3. Heel/Toe Will Come in Handy
Using the "Heel/Toe" method to rock and tilt the angle of the transducer will help to line up the vessel to the correct Doppler angle. This is especially useful when there is "deep dive" of the vessel or when there is a tortuous curve. By using your hand to angle the transducer, you can maintain that 60 degree angle and ensure that each Doppler sample is angled correctly. 

4. It's All About the Angle
Remember your Doppler angle should be parallel to blood flow through the vessel (not the vessel wall). This is important when there is a stenosis, because often the flow direction will change due to the shape of the plaque. Also, it's important to remember that the SVU recommends keeping your Doppler angle between 45-60 degrees in order to maintain consistency in reporting velocities. It can be helpful if you are doing a follow up study for a patient with a known stenosis to check the prior ultrasound images (not just the report) and review the Doppler angle used previously and where the stenosis was sampled. This can help to reduce errors between sonographers and ensure that the velocities reported are consistent and only different if there is truly a reduction in vessel lumen since the previous exam. 

5. Attention to Detail
Sometimes those tortuous vessels and deep vessels can be difficult. Pay attention to your PRF/scale, your wall filter settings and your color box angle. This can help bring in flow in those difficult exams. Often steering your color box straight will help to pick up those deep diving vessels.