1. Personnel and responsibilities
1.1. Responsible physician: A physician experienced in cerebrovascular disease has to be responsible for all diagnostic services provided by the neurosonology laboratory, both concerning the appropriateness and technical aspects of testing as well as the practical performance, documentation and correct interpretation.

1.1.1. Qualification of the responsible physician: The physician is specifically qualified according to the ERN criteria.

1.1.2 Continuous education: The responsible physician has to maintain his level of knowledge in the field of neurovascular ultrasound by participating to CME courses concerning vascular ultrasound or equivalent training courses.

1.2. The medical staff working in the neurovascular lab under the supervision of the responsible physician takes part in the practical examination, documentation and reporting but needs supervision by the responsible physician unless they have the same qualification.

1.3. The technical staff: The technical staff is not an essential requirement but in general it improves quality of service, as it can provide secretary work or take part in the examination. If it takes part in the examination of patients, the physician in charge is responsible for the correct application and reporting of the test. The technical staff must be certified by an established training program (nurse, medical or radiological assistant) or by a training of at least 12 month full-time in a certified neurosonology laboratory. The physician in charge is also responsible for the training of technical staff as well as for an adequate continuous education.

2. Standards of examination
2.1. The extracranial examination (CW-Doppler-sonography, (CW) Color Duplex-sonography) includes the following arteries always on both sides: common carotid artery (CCA) external carotid artery (ECA)internal carotid artery (ICA) vertebral artery (VA) subclavian artery (SC) branches of the ophthalmic artery (if appropriate) venous vessels (if appropriate) The ICA has to be examined close to the origin and followed distally as far as possible. The vertebral artery has to be examined at least in two segments, always as close as possible at the origin and in the V2 or V3 segment.

2.2. The intracranial examinations (transcranial Doppler sonography, transcranial duplex sonography) encompasses the ICA siphon, terminal ICA, M1 segment of the middle cerebral artery (MCA), A1 segment of the anterior cerebral artery (ACA), P1 and P2 segments of the posterior cerebral artery (PCA) through the transtemporal window; V3 and V4 segments of VA, proximal middle and distal segments of the basilar artery (BA) through the occipital approach . Other relevant procedures (e.g. PFO detection, MES detection, CO2 reactivity) can be included if appropriate.

3. Standards of documentation, reports and interpretation:
3.1. Format: Reports have to be given in a standard format. Identification of the technologist or physician performing the vascular examination must appear on the record. The final results and related report has to be signed by the responsible physician or another member of the medical staff with similar reporting experience as described for the responsible physician.

3.2. Content: The contents of the report must include: a. The clinical indication leading to the performance of the examinations b. A detailed description of the techniques used and the result of the examination of each examined artery or vein. c. The final conclusion (interpretation of results)

3.3. Documentation: Documentation in the report has to be provided for each examined arterial segment. If it is not possible to examine a specific segment, the most probable reason for that has to be indicated. In case of abnormal findings, results have to be quantified: blood flow velocity, the percentage of stenosis, etc. Pathologic findings should be visualized and documented in two planes if possible.

APPLICATION FORM