Ultrasound protocols to measure carotid intima-media thickness in trials; comparison of reproducibility, rate of progression, and effect of intervention in subjects with familial hypercholesterolemia and subjects with mixed dyslipidemia

Figures & data

Figure 1. Meijer's arc.

Table I. The 60 different ultrasound protocols constructed using the study data on segments, walls, and angles measured.

									Angles
				Walls		Segments			90	120	150	180
Segment	Wall	Angles	Approach	FW	NW	CCA	BIF	ICA	270	240	210	180
Mean common CIMT protocols
CCA	FW & NW	1 angle	01	+	+	+			+
			02	+	+	+				+
			03	+	+	+					+
			04	+	+	+						+
		2 angles	05	+	+	+			+	+
			06	+	+	+				+	+
			07	+	+	+					+	+
		3 angles	08	+	+	+			+	+	+
			09	+	+	+				+	+	+
		4 angles	10	+	+	+			+	+	+	+
	FW	1 angle	11	+		+			+
			12	+		+				+
			13	+		+					+
			14	+		+						+
		2 angles	15	+		+			+	+
			16	+		+				+	+
			17	+		+					+	+
		3 angles	18	+		+			+	+	+
			19	+		+				+	+	+
		4 angles	20	+		+			+	+	+	+
Mean maximum CIMT protocols
CCA & BIF	FW & NW	1 angle	21	+	+	+			+
			22	+	+	+				+
			23	+	+	+	+				+
			24	+	+	+	+					+
		2 angles	25	+	+	+	+		+	+
			26	+	+	+	+			+	+
			27	+	+	+	+				+	+
		3 angles	28	+	+	+	+		+	+	+
			29	+	+	+	+			+	+	+
		4 angles	30	+	+	+	+		+	+	+	+
	FW	1 angle	31	+		+	+		+
			32	+		+	+			+
			33	+		+	+				+
			34	+		+	+					+
		2 angles	35	+		+	+		+	+
			36	+		+	+			+	+
			37	+		+	+				+	+
		3 angles	38	+		+	+		+	+	+
			39	+		+	+			+	+	+
		4 angles	40	+		+	+		+	+	+	+
CCA & BIF & ICA	FW & NW	1 angle	41	+	+	+	+		+
			42	+	+	+	+			+
			43	+	+	+	+				+
			44	+	+	+	+					+
		2 angles	45	+	+	+	+	+	+	+
			46	+	+	+	+	+		+	+
			47	+	+	+	+	+			+	+
		3 angles	48	+	+	+	+	+	+	+	+
			49	+	+	+	+	+		+	+	+
		4 angles	50	+	+	+	+	+	+	+	+	+
	FW	1 angle	51	+		+	+	+	+
			52	+		+	+	+		+
			53	+		+	+	+			+
			54	+		+	+	+				+
		2 angles	55	+		+	+	+	+	+
			56	+		+	+	+		+	+
			57	+		+	+	+			+	+
		3 angles	58	+		+	+	+	+	+	+
			59	+		+	+	+		+	+	+
		4 angles	60	+		+	+	+	+	+	+	+

CIMT = carotid intima-media thickness; CCA=common carotid artery segment; BIF = bifurcation segment; ICA = internal carotid artery segment; NW = near wall; FW=far wall.

Table II. Base-line characteristics of the RADIANCE 1 and RADIANCE 2 study populations. Values presented as mean (standard deviation) or number (percentage).

	RADIANCE 1	RADIANCE 2
	n=872	n=752
Age (years)	45 (12.5)	57 (8.2)
Male, n (%)	431 (49.4)	482 (64)
Mean maximum CIMT (mm)	1.14 (0.30)	1.31 (0.31)
Mean common CIMT (mm)	0.72 (0.15)	0.83 (0.15)
Systolic blood pressure (mmHg)	116 (11)	120 (11)
Diastolic blood pressure (mmHg)	73 (7)	74 (7)
HDL cholesterol (mg/dL)	52 (13)	47 (11)
LDL cholesterol (mg/dL)	139 (37)	100 (20)
Triglycerides (mg/dL)	113 (64)	183 (80)
Waist circumference (cm)	89 (12)	100 (13)
BMI (kg/m^2)	26.7 (4.4)	30.1 (4.4)
Hypertension, n (%)^a	230 (26.4)	390 (52)

BMI = body mass index; CIMT = carotid intima-media thickness; HDL = high density lipoprotein; LDL = low density lipoprotein. ^aHypertension defined as: systolic blood pressure >130 mmHg or diastolic blood pressure >85 mmHg or use of blood pressure-lowering medication.

