The three biggest changes in vascular ultrasound over its lifetime

Vascular ultrasound as a modality has only been available and active since around 1980. Ultrasound imaging itself goes back a bit further to 1958 and the publication in the Lancet of the paper Investigation of Abdominal Masses by Pulsed Ultrasound, by Donald, MacVicar and Brown. Vascular ultrasound uses the Doppler effect to measure the velocity of blood noninvasively. In the early days, Doppler waveforms were the only method available to view and investigate blood flow in diseased vessels. Since then, the three biggest technical changes have been: Firstly, the introduction of duplex scanning, whereby vessels may be imaged in conjunction with viewing the Doppler waveforms. Secondly, the introduction of colour Doppler, in which the direction and velocity of flow may be shown directly on the image of the vessel using a colour scale. And thirdly, the introduction of digital storage and manipulation of images. We are now on the cusp of a fourth significant technological development making available high-resolution microvascular imaging and real-time vector displays.

Professionally, we started in 1980 with just three or four centres around the country performing vascular ultrasound with first generation equipment, in most cases as a one-man-band. We had to teach ourselves, comparing notes with one another and working with vascular surgeons to improve our reporting. From that start I believe the three most important developments have been: Firstly, in 1992 the Society for vascular technology was formed to provide a society to develop professional standards within the rapidly developing field of vascular ultrasound. Secondly, a major development towards this end was the introduction of the CSVS accreditation scheme, which has more recently been supplemented by the modernising scientific careers vascular pathway, thereby ensuring a professional standard of care across the country. The third key development was the recognition in the 2004 agenda for change modernisation of the NHS, that vascular scientists were equivalent to reporting sonographers in their skills and responsibilities.

Crispian Oates