{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T20:50:21Z","timestamp":1772657421503,"version":"3.50.1"},"reference-count":82,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:00:00Z","timestamp":1756339200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:00:00Z","timestamp":1756339200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001343","name":"University of Pretoria","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001343","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Ultrasound"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Duplex carotid ultrasound is a non-invasive imaging test that is essential for assessing carotid artery disease, particularly in determining the presence and severity of atherosclerosis and the risk of cerebrovascular events. However, the interpretation of ultrasound results can differ widely due to variations in diagnostic criteria, lack of standardization in scanning methods, and differing approaches to evaluating carotid intimal medial thickness (CIMT), plaques, and stenosis. These inconsistencies create challenges in clinical practice and the reproducibility of results. While various protocols for CIMT, plaque measurement, and stenosis grading are available in the literature, a standardized global protocol is still lacking. This article presents a scoping review of current carotid duplex ultrasound scanning and reporting protocols. It aims to identify existing protocols and guidelines for carotid ultrasound scanning and reporting, highlight variations, and propose a standardized approach to enhance diagnostic accuracy and clinical outcomes in carotid atherosclerosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using predefined search protocols developed in collaboration with the specialized librarian from the University of Pretoria, we searched different databases and gray literature to identify existing protocols on carotid ultrasound including scanning technique, carotid intimal medial thickness, carotid plaques, and carotid stenosis grading. Due to limitations in the length of the review, and the existence of a large number of protocols, this review focused on the protocols developed and published by institutions and professional societies rather than individual articles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 2496 articles identified from databases and 22 from other sources, 17 articles met the criteria for this review. The most common criteria that was found following this review are those established by the Society of Radiologists in Ultrasound (SRU) in 2003. The researchers further noted that these criteria were, however, been criticized for relying heavily on peak systolic velocities, a measurement that, when used alone, can be misleading. Literature further demonstrated that other researchers and professional societies have called for consensus on unified criteria for the diagnosis of carotid atherosclerosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>While carotid ultrasound is an important, non-invasive, and widely available method for evaluating carotid atherosclerosis, the variations in scanning techniques, measurements, and cut-off values underscore the need for standardized diagnostic criteria. Standardization is essential to provide consistent patient care and ensure accurate examination in various clinical settings. This will lead to the reduction of stroke and cardiovascular incidence which are the leading causes of death worldwide and more prevalent in low-income countries.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s40477-025-01064-1","type":"journal-article","created":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T02:45:30Z","timestamp":1756349130000},"page":"783-801","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A comprehensive scoping review of existing carotid duplex ultrasound scanning and reporting protocols: identifying gaps and opportunities for standardization of practice in low-income countries"],"prefix":"10.1007","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3455-4346","authenticated-orcid":false,"given":"Theonille","family":"Mukabagorora","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda","family":"Mbonambi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zarina","family":"Lockhat","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amiable","family":"Musafiri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramadimetja Mable","family":"Kekana","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,8,28]]},"reference":[{"issue":"9","key":"1064_CR1","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1016\/j.mpmed.2020.06.002","volume":"48","author":"SJ Murphy","year":"2020","unstructured":"Murphy SJ, Werring DJ (2020) Stroke: causes and clinical features. Medicine (Abingdon) 48(9):561\u2013566. https:\/\/doi.org\/10.1016\/j.mpmed.2020.06.002","journal-title":"Medicine (Abingdon)"},{"issue":"17","key":"1064_CR2","doi-asserted-by":"publisher","DOI":"10.1161\/jaha.123.030739","volume":"12","author":"H Ihle-Hansen","year":"2023","unstructured":"Ihle-Hansen H, Vigen T, Berge T, Walle-Hansen MM, Hagberg G, Ihle-Hansen H et al (2023) Carotid plaque score for stroke and cardiovascular risk prediction in a middle-aged cohort from the general population. J Am Heart Assoc 12(17):e030739. https:\/\/doi.org\/10.1161\/jaha.123.030739","journal-title":"J Am Heart Assoc"},{"issue":"7","key":"1064_CR3","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD013172.pub2","volume":"7","author":"N Cassola","year":"2022","unstructured":"Cassola N, Baptista-Silva JC, Nakano LC, Flumignan CD, Sesso R, Vasconcelos V et al (2022) Duplex ultrasound for diagnosing symptomatic carotid stenosis in the extracranial segments. Cochrane Database Syst Rev 7(7):Cd013172. https:\/\/doi.org\/10.1002\/14651858.CD013172.pub2","journal-title":"Cochrane Database Syst Rev"},{"key":"1064_CR4","doi-asserted-by":"publisher","DOI":"10.3390\/life14010073","author":"L Saba","year":"2024","unstructured":"Saba L, Scicolone R, Johansson E, Nardi V, Lanzino G, Kakkos SK et al (2024) Quantifying carotid stenosis: history, current applications, limitations, and potential: how imaging is changing the scenario. Life. https:\/\/doi.org\/10.3390\/life14010073","journal-title":"Life"},{"issue":"7","key":"1064_CR5","doi-asserted-by":"publisher","first-page":"283","DOI":"10.2176\/jns-nmc.2022-0362","volume":"63","author":"M Uno","year":"2023","unstructured":"Uno M (2023) History of carotid artery reconstruction around the world and in Japan. Neurol Med Chir (Tokyo) 63(7):283\u2013294. https:\/\/doi.org\/10.2176\/jns-nmc.2022-0362","journal-title":"Neurol Med Chir (Tokyo)"},{"issue":"2","key":"1064_CR6","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1007\/s40477-016-0193-6","volume":"19","author":"C Mozzini","year":"2016","unstructured":"Mozzini C, Roscia G, Casadei A, Cominacini L (2016) Searching the perfect ultrasonic classification in assessing carotid artery stenosis: comparison and remarks upon the existing ultrasound criteria. J Ultrasound 19(2):83\u201390. https:\/\/doi.org\/10.1007\/s40477-016-0193-6","journal-title":"J Ultrasound"},{"issue":"3","key":"1064_CR7","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1177\/1358863X211002644","volume":"26","author":"RE Zierler","year":"2021","unstructured":"Zierler RE (2021) From Doppler to duplex: a personal early history of the vascular laboratory. Vasc Med 26(3):338\u2013345. https:\/\/doi.org\/10.1177\/1358863X211002644","journal-title":"Vasc Med"},{"issue":"9","key":"1064_CR8","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1002\/jcu.1870150906","volume":"15","author":"DC Taylor","year":"1987","unstructured":"Taylor DC, Strandness DE Jr. (1987) Carotid artery duplex scanning. J Clin Ultrasound 15(9):635\u2013644. https:\/\/doi.org\/10.1002\/jcu.1870150906","journal-title":"J Clin Ultrasound"},{"issue":"2","key":"1064_CR9","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1053\/j.semvascsurg.2014.01.003","volume":"26","author":"K Quirk","year":"2013","unstructured":"Quirk K, Bandyk DF (2013) Interpretation of carotid duplex testing. Semin Vasc Surg 26(2):72\u201385. https:\/\/doi.org\/10.1053\/j.semvascsurg.2014.01.003","journal-title":"Semin Vasc Surg"},{"issue":"5","key":"1064_CR10","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1177\/1358863x211011253","volume":"26","author":"HL Gornik","year":"2021","unstructured":"Gornik HL, Rundek T, Gardener H, Benenati JF, Dahiya N, Hamburg NM et al (2021) Optimization of duplex velocity criteria for diagnosis of internal carotid artery (ICA) stenosis: a report of the Intersocietal Accreditation Commission (IAC) vascular testing division carotid diagnostic criteria committee. Vasc Med 26(5):515\u2013525. https:\/\/doi.org\/10.1177\/1358863x211011253","journal-title":"Vasc Med"},{"issue":"7","key":"1064_CR11","doi-asserted-by":"publisher","first-page":"1423","DOI":"10.1002\/jum.16150","volume":"42","author":"JF Polak","year":"2023","unstructured":"Polak JF, Alexandrov AV (2023) Accuracy of the society of radiologists in ultrasound (SRU) carotid Doppler velocity criteria for grading North American symptomatic carotid endarterectomy trial (NASCET) stenosis: a meta-analysis. J Ultrasound Med 42(7):1423\u20131435. https:\/\/doi.org\/10.1002\/jum.16150","journal-title":"J Ultrasound Med"},{"issue":"2","key":"1064_CR12","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1007\/s00330-022-09024-7","volume":"33","author":"L Saba","year":"2023","unstructured":"Saba L, Loewe C, Weikert T, Williams MC, Galea N, Budde RPJ et al (2023) State-of-the-art CT and MR imaging and assessment of atherosclerotic carotid artery disease: standardization of scanning protocols and measurements-a consensus document by the European Society of Cardiovascular Radiology (ESCR). Eur Radiol 33(2):1063\u20131087. https:\/\/doi.org\/10.1007\/s00330-022-09024-7","journal-title":"Eur Radiol"},{"key":"1064_CR13","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/187872","volume":"2012","author":"KR Byrnes","year":"2012","unstructured":"Byrnes KR, Ross CB (2012) The current role of carotid duplex ultrasonography in the management of carotid atherosclerosis: foundations and advances. Int J Vasc Med 2012:187872. https:\/\/doi.org\/10.1155\/2012\/187872","journal-title":"Int J Vasc