ICAVL Application - Michigan Vascular Association

ICAVL Application
Suzanne Dowers, BS, RVT
Laboratory Supervisor
DMC Harper Hospital
16 March 2011

Preparing Your Application
How To Prepare
Case Studies and Send a Submission
IAC Agreement
Attachments
Helpful Resources
Sample Documents
CME Resources
Links & References & Webcasts
IAC Newsletter

How to Prepare - Case Studies
Case study submissions are required in order to assess the
interpretative and technical quality of the laboratory. All of
the details of the vascular anatomy should be visualized
adequately.
Please note:
All cases must be selected from within the past 12 months
from the date of application filing.
Remember to submit the entire application, including case
studies, in duplicate.
Case study requirements have been grouped into the
following categories:
EXTRACRANIAL CEREBROVASCULAR,
INTRACRANIAL CEREBROVASCULAR,
PERIPHERAL ARTERIAL,
PERIPHERAL VENOUS,
VISCERAL VASCULAR and SCREENING

How to Send a Submission
Please note: Laboratories are required to send printed or
electronic final reports.
Submit all images utilized in the interpretation of a study by a physician.
Use sample cases from as many medical and technical staff members that
interpret or perform the vascular examinations in the laboratory as
possible.
Two reviewers evaluate every application; therefore it is
imperative that all case study materials submitted to the ICAVL
be sent in duplicate.
If you are unable to submit digital images, high quality black-and-white and
color copies of processed images may be submitted on paper.
Cases are to be performed with current personnel on current equipment.
Labeling Your Submission
Label all cases (an adhesive label affixed to each page is
recommended), including any disks or hard copies, with:
Laboratory name/ID number/site location
Patient name
Date of study
Type of study

How to Prepare – IAC Agreement
A completed IAC Accreditation Agreement
(current published version is 7/2010) in order
to receive an accreditation decision.
Download the IAC Agreement
To download the IAC Agreement and get complete
instructions, visit the Legal>Agreement section of the IAC
website»
Download the IAC Policies and Procedures
To download the IAC Policies and Procedures and get
complete instructions, visit the Legal>Policies & Procedures
section of the IAC website»

How to Prepare - Attachments
Applicant laboratories are required to upload and
submit all attachments electronically.
Case study materials [i.e., reports, hard copy and CDs]
must still be shipped to the ICAVL office, in duplicate.
Uploading of electronic or scanned documents Is an
easy process.
Upon being prompted within the application questionnaire
for a specific document, the user clicks “browse," selects
the appropriate document from their computer or
memory/storage device and then clicks “open.
The document is uploaded to the correct location within
the application and then saved once the user navigates
away from that page by clicking the “previous,” “next” or
“end” button at the bottom of the screen.
Only the file types in the box listed to the right may be
used when uploading attachments to the application
questions.
The file size for each document must be less that 4 MB.
This includes .zip/compressed files.
ACCEPTABLE
FILE
FORMATS
.txt
.doc
.docx
.rtf
.tiff
.gif
.jpg
.jpeg
.png
.pdf
.xls
.xlsx

Useful Resources
The on line tool section
is full of resources to
help you through the
ICAVL accreditation
process, including:
Sample documents
Links & references
CME resources
On Demand webcasts
IAC Newsletter
VERY USEFUL
Sample Forms:
• Blank QA Log
• Venous QA Log
• Instructions for a QA Log

QA Log Instructions
No.
1
Ident
ificati
on 2
Side 3
Vascular
lab study
4
Vascular
lab date 5
Correl
ative
study 6
Correl
ative
study
date 7
Vascul
ar lab
finding
s 8
Correlativ
e study
findings 9
Match
by
locatio
n 10
Match
by
severit
y 11
Diagnostic
criteria
correct in
report 12
1
2
No. 1 : Each correlation gets its own line. See standards for the number of correlations needed for each type
of examination.
Identification 2 : Each patient should be identified. Examples: medical record number, laboratory examination
number.
Side 3 : Bilateral examinations should generally be two correlations (one line for each side) as long as the
correlative study is also performed bilaterally. If the correlation study is performed on one side only, one
correlation is recorded (for example, bilateral carotid ultrasound but a unilateral contrast angiogram is one
correlation). Some examinations do not have a side (for example, hepatoportal examination).
Vascular lab study 4 : Name of the vascular lab study.
Vascular lab date 5 : Date of the vascular lab study.
Correlative study 6 : Type of correlative study. Only one correlative study is used even if several different
correlative tests have been performed. Contrast arteriography/venography is used if it is available. CT or MR
is used next, followed by surgical correlation, followed by other correlations. See specific standards for
acceptable correlative studies.

