Xradiologist

Name:


Exam Date:


Comparison:


Indication:


Technique:
Multisegmental plethesmography pressure waveform analysis with bi-directional flow of the bilateral lower extremities with ankle brachial indices was performed.


Findings:
Right:

Brachial pressure ____

Dorsalis pedis pressure ____

Posterior tibial pressure ____

Great toe pressure ____

ABI is ____

Ankle wave form is ____ (mild, moderate, severely dampened, or, not obtained)

TBI is ____

Great toe waveform is ____ (mild, moderate, severely dampened, or, not obtained)


Left:

Brachial pressure ____

Dorsalis pedis pressure ____

Posterior tibial pressure ____

Great toe pressure ____

ABI is ____

Ankle wave form is ____ (mild, moderate, severely dampened, or, not obtained)

TBI is ____

Great toe waveform is ____ (mild, moderate, severely dampened, or, not obtained)


Impression:
1. Normal ABI's (or decreased ABI/s recommend clinical correlation for arterial occlusive disease).
2. Normal TBI's (or decreased TBI/s with pressure/s sufficient/ insufficient for wound healing).

Click here to see normal values for ABI/TBI Ultrasound