Table III. Reproducibility of CIMT measurements at base-line in the RADIANCE 1 study (n=748), estimated as intra-class correlation coefficients (ICC) and the mean difference in CIMT (mm) between duplicate scans. Protocols were ranked in an order of low to high reproducibility (increasing ICC and decreasing standard deviation of mean difference): the higher the rank, the better the protocol. Ranking ICC for all protocols (reported for CCA the top 4; for MeanMax the top 8, and for all the top 10). Please see Table I for precise information on the angles used in each protocol.

					Ranking ICC					Ranking SD
Segments	Walls	Angles	Approach	ICC	Mean common CIMT	Mean maximum CIMT	Overall	Mean	SD	Mean common CIMT	Mean maximum CIMT	Overall
CCA	FW & NW	1 angle	1	0.843				0.0032	0.0866			53
			2	0.868				0.0058	0.0852			54
			3	0.864				0.0000	0.0874			52
			4	0.811				0.0029	0.1000
		2 angles	5	0.891				0.0075	0.0805	18		58
			6	0.904	18		58	0.0020	0.0777	20		60
			7	0.884				0.0014	0.0849			55
		3 angles	8	0.908	20		60	0.0048	0.0784	19		59
			9	0.904	17		57	0.0026	0.0808	17		57
		4 angles	10	0.906	19		59	0.0041	0.0814			56
	FW	1 angle	11	0.803				0.0016	0.1162
			12	0.830				0.0058	0.1094
			13	0.846				−0.0004	0.1043
			14	0.809				0.0033	0.1129
		2 angles	15	0.856				0.0070	0.1061
			16	0.879				0.0023	0.0984
			17	0.871				−0.0007	0.0993
		3 angles	18	0.886				0.0036	0.0985
			19	0.886				0.0007	0.0983
		4 angles	20	0.891				0.0016	0.0979			51
CCA & BIF	FW & NW	1 angle	21	0.839				0.0023	0.1476
			22	0.863				−0.0061	0.1391
			23	0.869				−0.0025	0.1323
			24	0.844				0.0023	0.1363
		2 angles	25	0.880				0.0000	0.1425
			26	0.890				−0.0081	0.1354
			27	0.886				−0.0034	0.1314
		3 angles	28	0.893				−0.0032	0.1425
			29	0.896		34		−0.0074	0.1368
		4 angles	30	0.899		36	52	−0.0032	0.1427
	FW	1 angle	31	0.774				−0.0022	0.2051
			32	0.815				−0.0058	0.1932
			33	0.846				−0.0073	0.1790
			34	0.817				0.0008	0.1858
		2 angles	35	0.836				−0.0023	0.1963
			36	0.869				−0.0116	0.1778
			37	0.868				−0.0115	0.1760
		3 angles	38	0.868				−0.0059	0.1871
			39	0.870				−0.0140	0.1859
		4 angles	40	0.876				−0.0086	0.1883
CCA & BIF & ICA	FW & NW	1 angle	41	0.864				0.0006	0.1295		33
			42	0.883				−0.0104	0.1239		39
			43	0.879				0.0010	0.1215		40
			44	0.851				0.0037	0.1286		36
		2 angles	45	0.893		33		−0.0045	0.1290		35
			46	0.900		37	53	−0.0081	0.1246		38
			47	0.888				0.0004	0.1253		37
		3 angles	48	0.898		35	51	−0.0040	0.1342
			49	0.902		40	56	−0.0071	0.1293		34
		4 angles	50	0.901		38	54	−0.0042	0.1373
	FW	1 angle	51	0.902		39	55	−0.0056	0.1721
			52	0.844				−0.0111	0.1696
			53	0.861				−0.0024	0.1593
			54	0.812				0.0025	0.1777
		2 angles	55	0.865				−0.0097	0.1697
			56	0.881				−0.0134	0.1616
			57	0.871				−0.0054	0.1661
		3 angles	58	0.882				−0.0105	0.1691
			59	0.884				−0.0130	0.1699
		4 angles	60	0.890				−0.0109	0.1723

CIMT = carotid intima-media thickness; CCA=common carotid artery segment; BIF = bifurcation segment; ICA = internal carotid artery segment; NW = near wall; FW=far wall; ICC = intra-class correlation coefficient; mean = mean difference; SD = standard deviation.

