Renal

Doppler Protocol
Structure Scan Plane LABEL Landmarks Identified Images Stored
RT Kidney Sagittal RT KIDNEY SAG • Right kidney mid Gray Scale
MID • Renal sinus Gray Scale with measurement
• Liver Power Doppler
RT Segmental Sagittal RT SEGMENTAL • Right kidney mid Color and Spectral Doppler with AT,
Renal Artery RA SUP • Renal sinus PSV, EDV, and RI
RT Segmental Sagittal RT SEGMENTAL • Right kidney mid Color and Spectral Doppler with AT,
Renal Artery RA MID • Renal sinus PSV, EDV, and RI
RT Segmental Sagittal RT SEGMENTAL • Right kidney mid Color and Spectral Doppler with AT,
Renal Artery RA INF • Renal sinus PSV, EDV, and RI
RT Renal Vein Transverse RT RENAL VEIN • Right kidney mid Color Doppler
At Hilum AT HILUM • Renal hilum Color and Spectral Doppler
RT Main Renal Transverse RT MAIN RA • Right kidney mid Color Doppler
Artery At Hilum AT HILUM • Renal hilum Color and Spectral Doppler with AT,
PSV, EDV, and RI
RT Main Renal Transverse RT MAIN RA • Mid right main RA Color and Spectral Doppler with AT,
Artery Mid MID PSV, EDV, and RI
RT Main Renal Transverse RT MAIN RA • Mid aorta Color Doppler
Artery At Origin AT ORIGIN • Origin of right RA Color and Spectral Doppler with AT,
PSV, EDV, and RI
Aorta at the Sagittal AORTA • Mid aorta Gray Scale
level of the RA Color Doppler
Aorta at the Sagittal AORTA • Mid aorta Color and Spectral Doppler with PSV
level of the RA o just above renal and EDV
artery origin
LT Kidney Sagittal LT KIDNEY SAG • Left kidney mid Gray Scale
MID • Renal sinus Gray Scale with measurement
• Spleen Power Doppler
LT Segmental Sagittal LT SEGMENTAL • Left kidney mid Color and Spectral Doppler with AT,
Renal Artery RA SUP • Renal sinus PSV, EDV, and RI
LT Segmental Sagittal LT SEGMENTAL • Left kidney mid Color and Spectral Doppler with AT,
Renal Artery RA MID • Renal sinus PSV, EDV, and RI
LT Segmental Sagittal LT SEGMENTAL • Left kidney mid Color and Spectral Doppler with AT,
Renal Artery RA INF • Renal sinus PSV, EDV, and RI

LT Renal Vein Transverse LT RENAL VEIN • Left kidney mid Color Doppler
At Hilum AT HILUM • Renal hilum Color and Spectral Doppler

LT Main Renal Transverse LT MAIN RA • Left kidney mid Color Doppler
Artery At Hilum AT HILUM • Renal hilum Color and Spectral Doppler with AT,
PSV, EDV, and RI
LT Main Renal Transverse LT MAIN RA • Mid left main RA Color and Spectral Doppler with AT,
Artery Mid MID PSV, EDV, and RI
LT Main Renal Transverse LT MAIN RA • Mid aorta Color Doppler
Artery At Origin AT ORIGIN • Origin of left RA Color and Spectral Doppler with AT,
PSV, EDV, and RI

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 Renal Doppler Protocol

Image Correlation

ESP
PSV ESP = Early systolic peak

AT = Acceleration time

PSV= Peak systolic velocity

AT

Tips
• Explain to the patient that this is a lengthy examination and that their cooperation with breathing instructions will
cut down some on the exam time.
• This is a technically difficult exam limited by patient body habitus and bowel gas. Inability to visualize any portion
of the main renal artery should be reported to the interpreting physician.
• Scan through the kidney first before storing any images.
• In addition to documenting renal size, you are also evaluating cortical echogenicity and thickness.
• Any pathology seen, such as masses or hydronephrosis, should be documented.
• If renal artery stenosis is suspected, document that segment of the vessel in gray scale and color Doppler. Then
obtain spectral waveforms at the site of stenosis as well as just distal to it.
• If a renal artery stent is present, document the stent in gray scale and color Doppler. Spectral waveforms should
be obtained (if possible) proximal to, within, and just distal to the stent. Velocities will be increased throughout
the stent.

Color and Power Doppler

• Color images should relay the same information as your gray scale & spectral images
• Using a curved transducer will not allow you to steer your color box with the vessel direction
• Power Doppler over the sagittal mid kidney will allow you to assess overall organ perfusion
• Color bruit in any vessel is indicative of a stenosis and should prompt further interrogation with spectral Doppler
• Absence of flow with optimized color and power Doppler settings is indicative of occlusion

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 Renal Doppler Protocol

Spectral Doppler
• Have patient hold their breath when obtaining spectral waveforms to decrease movement
• Must use angle correct, and the angle must be less than 60 degrees. Less than 20 degrees is optimal for intrarenal
waveforms.
• Gate (SV length) must be in center of vessel and an appropriate width for size of vessel
• Adjust your PRF (scale) to display a large waveform so that you can obtain appropriate measurements
• Increase your sweep speed to display between 2 to 3 cycles for the renal artery waveforms
• Normal aortic PSV proximal to and at the level of the renal arteries ranges from 60-100 cm/s
• Normal proximal renal artery PSV ranges from 90-120 cm/s
• Renal artery velocities will decrease as you move distally and into the kidney
• Acceleration time, peak systolic and end diastolic velocities, and resistive index should be obtained from all renal
artery waveforms
• Acceleration time is calculated by measuring the time from the onset of systole to the ESP.
o Normal AT for renal arteries is < 0.07 seconds
• RI is calculated by the machine using the PSV and EDV. If the machine does not automatically calculate it for you,
you will need to manually select the RI measurement after obtaining your PSV and EDV.
o 0.6 is considered a normal RI for renal arteries
o RIs in young children may be slightly higher
• Dampened waveform with loss of ESP (tardus-parvus) in distal main and segmental renal arteries indicates
proximal renal artery stenosis exceeding 80%


Renal/Aortic Ratio (RAR)
• Proximal renal artery PSV divided by Aorta PSV = RAR
• Any disease processes affecting the aortic velocities will have an effect on the RAR

Classification of Proximal Renal Artery Stenosis

Degree of Hemodynamic AT at hilum RI

Renal Artery Renal/Aortic Poststenotic
Stenosis Significance and
PSV Ratio Turbulence
intrarenal

< 60% no > 180 cm/sec < 3.5 absent > 0.07 < 0.7
second

> 60% yes > 180 cm/sec > 3.5 present > 0.1 second > 0.7

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