Advanced Practice - Venous —
Training activity: 4

Details

Analyse and interpret ultrasound scans to diagnose a DVT

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

• Local SOPs and national guidance
• Vein pathology and ultrasound characteristics
• Effects of venous thrombosis on haemodynamics
• Determining age of thrombus and treatment options
• Clinical presentation of acute and chronic disease
• Documentation
• Communication skills
• Scope of personal and professional practice
• Limitations of the scan or protocol
• Consequences of misdiagnosis
• Acting on urgent findings

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 successfully analysing and interpreting ultrasound scans to diagnose a DVT.
• Consider how the learning outcomes apply, specifically in relation to analysing and interpreting ultrasound findings with reference to haemodynamics and summarising treatment pathways.
• Discuss with your training officer to gain clarity of what is expected of you in relation to criteria for a confident and accurate diagnosis, including differentiation between acute and chronic DVT characteristics.

What is your prior experience of this activity?

• Think about what you already know about DVT pathophysiology, ultrasound characteristics of acute vs. chronic DVT, and differential diagnoses (e.g., Baker’s cyst).
• Consider possible challenges you might face during the activity, such as interpreting equivocal compression findings, differentiating post-thrombotic syndrome features, or managing discordant clinical/scan data.
• 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 for highly complex cases, uncertain differential diagnoses, or when the diagnosis suggests immediate clinical intervention is required.
• Acknowledge how you feel about embarking on this scan interpretation activity.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as pattern recognition for acute and chronic thrombus, application of diagnostic criteria based on haemodynamics, and correlation with clinical history.
• Identify the specific insights you hope to gain into the diagnostic accuracy of ultrasound for DVT and the nuances of treatment pathways based on the DVT type.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of scan interpretation (e.g., improving systematic review or verifying measurements).
• Identify important information you need to consider before embarking on the activity, such as current guidelines for DVT diagnosis and management, and reviewing differential diagnoses that mimic DVT.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst analysing and interpreting ultrasound scans to diagnose a DVT?
• Are you encountering situations such as:
  • Equivocal or borderline compression findings in a major vein (e.g., partial compression achieved, but residual thrombus is uncertain)?
  • Scan features suggest chronic DVT (e.g., recanalisation, collaterals), but the clinical history is acute or recent, complicating the age classification?

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 applying diagnostic criteria or cross-referencing findings?
• Consider the steps you are taking in the moment, such as:
  • Immediately reviewing B-mode characteristics (echogenicity, homogeneity) to age the thrombus (acute vs. chronic)
  • Pausing analysis to consult diagnostic criteria for Post-Thrombotic Syndrome features to differentiate from acute events
• How are you feeling in that moment? For instance, are you finding it difficult to adapt your interpretation strategy due to discordant data? Is it affecting your confidence in reaching a successful, definitive diagnosis?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully applying diagnostic criteria to differentiate acute vs. chronic DVT features? Or are you needing support because the findings are highly complex or suggest immediate clinical intervention is required, necessitating senior pathological review?
• What are you learning as a result of the unexpected development? For example, are you mastering pattern recognition for DVT features? Or gaining insight into the nuances of treatment pathways based on the DVT age?

On action

What happened?

• Begin by summarising the key steps you took when analysing and interpreting the ultrasound scans for DVT, including the specific findings focused on (e.g., non-compressibility, thrombus echogenicity) and the diagnostic conclusion reached (e.g., acute vs. chronic DVT).
• Consider specific events, actions, or interactions which felt important, such as reconciling ambiguous images, managing conflicting findings (e.g., compression status vs. clinical symptoms), or discussions with colleagues.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately revising the initial diagnostic conclusion when further review of B-mode images revealed post-thrombotic changes. How did you feel during this experience, e.g., did you feel determined to achieve accurate classification or stressed by the ambiguity of the findings?

How has this experience contributed to your developing practice?

• Identify what learning you can take from analysing and interpreting these scans. What strengths did you demonstrate, e.g., systematic application of diagnostic criteria for DVT or ability to integrate multiple pieces of information?
• What skills and/or knowledge gaps were evident, e.g., difficulty differentiating subtle acute versus chronic DVT characteristics or recognising specific artefacts that mimic thrombus?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in integrating complex haemodynamic and morphological data?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding a difficult differential diagnosis (e.g., DVT vs. Baker’s cyst) or escalating for a second opinion to ensure diagnostic accuracy, 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 the accuracy and speed of DVT classification.
• What will you do differently next time you approach DVT interpretation, for instance, by proactively establishing a checklist for evaluating thrombus echogenicity and collateral presence to systematically differentiate acute from chronic disease?
• Do you need to practise any aspect of the activity further, such as reviewing specific case types or key learning outcomes related to applying haemodynamic principles to venous pathology?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of analysing and interpreting DVT scans 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 case required urgent differentiation between acute-on-chronic DVT forced you to re-evaluate the speed and rigour of your thrombus characterisation and collateral assessment you applied during your first attempt at interpretation.
• Considering what you understand about DVT diagnostic criteria, acute vs. chronic features, and haemodynamic interpretation 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 analytical and interpretive skills for diagnosing DVT based on further learning and experiences? For example, how you proactively integrated a systematic check for thrombus echogenicity and age to consistently differentiate acute from chronic occlusion, demonstrating you have adapted improvements based on further learning.
• Has discussing complex DVT interpretation cases (e.g., equivocal compression, extensive Post-Thrombotic Syndrome features) or the impact of misdiagnosis on patient treatment pathways with colleagues changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior colleague about an unrecognised acute DVT component refined your understanding of the critical importance of meticulous diagnostic interpretation.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent DVT analysis experiences, contributed to your overall confidence and competence in analysing and interpreting ultrasound findings for venous disease, particularly in preparing for assessments like CBDs? For example, how your accumulated ability in accurately classifying DVT type and age now enables you to confidently discuss the diagnostic criteria and summarise treatment pathways for lower limb venous disease during a CBD assessment.
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to diagnosing DVT? 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 the findings suggest a highly acute, proximal DVT requiring immediate clinical intervention outside routine reporting time.
• Looking holistically at your training journey, how has this initial DVT analysis and interpretation experience, revisited with your current perspective, contributed to your development in meeting the objectives related to analysing and interpreting ultrasound findings and summarising treatment pathways? For example, how this foundational experience has supported your development in applying critical understanding of venous disease pathophysiology.

Relevant learning outcomes

#	Outcome
# 5	Outcome Analyse and interpret ultrasound findings for venous disease of the lower limbwith reference to haemodynamics.
# 8	Outcome Summarise the treatment pathways for lower limb venous disease.
# 9	Outcome Appraise the impact of research evidence on national guidelines.