Module information

Module details

Title
Advanced Practice - Extra Cranial
Type
Specialist
Module code
S-V-S4
Credits
10
Phase
3
Requirement
Compulsory

Aim of this module

This module provides the trainee with the knowledge, understanding and practical skills to safely and confidently accept referrals, perform a full diagnostic scan and descriptive report of cerebrovascular disease and understand its importance in the patient treatment pathway.

Work-based content

Competencies

# Learning outcome Competency Action
# 1 Learning outcome 1, 7, 9, 10 Competency

Triage incoming referrals

Action View
# 2 Learning outcome 2, 3, 4, 7, 8, 9 Competency

Perform optimised extracranial arterial ultrasound scans to identify and grade significant extracranial disease to include:

  • Minor
  • Moderate
  • Severe
  • Occlusive

 

Action View
# 3 Learning outcome 2, 3, 4, 7, 8, 9 Competency

Analyse and interpret the results of an extracranial arterial ultrasound scans, including:

  • Minimal disease
  • Moderate disease
  • Severe disease
  • Occlusive disease
Action View
# 4 Learning outcome 2, 3, 7 Competency

Perform extracranial carotid ultrasound scans and assess the plaque morphology, grading a range of plaque types

Action View
# 5 Learning outcome 4, 5, 7, 8, 9, 10 Competency

Produce descriptive clinical reports of ultrasound analysis or an extracranial arterial ultrasound scan

Action View
# 6 Learning outcome 3, 4, 5, 8 Competency

Review and report ultrasound finding with subclavian steal phenomenon

Action View
# 7 Learning outcome 3, 4 Competency

Identify and minimise artefacts caused by pathology during  extracranial artery ultrasound scans using:

  • B Mode image
  • Colour Doppler
  • The spectral Doppler
Action View
# 8 Learning outcome 4, 6, 7, 8, 9, 10 Competency

Communicate the findings of a positive extracranial artery scan to:

  • The multidisciplinary team
  • A patient
Action View

Assessments

Complete 2 Case-Based Discussions

Complete 2 DOPS or OCEs

Direct Observation of Practical Skills Titles

  • Correctly identify a severely diseased carotid artery.
  • Correctly identify trickle flow in a sub-occlusive internal carotid artery.
  • Correctly identify and assess a complete occlusion of an internal carotid artery.
  • Correctly identify and assess retrograde flow in the vertebral artery.
  • Correctly identify and assess an extracranial dissection.
  • Perform an ultrasound scan on an immobile patient (i.e. A patient based in ICU, reduced mobility post stoke or wheelchair bound).

Observed Clinical Event Titles

  • Explain ultrasound findings to professional peers in a multidisciplinary team meeting.
  • Gather a relevant clinical history with a patient presenting with a transient ischemic attack.
  • Discuss a significant finding with a patient.

Learning outcomes

# Learning outcome
1

Review and triage referrals for extracranial cerebrovascular scans.

2

Assess disease in the extracranial arteries using ultrasound.

3

Apply ultrasound physics to correctly optimise an ultrasound scan.

4

Analyse and interpret the ultrasound findings for extracranial arteries with reference haemodynamics.

5

Produce an interpretive clinical report of the extracranial arterial scan findings.

6

Identify and communicate urgent and non-urgent results of the scan to both patients and the multidisciplinary team.

7

Appraise the impact of research evidence on national guidelines.

8

Critically evaluate the clinical significance of incidental findings.

9

Summarise surgical and endovascular interventions performed for carotid disease.

10

Describe the potential risks and benefits associated with intervention.

Clinical experiences

Important information

Clinical experiences help you to develop insight into your practice and greater understanding of your specialty. Clinical experiences should be included in your training plan and you may be asked to help organise your experiences. While Clinical Experiences are not assessed, reflections and observations from your experiences can be used to support evidence for competencies to demonstrate your awareness and appreciation of your specialty and it’s impact on patient care. You may find it helpful to capture thoughts from your experiences in your reflective log.

Activities

  1. Observe an internal carotid artery endarterectomy.
  2. Observe an endovascular internal carotid artery stent procedure.
  3. Attend a neurology multidisciplinary team meeting.
  4. Shadow a patient presenting to a TIA service throughout their pathway.
  5. Observe a radiologist reporting an MRI and CT scan for patients who are being investigated for a stoke or TIA.
  6. Observe a patient undertaking physical rehabilitation after suffering a stroke.
  7. Observe a speech therapist and their sessions with patients who have suffered a stroke.
  8. Observe a series of patients on the NHS sickle cell and thalassaemia screening programme undergoing TCD spectra to assess intracranial circulation.
  9. Observe the measurement of carotid IMT.

Academic content (MSc in Clinical Science)

Important information

The academic parts of this module will be detailed and communicated to you by your university. Please contact them if you have questions regarding this module and its assessments. The module titles in your MSc may not be exactly identical to the work-based modules shown in the e-portfolio. Your modules will be aligned, however, to ensure that your academic and work-based learning are complimentary.

Learning outcomes

On successful completion of this module the trainee will be able to:

  1. Demonstrate a critical awareness of the symptoms of carotid disease and appraise the clinical consequences arising from this condition.
  2. Critically evaluate the haemodynamics of extracranial arterial pathology.
  3. Analyse and interpret extracranial ultrasound findings (anticipated and incidental).
  4. Critically evaluate the surgical and endovascular interventions performed for carotid disease.
  5. Critically appraise evidence-based guidelines relating to carotid disease investigation and management.

Indicative content

Stroke and TIA

Brain and neck artery anatomy
  • Anatomical variations relevant to ultrasound scanning
  • Symptoms, definitions and signs
    • Haemorrhagic stroke
    • Ischaemic stroke
    • Transient ischaemic attack TIA
  • Pathways, guidelines and recommendations
Current treatments and patient management
  • Medical
  • Endovascular
  • Surgical
  • Emerging treatments and procedures
  • Scientific evidence for carotid disease diagnosis and assessment
    • NASCET, ECST
    • Latest research and trials
Ultrasound Scanning
  • Protocol recommendations
  • Role of ultrasound in assessing extracranial arteries
    • Spectral waveforms and haemodynamic grading of stenoses
    • Plaque characterisation
    • IMT
  • Subclavian steal
  • Limitations and technical challenges
    • Tortuosity
    • Tandem lesions
    • Aortic arch disease
    • Carotid syphon and distal lesions
    • Contralateral disease
    • Calcification and shadowing
  • Cardiac disease and relation to extracranial waveforms
    • Arrhythmia
    • Aortic stenosis
    • Hypertension and hypotension
    • Cardiac failure
  • Ultrasound reporting recommendations and guidelines
Complementary diagnostic brain and carotid imaging
  • CTA and MRA
Differential diagnoses and non-arteriosclerotic pathology
  • Carotid dissection
  • Carotid body tumour
  • Aneurysm
  • Vasospasms
  • Giant cell arteritis

Transcranial Doppler

Neck and head anatomy relevant to TCD

Technology: imaging and non-imaging
  • Scanning protocols and acoustic windows
  • Pulsed spectral Doppler
  • Ultrasound Imaging
  • TCD measurements, parameters and indices, i.e. PI
Pathology and clinical applications
  • Sickle cell anaemia
  • Subarachnoid haemorrhage
  • Emboli detection and monitoring
  • Non-invasive monitoring of intracranial pressure ICP
  • Brain death

Module assigned to

Specialties

Specialty code Specialty title Action
Specialty code SPS1-2-22 Specialty title Vascular Science [2022] Action View