Med"},{"issue":"3","key":"1064_CR14","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1055\/s-0029-1245336","volume":"31","author":"C Arning","year":"2010","unstructured":"Arning C, Widder B, von Reutern GM, Stiegler H, G\u00f6rtler M (2010) Revision of DEGUM ultrasound criteria for grading internal carotid artery stenoses and transfer to NASCET measurement. Ultraschall Med 31(3):251\u2013257. https:\/\/doi.org\/10.1055\/s-0029-1245336","journal-title":"Ultraschall Med"},{"issue":"12","key":"1064_CR15","doi-asserted-by":"publisher","first-page":"946","DOI":"10.1161\/CIRCULATIONAHA.119.043963","volume":"141","author":"JA Columbo","year":"2020","unstructured":"Columbo JA, Zwolak RM, Arous EJ, Goodney PP, Lilly MP, Welch HG (2020) Variation in ultrasound diagnostic thresholds for carotid stenosis in the United States. Circulation 141(12):946\u2013953. https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.119.043963","journal-title":"Circulation"},{"issue":"2","key":"1064_CR16","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1016\/j.echo.2007.11.011","volume":"21","author":"JH Stein","year":"2008","unstructured":"Stein JH, Korcarz CE, Hurst RT, Lonn E, Kendall CB, Mohler ER et al (2008) Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American society of echocardiography carotid intima-media thickness task force. Endorsed by the society for vascular medicine. J Am Soc Echocardiogr 21(2):93\u2013111. https:\/\/doi.org\/10.1016\/j.echo.2007.11.011","journal-title":"J Am Soc Echocardiogr"},{"issue":"8","key":"1064_CR17","doi-asserted-by":"publisher","first-page":"917","DOI":"10.1016\/j.echo.2020.04.021","volume":"33","author":"AM Johri","year":"2020","unstructured":"Johri AM, Nambi V, Naqvi TZ, Feinstein SB, Kim ESH, Park MM et al (2020) Recommendations for the assessment of carotid arterial plaque by ultrasound for the characterization of atherosclerosis and evaluation of cardiovascular risk: from the American Society of Echocardiography. J Am Soc Echocardiogr 33(8):917\u2013933. https:\/\/doi.org\/10.1016\/j.echo.2020.04.021","journal-title":"J Am Soc Echocardiogr"},{"issue":"7","key":"1064_CR18","doi-asserted-by":"publisher","first-page":"467","DOI":"10.7326\/m18-0850","volume":"169","author":"AC Tricco","year":"2018","unstructured":"Tricco AC, Lillie E, Zarin W, O\u2019Brien KK, Colquhoun H, Levac D et al (2018) PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 169(7):467\u2013473. https:\/\/doi.org\/10.7326\/m18-0850","journal-title":"Ann Intern Med"},{"issue":"57","key":"1064_CR19","doi-asserted-by":"publisher","first-page":"179","DOI":"10.15557\/JoU.2014.0018","volume":"14","author":"M Elwertowski","year":"2014","unstructured":"Elwertowski M, Ma\u0142ek G (2014) Standards of the Polish ultrasound society \u2013 update. Examination of extracranial carotid and vertebral arteries. J Ultrason 14(57):179\u2013191. https:\/\/doi.org\/10.15557\/JoU.2014.0018","journal-title":"J Ultrason"},{"issue":"10","key":"1064_CR20","doi-asserted-by":"publisher","DOI":"10.36660\/abc.20230695","volume":"120","author":"ACL Albricker","year":"2023","unstructured":"Albricker ACL, Freire CMV, Santos SND, Alcantara ML, Cantisano AL, Porto CLL et al (2023) Recommendation update for vascular ultrasound evaluation of carotid and vertebral artery disease: DIC, CBR and SABCV - 2023. Arq Bras Cardiol 120(10):e20230695. https:\/\/doi.org\/10.36660\/abc.20230695","journal-title":"Arq Bras Cardiol"},{"key":"1064_CR21","unstructured":"Southwestern U. Ultrasound - Carotid Doppler complete evaluation. UT Southwestern Medical Center. UT Southwestern: UT Southwestern; 2022, 2024."},{"issue":"2","key":"1064_CR22","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1148\/radiol.2292030516","volume":"229","author":"EG Grant","year":"2003","unstructured":"Grant EG, Benson CB, Moneta GL, Alexandrov AV, Baker JD, Bluth EI et al (2003) Carotid artery stenosis: gray-scale and Doppler US diagnosis\u2013Society of Radiologists in Ultrasound consensus conference. Radiology 229(2):340\u2013346. https:\/\/doi.org\/10.1148\/radiol.2292030516","journal-title":"Radiology"},{"issue":"3","key":"1064_CR23","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1016\/j.ejvs.2008.10.015","volume":"37","author":"CP Oates","year":"2009","unstructured":"Oates CP, Naylor AR, Hartshorne T, Charles SM, Fail T, Humphries K et al (2009) Joint recommendations for reporting carotid ultrasound investigations in the United Kingdom. Eur J Vasc Endovasc Surg 37(3):251\u2013261. https:\/\/doi.org\/10.1016\/j.ejvs.2008.10.015","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"1064_CR24","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1186\/1476-7120-8-39","volume":"8","author":"KW Beach","year":"2010","unstructured":"Beach KW, Bergelin RO, Leotta DF, Primozich JF, Sevareid PM, Stutzman ET et al (2010) Standardized ultrasound evaluation of carotid stenosis for clinical trials: University of Washington Ultrasound Reading Center. Cardiovasc Ultrasound 8:39. https:\/\/doi.org\/10.1186\/1476-7120-8-39","journal-title":"Cardiovasc Ultrasound"},{"issue":"6","key":"1064_CR25","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1053\/ejvs.2002.1621","volume":"23","author":"T