Table IV. Left side: Annual rate of progression of CIMT (mm), its precision (standard errors), absolute ratio of progression/precision and ranking of the ratio for all 60 ultrasound protocols in the RADIANCE 1 study for the atorvastatin only group (n=364). Right side: Effect of treatment on CIMT rate of progression over time in RADIANCE 1 (n=748). Regression coefficients represent the increase in CIMT per year due to treatment with torcetrapib. Protocols were ranked in an order from low to high: the higher the rank, the better the protocol. Ranking reported for CCA the top 4; for MeanMax the top 8, and for all the top 10. Please see Table I for precise information on the angles used in each protocol.

			Progression rates						Treatment effects
						Ranking ratio						Ranking ratio
Segments; Walls	Angles	Approach	Progression	SE	Ratio	Mean common CIMT	Mean Max CIMT	Overall	Regression coefficient	SE	Ratio	Mean common CIMT	Mean Max CIMT	Overall
CCA; FW & NW	1 angle	1	0.00029	0.00066	0.44				0.00107	0.00089	1.21
		2	−0.00056	0.00054	1.05				0.00196	0.00078	2.50
		3	−0.00220	0.00063	3.52	18		58	0.00320	0.00091	3.52	17		57
		4	−0.00302	0.00081	3.73	20		60	0.00315	0.00104	3.02			51
	2 angles	5	−0.00040	0.00059	0.67				0.00156	0.00081	1.93
		6	−0.00172	0.00055	3.15			56	0.00310	0.00083	3.74	19		59
		7	−0.00259	0.00071	3.65	19		59	0.00366	0.00094	3.91	20		60
	3 angles	8	−0.00145	0.00061	2.36				0.00252	0.00086	2.92
		9	−0.00210	0.00065	3.25	17		57	0.00334	0.00089	3.73	18		58
	4 angles	10	−0.00167	0.00067	2.48				0.00281	0.00091	2.73
CCA; FW	1 angle	11	−0.00092	0.00085	1.09				0.00087	0.00116	0.75
		12	−0.00069	0.00074	0.93				0.00192	0.00104	1.86
		13	−0.00220	0.00081	2.71			54	0.00374	0.00112	3.35			56
		14	−0.00193	0.00087	2.21				0.00180	0.00116	1.55
	2 angles	15	−0.00150	0.00073	2.07				0.00207	0.00100	2.07
		16	−0.00186	0.00072	2.60			52	0.00328	0.00102	3.23			55
		17	−0.00212	0.00079	2.68			53	0.00342	0.00108	3.16			54
	3 angles	18	−0.00215	0.00074	2.90			55	0.00313	0.00102	3.07			52
		19	−0.00188	0.00075	2.52				0.00307	0.00104	2.96
	4 angles	20	−0.00197	0.00078	2.53			51	0.00287	0.00105	3.09			53
CCA & BIF; FW&NW	1 angle	21	0.00133	0.00115	1.16		36		0.00305	0.00155	1.97		36
