• Physicians who want to begin the process of achieving credentialed status in the interpretation of adult echocardiography.
• Resident Physicians beginning their cardiac ultrasound rotation or fellowship.
• Any Physician interpreting echocardiograms who has not formally updated his or her training within the lat ten years.
• Veterinarians who wish to apply principles of human cardiac measurement parameters to their practice.
• All Technologists who have performed cardiac ultrasound studies for longer than one year and who desire a deeper understanding of the basis for clinical interpretation and application of the data.
• Engineers or research professionals contemplating the use of cardiac ultrasound as and end-point measurement tools for any clinical project.

Upon successful completion of this course the learner should be able to:

• Articulate the four goals of the carotid and vertebral duplex report as they relate to the medical and invasive management of the patient with carotid artery disease.
• Discuss the potential confusion typically generated from use of nonstandard terminology for image and Doppler findings.
• Apply standard terminology to the final report format, summarizing technical findings and stating a final conclusion.
• Articulate reported findings in categorical increments of either 20% or 25% diameter loss without ambiguity, to allow for complete quality control assessment.
• Articulate reported findings in categorical increments of either 20% or 25% diameter loss without ambiguity, to allow for complete quality control assessment.
• Oversee the proper settings for the system's display monitor's contrast and brightness controls to optimize gray scale display range.
• Maintain quality control and provide continuing feedback to staff regarding optimization of image projection, planar orientation, and gain level/balance.
• Differentiate between image artifact and true targets by applying a simple geometric paradigm.
• Describe the concept of signal compression and the role of image post processing in the complete analysis of plaque morphology.
• ‣Define and apply the following terms to the analysis of vessel pathology; explain the clinical significance of each.
        • homogeneous
        • heterogeneous
        • hypoechoic
        • hyperechoic, hyperechoic with shadowing
        • anechoic
• Demonstrate critical acuity in stratifying data quality prior to objective assessment.
• Standardize the measurement and reporting of the intima/medial thickness measurement by degree and location.
• Differentiate surface contour from multiplanar views as smooth, irregular, or ulcerated; discuss the clinical ramifications of each.
• List the four unique categorical effects of luminal stenosis on blood flow; relate each to the detected Doppler waveform.
• Differentiate the unique contribution and limitation of high resolution imaging and Doppler in the assessment of stenosis less than, and greater than, 50-60% diameter obstruction.
• Describe the relationship of velocity and cross sectional area to blood flow.
• List and describe the seven factors present in the cervical carotid artery which can induce turbulence and discuss how each one can falsely influence the suspicion of stenosis in a normal vessel.
• Describe the concepts of spectral broadening as displayed on color and achromatic Doppler systems and discuss the practical limitation of attempts to measure it.
• Articulate the limited role of color Doppler in the quantitative assessment of disease.
• Describe the criteria and physiologic basis for systolic and diastolic velocity ratio analysis in the common or internal carotid artery segments, citing potential pitfalls.
• Recognize aliasing in the achromatic Doppler waveform display and describe the means by which its limitations may be overcome.
• Describe the criteria and basis for prediction of stenosis by absolute systolic or diastolic velocities, citing inherent limitations with each.
• Discuss the potential role of acceleration time measurement in the indirect assessment of proximal or distal carotid arterial occlusive
disease.
• Explain the relationship of stenosis on blood flow and pressure at successively severe degrees of narrowing, to the point of total occlusion.
• Explain why velocity analysis alone cannot differentiate between normal and subtotal occlusive states.
• Explain why Doppler ultrasound cannot discriminate between non- and very-slow-moving blood flow; detail the means whereby the operator can maximize signal-to-noise ratio in such circumstances.
• List the predominant and supportive criteria strongly associated with total vessel occlusion; state the specific verbiage to be used in reporting it.
• Discuss the circumstances whereby periophthalmic or transcranial Doppler may elucidate or amplify the diagnosis of pressure-reducing carotid stenosis; differentiate the unique contribution of each.
• Demonstrate recall of criteria, verbiage, and format for analysis of select cases demonstrating abdominal and lower/upper extremity arterial and/or venous pathology.
• Systematically apply a diagnostic matrix protocol to select case findings.