Jogestrand","year":"2002","unstructured":"Jogestrand T, Lindqvist M, Nowak J (2002) Diagnostic performance of duplex ultrasonography in the detection of high grade internal carotid artery stenosis. Eur J Vasc Endovasc Surg 23(6):510\u2013518. https:\/\/doi.org\/10.1053\/ejvs.2002.1621","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"1064_CR26","doi-asserted-by":"publisher","DOI":"10.1080\/03009734.2016.1201177","volume-title":"Simplified ultrasound protocol for the exclusion of clinically significant carotid artery stenosis","author":"D H\u00f6gberg","year":"2016","unstructured":"H\u00f6gberg D, Dellagrammaticas D, Kragsterman B, Bj\u00f6rck M, Wanhainen A (2016) Simplified ultrasound protocol for the exclusion of clinically significant carotid artery stenosis. Open Academia, Uppsala"},{"issue":"4","key":"1064_CR27","doi-asserted-by":"publisher","first-page":"1029","DOI":"10.1016\/j.jvs.2016.11.028","volume":"65","author":"JA Columbo","year":"2017","unstructured":"Columbo JA, Suckow BD, Griffin CL, Cronenwett JL, Goodney PP, Lukovits TG et al (2017) Carotid endarterectomy should not be based on consensus statement duplex velocity criteria. J Vasc Surg 65(4):1029\u201338.e1. https:\/\/doi.org\/10.1016\/j.jvs.2016.11.028","journal-title":"J Vasc Surg"},{"key":"1064_CR28","first-page":"183","volume-title":"Guidelines for noninvasive vascular laboratory testing: a report from the American society of echocardiography and the society for vascular medicine and biology","author":"M Gerhard-Herman","year":"2006","unstructured":"Gerhard-Herman M, Gardin JM, Jaff M, Mohler E, Roman M, Naqvi TZ (2006) Guidelines for noninvasive vascular laboratory testing: a report from the American society of echocardiography and the society for vascular medicine and biology. Sage Publications Ltd., London, pp 183\u2013211"},{"key":"1064_CR29","doi-asserted-by":"publisher","DOI":"10.36660\/abc.20230695","volume":"120","author":"ACL Albricker","year":"2023","unstructured":"Albricker ACL, Freire CMV, Santos SNd, Alcantara MLd, Cantisano AL, Porto CLL et al (2023) Recommendation update for vascular ultrasound evaluation of carotid and vertebral artery disease: DIC, CBR and SABCV\u20132023. Arq Bras Cardiol 120:e20230695","journal-title":"Arq Bras Cardiol"},{"key":"1064_CR30","unstructured":"Ultrasound(USA) Sfv. Professional performance guidelines, extracranial cerebrovascular duplex ultrasound evaluation (Updated 2019) (2019)"},{"issue":"4","key":"1064_CR31","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1159\/000343145","volume":"34","author":"PJ Touboul","year":"2012","unstructured":"Touboul PJ, Hennerici MG, Meairs S, Adams H, Amarenco P, Bornstein N et al (2012) Mannheim carotid intima-media thickness and plaque consensus (2004-2006-2011). An update on behalf of the advisory board of the 3rd, 4th and 5th watching the risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany, 2011. Cerebrovasc Dis 34(4):290\u2013296. https:\/\/doi.org\/10.1159\/000343145","journal-title":"Cerebrovasc Dis"},{"issue":"1","key":"1064_CR32","first-page":"62","volume":"17","author":"L Saba","year":"2024","unstructured":"Saba L, Cau R, Murgia A, Nicolaides AN, Wintermark M, Castillo M et al (2024) Carotid plaque-RADS: a novel stroke risk classification system. Cardiovascular Imaging 17(1):62\u201375","journal-title":"Cardiovascular Imaging"},{"issue":"19","key":"1064_CR33","doi-asserted-by":"publisher","first-page":"1270","DOI":"10.21037\/atm-20-1188a","volume":"8","author":"VJ Del Brutto","year":"2020","unstructured":"Del Brutto VJ, Gornik HL, Rundek T (2020) Why are we still debating criteria for carotid artery stenosis? Ann Transl Med 8(19):1270. https:\/\/doi.org\/10.21037\/atm-20-1188a","journal-title":"Ann Transl Med"},{"key":"1064_CR34","doi-asserted-by":"crossref","unstructured":"Froio A, Rossi L, Pasquadibisceglie S, Biasi GM (2013) Ultrasonic characterization of carotid plaques and its clinical implications. In: Noninvasive vascular diagnosis: a practical guide to therapy. 157\u201371.","DOI":"10.1007\/978-1-4471-4005-4_11"},{"issue":"4","key":"1064_CR35","doi-asserted-by":"publisher","first-page":"326","DOI":"10.1111\/cpf.12236","volume":"36","author":"T Jogestrand","year":"2016","unstructured":"Jogestrand T, Fred\u00e9n-Lindqvist J, Lindqvist M, Lundgren S, Tillman AS, Zachrisson H (2016) Discrepancies in recommended criteria for grading of carotid stenosis with ultrasound. Clin Physiol Funct Imaging 36(4):326\u2013329. https:\/\/doi.org\/10.1111\/cpf.12236","journal-title":"Clin Physiol Funct Imaging"},{"issue":"1","key":"1064_CR36","doi-asserted-by":"publisher","first-page":"11","DOI":"10.14366\/usg.13018","volume":"33","author":"W Lee","year":"2014","unstructured":"Lee W (2014) General principles of carotid Doppler ultrasonography. Ultrasonography 33(1):11\u201317. https:\/\/doi.org\/10.14366\/usg.13018","journal-title":"Ultrasonography"},{"issue":"4","key":"1064_CR37","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1053\/ejvs.2001.1331","volume":"21","author":"K Logason","year":"2001","unstructured":"Logason K, B\u00e4rlin T, Jonsson ML, Bostr\u00f6m A, H\u00e5rdemark HG, Karacagil S (2001) The importance of Doppler angle of insonation on differentiation between 50\u201369% and 70\u201399% carotid artery stenosis. Eur J Vasc Endovasc Surg 21(4):311\u2013313. https:\/\/doi.org\/10.1053\/ejvs.2001.1331","journal-title":"Eur J Vasc Endovasc Surg"},{"issue":"4","key":"1064_CR38","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1053\/ejvs.2001.1331","volume":"21","author":"K Logason","year":"2001","unstructured":"Logason K, B\u00e4rlin T, Jonsson M-L, Bostr\u00f6m A, H\u00e5rdemark H-G, Karacagil S (2001) The importance of Doppler angle of insonation on differentiation between 50\u201369% and 70\u201399% carotid artery stenosis. Eur J Vasc Endovasc Surg 21(4):311\u2013313","journal-title":"Eur J Vasc Endovasc Surg"},{"issue":"9","key":"1064_CR39","doi-asserted-by":"publisher","first-page":"1187","DOI":"10.7863\/jum.2006.25.9.1187","volume":"25","author":"M Tola","year":"2006","unstructured":"Tola M, Yurdakul M (2006) Effect of Doppler angle in diagnosis of internal carotid artery stenosis. J Ultrasound Med 25(9):1187\u20131192. https:\/\/doi.org\/10.7863\/jum.2006.25.9.1187","journal-title":"J Ultrasound Med"},{"key":"1064_CR40","doi-asserted-by":"publisher","DOI":"10.7863\/jum.2005.24.4.403","author":"KW Beach","year":"2005","unstructured":"Beach KW (2005) D. Eugene Strandness, Jr, MD, and the revolution in noninvasive vascular diagnosis part 2: progression of vascular disease. J Ultrasound Med. https:\/\/doi.org\/10.7863\/jum.2005.24.4.403","journal-title":"J Ultrasound Med"},{"issue":"2 Suppl","key":"1064_CR41","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1177\/2047487312448990","volume":"19","author":"PJ Touboul","year":"2012","unstructured":"Touboul PJ, Grobbee DE, den Ruijter H (2012) Assessment of subclinical atherosclerosis by carotid intima media thickness: technical issues. Eur J Prev Cardiol 19(2 Suppl):18\u201324. https:\/\/doi.org\/10.1177\/2047487312448990","journal-title":"Eur J Prev Cardiol"},{"key":"1064_CR42","unstructured":"The American College of Radiology. ACR\u2013AIUM\u2013SPR\u2013SRU Practice parameter for the performance of an ultrasound examination of the extracranialcerebrovascular system. 2021."},{"issue":"1","key":"1064_CR43","first-page":"115","volume":"22","author":"American Institute of Ultrasound in M","year":"2003","unstructured":"American Institute of Ultrasound in M, American College of R (2003) AIUM standard for the performance of ultrasound examination of the extracranial cerebrovascular system. J Ultrasound Med 22(1):115\u2013120","journal-title":"J Ultrasound Med"},{"issue":"1","key":"1064_CR44","doi-asserted-by":"publisher","first-page":"145","DOI":"10.7863\/jum.2012.31.1.145","volume":"31","author":"American Institute of Ultrasound in M","year":"2012","unstructured":"American Institute of Ultrasound in M, American College of R, Society of Radiologists in U (2012) AIUM practice guideline for the performance of an ultrasound examination of the extracranial cerebrovascular system. J Ultrasound Med 31(1):145\u2013154. https:\/\/doi.org\/10.7863\/jum.2012.31.1.145","journal-title":"J Ultrasound Med"},{"key":"1064_CR45","doi-asserted-by":"publisher","DOI":"10.1002\/jum.15877","author":"American Institute of Ultrasound in M","year":"2016","unstructured":"American Institute of Ultrasound in M (2016) AIUM Practice parameter for the performance of an ultrasound examination of the extracranial cerebrovascular system. J Ultrasound Med. https:\/\/doi.org\/10.1002\/jum.15877","journal-title":"J Ultrasound Med"},{"key":"1064_CR46","doi-asserted-by":"publisher","unstructured":"(2018) AIUM-ACR-SPR-SRU Practice Parameter for the Performance and Interpretation of a Diagnostic Ultrasound Examination of the Extracranial Head and Neck. J Ultrasound Med. 37(11):E6-E12. https:\/\/doi.org\/10.1002\/jum.14830","DOI":"10.1002\/jum.14830"},{"issue":"2","key":"1064_CR47","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1007\/s40119-022-00261-x","volume":"11","author":"V Fern\u00e1ndez-Alvarez","year":"2022","unstructured":"Fern\u00e1ndez-Alvarez V, Linares S\u00e1nchez M, L\u00f3pez Alvarez F, Su\u00e1rez Nieto C, M\u00e4kitie AA, Olsen KD et al (2022) Evaluation of intima-media thickness and arterial stiffness as early ultrasound biomarkers of carotid artery atherosclerosis. Cardiol Ther 11(2):231\u2013247","journal-title":"Cardiol Ther"},{"issue":"2","key":"1064_CR48","doi-asserted-by":"publisher","first-page":"282","DOI":"10.5551\/jat.61283","volume":"29","author":"M Zaid","year":"2022","unstructured":"Zaid M, Fujiyoshi A, Hisamatsu T, Kadota A, Kadowaki S, Satoh A et al (2022) A comparison of segment-specific and composite measures of carotid intima-media thickness and their relationships with coronary calcium. J Atheroscler Thromb 29(2):282\u2013295. https:\/\/doi.org\/10.5551\/jat.61283","journal-title":"J Atheroscler Thromb"},{"issue":"2","key":"1064_CR49","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1097\/CRD.0000000000000077","volume":"24","author":"M Carpenter","year":"2016","unstructured":"Carpenter M, Sinclair H, Kunadian V (2016) Carotid intima media thickness and its utility as a predictor of cardiovascular disease: a review of