IAC Vascular Testing Comment Period

The IAC periodically reviews and updates its Standards. As part of the revision process, the IAC accepts public comments for 30 or 60 days as related to proposed changes to existing Standards. In order to provide comments, the IAC Comment Form below must be completed and electronically submitted by the provided deadline. The IAC does not accept comments that are e-mailed.

To submit a comment:

1. Click Start Comment Period.
2. Review the proposed removal, addition or revision to the Standard and comment in the box provided.
3. Click Next Standard to proceed through all of the proposed changes.
4. Once all your comments are entered, complete information on the final page and hit Submit Comments. You must hit Submit Comments on the final page for your comments to be received by IAC.

If you don't wish to comment on a particular Standard, you may leave that box blank and proceed on by clicking Next Standard.

If you'd like to reference the complete, current published Stadnards you may do so at intersocietal.org/programs/vascular-testing/standards.

To report issues with this form, please e-mail webmaster@intersocietal.org.

Standard 1.1.1.3A
Medical Director Required Training and Experience

In Section 1A: Personnel and Supervision, IAC is proposing the following Standard be REMOVED from the pathways for Medical Director Required Training and Experience:

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Informal Training – The informal training pathway allows for qualification of interpreting physicians through a combination of Continuing Medical Education (CME) and supervised practical and supervised interpretive experience.

• A minimum of 40 hours of relevant Category 1 CME credits must be acquired within the three-year period prior to the initial application. 
  • 20 hours must be courses specifically designed to provide knowledge of the techniques, limitations, accuracies and methods of interpretations of noninvasive vascular examinations that the physician will interpret.
  • 20 hours may be dedicated to appropriate clinical topics relevant to noninvasive vascular testing.
  • Eight of the 40 hours must be specific to each testing area the physician will interpret.
• The physician must acquire a minimum of eight hours supervised practical experience for each testing area to be interpreted; observing or participating in testing procedures in a facility accredited for vascular test.
• Experience must be documented with a letter from the Medical Director of the facility where the experience was obtained.
• The physician must acquire experience in the interpretation of exams while under the supervision of a physician who has already met the IAC Vascular Testing Standard. Experience must be acquired in each of the testing areas in which the physician will be providing interpretations for the following minimum number of studies:
  • extracranial cerebrovascular – 100 cases
  • intracranial cerebrovascular – 100 cases
  • peripheral arterial physiologic – 100 cases
  • peripheral arterial duplex – 100 cases
  • venous duplex ultrasound – 100 cases
  • visceral vascular duplex ultrasound – 100 cases

Comment: Interpretive experience must be documented with a letter from the supervising physician of the facility where the experience was obtained indicating the dates of participation and the number of cases in each testing area.

Standard 1.3.1.3A
Medical Staff Required Training and Experience

In Section 1A: Personnel and Supervision, IAC is proposing the following Standard be REMOVED from the pathways for Medical Staff Required Training and Experience:

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Informal Training – The informal training pathway allows for qualification of interpreting physicians through a combination of Continuing Medical Education (CME) and supervised practical and supervised interpretive experience.

• A minimum of 40 hours of relevant Category 1 CME credits must be acquired within the three-year period prior to the initial application. 
  • 20 hours must be courses specifically designed to provide knowledge of the techniques, limitations, accuracies and methods of interpretations of noninvasive vascular examinations that the physician will interpret.
  • 20 hours may be dedicated to appropriate clinical topics relevant to noninvasive vascular testing.
  • Eight of the 40 hours must be specific to each testing area the physician will interpret.
• The physician must acquire a minimum of eight hours supervised practical experience for each testing area to be interpreted; observing or participating in testing procedures in a facility accredited for vascular test.
• Experience must be documented with a letter from the Medical Director of the facility where the experience was obtained.
• The physician must acquire experience in the interpretation of exams while under the supervision of a physician who has already met the IAC Vascular Testing Standard. Experience must be acquired in each of the testing areas in which the physician will be providing interpretations for the following minimum number of studies:
  • extracranial cerebrovascular – 100 cases
  • intracranial cerebrovascular – 100 cases
  • peripheral arterial physiologic – 100 cases
  • peripheral arterial duplex – 100 cases
  • venous duplex ultrasound – 100 cases
  • visceral vascular duplex ultrasound – 100 cases

Comment: Interpretive experience must be documented with a letter from the supervising physician of the facility where the experience was obtained indicating the dates of participation and the number of cases in each testing area.

