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Neurosonology in Croatia

Carotid and vertebral artery ultrasound, as well as transcranial Doppler ultrasound in neurosonology, has a long tradition in Croatia for diagnostic purposes. The first neurosonology laboratory was founded in Zagreb in the mid seventies, when continous-wave Doppler was used for analysis of the carotid bifurcation. The first transcranial Doppler, for the evaluation of the intracranial circulation, was introduced in the same laboratory in 1987. This was in parallel with the carotid Duplex evaluation. Two years later, color Doppler imaging was introduced. Nowadays, the same Center in Zagreb is the referral center for neurovascular disorders of the Croatian Ministry of Health. For more than ten years, this center has been the educational center for neurosonology evaluation, with the tradition of educational courses being given at least once a The National medical social security covers almost the whole population in Croatia. This government insurance pays for patients with cerebrovascular disorders who are admitted to hospitals, and neurosonology investigations are performed. While mostly neurologists are performing carotid and vertebral color Doppler imaging, only neurologists do Transcranial Doppler. In each neurology clinic or department, a trained neurologist is selected to perform both the extracranial and intracranial neurosonology evaluations. In intensive care units anesthesiologists or infectious disease specialist sometimes performs transcranial Doppler. In some clinics, carotid and vertebral color radiologists do Doppler examinations. Transcranial color Doppler in children is performed by neuropedestrians. Due to the restricted access to magnetic resonance imaging and angiography, the most common diagnostic tests preformed are ultrasound examination. Only a minority of patients with carotid stenosis suitable for endarterectomy undergoes intraarterial digital subtraction angiography prior to the surgical procedure. Decisions for regarding endarterectomy are made at a multidisciplinary meeting of neurologist, vascular surgeon, radiologist, and cardiologist, where the video of carotid color Doppler imaging is reviewed. The neurosonology investigation in asymptomatic patients with stroke risk factors can be performed as an outpatient service. The national medical social security covers the cost of the investigation. The price for carotid and vertebral color Doppler flow imaging is 67 Euro and for transcranial Doppler 33 Euros. Ultrasound contrast enhancing agents are not used. The existing rules for the accreditation of neurosonology laboratories concern the certification of the adherence of the machine to the international safety standard, and training and experience of the doctors according to the internationational EFSUMB standards. Despite its large use, neurosonology is not a subject of teaching in medical schools, and is only a part of specialty training. Therefore, The Neurology Clinic University "Sestre milosrdnice", as the head of The Society of the Neurovascular Disorders, and a Referral Center for Neurovascular Disorders Croatian Ministry of Health, is organizing at least once a year. The training in neurosonology, is divided in two parts. The first part is training in extracranial ultrasound evaluation, and the second in intracranial evaluation. It consists of lectures, seminars, demonstration videos and hand-on training with experienced neurosonologist. After the training, the candidate performs 300 independent examinations of the extracranial circulation and 100 examinations of the intracranial circulation all 400 with the documentation. He is now eligible to take the certification examination. The examination consists of a practical part, with the discussion of the findings, and a theoretical part. After passing the examination, the candidate may apply for a neurosonology license at Medical Assembly. The license is renewed every six years. There are two main scientific societies devoted to ultrasound in Croatia: Croatian Society for Ultrasound in Medicine and Biology, and Croatian Neurosonology Society. Croatian Society for Ultrasound in Medicine and Biology is the host of the l6th Eurosonology Congress 6-9 June 2004 in Zagreb. A session devoted to neurosonology will be included.

neurosonology

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