evidence. Cardiol Rev 24(2):70\u201375","journal-title":"Cardiol Rev"},{"issue":"9","key":"1064_CR50","doi-asserted-by":"publisher","first-page":"1089","DOI":"10.1161\/01.CIR.0000120708.59903.1B","volume":"109","author":"IM Van Der Meer","year":"2004","unstructured":"Van Der Meer IM, Bots ML, Hofman A, Iglesias del Sol A, Van der Kuip DA, Witteman JC (2004) Predictive value of noninvasive measures of atherosclerosis for incident myocardial infarction: the Rotterdam study. Circulation 109(9):1089\u20131094","journal-title":"Circulation"},{"issue":"3","key":"1064_CR51","doi-asserted-by":"publisher","first-page":"285","DOI":"10.21037\/qims.2016.05.03","volume":"6","author":"SS Yee Ho","year":"2016","unstructured":"Yee Ho SS (2016) Current status of carotid ultrasound in atherosclerosis. Quant Imaging Med Surg 6(3):285\u2013296","journal-title":"Quant Imaging Med Surg"},{"issue":"1","key":"1064_CR52","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1161\/01.STR.0000196964.24024.ea","volume":"37","author":"MW Lorenz","year":"2006","unstructured":"Lorenz MW, von Kegler S, Steinmetz H, Markus HS, Sitzer M (2006) Carotid intima-media thickening indicates a higher vascular risk across a wide age range: prospective data from the Carotid Atherosclerosis Progression Study (CAPS). Stroke 37(1):87\u201392. https:\/\/doi.org\/10.1161\/01.STR.0000196964.24024.ea","journal-title":"Stroke"},{"key":"1064_CR53","doi-asserted-by":"publisher","DOI":"10.1161\/circimaging.114.002262","author":"AD Gepner","year":"2015","unstructured":"Gepner AD, Young R, Delaney JA, Tattersall MC, Blaha MJ, Post WS et al (2015) Comparison of coronary artery calcium presence, carotid plaque presence, and carotid intima-media thickness for cardiovascular disease prediction in the multi-ethnic study of atherosclerosis. Circ Cardiovasc Imaging. https:\/\/doi.org\/10.1161\/circimaging.114.002262","journal-title":"Circ Cardiovasc Imaging"},{"issue":"1","key":"1064_CR54","doi-asserted-by":"publisher","first-page":"38","DOI":"10.5853\/jos.2013.15.1.38","volume":"15","author":"SA Peters","year":"2013","unstructured":"Peters SA, Bots ML (2013) Carotid intima-media thickness studies: study design and data analysis. J Stroke 15(1):38\u201348. https:\/\/doi.org\/10.5853\/jos.2013.15.1.38","journal-title":"J Stroke"},{"issue":"5","key":"1064_CR55","doi-asserted-by":"publisher","DOI":"10.1093\/ehjopen\/oead089","volume":"3","author":"L Seekircher","year":"2023","unstructured":"Seekircher L, Tschiderer L, Lind L, Safarova MS, Kavousi M, Ikram MA et al (2023) Intima-media thickness at the near or far wall of the common carotid artery in cardiovascular risk assessment. Eur Heart J Open 3(5):oead089. https:\/\/doi.org\/10.1093\/ehjopen\/oead089","journal-title":"Eur Heart J Open"},{"issue":"1","key":"1064_CR56","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1016\/j.atherosclerosis.2011.06.044","volume":"220","author":"Y Inaba","year":"2012","unstructured":"Inaba Y, Chen JA, Bergmann SR (2012) Carotid plaque, compared with carotid intima-media thickness, more accurately predicts coronary artery disease events: a meta-analysis. Atherosclerosis 220(1):128\u2013133. https:\/\/doi.org\/10.1016\/j.atherosclerosis.2011.06.044","journal-title":"Atherosclerosis"},{"issue":"8","key":"1064_CR57","doi-asserted-by":"publisher","first-page":"317","DOI":"10.4070\/kcj.2009.39.8.317","volume":"39","author":"TG Kwon","year":"2009","unstructured":"Kwon TG, Kim KW, Park HW, Jeong JH, Kim KY, Bae JH (2009) Prevalence and significance of carotid plaques in patients with coronary atherosclerosis. Korean Circ J 39(8):317\u2013321. https:\/\/doi.org\/10.4070\/kcj.2009.39.8.317","journal-title":"Korean Circ J"},{"issue":"9","key":"1064_CR58","doi-asserted-by":"publisher","first-page":"1042","DOI":"10.1093\/ehjci\/jex239","volume":"19","author":"H Sillesen","year":"2018","unstructured":"Sillesen H, Sartori S, Sandholt B, Baber U, Mehran R, Fuster V (2018) Carotid plaque thickness and carotid plaque burden predict future cardiovascular events in asymptomatic adult Americans. Eur Heart J-Cardiovasc Imaging 19(9):1042\u20131050","journal-title":"Eur Heart J-Cardiovasc Imaging"},{"issue":"4","key":"1064_CR59","doi-asserted-by":"publisher","first-page":"864","DOI":"10.1161\/01.STR.0000121161.61324.ab","volume":"35","author":"A Landry","year":"2004","unstructured":"Landry A, Spence JD, Fenster A (2004) Measurement of carotid plaque volume by 3-dimensional ultrasound. Stroke 35(4):864\u2013869. https:\/\/doi.org\/10.1161\/01.STR.0000121161.61324.ab","journal-title":"Stroke"},{"issue":"7","key":"1064_CR60","doi-asserted-by":"publisher","first-page":"466","DOI":"10.2459\/JCM.0000000000001314","volume":"23","author":"L Gargani","year":"2022","unstructured":"Gargani L, Baldini M, Berchiolli R, Bort IR, Casolo G, Chiappino D et al (2022) Detecting the vulnerable carotid plaque: the carotid artery multimodality imaging prognostic study design. J Cardiovasc Med 23(7):466\u2013473. https:\/\/doi.org\/10.2459\/JCM.0000000000001314","journal-title":"J Cardiovasc Med"},{"issue":"5","key":"1064_CR61","doi-asserted-by":"publisher","first-page":"10121","DOI":"10.3390\/ijms160510121","volume":"16","author":"E