International Certification

Conditions of Participation

The aim of international certification is to elevate the level of quality of diagnostic Neurosonology by awarding those who proved to be able to teach and proficiently execute this method in theory and practice.

The following should be the standard format of the certification in Neurosonology:

1. Conditions of participation

The examinee has to be board certified physician and member of the NSRG or ESNCH. Theoretical and practical knowledge and experience is mandatory.

2. General structure

The process of certification has two components:

1. Multiple choice test (MC-test)
2. Hands-on examination

Full certification needs both components. It is possible to pass only the theoretical part (MC-test), but for the practical test the MC-test is a precondition either beforehand or in parallel at the same meeting.

3. Multiple Choice (MC) Test

3.1. General considerations and responsibilities

The international commission of certification has organized the MC-test.
The certification process requires the following:

A local organizer and 2. A member of the commission who is responsible for the correct implementation of the certification process. The local organizer can not be both a member of the commission and the local 2 organizer at the same time. There must be two separate responsible people present to administer the examination.

The questions are created, collected and administered by the members of the commission.

The questions and correct answers are not available publicly. All questions for the MC-test will be incorporated in a central collection of registered and approved questions.

3.2. Questions

3.2.1 40 questions should be given to the participants. They relate to neurovascular examinations including the following topics:

– Anatomy
– Pathophysiology and hemodynamics
– Physics and instrumentation
– Diagnostic criteria and interpretation of tests

3.2. 2 Choice of 4 answers, only one is correct

3.2.3 The threshold to pass the exam at the level of ESNCH Expert in Neurosonology is 75 % correct answers (30 of 40 questions)

3.2.4 Candidates that have between 62,5% and 72,5% correct answers (25 to 29) will pass the exam at the level of ESNCH Certified Neurosonologist.

4. Hands-on Examination

The participant should be able to use extracranial and transcranial colour duplex sonography in addition to Doppler sonography.

The examinee will be confronted with one of two possible tasks depending on the decision of the local organizer of the test: A-subject without pathology (4.1.), or B-examination of a patient (4.2.)

4.1 . Unilateral examination of a subject without major pathology,
without transmission problems of the scull:

They must image and document the following arteries of one side, including angle correction for velocity measurements (where applicable):

– Supratrochlear A. (branch of the ophthalmic artery) (CW)
– ICA at the origin and 2-3 cm downstream (Colour Duplex)
– VA (V3 or V0/1) (Colour Duplex)
– MCA (PW or Colour Duplex), or BA (PW or Colour Duplex).

4.2 Examination of a patient with well defined pathology

The test should focus on to the pathology

4.3 Details of the practical examination

4.3.1 Allotted time for the practical test not more than 30 min.

Each applicant will perform the exam under supervision of two members of the international certification committee (or nominated examiners of equal experience) . not more than 1 examiner should be from the same country as the examinee.

4.3.2 The applicant can familiarize with the devices beforehand and will be given technical support during the exam.

4.3.3 In case of stenosis the participant has to classify the finding into degree of disease (verbal description): low, moderate, severe, near occlusive, total occlusion.

4.3.4 The participant has to present the criteria he is applying for quantification of the neurosonologic test including ECST or NASCET criteria referring to the angiogram

4.3.5 Criterion to pass should be that the participant:

In case of examining a patient:
Describes the finding without misclassifying of more then one degree (as described above) of stenosis

Classifies correctly in occlusion versus stenosis.

In case of examining a subject:
Is able to differentiate and document correctly the above mentioned arteries in the allotted time

Prof. Dr. Eva Bartels

Recommended Reading:

  1. Understanding Ultrasound Physics, Third Edition. Sidney K. Edelman
  2. Diagnostic Ultrasound: Principles and Instruments (Diagnostic Ultrasound: Principles & Instruments. Frederick W. Kremkau PhD
  3. Cerebrovascular Ultrasound in Stroke Prevention and Treatment. Andrei V. Alexandrov (Editor)
  4. Charles H. Tegeler MD, Viken L. Babikian MD, Camilo R. Gomez MD
  5. Atlas of Neurosonology. Ekaterina Titianova, Kurt Niederkorn, Emilia Christova (Editors),
  6. Cerebrovascular Ultrasound: Theory, Practice and Future Developments. M. G. Hennerici, Stephen P. Meairs and M. Hennerici
  7. Neurosonology and neuroimaging of stroke. M. Valdueza, St. J. Schreiber, J.E. Roehl, R. Klingenbiel. Thieme 2008.
  8. Ultrasound Diagnosis of Cerebrovascular Disease: Doppler sonography of the extra- and intracranial arteries; Duplex-sonography. G. M. von Reutern, H.J Buedingen, Thieme 1993
  9. Doppler Ultrasound, physics, instrumentation and signal processing. D.H. Evans, W. N, Mc Dicken, John Wiley 2000
  10. Color-Coded Duplex Ultrasonography of Cerebral Vessels. Atlas and Manual. E. Bartels, Schattauer 2018
  11. Transcranial and Cervical Ultrasound in Stroke. Vosko M.R., Newell D.W., Alexandrov A.V. In: Caplan L.R., Biller J., Leary M.C., Lo E.H., Thomas A.J., Yenari M., Zhang J.H., editors. Primer on Cerebrovascular Diseases. Academic Press; 2017:702–707.ISBN: 9780128030585
  12. Manual of Neurosonology. László Csiba (ed.); Claudio Baracchini (ed.). Cambridge University Press; April 2016. ISBN: 9781316689264
  13. Neurosonology in Critical Care: Monitoring the Neurological Impact of the Critical Pathology. Camilo N. Rodríguez, Claudio Baracchini, Jorge H. Mejia-Mantilla, Marek Czosnyka, Jose I Suarez, László Csiba, Corina Puppo, Eva Bartels. Springer International Publishing, 24.11.2021 – 1149 p. ISBN 3030814181, 9783030814182