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Lab Name:
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Date of Service:
Last Name:
First Name:
Date of Birth:
MRN:
Generic Template
Indication:
Ordering Provider:
Technologist:
Pertinent History:
Technique
The extracranial cerebrovascular arteries were evaluated from the base of the neck through the level of the cranium with high frequency medical ultrasound. Images and Doppler waveforms were recorded.
Findings
Right
Left
B-mode Appearance
CCA:
Normal
Calcfied
Soft Plaque
Heterogenous Plaque
OCCLUDED
See Comments
Bifurcation:
Normal
Calcfied
Soft Plaque
Heterogenous Plaque
OCCLUDED
See Comments
ICA:
Normal
Calcfied
Soft Plaque
Heterogenous Plaque
OCCLUDED
See Comments
CCA:
Normal
Calcfied
Soft Plaque
Heterogenous Plaque
OCCLUDED
See Comments
Bifurcation:
Normal
Calcfied
Soft Plaque
Heterogenous Plaque
OCCLUDED
See Comments
ICA:
Normal
Calcfied
Soft Plaque
Heterogenous Plaque
OCCLUDED
See Comments
Doppler Measurements
Prox SCA:
cm/s
Prox CCA:
cm/s
Mid/Dist CCA:
cm/s
ICA:
cm/s
ICA/CCA Ratio:
ECA:
cm/s
Vert Waveform:
Antegrade
Early Diastolic Deceleration
Bi-directional
Retrograde
Absent
Not Visualized
Prox SCA:
cm/s
Prox CCA:
cm/s
Mid/Dist CCA:
cm/s
ICA:
cm/s
ICA/CCA Ratio:
ECA:
cm/s
Vert Waveform:
Antegrade
Early Diastolic Deceleration
Bi-directional
Retrograde
Absent
Not Visualized
Impression
Right
Left
Normal
< 50% Stenosis
50 - 69% Stenosis
>=70% Stenosis
Near Occlusion
Total Occlusion
Normal
< 50% Stenosis
50 - 69% Stenosis
>=70% Stenosis
Near Occlusion
Total Occlusion
Comparison to Prior Exam
No prior study available for comparison
No change since prior study
Findings are worse than on the prior study
Findings are improved since the prior study
Recommendation
No follow up required
Follow up with repeat ultrasound in 1 year
Follow up with repeat ultrasound in 6 months
Follow up with vascular consultation
Comments