Training activity information
Details
Identify and minimise artefacts caused by pathology during extracranial artery ultrasound scans using:
- B Mode image
- Colour Doppler
- The spectral Doppler
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
- Artifact causes and corrections
- Imaging controls and optimisation
- Quality assurance
- pathophysiology
- Ultrasound physics
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 effectively planning and preparing to undertake upper limb nerve conduction studies, specifically identifying and minimising pathology-related artefacts during extracranial artery ultrasound scans using B Mode, Colour Doppler, and Spectral Doppler.
- Consider how the learning outcomes apply, specifically in relation to planning and preparing and applying legislation, guidelines, and managing risk when planning and preparing for the studies, specifically applying ultrasound physics to correctly optimise an ultrasound scan.
- Discuss with your training officer to gain clarity of what is expected of you in relation to expectations for equipment setup, patient flow logistics, and integrating necessary safety protocols, specifically expectations for artefact management.
What is your prior experience of this activity?
- Think about what you already know about planning medical procedures or preparing clinical rooms, specifically ultrasound artefacts and techniques to minimise them.
- Consider possible challenges you might face during the activity, such as logistical issues with moving NCS equipment, ensuring necessary resources (e.g., limb temperature monitors) are available, or understanding procedural requirements, specifically distinguishing true pathology from artefact, dealing with dense calcification causing shadowing.
- 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 the complexity of the planned study requires specialised equipment or protocols not covered in routine procedure, or if persistent, unresolvable artefact severely compromises diagnostic quality.
- Acknowledge how you feel about identifying and minimising pathology artefacts during scanning whilst using the different ultrasound types.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as planning complex clinical procedures, specifically identifying and troubleshooting artefacts, drawing upon previous experiences of the activity.
- Identify the specific insights you hope to gain into the detailed requirements for upper limb NCS planning, including patient flow, equipment setup, and integrating safety protocols, specifically how different artefacts affect interpretation and reporting.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of similar planning or preparation activities, specifically dealing with scan artefacts.
- Identify important information you need to consider before embarking on the activity, such as reviewing the anatomy of upper limb nerves (median, ulnar, radial) and the procedures for motor/sensory nerve conduction studies, as this knowledge is foundational for planning, specifically the limitations and technical challenges such as calcification and shadowing.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst encountering and managing artefacts during extracranial artery ultrasound scans?
- Are you encountering situations such as:
- Unusually severe shadowing caused by dense calcification, unexpected reverberation obscuring the lumen, or artefacts that mimic pathology?
- A critical artefact (e.g., severe Colour Doppler blooming) arises specifically at a site of severe stenosis, preventing accurate velocity measurement?
How are you reacting to the unexpected development?
- How is this impacting your actions? For example, are you responding appropriately to the situation when a challenging artefact obscured critical information? Did you adapt or change your scanning technique, probe manipulation, or machine settings (e.g., B Mode, Colour Doppler, Spectral Doppler) to minimise or overcome the artefact?
- Consider the steps you are taking in the moment, such as:
- Immediately adjusting spatial compounding or frequency to mitigate shadowing and optimise the view of the vessel distal to the calcification.
- Altering the pulse repetition frequency (PRF) and wall filter settings to minimise Colour Doppler blooming over a high-velocity jet.
- How are you feeling in that moment? For instance, are you finding it difficult to adapt your approach to effectively minimise the artefacts? Is it affecting your confidence in obtaining a diagnostic quality image despite the artefacts?
What is the conclusion or outcome?
- Identify how you worked within your scope of practice. For example, are you successfully applying physics principles to mitigate artefact and obtain diagnostic data? Or are you needing support because a severe, unresolvable artefact is obscuring critical diagnostic information, requiring a senior colleague to confirm the limitations?
- What are you learning as a result of the unexpected development? For example, are you mastering advanced artefact troubleshooting techniques? Or gaining insight into the technical limitations imposed by specific pathologies?
On action
What happened?
- Begin by summarising the key points of your experience identifying and minimising artefacts.
- Consider specific events, actions, or interactions which felt important, such as identifying the source of a persistent noise, adjusting the wall filter, or your feelings.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately adjusting the wall filter and PRF settings when severe aliasing complicated the Spectral Doppler waveform, adapting the technique in real-time.
- How did you feel during this experience, e.g., did you feel satisfaction in overcoming them or frustration with artefacts?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience. What strengths did you demonstrate, e.g., in recognising and mitigating specific artefacts?
- What skills and/or knowledge gaps were evident, e.g., understanding the technical source of a specific artefact, or advanced machine controls?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in managing artefacts?
- Identify any challenges you experienced, such as needing to seek advice or clarification on a persistent artefact, or if an artefact significantly impacted your ability to obtain diagnostic images, and how you reacted to this.
- Acknowledge any changes in your own feelings now that you are looking back on the experience.
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 technical troubleshooting and artefact mitigation strategies.
- What will you do differently next time you approach an ultrasound scan and encounter artefacts, for instance, by proactively creating a technical troubleshooting checklist for common artefacts like aliasing and shadowing, based on B Mode, Colour Doppler, and Spectral Doppler settings?
- Do you need to practise any aspect of the activity further, such as specific artefact resolution techniques?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of identifying and minimising artefacts 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 scan suffered from persistent Colour Doppler blooming over a high-velocity jet forced you to re-evaluate the rigidity of your initial settings optimisation process you applied during your first attempt at artefact management.
- Considering what you understand about ultrasound physics, the influence of pathology (e.g., calcification) on image quality, and technical troubleshooting 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 artefact minimisation technique based on further learning and experiences? For example, how you proactively reviewed and integrated the technical requirements for adjusting the Pulse Repetition Frequency (PRF) and wall filter settings to mitigate aliasing and blooming, demonstrating you have adapted improvements based on further learning.
- Has discussing persistent or confounding artefacts or the impact of unresolved technical issues on diagnostic yield 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 acoustic shadowing obscured a critical lesion refined your understanding of the critical nature of proactive technical management.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent artefact management experiences, contributed to your overall confidence and competence in identifying and minimising artefacts caused by pathology, particularly in preparing for assessments like Direct Observations of Practical Skills (DOPS)? For example, how your accumulated ability in technical troubleshooting now enables you to confidently navigate severe acoustic shadowing or colour ghosting 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 identifying and minimising artefacts? 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 persistent, severe electrical noise requires inspection of the power supply or transducer that falls outside routine technical troubleshooting scope.
- Looking holistically at your training journey, how has this initial artefact management experience, revisited with your current perspective, contributed to your development in meeting the objectives related to applying ultrasound physics to correctly optimise an ultrasound scan? For example, how this foundational experience has supported your development in troubleshooting limitations and technical challenges.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 3 |
Outcome
Apply ultrasound physics to correctly optimise an ultrasound scan. |
| # 4 |
Outcome
Analyse and interpret the ultrasound findings for extracranial arteries with reference haemodynamics. |