Laboratory Name: Harper Vascular lab
Correlation for: VENOUS STUDIES
#
Patient
Identifi
cation
Side
QA Log – Vascular
Vascular
Lab Study Study Date Study
Quality Assurance Log
Correl.Study
Date
Vascular Lab
Findings
Correlative
Study Findings
Match by
Location
Match by
Severity
Diagnostic
Criteria
Correct in
1 P.H. LT Ven dup 3/10/2010 Venogram 4/28/2010 DVT, CFV, FV, POP V DVT FV & POP V Yes Yes Yes
2 C.J. RT Ven dup 9/14/2010 Venogram 9/16/2010 DVT, CFV, FV, POP V DVT FV extensive Yes Yes Yes
3 R.B. RT Ven dup 6/18/2010 Venogram 6/20/2010 DVT, CFV DVT CFV Yes Yes Yes
4 S.S. RT Ven dup 1/30/2010 Venogram 2/2/2010
DVT, CFV, FV, POP V,
PTV, PER V DVT CFV, FV Yes Yes Yes
5 S.S. LT Ven dup 1/30/2010 Venogram 2/2/2010 DVT CFV, FV DVT CFV, FV Yes Yes Yes
6 B.J. RT Ven dup 2/19/2010 Venogram 2/25/2010 DVT EIV, CFV, FV Diploid IVC filter Yes Yes Yes
7 B.J. LT Ven dup 2/19/2010 Venogram 2/25/2010 DVT CFV, FV, POP V Diploid IVC Yes Yes Yes
8 R.B. RT Ven dup 7/7/2010 Venogram 9/13/2010 DVT FV, CFV DVT CFV Yes Yes Yes
9 R.B. LT Ven dup 7/7/2010 Venogram 9/13/2010 DVT CFV DVT CFV Yes Yes Yes
10 R.A. LT Ven dup 1/4/2010 Venogram 1/5/2010 No DVT No DVT Yes Yes Yes
11 H.H. LT Ven dup 3/19/2010 Venogram 4/14/2010 DVT EIV, CFV EIV Yes Yes Yes
12 T.C. LT Ven dup 3/16/2010 Venogram 6/16/2010 Insuff. (fem) EIV OCC Yes Yes Yes
13 D.R. RT Ven dup 7/29/2010 Venogram 8/20/2010 Insuff. Insuff. Yes Yes Yes
14 S.S LT Ven dup 3/30/2010 Venogram 4/2/2010 DVT FV, POP V LT DVT CIV Yes Yes Yes
15 L.S. LT Ven dup 8/31/2010 Venogram 8/31/2010 DVT, PTV, PER PE Yes Yes Yes
16 J.W. RT Ven dup 8/28/2009 Venogram 8/29/2009 DVT CFV DVT CFV Yes Yes Yes
17 C.D. RT Ven dup 1/21/2010 Venogram 2/23/2010 Venous stasis Venous stasis Yes Yes Yes
18 H.H LT Ven dup 5/3/2010 Venogram 5/4/2010 DVT, PE DVT, PE Yes Yes Yes
19 S.R RT Ven dup 2/2/2010 Venogram 3/25/2010 Chronic Chronic Yes Yes Yes
20 S.R. LT Ven dup 2/2/2010 Venogram 3/25/2010 Insuff. Insuff. Yes Yes Yes
21 F.S RT Ven dup 10/10/2009 Venogram 8/26/2010 Insuff. Insuff. Yes Yes Yes
22 A.F. RT Ven dup 1/23/2008 Venogram 1/24/2008 DVT, CFV, FV, POP V DVT CFV & FV Yes Yes Yes
23 S.M. RT Ven dup 7/14/2010 Operative 8/26/2010 2.6 sec Ablation (R GSV) Yes Yes Yes
24 T.J. RT Ven dup 5/14/2010 Operative 6/30/2010 2.9 sec Ablation (R GSV) Yes Yes Yes
25 L.M. RT Ven dup 5/13/2010 Operative 7/14/2010 1.6 sec Ablation (R GSV) Yes Yes Yes
26 M.P. RT Ven dup 5/24/2010 Operative 6/30/2010 DVT CFV, 3.3 FV, sec POP V, PTV Ablation (R GSV) Yes Yes Yes
27 J.J RT Ven dup 5/6/2010 Venogram 6/7/2010
& PERV RT DVT CFV Yes Yes Yes
28 W.D. RT Ven dup 5/11/2010 Venogram 5/16/2010 DVT CFV RT CFV Yes Yes Yes
29 M.D. LT Ven dup 9/22/2010 Venogram 9/27/2010 DVT ILIOFEM ILIOFEM Yes Yes Yes
30 G.T. RT Ven dup 7/19/2010 Operative 7/27/2010 DVT CFV, FV, POP V, PTV, Diploid IVC filter Yes Yes Yes
% Agreement*= 100%

