High-level Carotid Ultrasound Must be Performed by a Physician

Please let me state my astonishment regarding the editorial “Who’s doing your scan?” [1]. From a neurological standpoint, there are extreme differences in the quality of British and German vascular ultrasound, such as the grading of carotid stenosis. The multidisciplinary German-Austrian guideline on the diagnosis, treatment and follow-up of extracranial carotid stenosis recommends ultrasonography as the main diagnostic technique [2] with application of the current DEGUM criteria [3]. In the United Kingdom, however, an ultrasound scan is applied only as a screening test. Further tests such as CTA or MRA are necessary to confirm the diagnosis [4]. As ultrasound equipment is the same in the UK and Germany, only the differences in scan application (technician vs. physician) can explain the differences seen in the quality of the results. Moreover, according to the German-Austrian guideline [2], ultrasonography performed by a physician is given preference over CTA and MRA, the diagnostic standards in the UK.

• References

• 1 Edwards HM, Sidhu PS. Who’s doing your scan? A European perspective on ultrasound services. Ultraschall in Med 2017; 38: 479-482
• 2 Eckstein HH. et al. Clinical Practice Guideline: The diagnosis, treatment and follow-up of extracranial carotid stenosis–a multidisciplinary German-Austrian guideline based on evidence and consensus. Dtsch Arztebl Int 2013; 110: 468-476
• 3 Arning C, Widder B, von Reutern GM. et al. Revision of DEGUM ultrasound criteria for grading internal carotid artery stenoses and transfer to NASCET measurement. Ultraschall in Med 2010; 31: 251-257
• 4 https://www.nhs.uk/Conditions/Carotidendarterectomy/Pages/Diagnosis.aspx