International Certification

International Certification for Neurosonology

The project of an International Certification for Neurosonology was launched by the officers and the executive committee of the NSRG during the 2005 meeting in Osaka Japan. Later the European Society of Neurosonology and Cerebral Hemodynamics, ESNCH, joined this initiative. The aim is to improve the quality worldwide. The certificate should indicate a high level of theoretical knowledge of the candidate and sufficient practical skill to be able to teach Neurosonology. In countries with established quality control and elaborated regulations outstanding personal qualification can be used to support accreditation on a national level. The following experts were nominated members of the international commission:

E. Bartels M. Jauss E.B. Ringelstein M. Matsumoto
M. Kaps L. Csiba G.-M. von Reutern K. Niederkorn
N.V. Ramani C. Baracchini C. Tegeler D. Ratanakorn
Uwe Walter      

The Chairman of the project is Prof. Dr. Michael von Reutern, Germany, the Commission Vice Chair is Prof. Dr. Eva Bartels, Germany. They first discussed the format of the certification. The problem is that practical involvement and responsibilities for ultrasonic examinations are not the same in different regions of the world. The decision was made to offer first a Multiple Choice (MC)-examination and those who pass will than take an additional practical exam with patients or subjects. Members of the commission were asked the help to build up a database of MC-questions. Suitable questions were selected from the submitted ones and formatted. A trial examination to test the appropriateness and format was done during the ESNCH meeting in Düsseldorf, May 2006. The final format was decided afterwards and published.

The first official Certification was offered during the ESNCH/NSRG meeting in Budapest 2007 (L. Csiba and L. Olah), followed by the meeting of the ESNCH in Geneve Italy 2008 (M. del Sette) and Riga 2009 (G. Baltgaile). In addition a certification was offered at the end of the International course in Bertinoro, Italy (C. Baracchini et al.) during the 1st International Neurosonology Training Course in 2008. Dr. Ramani organized a test in Singapore and together with Dr. Navarro a second one in Kuala Lumpur in 2009. A further exam took place in Budapest in March 2010. The last examination for International Certification for Neurosonology took place in Madrid during the 15th Meeting of the ESNCH, 22-25 May 2010.

Between 20% and 45% of candidates successfully passed the MC-test, all of them passed the following practical test. This selection is due to the teaching level of questions including physics and instrumentation. It has also to be recognized that English terminology was an additional handicap for non-native speakers, which is the majority of candidates. In this issue the complete list of successfully participating and awarded physicians is published. Technicians were accepted to take part at the MC-test receiving a special certificate. Some ranged among the best.

It is planned of offer this Certification under the umbrella of the WFN at further NSRG and ESNCH meetings e.g. the NSRG meeting in Cairns Australia as well during advanced courses of Neurosonology. Efforts are needed to brush up and enlarge the database of questions, which will not be an easy task. Any submitted questions (4 answers, one correct) are welcome.

G.-Michael von Reutern, MD
Chairman of Commission

Eva Bartels, MD
Commission Vice Chair

Commission for International Certification in Neurosonology

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 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. Practical examination (“hands on”)

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 cannot be both a member of the commission and the local 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 is 75 % correct answers (30 of 40 questions)

4. Practical 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:

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)

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. G.-M. von Reutern
Prof. Dr. Eva Bartels