Pulsed Wave Doppler Measurements of Maximum Velocity: Dependence on Sample Volume Size

Pulsed wave (PW) Doppler ultrasound is routinely used in the clinic to assess blood flow. Our annual Doppler quality assurance tests revealed unexpectedly large errors in measurement of maximum velocity, exceeding our tolerance (error >20%), when using certain scanners with small Doppler sample volume dimensions. The aim of this study was to assess the dependence of maximum velocity estimates on PW Doppler sample volume size. A flow phantom with known steady flow was used to acquire maximum velocity estimates (maximum velocities of 24, 39 and 85 cm/s and sample volume range of 0.3-20 mm) with a variety of transducers and scanners in clinical use (51 probes from 4 manufacturers). Selected acoustic outputs were characterized using free-field hydrophone measurements. All maximum velocity estimates were within our tolerance for sample volume sizes ≥1.5 mm, although maximum velocity estimates typically increased with decreasing sample volume size. Errors exceeding our tolerance were commonly found for one manufacturer when using smaller sample volumes, resulting in up to 75% overestimation. Although intrinsic spectral broadening based on transit time considerations may help explain our findings, the sample volume dependence raises potential clinical concerns that users should be aware of and which manufacturers should consider addressing.