Standard 3.2.6A
Examination Interpretation and Reports

In Section 3A: Examination Reports and Records, IAC is proposing the following Standard be CHANGED for requirements for final reports as shown below in bold green under New Standard:

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Old Standard

The final report must be typed and must include, but is not limited to:

• patient identification;
• date of the examination;
• appropriate clinical indications leading to the performance of the examination;
• an adequate description of the examination performed and must include the name of the examination and its integral parts;
• description of pertinent positive and negative findings, including velocity measurements for arterial duplex examinations and venous examinations as required by the venous protocol;
• if disease is present it must be characterized according to its location, extent, severity and etiology whenever possible;
• incidental findings;
• reasons for a technically limited, suboptimal or incomplete examination; summary (impression/conclusion) of the examination findings;
• comparison with previous related studies when available;
• interpreting physician typed name and signature and/or electronic verification;
• date of interpreting physician signature or verification.

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New Standard

The final report must be typed and must include, but is not limited to:

• patient identification;
• date and time of the examination;
• ordering provider;
• appropriate clinical indications leading to the performance of the examination;
• an adequate description of the examination performed and must include the name of the examination and its integral parts;
• description of pertinent positive and negative findings, including velocity measurements for duplex examinations as required by the protocol;
• if disease is present it must be characterized according to its location, extent, severity and etiology whenever possible;
• incidental findings;
• reasons for a technically limited, suboptimal or incomplete examination; summary (impression/conclusion) of the examination findings;
• comparison with previous related studies when available, must include the date of the previous exam;
• interpreting physician typed name and signature and/or electronic verification;
• date of interpreting physician signature or verification.

 

Standard 6.1.3.3A
Multiple Sites

In Section 6A: Multiple Sites, IAC is proposing the following Standard be CHANGED for requirements for multiple sites as shown below in bold green under New Standard:

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Old Standard

A lead technologist is appointed at each multi-site facility and reports to the Technical Director weekly, either in person or via tele/video conferencing to ensure compliance with the IAC Vascular Testing Standards. 

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New Standard

A lead technologist is appointed at each multi-site facility and reports to the Technical Director weekly, either in person or via tele/video conferencing to ensure compliance with the IAC Vascular Testing Standards. Records must be maintained of these conferences and submitted upon request.

Standard 2.3.6B
Intracranial Cerebrovascular Testing

In Section 2B: Intracranial Cerebrovascular Testing, IAC is proposing the following Standard be CHANGED for protocol requirements for Intracranial Cerebrovascular Testing as shown below in bold green under New Standard:

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Old Standard

Separate written protocols for additional intracranial cerebrovascular examinations (if performed) must include, but may not be limited to:

• emboli detection;
• vasomotor reactivity;
• right-to-left shunt;
• assessment of cerebral circulatory arrest;
• peri-procedural or intra-operative monitoring;
• monitoring of reperfusion therapies in acute stroke;
• monitoring in the neuro-intensive care setting.

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New Standard

Separate written protocols for additional intracranial cerebrovascular examinations (if performed) must include, but may not be limited to:

• emboli detection;
• vasomotor reactivity;
• right-to-left shunt;
• assessment of cerebral circulatory arrest;
• peri-procedural or intra-operative monitoring;
• monitoring of reperfusion therapies in acute stroke;
• monitoring in the neuro-intensive care setting;
• assessment of intracranial vasospasm.

Standard 3.2.4B
Peripheral Arterial Testing

In Section 3B: Peripheral Arterial Testing, IAC is proposing the following Standard be CHANGED for supplemental equipment requirements for Peripheral Arterial Testing as shown below in bold green under New Standard:

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Old Standard

Supplemental Equipment

• Photoplethysmography (PPG), if used for testing, must be provided with:
  • appropriate electrical coupling for signal display;
  • capability of providing a permanent recording of the waveform.
• Limb air plethysmography (pulse volume recording-PVR¬), if used for testing, must be provided with:
  • appropriately sized pneumatic cuffs;
  • capability of being calibrated before each examination;
  • capability of measuring small limb volume changes;
  • capability of providing a permanent recording of the data.
• Treadmill exercise/stress testing, if used for testing, must be provided with:
  • motor-driven treadmill capable of providing constant speed and inclination.

Comment: Other forms of standardized exercise may be utilized as required by the protocol.

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New Standard

Supplemental Equipment

• Photoplethysmography (PPG), if used for testing, must be provided with:
  • appropriate electrical coupling for signal display;
  • capability of providing a permanent recording of the waveform.
• Limb air plethysmography (pulse volume recording-PVR¬), if used for testing, must be provided with:
  • appropriately sized pneumatic cuffs;
  • capability of being calibrated before each examination;
  • capability of measuring small limb volume changes;
  • capability of providing a permanent recording of the data.
• Treadmill exercise/stress testing, if used for testing, must be provided with:
  • motor-driven treadmill capable of providing constant speed and inclination.
  • If additional examinations are performed and additional testing equipment is utilized it must be listed in these Standards. A written protocol, diagnostic criteria and quality improvement methods must be in place and available for review upon request.

Comment: Other forms of standardized exercise may be utilized as required by the protocol.

