Applied Fundamentals of Vascular Science —
Training activity: 12

Details

Perform and report abdominal aortic ultrasound scans on patients with aneurysms

Type

Entrustable training activity (ETA)

Evidence requirements

Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion. ​

Reflection at multiple timepoints on the trainee learning journey for this activity.

Considerations

• Patient centred care and support
• Local SOPs
• National, international guidelines and standards
• Documentation and record keeping
• Use of machine controls
• Ultrasound principles
• National AAA screening programme
• Communication of results
• Recommendations for onward investigation
• Limitations and pitfalls
• Artifact causes and corrections
• Principles of Doppler ultrasound
• Selection of appropriate probes for patient/vessel
• Patient positioning and exam technique
• Anatomy of the abdominal arteries on ultrasound
• Local SOPs for report writing
• Acting on clinically urgent findings
• Referrals and escalation

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

What does success look like?

• Identify what is expected of you in relation to performing the necessary ultrasound measurements and producing a detailed report for abdominal aortic aneurysms (AAA).
• Consider how the learning outcomes apply, specifically in relation to assessing vascular anatomy using ultrasound and preparing the associated diagnostic clinical reports.
• Discuss with your training officer to gain clarity of what is expected of you in relation to the specific measurement criteria for the abdominal aorta (e.g., outer-to-outer diameter) and the necessary reporting requirements for size and morphology.

What is your prior experience of this activity?

• Think about what you already know about abdominal anatomy, vascular ultrasound imaging principles, and the expected appearance of an abdominal aortic aneurysm (AAA).
• Consider possible challenges you might face during the activity, such as technical difficulty due to bowel gas obstructing the aorta or ensuring precise measurement planes in a tortuous or complex aneurysm.
• Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom. You will need to seek advice from your Training Officer when required, for example if you encounter an unexpectedly large or symptomatic aneurysm requiring immediate clinical escalation or if image quality prevents reliable measurement.
• Acknowledge how you feel about scanning patients with known or suspected abdominal aortic aneurysms.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as accurate B-mode measurement of the aorta in multiple planes or effectively documenting wall characteristics and intraluminal thrombus.
• Identify the specific insights you hope to gain into the clinical implications of aneurysm size and growth rate for patient management and follow-up protocols.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of abdominal scanning or complex vascular reporting where detailed anatomical description was key.
• Identify important information you need to consider before embarking on the activity, such as reviewing the local guidelines on AAA reporting templates and the anatomical landmarks required for proximal and distal measurement.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst performing and reporting abdominal aortic ultrasound scans on patients with aneurysms?
• Are you encountering situations such as:
  • Technical difficulty arises due to severe bowel gas obscuring critical measurement landmarks (e.g., the aneurysm neck or iliac arteries), compromising the accuracy of the required diameter measurements?
  • The appearance of the aneurysm suggests an unexpected, high-risk pathology (e.g., suspected rupture, dissection, or rapid growth), conflicting with the patient’s known status?

How are you reacting to the unexpected development?

• How is this impacting your actions? For example, are you responding to the situation appropriately? Are you adapting or changing your scanning technique (e.g., modifying patient position, using oblique views) to overcome technical barriers or immediately escalating critical findings according to local protocol?
• Consider the steps you are taking in the moment, such as:
  • Immediately trying alternative acoustic windows or patient positions (e.g., lateral decubitus) to improve visualisation and ensure accurate measurement planes are obtained.
  • Immediately ceasing the non-essential parts of the scan and escalating the case to a senior colleague or medical team if signs of rupture or dissection are suspected.
• How are you feeling in that moment? For instance, are you finding it difficult to maintain focus on precise measurement while managing image quality fluctuations? Is it affecting your confidence in accurately identifying and reporting the aneurysm’s critical features?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully obtaining reliable outer-to-outer diameter measurements despite technical challenges and accurately describing the morphology? Or are you needing support because image quality is too poor to reliably assess critical features (e.g., mural thrombus extent), requiring senior review or alternative imaging request?
• What are you learning as a result of the unexpected development? For example, are you mastering advanced scanning techniques for managing technically difficult abdomens? Or gaining insight into the critical details required in a report that necessitate urgent clinical action?

