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Transcranial Doppler (TCD) is a non invasive ultrasound technology used to evaluate blood flow velocity in the major basal

intracranial arteries. TCD may be used on its own or in conjunction with other imaging modalities. A thorough neurovascular exam should include TCD, as carotid obstructions seen with duplex imaging may have significant intracranial effects that should be considered in patient management decisions. Current applications of TCD include: 1. Detection and monitoring of vasospasm following aneurysmal subarachnoid hemorrhage. 2. Screening for basilar artery stenosis. 3. Diagnosis of intracranial stenosis and occlusion. 4. Evaluation of intracranial effects of extracranial stenosis, including assessment of collateral flow pathways. 5. Evaluation of vasomotor reserve. 6. Support of the diagnosis of brain death. 7. Evaluation and monitoring of intracranial blood flow during surgical procedures. 8. Detection of patent foramen ovale. 9. Identification of feeder arteries in AVM's. Emerging applications of TCD include the classification and quantification of intracranial emboli, as researchers are investigating the appearance of high intensity transient signals in the TCD waveform as indicators of circulating microemboli. The accuracy and clinical significance of this technique has not yet been scientifically established. The Neurovision TCD system has been engineered to meet the distinct requirements of the clinical environment. Multigon encourages you to browse our website or contact us for more information on transcranial Doppler, teaching aids and training courses.

Transcranial Doppler Ultrasound

Doppler ultrasound scanning measures blood flowing through the carotid arteries or the arteries at the base of the brain. This test assesses the risk of stroke. This technique shows different speeds of blood flow in different colors on a computer screen. It also can show blocked or reduced blood flow in the arteries of the neck that could cause a stroke. Additionally, it can show blood clots in leg veins that could break loose and block blood flow to the lungs. During duplex Doppler ultrasound, a handheld instrument (transducer) is passed lightly over the skin above a blood vessel. The transducer sends and receives

sound waves that are amplified through a microphone. The sound waves bounce off solid objects, including blood cells. The movement of blood cells causes a change in pitch of the reflected sound waves (called the Doppler effect). If there is no blood flow, the pitch does not change. A computer processes the information from the reflected sound waves to provide graphs or pictures that represent the flow of blood through the blood vessels. These can be saved for future review or evaluation. There are four types of Doppler ultrasound, including:

Continuous wave Doppler. This measures how continuous sound waves change in pitch as they encounter blood flow blockages or narrowed blood vessels. This type of ultrasound can be done at a person's hospital bedside to provide a quick estimate of the damage or disease.

Duplex Doppler. This produces a picture of a blood vessel and the organs that surround it. A computer converts the Doppler sounds into a graph that provides information about the speed and direction of blood flow through the blood vessel being examined.

Color Doppler. In this procedure, a computer converts the Doppler sounds into colors that are overlaid on the image of a blood vessel. The colors represent the speed and direction of flow through the vessel.

Power Doppler. This is a new technique being developed that is up to five times more sensitive than color Doppler. Power Doppler can get pictures that are difficult or impossible from standard color Doppler. Power Doppler is most commonly used to evaluate blood flow through vessels within solid organs. Blood flow in individual blood vessels is most commonly evaluated by duplex Doppler.

What is a transcranial doppler ultrasound (TCD)?

TCD is a non-invasive ultrasound method used to examine the blood circulation within the brain. During TCD, sound waves, inaudible to the human ear, are transmitted through the tissues of the skull. These sound waves reflect off blood cells moving within the blood vessels, allowing the radiologist to calculate their speed. The sound waves are recorded and displayed on a computer screen. Your physician has recommended that you have this test to determine the amount of blood flow to certain areas of your brain. The TCD ultrasound can also be used to monitor blood flow in the brain during surgical procedures. TCD ultrasound images help in the diagnosis of a wide range of conditions affecting blood flow to the brain and within the brain. TCD ultrasound may be used with other diagnostic procedures or by itself.

Before the test

There is no special preparation for the TCD ultrasound.

During the test

It is not necessary to change into a hospital gown or remove jewelry. Your ultrasound test is performed by specially trained technologists or registered nurses and interpreted by a board-certified radiologist. You will either lie on a padded examining table or sit in a chair during the test. A small amount of water-soluble gel is applied to the skin over the area to be examined. The gel is usually applied on the back of the neck, above the cheek bone, in front of the ear and over the eyelid. The gel does not harm your skin or stain your clothes. A small device called a transducer is held in place on the skin's surface until the blood flow information has been recorded. There is virtually no discomfort during the test. You will need to keep your head still and avoid talking during the test. The ultrasound takes about 20 to 30 minutes to complete.

After the test

The gel will be wiped off your skin. Your physician will discuss the test results with you.

Are there any side effects?

Studies have shown ultrasound is not hazardous. There are no harmful side effects. In addition, ultrasound does not use radiation, as X-ray tests do. ler.aspx