Standard 3.7.1.3B
Peripheral Arterial Testing

In Section 3B: Peripheral Arterial Testing, IAC is proposing the following Standard be CHANGED for documentation requirements for Peripheral Arterial Testing as shown below in bold green under New Standard:

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Old Standard

• Spectral Doppler waveforms and velocity measurements must be documented as required by the protocol and must include at a minimum:
• common femoral artery;
• superficial femoral artery;
• proximal deep femoral artery;
• popliteal artery;
• tibial arteries;
• aorta, common and external iliac arteries (when appropriate);
• bypass graft when present, including proximal and distal anastomoses, inflow and outflow arteries;
• stent(s) when present.
  • native artery at the proximal end of the stent;
  • proximal stent;
  • mid stent;
  • distal stent;
  • native artery at the distal end of the stent.

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New Standard

• Spectral Doppler waveforms and velocity measurements must be documented as required by the protocol and must include at a minimum:
• common femoral artery;
• superficial femoral artery;
• proximal deep femoral artery;
• popliteal artery;
• posterior tibial, dorsalis pedis and anterior tibial arteries;
• aorta, common and external iliac arteries (when appropriate);
• bypass graft when present, including proximal and distal anastomoses, inflow and outflow arteries;
• stent(s) when present.
  • native artery at the proximal end of the stent;
  • proximal stent;
  • mid stent;
  • distal stent;
  • native artery at the distal end of the stent.

Standard 3.7.1.4B
Peripheral Arterial Testing

In Section 3B: Peripheral Arterial Testing, IAC is proposing the following Standard be CHANGED for documentation requirements for Peripheral Arterial Testing as shown below in bold green under New Standard:

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Old Standard

Abnormalities require additional images, waveforms and velocity measurements.

 

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New Standard

Abnormalities require additional images, waveforms and velocity measurements.

Comment: Long stents (e.g., femoral-to-popliteal covered stent graft) may require multiple mid stent images to localize stenosis when present. Outflow vessel (whether arterial or venous in context of deep venous arterialization) should be included.

Comment: Limitation of the study must be documented in the report.

Standard 4.3.3B
Peripheral Venous Testing

In Section 4B: Peripheral Venous Testing, IAC is proposing the following Standard be CHANGED for protocol requirements for Peripheral Venous Testing as shown below in bold green under New Standard:

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Old Standard

anatomic extent that constitutes a complete examination includes evaluation of the entire course of the accessible portion of each vessel:

• variations in technique following vascular interventions, including dialysis access 
• variations in technique and documentation for limited exams.

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New Standard

anatomic extent that constitutes a complete examination includes evaluation of the entire course of the accessible portion of each vessel:

• variations in technique following vascular interventions, including dialysis access and endovascular mesh stenting;
• variations in technique and documentation for limited exams.

Standard 4.7B
Peripheral Venous Testing

In Section 4B: Peripheral Venous Testing, IAC is proposing the following Standard be ADDED for documentation requirements for Peripheral Venous Testing as shown below in bold green under New Standard:

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New Standard

Vein mapping of the lower extremity, if performed, must include:

• assessment of the veins, including tourniquet use as required by the protocol;
• vein patency and diameter.

Standard 4.7.5B
Peripheral Venous Testing

In Section 4B: Peripheral Venous Testing, IAC is proposing the following Standard be CHANGED for documentation requirements for Peripheral Venous Testing as shown below in bold green under New Standard:

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Old Standard

Vein mapping, if performed, must include:

• assessment of the veins, including tourniquet use as required by the protocol;
• vein patency and diameter.

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New Standard

Vein mapping of the upper extremity, if performed, must include:

• assessment of the veins, including tourniquet use as required by the protocol;
• vein patency and diameter.

Standard 1.1C
QI Program

In Section 1C: Quality Improvement Program, IAC is proposing the following Standard be REVISED to remove case review requirements for QI Program as shown below under New Standard:

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Old Standard

The facility must have a written Quality Improvement (QI) program to evaluate all types of procedures performed in the facility on an ongoing basis. The QI program must include the QI measures outlined below but may not be limited to the evaluation and review of:

• test appropriateness;
• technical quality and, if applicable, safety of the imaging;
• interpretive quality review;
• report completeness and timeliness; and
• case review.

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New Standard

The facility must have a written Quality Improvement (QI) program to evaluate all types of procedures performed in the facility on an ongoing basis. The QI program must include the QI measures outlined below but may not be limited to the evaluation and review of:

• test appropriateness;
• technical quality and, if applicable, safety of the imaging;
• interpretive quality review; and
• report completeness and timeliness.

Standard 2.1.5C
QI Measures

In Section 2C: QI Measures, IAC is proposing the following Standard be REMOVED from the required QI measures:

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Case Review

• Case review with any appropriate imaging modality, surgical findings, clinical outcome or other comparison of a minimum of four cases annually with at least two cases per relevant testing area (extracranial, intracranial, arterial, venous, visceral, screening).