During the meeting of the EAN Scientific Panel of Neurosonology in Copenhagen 2016, it was decided to establish a Network of European Reference Centers in Neurosonology (ERNSono). This network is designed as a reference network, which works in close cooperation with the European Society of Neurosonology and Cerebral Hemodynamics [WON/ESNCH]). The Executive Committee of the ESNCH has decided during the annual meeting in Berlin 2017 to joiand to support this initiative.

Objective
Neurosonology is an outstanding diagnostic instrument in the hand of clinical neurologists with unique selling points such as specific imaging technology, high spatial resolution, online observation, noninvasiveness as well as broad and easy availability in the clinical routine all over Europe. Beside “traditional” vascular neurology, currently new fields of application such as muscle and nerve imaging, orbital ultrasound and online monitoring techniques in intensive care are booming. There is a definite need for a well-structured clinical network to seek for further technical progress, to offer a profound education and training program, to test the usefulness of ultrasound in new fields, to implement it in clinical trials and to foster the application of sonography in daily practice. The EAN as the leading neurological society in Europe in concert with the WON/ESNCH as the leading society in the field of neurosonology offers now the unique opportunity to launch the ERNSono.

Criteria for ERNSono Accreditation
A. Equipment of the Neurosonology Laboratory 1. High-end duplex sonographic machine with duplex probe for examination of cervical arteries, transcranial duplex probe, convex probe (optional), and probe for neuromuscular ultrasound (optional)
2. Transcranial Doppler with monitoring headframe
3. Transportable duplex sonographic machine (for examination in intensivecare units) – optional
B. Personnel facilities 1. The Chief of the neurosonology laboratory has to be a neurologist sonographer with certified national or international experience in neurosonology*. The Chief must have examined more than 3000 patients confirmed by the head of the clinical department or institution.
2. Two sonographers/medical staff with national or international certified experience in neurosonology. They must have examined more than 2000 patients confirmed by the head of the clinical department.
3. Membership in European neurosonological organizations (EAN Neurosonology Panel and either WON/ESNCH or Neurosonology Research Group of the WFN).

C. Application of the following neurosonological methods
1. Duplex sonography of the cervical vessels;
2. Transcranial duplex color-coded sonography;
3. Transcranial sonography of brain parenchyma;
4. Transcranial Doppler;
5. Transcranial Doppler monitoring (MES, vasomotor reactivity, PFO, etc.);
6. ICU applications (cannulation, ONSD, LP, vasospasm);
7. Optional: Cerebral circulatory arrest (brain death);
8. Optional: Neuromuscular ultrasound

D. Scientific activities.
1. At least 5 publications, of which 2 in the last five years, as first or senior author with neurosonology topics in journals with IF > 1.0.
2. Publications must contain original data.

E. Proven research network activities in Neurosonology (collaborative studies and projects, collaborative teaching courses as faculty member).

F. Teaching activities
1. Organization or active participation as faculty in atleast 3 international neurosonological courses during the last 10 years under the auspices of national or international societies.
2. Compliance and support of the teaching and certification concept of the EAN/WON/ESNCH/NSRG.

G. The Neurosonology Laboratory belongs to the clinical department of Neurology or Institution, which can provide instructive patients for teaching courses and recruit cases for research trials.

H. Adherence to the ERN Standards for Neurosonology Laboratories

I. Re-accreditation every 5 yrs.

J. Letter of recommendation from SP member

Perspective
The ERNSono may serve as a perfect starting point to establish a functional network connecting health care providers and centers of expertise of highly specialized healthcare, for the purpose of improving access to diagnosis and treatment, and offering high-quality healthcare for patients. The ERN will promote expertise and support health care providers in order to bring local, regional and national provision of healthcare closer to the patients.

It is the aim of ERNSono to include as many qualified centers in Europe as possible into the network.

*WON/ESNCH International Certification for Neurosonology or official certification granted by the national neurological societies (or their sections).