CME Resources
As outlined in the ICAVL Standards, part of the criteria
for achieving ICAVL accreditation is the fulfillment of
certain continuing education requirements by
laboratory staff members.
As a service to vascular professionals looking for
noninvasive vascular-related CME, the ICAVL
maintains the following list of resources for continuing
education. The courses contained herein typically
provide 5 or more of these relevant credits.
UPCOMING CME COURSES
RECURRING COURSES & SELF-STUDY
STUDY
ONLINE CME
WORK RELATED MUSCULOSKELETAL DISORDERS
(MSD) CME

Related Links and Webcast
ICAEL: Echocardiography Laboratory
Accreditation
The Intersocietal Commission for the
Accreditation of Echocardiography
Laboratories
ICANL: Nuclear Medicine, Nuclear
Cardiology and PET Accreditation
The Intersocietal Commission for the
Accreditation of Nuclear Medicine
Laboratories
ICAMRL: Magnetic Resonance
Laboratory Accreditation
The Intersocietal Commission for the
Accreditation of Magnetic Resonance
Laboratories
ICACTL: Computed Tomography
Laboratory Accreditation
The Intersocietal Commission for the
Accreditation of Computed Tomography
Laboratories
ICACSF: Carotid Stenting Facility
Accreditation
The Intersocietal Commission for the
Accreditation of Carotid Stenting
Facilities
http://www.intersocietal.org/icavl/
seeking/on_demand.htm

IAC Newsletter
The Autumn 2010 Issue of the IAC Newsletter is
available on line.
The IAC Newsletter is now online in 2010! If your laboratory has
enjoyed the printed newsletter in the past, the IAC is excited to
announce the delivery of our publication directly to your e-mail.
Now in an online format, the IAC Newsletter continues to reach out
to imaging laboratories with information about IAC accreditation
that will enhance the operations and level of patient care provided,
with direct applicability to the accreditation process.
Every issue of the IAC Newsletter brings you important
accreditation news pertaining to the IAC as a whole, as well as
news sections specific to each division which include the latest
program updates, policy changes and other pertinent information.
View the Autumn 2010 Issue of the IAC Newsletter»
http://www.intersocietal.org/icavl/main/newsletter.htm

Sample of a Protocol
------------------------ 4.1.4D
------------------------- HOSPITAL
I. SUBJECT: Peripheral Arterial Disease Modality Discrepancies
II. EFFECTIVE Date: 4/08, Reviewed 4/10
III. SIGNATURE: ______________________________________
IV. POLICY: Method for resolution of multiple testing modalities or
discrepancy in the interpretation of peripheral arterial disease.
V. PROCEDURES:
1. Comparison of vascular lab findings with same and/or other modality
and correlate.
2. Upon discrepancy, vascular study reviewed by technical staff and
vascular surgeon.
3. When available, gold standard comparison considered arteriography.
Although CTA and MRA also maybe used based upon specific conditions.
4. Correlation is made with patient history and symptoms, and determine
appropriate education of technologists and interpreting physicians,
and/or corrective action regarding technique and/or protocol when
indicated.

The hardest is step is …