		22	0.00045	0.00096	0.47				0.00043	0.00129	0.34
		23	−0.00036	0.00091	0.40				0.00343	0.00131	2.63		40
		24	−0.00018	0.00113	0.16				0.00208	0.00150	1.39
	2 angles	25	0.00069	0.00105	0.65				0.00159	0.00140	1.14
		26	−0.00037	0.00092	0.40				0.00265	0.00129	2.06		37
		27	−0.00020	0.00097	0.20				0.00328	0.00140	2.35		39
	3 angles	28	0.00020	0.00098	0.20				0.00270	0.00138	1.96		35
		29	−0.00017	0.00097	0.18				0.00208	0.00136	1.53		34
	4 angles	30	0.00037	0.00102	0.36				0.00207	0.00142	1.46		33
CCA & BIF; FW	1 angle	31	−0.00022	0.00157	0.14				0.00213	0.00209	1.02
		32	0.00022	0.00130	0.17				−0.00098	0.00174	0.56
		33	−0.00084	0.00133	0.63				0.00400	0.00186	2.15		38
		34	0.00196	0.00162	1.21		38		−0.00048	0.00214	0.22
	2 angles	35	−0.00052	0.00136	0.38				0.00046	0.00182	0.25
		36	−0.00101	0.00127	0.80				0.00243	0.00174	1.40
		37	0.00031	0.00136	0.23				0.00248	0.00196	1.27
	3 angles	38	−0.00099	0.00132	0.75				0.00233	0.00178	1.31
		39	−0.00008	0.00133	0.06				0.00082	0.00186	0.44
	4 angles	40	−0.00012	0.00139	0.09				0.00074	0.00188	0.39
CCA & BIF & ICA; FW & NW	1 angle	41	0.00163	0.00108	1.50		40		0.00173	0.00144	1.20
		42	0.00035	0.00086	0.41				−0.00022	0.00117	0.19
		43	0.00090	0.00089	1.01		34		0.00141	0.00126	1.12
		44	0.00006	0.00110	0.06				0.00124	0.00140	0.88
	2 angles	45	0.00109	0.00098	1.11		35		0.00055	0.00130	0.42
		46	0.00049	0.00090	0.54				0.00077	0.00124	0.62
		47	0.00054	0.00092	0.59				0.00171	0.00131	1.30
	3 angles	48	0.00126	0.00096	1.31		39		0.00095	0.00131	0.72
		49	0.00053	0.00093	0.57				0.00058	0.00129	0.45
	4 angles	50	0.00119	0.00099	1.19		37		0.00058	0.00136	0.43
CCA & BIF & ICA; FW	1 angle	51	0.00043	0.00140	0.31				0.00126	0.00189	0.67
		52	−0.00030	0.00111	0.27				−0.00133	0.00154	0.86
		53	0.00032	0.00116	0.28				0.00200	0.00167	1.20
		54	0.00134	0.00149	0.90		33		−0.00012	0.00192	0.06
	2 angles	55	−0.00042	0.00116	0.36				−0.00006	0.00162	0.03
		56	−0.00040	0.00113	0.35				0.00057	0.00157	0.37
		57	0.00026	0.00122	0.21				0.00178	0.00180	0.99
	3 angles	58	−0.00012	0.00116	0.10				0.00094	0.00161	0.59
		59	−0.00023	0.00120	0.19				0.00014	0.00171	0.08
	4 angles	60	−0.00010	0.00122	0.08				0.00043	0.00173	0.25

