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The Importance of Getting Your Ultrasounds Standing Up

The Importance of Getting Your Ultrasounds Standing Up

Posted on April 28, 2021 by Dr. Stephen Rivard

Duplex Ultrasonography is the essential tools for evaluating patients with varicose vein disease. While there are other evaluation techniques, ultrasound is the preferred method of examining venous physiology and anatomy. Moreover, Doppler ultrasound is also used to assess the effectiveness of minimally invasive varicose vein treatments.

Accurate detection of complications in the superficial and deep veins requires correct patient positioning during evaluation. Traditionally, venous ultrasound exams have been performed when the patient is lying down however, when diagnosing for venous disease the standing position is the most appropriate. Here are a few reasons why you should get your ultrasounds standing up.

  1. Get an Accurate Venous Diagnosis

    Ultrasound equipment plays a significant role in the process of varicose vein examination and diagnosis. The equipment works by producing painless and harmless sound waves that help the vein specialist understand your vein problem.

    Diagnostic vein ultrasounds that are meant to identify the presence of blood clots in the deep veins are to be done with the patient lying down. However, this when performing an ultrasound to detect venous insufficiency, the appropriate evaluation position is standing.  When the tests are done in the standing position, gravity helps pull the blood into the legs. In normal veins, squeezing the muscles in the calf will push the blood upwards, and when released, the ultrasound won't show backflow as long as the valves are working perfectly. On the other hand, leaky valves permit backflows when pressure is applied to the calf.

  2. Medical Studies Support the Standing Position

    According to The American Vein and Lymphatic Society, all ultrasound scans for varicose veins should be conducted while the patient is standing. Unless the patient has some physical constraints making standing up unfeasible, the standing position tends to produce better scan results.

    Several studies on reverse Trendelenburg /supine/lying down position versus standing position shows that duplex scans for venous abnormalities are best in an upright position. In fact, the researchers concluded that supine positions might lead to false negative or false positive readings. 95% of those ultrasounds returned false positive findings. At least 15% of patients that showed negative results for venous reflux when examined in the supine position showed positive venous reflux when examined in the standing position. This means that evaluating patients in the standing position can change the clinical course of otherwise a previous false-negative diagnosis.

    The standing position provides a more detailed view of the pathophysiology of reflux in problematic veins in the patient's lower extremities. It achieves this by facilitating a more comprehensive study.


Patient positioning can significantly alter venous hemodynamics and influence the results of ultrasound tests. Getting an accurate diagnosis is essential for quick relief for your varicose veins issues. Performing the Doppler ultrasonography examination in the standing position gives the vein specialist a better understanding of your veins, unlike the supine position where false negatives or positives are likely.

If you have the signs and symptoms of varicose veins, but the previous ultrasound was done while lying down, it's time you get evaluated in the correct position. At Illinois Veins Specialists, we understand the importance of accurate venous assessment and diagnosis. Our vein experts can help you get the proper varicose vein treatment in Barrington.

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Tagged Initial Consultation for Varicose Veins, ultrasound guided sclerotherapy, signs of vein disease, Varicose veins disease, ultrasound-guided endovenous laser therapy, varicose vein