Picano","year":"2015","unstructured":"Picano E, Paterni M (2015) Ultrasound tissue characterization of vulnerable atherosclerotic plaque. Int J Mol Sci 16(5):10121\u201310133. https:\/\/doi.org\/10.3390\/ijms160510121","journal-title":"Int J Mol Sci"},{"issue":"4","key":"1064_CR62","doi-asserted-by":"publisher","DOI":"10.1161\/SVIN.122.000727","volume":"3","author":"JE Siegler","year":"2023","unstructured":"Siegler JE (2023) The attributable risk of nonstenotic cervical carotid plaque in cryptogenic embolic stroke. Stroke Vasc Interv Neurol 3(4):e000727. https:\/\/doi.org\/10.1161\/SVIN.122.000727","journal-title":"Stroke Vasc Interv Neurol"},{"key":"1064_CR63","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2021.706490","volume":"8","author":"H Li","year":"2021","unstructured":"Li H, Xu X, Luo B, Zhang Y (2021) The predictive value of carotid ultrasonography with cardiovascular risk factors\u2014a \u201cSPIDER\u201d promoting atherosclerosis. Front Cardiovasc Med 8:706490","journal-title":"Front Cardiovasc Med"},{"issue":"10","key":"1064_CR64","doi-asserted-by":"publisher","first-page":"1274","DOI":"10.1002\/bjs.1800801016","volume":"80","author":"G Geroulakos","year":"1993","unstructured":"Geroulakos G, Ramaswami G, Nicolaides A, James K, Labropoulos N, Belcaro G et al (1993) Characterization of symptomatic and asymptomatic carotid plaques using high-resolution real-time ultrasonography. Br J Surg 80(10):1274\u20131277. https:\/\/doi.org\/10.1002\/bjs.1800801016","journal-title":"Br J Surg"},{"issue":"9","key":"1064_CR65","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD001081.pub4","volume":"9","author":"A Rerkasem","year":"2020","unstructured":"Rerkasem A, Orrapin S, Howard DP, Rerkasem K (2020) Carotid endarterectomy for symptomatic carotid stenosis. Cochrane Database Syst Rev 9(9):Cd001081. https:\/\/doi.org\/10.1002\/14651858.CD001081.pub4","journal-title":"Cochrane Database Syst Rev"},{"key":"1064_CR66","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/3238165","volume":"2018","author":"ES Donkor","year":"2018","unstructured":"Donkor ES (2018) Stroke in the 21(st) century: a snapshot of the burden, epidemiology, and quality of life. Stroke Res Treat 2018:3238165. https:\/\/doi.org\/10.1155\/2018\/3238165","journal-title":"Stroke Res Treat"},{"key":"1064_CR67","doi-asserted-by":"publisher","DOI":"10.3390\/medicina56120711","author":"K Psychogios","year":"2020","unstructured":"Psychogios K, Magoufis G, Kargiotis O, Safouris A, Bakola E, Chondrogianni M et al (2020) Ultrasound assessment of extracranial carotids and vertebral arteries in acute cerebral ischemia. Medicina (Kaunas). https:\/\/doi.org\/10.3390\/medicina56120711","journal-title":"Medicina (Kaunas)"},{"issue":"3","key":"1064_CR68","doi-asserted-by":"publisher","first-page":"916","DOI":"10.1161\/strokeaha.111.636084","volume":"43","author":"GM von Reutern","year":"2012","unstructured":"von Reutern GM, Goertler MW, Bornstein NM, Del Sette M, Evans DH, Hetzel A et al (2012) Grading carotid stenosis using ultrasonic methods. Stroke 43(3):916\u2013921. https:\/\/doi.org\/10.1161\/strokeaha.111.636084","journal-title":"Stroke"},{"issue":"3","key":"1064_CR69","first-page":"299","volume":"48","author":"M Snow","year":"2007","unstructured":"Snow M, Ben-Sassi A, Winter RK, Verghese A, Hibberd R, Saad RA et al (2007) Can carotid ultrasound predict plaque histopathology? J Cardiovasc Surg (Torino) 48(3):299\u2013303","journal-title":"J Cardiovasc Surg (Torino)"},{"key":"1064_CR70","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0291450","author":"SR Sultan","year":"2023","unstructured":"Sultan SR, Khayat M, Almutairi B, Marzouq A, Albngali A, Abdeen R et al (2023) B-mode ultrasound characteristics of carotid plaques in symptomatic and asymptomatic patients with low-grade stenosis. PLoS ONE. https:\/\/doi.org\/10.1371\/journal.pone.0291450","journal-title":"PLoS ONE"},{"issue":"3\u20134","key":"1064_CR71","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1053\/j.semvascsurg.2020.05.003","volume":"33","author":"RE Zierler","year":"2020","unstructured":"Zierler RE (2020) Carotid duplex criteria: what have we learned in 40 years? Semin Vasc Surg 33(3\u20134):36\u201346. https:\/\/doi.org\/10.1053\/j.semvascsurg.2020.05.003","journal-title":"Semin Vasc Surg"},{"issue":"4","key":"1064_CR72","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1097\/00013644-200312000-00005","volume":"19","author":"EG Grant","year":"2003","unstructured":"Grant EG, Benson CB, Moneta GL, Alexandrov AV, Baker JD, Bluth EI et al (2003) Carotid artery stenosis: grayscale and Doppler ultrasound diagnosis\u2013Society of Radiologists in Ultrasound consensus conference. Ultrasound Q 19(4):190\u2013198. https:\/\/doi.org\/10.1097\/00013644-200312000-00005","journal-title":"Ultrasound Q"},{"issue":"1","key":"1064_CR73","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1007\/s13760-016-0676-4","volume":"117","author":"O Matz","year":"2017","unstructured":"Matz O, Nikoubashman O, Rajkumar P, Keuler A, Wiesmann M, Schulz JB et al (2017) Grading of proximal internal carotid artery (ICA) stenosis by Doppler\/duplex ultrasound (DUS) and