CIMT=carotid intima-media thickness; CCA=common carotid artery segment; BIF=bifurcation segment; ICA=internal carotid artery segment; SE=standard error; PP ratio=progression/precision ratio, calculated as progression/SE. Protocols were ranked in an order of lowest to highest absolute value of progression/SE ratio. Regression coefficient of CIMT represents the amount of increase in CIMT per year due to treatment with torcetrapib; treatment/precision ratio calculated as absolute value of beta divided by the SE; the regression model used: ‘Progression Rate=a+beta (treatment)’.

Table V. Reproducibility of CIMT measurements at base-line in the RADIANCE 2 study (n=521), estimated as intra-class correlation coefficients (ICC) and the mean difference in CIMT (mm) between duplicate scans and ranking for all protocols. Protocols were ranked in an order of low to high reproducibility (increasing ICC and decreasing standard deviation of mean difference): the higher the rank, the better the protocol. Ranking ICC for all protocols reported for CCA the top 4; for MeanMax the top 8 and for all the top 10. Please see Table I for precise information on the angles used in each protocol.

					Ranking ICC					Ranking SD
Segment	Wall	Angles	Approach	ICC	Mean common CIMT	Mean maximum CIMT	Overall	Mean	SD	Mean common CIMT	Mean maximum CIMT	Overall
CCA	FW & NW	1 angle	1	0.771				−0.0051	0.1114			53
			2	0.805				0.0000	0.1032			55
			3	0.743				−0.0009	0.1243
			4	0.705				−0.0020	0.1295
		2 angles	5	0.836				0.0007	0.0974	20		60
			6	0.834				−0.0019	0.0987	19		59
			7	0.797				0.0010	0.1107			54
		3 angles	8	0.843	19		56	−0.0009	0.0988	18		58
			9	0.830				0.0003	0.1029			56
		4 angles	10	0.847	20		58	0.0004	0.1000	17		57
	FW	1 angle	11	0.720				−0.0100	0.1504
			12	0.757				−0.0056	0.1365
			13	0.782				−0.0049	0.1269
			14	0.678				−0.0074	0.1572
		2 angles	15	0.821				−0.0012	0.1209
			16	0.827				−0.0066	0.1163			51
			17	0.780				−0.0041	0.1330
		3 angles	18	0.841	18		52	−0.0042	0.1159			52
			19	0.828			51	−0.0061	0.1209
		4 angles	20	0.841	17			−0.0040	0.1197
CCA & BIF	FW & NW	1 angle	21	0.773				−0.0050	0.1909
			22	0.775				0.0152	0.1803
			23	0.749				0.0013	0.1880
			24	0.732				0.0030	0.1854
		2 angles	25	0.811				0.0098	0.1809
			26	0.821		32		0.0115	0.1728
			27	0.809				0.0041	0.1706		34
		3 angles	28	0.842		36	54	0.0067	0.1738
			29	0.842		35	53	0.0095	0.1706		33
		4 angles	30	0.861		40	60	0.0057	0.1696		35
	FW	1 angle	31	0.684				−0.0074	0.2556
			32	0.717				0.0200	0.2374
			33	0.695				0.0047	0.2561
			34	0.721				0.0073	0.2420
		2 angles	35	0.743				0.0150	0.2451
			36	0.769				0.0150	0.2315
			37	0.773				0.0154	0.2319
		3 angles	38	0.785				0.0134	0.2346
			39	0.814				0.0181	0.2211
		4 angles	40	0.814				0.0162	0.2280
CCA & BIF & ICA	FW & NW	1 angle	41	0.798				−0.0053	0.1743
			42	0.773				0.0116	0.1738
			43	0.772				0.0024	0.1694		36
			44	0.760				−0.0013	0.1709
		2 angles	45	0.812				0.0100	0.1769
			46	0.816				0.0098	0.1686		38
			47	0.821				0.0061	0.1584		40
		3 angles	48	0.845		38	57	0.0093	0.1692		37
			49	0.843		37	55	0.0106	0.1643		39
		4 angles	50	0.855		39	59	0.0116	0.1708
	FW	1 angle	51	0.712				−0.0121	0.2328
			52	0.732				0.0113	0.2196
			53	0.753				−0.0006	0.2175
			54	0.745				0.0073	0.2202
		2 angles	55	0.768				0.0114	0.2227
			56	0.783				0.0102	0.2163
			57	0.803				0.0128	0.2076
		3 angles	58	0.808				0.0096	0.2149
			59	0.827		33		0.0183	0.2049
		4 angles	60	0.833		34		0.0174	0.2112

CIMT = carotid intima-media thickness; CCA = common carotid artery segment; BIF = bifurcation segment; ICA=internal carotid artery segment; NW = near wall, FW=far wall; ICC = intra-class correlation coefficient; mean = mean difference; SD = standard deviation.

Table VI. Left side: Annual rate of progression of CIMT (mm), its precision (standard errors), absolute ratio of progression/precision and ranking of the ratio for all 60 ultrasound protocols in the RADIANCE 2 study for the atorvastatin only group (n = 268). Right side: Effect of treatment on CIMT rate of progression over time in RADIANCE 2 (n = 521). Regression coefficients represent the increase in CIMT per year due to treatment with torcetrapib. Protocols were ranked in an order from low to high: the higher the rank, the better the protocol. Please see Table I for precise information on the angles used in each protocol. Ranking for all protocols (for CCA top 4; for MeanMax top 8 and for all the top 10).

