Training activity information
Details
Perform optimised ultrasound scans and correctly identify calf artery disease
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 and international guidance
- Clinical presentation of acute and chronic disease
- Image optimisation
- Flow measurements
- Anatomy and physiology
- Limitations of the scan
- Scope of personal and professional practice
- Acting on urgent findings
- Patient safety and communication
- Artifact causes and corrections
- Multidiscplinary working and pathways
- Targeted scanning principles
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 optimised ultrasound scans and correctly identify calf artery disease.
- Consider how the learning outcomes apply, specifically in relation to interpreting findings with reference to haemodynamics.
- Discuss with your training officer to gain clarity of what is expected of you in relation to the specific challenges and expected appearances of disease in calf vessels.
What is your prior experience of this activity?
- Think about what you already know about specific anatomical variations and common disease patterns of calf arteries.
- Consider possible challenges you might face during the activity, such as their small calibre, tortuosity, depth, and susceptibility to calcification.
- 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 on difficult calf vessel visualisation or interpretation of challenging findings.
- Acknowledge how you feel about achieving comprehensive and accurate assessment of the calf arteries.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as high-frequency probe skills, effective techniques for optimising flow in small vessels, and gaining proficiency in identifying and characterising calf artery disease.
- Identify the specific insights you hope to gain into the impact of calf artery disease on overall lower limb perfusion and patient symptoms.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of small vessel imaging or low flow states.
- Identify important information you need to consider before embarking on the activity, such as anatomical variations of calf arteries and common patterns of atherosclerotic disease.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst performing optimised ultrasound scans to identify calf artery disease?
- Are you encountering situations such as:
- The vessels are extremely small or deep, leading to low signal intensity and unresolvable technical difficulty in obtaining a clean spectral waveform?
- You unexpectedly identify a highly focal lesion in a segment where only diffuse disease was anticipated, requiring rapid adjustment of the scanning field of view?
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 approach to probe selection, vessel compression technique, or Colour Doppler gain settings to maximise detection?
- Consider the steps you are taking in the moment, such as:
- Immediately switching to a high-frequency linear array transducer to improve resolution for small, superficial calf vessels
- Adjusting the sample volume size and angle correction to ensure the cleanest possible spectral signal despite low flow or small calibre
- How are you feeling in that moment? For instance, are you finding it difficult to maintain focus and fine motor control for prolonged calf vessel scanning? Is it affecting your confidence in comprehensively identifying all distal disease?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully utilising technical adjustments to confirm the presence and nature of calf artery disease (e.g., monophasic flow pattern)? Or are you needing support because technical limitations persist, and interpretation of subtle disease patterns requires senior pathological review or alternative imaging modality suggestion?
- What are you learning as a result of the unexpected development? For example, are you mastering specific technical tricks for visualising the tibial or peroneal vessels in challenging patients? Or gaining insight into the typical distribution patterns of calf artery occlusive disease?
On action
What happened?
- Begin by summarising the key steps you took when performing the ultrasound scan and correctly identifying calf artery disease.
- Consider specific events, actions, or interactions which felt important, such as how you employed high-frequency probes to visualise small calibre vessels or the technical difficulty encountered when assessing flow distal to a calcified lesion.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately applying slight compression and switching to a lower flow Doppler setting to enhance visualisation of a deeply located peroneal artery.
- How did you feel during this experience, e.g., did you feel challenged by the technical demands of small vessel imaging or focused on achieving comprehensive assessment?
How has this experience contributed to your developing practice?
- Identify what learning you can take from the experience of scanning for calf artery disease. What strengths did you demonstrate, e.g., precise probe handling for small vessels or persistent effort in seeking out all three distal runoff vessels?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the specific anatomical variations that complicate calf artery tracking or difficulty applying adequate optimisation for low flow states?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development in calf artery scanning achieved? Has your practice improved in identifying calf artery disease?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding interpretation of challenging findings in deeply placed vessels or persistent artefacts that obscured the vessel lumen, 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 improving high-frequency probe skills and flow optimisation.
- What will you do differently next time you approach an ultrasound scan for calf artery disease, for instance, by proactively reviewing anatomical diagrams detailing common calf artery variations before the scan?
- Do you need to practise any aspect of the activity further, such as refining techniques for visualising vessels distal to heavy calcification or key learning outcomes related to assessing disease in the lower limb arteries using ultrasound?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of scanning and identifying calf artery disease since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how an instance where achieving a diagnostic image of the deep tibial vessels in a heavily calcified limb required switching to a high-frequency probe forced you to re-evaluate the rigidity of your initial probe selection strategy you applied during your first attempt at calf artery assessment.
- Considering what you understand about small vessel haemodynamics, high-frequency imaging, and calf artery anatomy 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 calf artery identification technique based on further learning and experiences? For example, how you proactively integrated specific high-frequency probe settings and low-flow Colour Doppler optimisation strategies to maximise signal detection in small vessels.
- Has discussing challenges in visualising and identifying calf artery disease (e.g., flow below the ankle, severe disease patterns) with peers or colleagues changed how you now view your initial experience in this training activity? For example, how professional storytelling with a mentor about a case where calf vessel findings were missed, leading to inappropriate surgical planning, refined your understanding of the critical nature of comprehensive distal assessment.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent calf artery scanning experiences, contributed to your overall confidence and competence in performing optimised ultrasound scans and correctly identifying calf artery disease, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated ability in adapting scanning techniques for small vessels now enables you to confidently demonstrate scanning skills on lower limb vessels 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 scanning and identifying calf artery disease? 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 have a clearer understanding of your limitations and routinely seek assistance when severe technical barriers (e.g., persistent shadowing due to heavy calcification) preclude reliable interpretation of calf artery disease.
- Looking holistically at your training journey, how has this initial calf artery disease scanning experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to analysing and interpreting ultrasound images with reference to haemodynamics and applying the principles of ultrasound physics to correctly optimise the scan? For example, how this foundational experience has supported your development in meeting the learning outcome related to assessing disease in the lower limb arteries using ultrasound.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 2 |
Outcome
Assess disease in the lower limb arteries using ultrasound. |
| # 4 |
Outcome
Apply ultrasound physics to correctly optimise an ultrasound scan of the lower limb arteries. |
| # 5 |
Outcome
Analyse and interpret the ultrasound findings of diseased arteries of the lower limb with reference to haemodynamics. |
| # 9 |
Outcome
Appraise the impact of research evidence on national guidelines. |