computed tomographic angiography (CTA): correlation and interrater reliability in real-life practice. Acta Neurol Belg 117(1):183\u2013188. https:\/\/doi.org\/10.1007\/s13760-016-0676-4","journal-title":"Acta Neurol Belg"},{"key":"1064_CR74","doi-asserted-by":"publisher","DOI":"10.1002\/jum.16150","author":"J Polak","year":"2022","unstructured":"Polak J, Alexandrov A (2022) Accuracy of the society of radiologists in ultrasound ( SRU ) carotid doppler velocity criteria for grading north american symptomatic carotid endarterectomy trial \u201c NASCET \u201d stenosis: a meta-analysis. J Ultrasound Med. https:\/\/doi.org\/10.1002\/jum.16150","journal-title":"J Ultrasound Med"},{"issue":"1","key":"1064_CR75","first-page":"68","volume":"26","author":"GM Hathout","year":"2005","unstructured":"Hathout GM, Fink JR, El-Saden SM, Grant EG (2005) Sonographic NASCET index: a new doppler parameter for assessment of internal carotid artery stenosis. AJNR Am J Neuroradiol 26(1):68\u201375","journal-title":"AJNR Am J Neuroradiol"},{"issue":"4","key":"1064_CR76","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1055\/s-0034-1385070","volume":"36","author":"G Hathout","year":"2015","unstructured":"Hathout G, Nayak N, Abdulla A, Huang J (2015) The revised sonographic NASCET index: a new hemodynamic parameter for the assessment of internal carotid artery stenosis. Ultraschall Med 36(4):362\u2013368. https:\/\/doi.org\/10.1055\/s-0034-1385070","journal-title":"Ultraschall Med"},{"issue":"1","key":"1064_CR77","doi-asserted-by":"publisher","first-page":"41","DOI":"10.54522\/jvsgbi.2024.156","volume":"4","author":"S Trochowski","year":"2024","unstructured":"Trochowski S, Akhtar A, Bond K, Corby A, Hiscocks C, Howard D et al (2024) Current practice in ultrasound grading of carotid artery stenosis in the UK and Ireland. J Vasc Soc GB Irel 4(1):41\u201347. https:\/\/doi.org\/10.54522\/jvsgbi.2024.156","journal-title":"J Vasc Soc GB Irel"},{"issue":"9","key":"1064_CR78","doi-asserted-by":"publisher","first-page":"1937","DOI":"10.1002\/jum.15579","volume":"40","author":"KA Campbell","year":"2021","unstructured":"Campbell KA, Kupinski AM, Miele FR, Silva PF, Zierler RE (2021) Changes in internal Carotid Artery Doppler velocity measurements with different angles of insonation: a pilot study. J Ultrasound Med 40(9):1937\u20131948. https:\/\/doi.org\/10.1002\/jum.15579","journal-title":"J Ultrasound Med"},{"issue":"8","key":"1064_CR79","doi-asserted-by":"publisher","first-page":"865","DOI":"10.6061\/clinics\/2012(08)02","volume":"67","author":"JH Park","year":"2012","unstructured":"Park JH, Razuk A, Saad PF, Telles GJ, Karakhanian WK, Fioranelli A et al (2012) Carotid stenosis: what is the high-risk population? Clinics 67(8):865\u2013870. https:\/\/doi.org\/10.6061\/clinics\/2012(08)02","journal-title":"Clinics"},{"issue":"22","key":"1064_CR80","first-page":"1033","volume":"22","author":"A Simon","year":"1993","unstructured":"Simon A, Segond P, Giard AM, Demure B, Gitel R, Levenson J (1993) Early diagnosis of silent atherosclerosis and detection of cardiovascular risk factors. A new strategy for the approach of cardiovascular prevention. Presse Med 22(22):1033\u20131038","journal-title":"Presse Med"},{"key":"1064_CR81","unstructured":"(2021) Joyce DL (Ed) The invisible silent killer. Mayo Clin. Proc. Elsevier"},{"key":"1064_CR82","doi-asserted-by":"crossref","unstructured":"Shishehbor MH, Castro-Dominguez Y (2022) Peripheral artery disease: the new and old silent killer. American College of Cardiology Foundation Washington DC. p. 1236\u20138.","DOI":"10.1016\/j.jacc.2022.02.006"}],"container-title":["Journal of Ultrasound"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40477-025-01064-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s40477-025-01064-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40477-025-01064-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T13:35:49Z","timestamp":1764768949000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s40477-025-01064-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,28]]},"references-count":82,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["1064"],"URL":"https:\/\/doi.org\/10.1007\/s40477-025-01064-1","relation":{},"ISSN":["1876-7931"],"issn-type":[{"value":"1876-7931","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,28]]},"assertion":[{"value":"26 December 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 July 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 August 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Authors declare that there is no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The study has been approved by the University of Pretoria, Faculty of Health Sciences Research Ethics Committee (76\/2023). Consent to participate was not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent to participate"}},{"value":"Figure\u00a0\n                      \n                      consists of an ultrasound image sourced from the First Author\u2019s clinical archive, alongside illustrations created using OneNote free software.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Artwork and illustrations guidelines"}}]}}