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1. Doppler training for
Clinicians
Dr. AliReza Bahmani
(Assistant Professor of Emergency Medicine)
(Evidence-Base-Medicine Fellowship)
Point of Care Ultrasound Instructor)
)

2. Liver Vasculature
Hepatic Artery
Portal Vein
Hepatic Veins

13. We use power doppler or color doppler to check the arterial
flow of the testis.
1. Power doppler is more sensitive to check flow than color in
testis and we use this option
2. We should reduce the wall filter as much as possible
3. We should also reduce the PRF (pulse repetition frequency)
4. We must adjust the color gain carefully so as not to mistake
the artefact for arterial flow.
5. To obtain the presence or absence of flow, use power
doppler and use spectral doppler to determine the artery or
vein and observe the resulting wave.
Testicular torsion

14. PRF setting. High-(a) middle-(b) and low-(c)

15. Wall Filter

16. In torsion, the testis increases in size , more hypoechoic and homogeneous
echotexture compared to the testicle on the opposite side.
- We must definitely take the spectral flow from it, because in the first stages of
torsion, we only lose venous flow and in the next hours we lose arterial flow.
• altered blood flow
• -Incomplete torsion
• elevated resistive index (RI >0.75) 3
• to and fro flow ( tardus parvus)
• - Complete torsion
• an absence of blood flow in both the testis and epididymis

17. Rt testicle Lt testicle

18. Spectral Doppler
shows high
resistance flow in
left testis with
diastolic reversal,
while the right
testis shows normal
low resistance flow.
Left sided scrotal
pain

19. Ovarian torsion
Ultrasound
Ultrasound is the initial imaging modality of choice. Sonographic features
include:
• Enlarged (>4 cm) ovary, midline ovary position, if the ovaries are
normal in size and symmetric, torsion is unlikely , ovarian oedema ,
variable echogenicity (hypo- or hyperechoic)
• Doppler findings in torsion are widely variable :
• little or no ovarian venous flow (common; sensitivity of 100% and
specificity of 97%)
• absent arterial flow (a less common, sign of poor prognosis)
• absent or reversed diastolic flow
• normal vascularity does not rule out intermittent torsion
• normal Doppler flow can also occasionally be found due to dual
supply from both the ovarian and uterine arteries

22. Venous Doppler
in
lower limbs
Phasicity