On action

What happened?

• Begin by summarising the key steps you took when performing and reporting the abdominal aortic ultrasound scan.
• Consider specific events, actions, or interactions which felt important, such as how you managed technical difficulty due to bowel gas or how you accurately documented the AAA morphology and diameter measurements.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately changing the patient’s position to overcome acoustic shadowing, or escalating the case upon suspecting a complex or rapidly growing aneurysm.
• How did you feel during this experience, e.g., did you feel focused on obtaining reliable measurements or stressed by the complexity of the pathology?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding AAA imaging. What strengths did you demonstrate, e.g., technical skill in imaging and accurately measuring the aorta in multiple planes or the ability to prepare a detailed diagnostic clinical report?
• What skills and/or knowledge gaps were evident, e.g., unfamiliarity with specific reporting criteria for size and morphology or difficulty ensuring precision in measurement planes in a tortuous aorta?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in assessing vascular anatomy using ultrasound?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding escalating findings suggestive of rupture or dealing with image quality issues that precluded reliable measurement, and how you reacted to this.

What will you take from the experience moving forward?

• Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received, with regards to technical imaging and accurate reporting of abdominal aortic aneurysms.
• What will you do differently next time you approach an abdominal aortic scan, for instance, by proactively reviewing the anatomical landmarks required for proximal and distal measurement before scanning?
• Do you need to practise any aspect of the activity further, such as refining B-mode measurement techniques or key learning outcomes related to preparing the associated diagnostic clinical reports?

Beyond action

Have you revisited previous experiences?

• How have your subsequent experiences of performing and reporting abdominal aortic ultrasound scans for patients with aneurysms since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how an instance where a subsequent large or complex aneurysm required immediate clinical escalation forced you to re-evaluate the speed and thoroughness of your critical measurement acquisition and emergency protocol verification during your first attempt at this training activity.
• Considering what you understand about vascular anatomy assessment, required measurement criteria (e.g., outer-to-outer diameter), and diagnostic reporting requirements (e.g., size, morphology) now, were the actions or considerations you identified after your initial reflection on this training activity sufficient? How have you since implemented or adapted improvements in your aneurysm scanning and reporting technique based on further learning and experiences? For example, how you proactively integrated multiple measurement planes and review of the AAA reporting template to ensure compliance with local/national standards.
• Has discussing technical difficulty due to bowel gas or the impact of inaccurate measurement on patient follow-up protocols with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior colleague about a scan where image quality precluded reliable measurement refined your understanding of the critical need for advanced troubleshooting techniques and comprehensive documentation of limitations.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent abdominal aortic aneurysm (AAA) scanning and reporting experiences, contributed to your overall confidence and ability in performing and reporting abdominal aortic ultrasound scans, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated ability in performing and reporting abdominal aortic ultrasound scans enables you to confidently perform, interpret and report a duplex scan on a patient with a known abdominal aortic aneurysm during a DOPS assessment.
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to AAA scanning and reporting? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, how your evolved approach means you now routinely seek advice immediately when image quality prevents reliable measurement or when findings suggest urgent, high-risk pathology (e.g., suspected rupture), recognising this requires immediate clinical consultation and escalation.
• Looking holistically at your training journey, how has this initial AAA scanning and reporting experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to assessing vascular anatomy using ultrasound and preparing the associated diagnostic clinical reports? For example, how this foundational experience has supported your development in meeting learning outcomes related to assessing vascular anatomy and preparing diagnostic reports.

Relevant learning outcomes

#	Outcome
# 1	Outcome Communicate effectively with a range of patients and other professionals.
# 2	Outcome Assess vascular anatomy using ultrasound.
# 3	Outcome Apply the principles of ultrasound safety and ergonomics whilst performing a scan.
# 5	Outcome Apply the principles of ultrasound physics to adjust and optimise an ultrasound machine to obtain quality images.
# 7	Outcome Analyse and interpret the results of a range of vascular scans.
# 8	Outcome Prepare the associated diagnostic clinical reports of the ultrasound scan performed.
# 9	Outcome Identify and communicate scan results to both patients and the multidisciplinary team.
# 10	Outcome Evaluate protocols and national guidelines and their impact of vascular science practice.