Renal Doppler Protocol

Structure Scan LABEL Landmarks Identified Images Stored
Plane
RT Kidney Sagittal RT KIDNEY  Right kidney mid Gray Scale
SAG MID  Renal sinus Gray Scale with measurement
 Liver Power Doppler
RT Sagittal RT  Right kidney mid Color and Spectral Doppler
Segmental SEGMENTAL  Renal sinus with AT, PSV, EDV, and RI
Renal RA SUP
Artery
RT Sagittal RT  Right kidney mid Color and Spectral Doppler
Segmental SEGMENTAL  Renal sinus with AT, PSV, EDV, and RI
Renal RA MID
Artery
RT Sagittal RT  Right kidney mid Color and Spectral Doppler
Segmental SEGMENTAL  Renal sinus with AT, PSV, EDV, and RI
Renal RA INF
Artery
RT Renal Transver RT RENAL  Right kidney mid Color Doppler
Vein se VEIN  Renal hilum Color and Spectral Doppler
At Hilum AT HILUM
RT Main Transver RT MAIN RA  Right kidney mid Color Doppler
Renal se At AT HILUM  Renal hilum Color and Spectral Doppler
Artery Hilum with AT, PSV, EDV, and RI
RT Main Transver RT MAIN RA  Mid right main RA Color and Spectral Doppler
Renal se MID with AT, PSV, EDV, and RI
Artery Mid
RT Main Transver RT MAIN RA  Mid aorta Color Doppler
Renal se At AT ORIGIN  Origin of right RA Color and Spectral Doppler
Artery Origin with AT, PSV, EDV, and RI
Aorta at Sagittal AORTA  Mid aorta Gray Scale
the level of Color Doppler
the RA
Aorta at Sagittal AORTA  Mid aorta Color and Spectral Doppler
the level of o just above with PSV and EDV
the RA renal artery
origin
LT Kidney Sagittal LT KIDNEY  Left kidney mid Gray Scale
SAG MID  Renal sinus Gray Scale with measurement
 Spleen Power Doppler
LT Sagittal LT  Left kidney mid Color and Spectral Doppler
Segmental SEGMENTAL  Renal sinus with AT, PSV, EDV, and RI
Renal RA SUP
Artery
LT Sagittal LT  Left kidney mid Color and Spectral Doppler
Segmental SEGMENTAL  Renal sinus with AT, PSV, EDV, and RI
Renal RA MID
Artery
LT Sagittal LT  Left kidney mid Color and Spectral Doppler
Segmental SEGMENTAL  Renal sinus with AT, PSV, EDV, and RI
Renal RA INF
Artery
LT Renal Transver LT RENAL  Left kidney mid Color Doppler
Vein se VEIN  Renal hilum Color and Spectral Doppler
At Hilum AT HILUM
LT Main Transver LT MAIN RA  Left kidney mid Color Doppler
Renal se At AT HILUM  Renal hilum Color and Spectral Doppler
Artery Hilum with AT, PSV, EDV, and RI
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Renal Doppler Protocol
LT Main Transver LT MAIN RA  Mid left main RA Color and Spectral Doppler
Renal se MID with AT, PSV, EDV, and RI
Artery Mid
LT Main Transver LT MAIN RA  Mid aorta Color Doppler
Renal se At AT ORIGIN  Origin of left RA Color and Spectral Doppler
Artery Origin with AT, PSV, EDV, and RI

Image Correlation

ES
P PS ESP = Early systolic peak

AT = Acceleration time

PSV= Peak systolic velocity

AT

Tips
 Explain to the patient that this is a lengthy examination and that their cooperation with
breathing instructions will cut down some on the exam time.
 This is a technically difficult exam limited by patient body habitus and bowel gas. Inability to
visualize any portion of the main renal artery should be reported to the interpreting
physician.
 Scan through the kidney first before storing any images.
 In addition to documenting renal size, you are also evaluating cortical echogenicity and
thickness.
 Any pathology seen, such as masses or hydronephrosis, should be documented.
 If renal artery stenosis is suspected, document that segment of the vessel in gray scale and
color Doppler. Then obtain spectral waveforms at the site of stenosis as well as just distal to
it.
 If a renal artery stent is present, document the stent in gray scale and color Doppler.
Spectral waveforms should be obtained (if possible) proximal to, within, and just distal to the
stent. Velocities will be increased throughout the stent.

Color and Power Doppler
 Color images should relay the same information as your gray scale & spectral images
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Renal Doppler Protocol
 Using a curved transducer will not allow you to steer your color box with the vessel direction
 Power Doppler over the sagittal mid kidney will allow you to assess overall organ perfusion
 Color bruit in any vessel is indicative of a stenosis and should prompt further interrogation
with spectral Doppler
 Absence of flow with optimized color and power Doppler settings is indicative of occlusion

Spectral Doppler
 Have patient hold their breath when obtaining spectral waveforms to decrease
movement
 Must use angle correct, and the angle must be less than 60 degrees. Less than 20 degrees is
optimal for intrarenal waveforms.
 Gate (SV length) must be in center of vessel and an appropriate width for size of
vessel
 Adjust your PRF (scale) to display a large waveform so that you can obtain
appropriate measurements
 Increase your sweep speed to display between 2 to 3 cycles for the renal artery
waveforms
 Normal aortic PSV proximal to and at the level of the renal arteries ranges from 60-
100 cm/s
 Normal proximal renal artery PSV ranges from 90-120 cm/s
 Renal artery velocities will decrease as you move distally and into the kidney
 Acceleration time, peak systolic and end diastolic velocities, and resistive index should be
obtained from all renal artery waveforms
 Acceleration time is calculated by measuring the time from the onset of systole to the
ESP.
o Normal AT for renal arteries is < 0.07 seconds
 RI is calculated by the machine using the PSV and EDV. If the machine does not
automatically calculate it for you, you will need to manually select the RI measurement after
obtaining your PSV and EDV.
o 0.6 is considered a normal RI for renal arteries
o RIs in young children may be slightly higher
 Dampened waveform with loss of ESP (tardus-parvus) in distal main and segmental renal
arteries indicates proximal renal artery stenosis exceeding 80%

Renal/Aortic Ratio (RAR)
 Proximal renal artery PSV divided by Aorta PSV = RAR
 Any disease processes affecting the aortic velocities will have an effect on the RAR

Classification of Proximal Renal Artery Stenosis

Degree Hemodyn Renal Renal/Ao Poststen AT at RI
of amic Artery rtic Ratio otic hilum
Stenosi Significan PSV Turbulenc and
s ce e intraren
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al

< 60% no > 180 < 3.5 absent > 0.07 < 0.7
cm/sec second

> 60% yes > 180 > 3.5 present > 0.1 > 0.7
cm/sec second

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