suggested Minimum Qualifications for Physicians Interpreting Noninvasive Vascular Diagnostic Studies

Bonnie Johnson, RDMS RVT FSVU; Gregory Moneta, MD; and Mark Oliver, MD RVT

nterpretation of vascular noninvasive studies requires a thorough understanding of anatomy, physiology, ultrasound physics and hemodynamics, as well as clinical vascular disease and its detection. Interpreting physicians should be licensed to practice medicine in the state in which they practice. A working knowledge of the various aspects of vascular aspects of vascular laboratory testing is required. This knowledge includes the scientific principles of noninvasive vascular studies, how studies are performed, and the trouble shooting process for each study type. Additionally, a familiarity with quality assurance procedures and the reliability of individual tests and clinical limitations is necessary. Interpreting physicians must understanding and review hard copy documentation of vascular laboratory tests and have an understanding and awareness of proper reporting procedures.

Physicians who acquire the necessary skills and meet the non-procedural requirements above should be considered qualified to interpret noninvasive vascular diagnostic studies. Obtaining the R.V.T. certificate is encouraged but, in itself, does not indicate competence in interpretation. Likewise, meeting minimum interpretation numbers alone does not indicate competence without adequate background, training, experience, and ongoing Continuing Medical Education (CME). Continuing Medical Education specific to vascular noninvasive diagnosis must be documented. It is understood that some physicians interpreting noninvasive vascular diagnostic studies will only be interpreting tests in a single area (for example: neurologists interpreting only cerebrovascular studies). For such physicians their experience in Continuing Medical Education should be in that specific area.

Minimum Qualifications

1. Licensed medical practitioner.
2. Training in anatomy, vascular physiology and hemodynamics, and ultrasound physics. Minimum training for medical school is not considered sufficient. Physicians interpreting vascular noninvasive studies should show evidence of additional training during residency or fellowship training or postgraduate CME course work including these basic principles.
3. Clinic experience in the diagnosis and treatment of vascular disease. Evidence of this experience may be obtained through established practice, residency/fellowship training in vascular disease, or supervised experience obtained following residency/fellowship training. Suggested experience levels for each of these categories are listed below.
   1. Established practice. SVS/SVU recognize that many physicians will be interpreting vascular laboratory studies prior to the publication of these guidelines. It is suggested that physicians in active practice for at least three years working in the vascular laboratory and who have interpreted the following minimum number of cases over a three year period meet clinical experience for interpretation of vascular laboratory studies: Carotid duplex 300, transcranial Doppler 300, peripheral arterial physiologic studies 300, peripheral arterial duplex studies 300, venous duplex studies 300, visceral duplex 225.
   2. For individuals recently completing residency or fellowship training, they should be able to demonstrate interpretation under supervision of the following numbers of tests during their training: Peripheral arterial physiologic 100, carotid ultrasound (duplex) 100, visceral vascular 75, peripheral arterial duplex 100, peripheral venous duplex 100, transcranial Doppler 100.
   3. In the absence of formal training during residency and fellowship, the following supervised experience should be obtained over a two year period: Peripheral physiologic tests 100, carotid ultrasound (duplex) 150, visceral vascular 75, peripheral arterial duplex 100, peripheral venous duplex 150, transcranial Doppler 100.

Continuing Medical Education
Continuing Medical Education (CME) specific to noninvasive vascular diagnosis or its underlying principles must be obtained. For physicians without documented residency or fellowship training, or those without adequate evidence of training as outlined above, 30 hours of CME specific to noninvasive vascular diagnosis be obtained initially. Additionally, all interpreting physicians are required to obtain thirty or more CME credit hours for each three year period on an ongoing basis.

See a list of SVU's other Position Papers and Standards