			Progression rates						Treatment effects
						Ranking ratio						Ranking ratio
Segments; Walls	Angles	Approach	Progression	SE	Ratio	Mean common CIMT	Mean maximum CIMT	Overall	Regression coefficient	SE	Ratio	Mean common CIMT	Mean maximum CIMT	Overall
CCA; FW & NW	1 angle	1	0.00289	0.00099	2.91				0.00199	0.00151	1.32
		2	0.00225	0.00136	4.75				0.00019	0.00132	0.14			55
		3	0.00405	0.00085	2.43				0.00156	0.00137	1.14
		4	0.00521	0.00116	0.84				0.00327	0.00152	2.14	19		54
	2 angles	5	0.00247	0.00102	5.44	19		58	0.00014	0.00131	0.11			59
		6	0.00440	0.00100	5.17	17		55	0.00098	0.00122	0.8
		7	0.00084	0.00101	3.47				0.00190	0.00134	1.41	18
	3 angles	8	0.00158	0.00119	5.61	20		60	0.00111	0.00126	0.88			57
		9	0.00474	0.00087	4.72				0.00098	0.00129	0.76			51
	4 angles	10	0.00472	0.00115	4.44				0.00071	0.00133	0.53
CCA; FW	1 angle	11	0.00429	0.00083	1.65				0.00274	0.00197	1.39	17
		12	0.00539	0.00101	4.51				−0.00088	0.00169	0.52			56
		13	0.00326	0.00094	4.39				−0.00101	0.00149	0.68
		14	0.00455	0.00108	1.33				0.00400	0.00185	2.16	20
	2 angles	15	0.00481	0.00086	4.09				0.00037	0.00164	0.22			60
		16	0.00529	0.00107	5.35	18		57	−0.00065	0.00144	0.45
		17	0.00414	0.00088	4.21				0.00089	0.00157	0.56
	3 angles	18	0.00480	0.00111	4.93			51	0.00002	0.00154	0.01
		19	0.00471	0.00092	4.34				0.00040	0.00152	0.26
	4 angles	20	0.00505	0.00114	5.13			54	0.00046	0.00160	0.29
CCA & BIF; FW&NW	1 angle	21	0.00456	0.00180	2.54				0.00283	0.00279	1.02		39	53
		22	0.00551	0.00226	3.73				0.00023	0.00229	0.10
		23	0.00560	0.00150	2.43				0.00154	0.00227	0.68
		24	0.00713	0.00206	2.26				0.00232	0.00248	0.94		38	52
	2 angles	25	0.00411	0.00169	4.27				0.00108	0.00241	0.45
		26	0.00515	0.00223	4.18				0.00025	0.00222	0.11
		27	0.00398	0.00176	3.74				0.00185	0.00240	0.77
	3 angles	28	0.00424	0.00229	4.51				0.00063	0.00234	0.27
		29	0.00675	0.00158	4.40				0.00033	0.00241	0.14
	4 angles	30	0.00745	0.00218	4.62				0.00027	0.00252	0.11
CCA & BIF; FW	1 angle	31	0.00627	0.00150	2.44				0.00303	0.00362	0.84		36
		32	0.00769	0.00203	3.47				−0.00027	0.00313	0.09
		33	0.00620	0.00166	2.30				0.00048	0.00306	0.16
		34	0.00650	0.00221	1.85				0.00486	0.00333	1.46		40	58
		35	0.00697	0.00155	3.42				0.00083	0.00318	0.26
	2 angles	36	0.00780	0.00216	3.78				−0.00178	0.00297	0.60
		37	0.00703	0.00160	2.93				0.00265	0.00323	0.82		35
		38	0.00763	0.00214	3.62				−0.00092	0.00303	0.30
	3 angles	39	0.00766	0.00166	3.57				−0.00014	0.00316	0.05
	4 angles	40	0.00796	0.00223	3.57				0.00006	0.00318	0.02
		41	0.00462	0.00171	2.70				0.00143	0.00253	0.57
		42	0.00625	0.00218	3.32				0.00172	0.00217	0.80		34
	1 angles	43	0.00463	0.00139	3.29				−0.00071	0.00211	0.34
		44	0.00631	0.00188	2.81				0.00031	0.00227	0.14
CCA & BIF & ICA; FW & NW		45	0.00509	0.00155	4.14				0.00101	0.00236	0.43
	2 angles	46	0.00707	0.00205	4.80		35		−0.00100	0.00210	0.48
		47	0.00470	0.00167	4.69		33		−0.00052	0.00218	0.24
	3 angles	48	0.00594	0.00213	4.88		36		−0.00098	0.00228	0.43
		49	0.00645	0.00156	5.44		40	59	−0.00144	0.00226	0.63
	4 angles	50	0.00838	0.00212	5.29		39	56	−0.00132	0.00242	0.54
		51	0.00667	0.00139	2.87				0.00144	0.00315	0.46
	1 angle	52	0.00874	0.00185	3.36				0.00218	0.00289	0.75
		53	0.00727	0.00155	3.44				−0.00217	0.00281	0.77		33
CCA & BIF & ICA; FW		54	0.00870	0.00210	2.79				0.00218	0.00300	0.73
		55	0.00737	0.00151	3.95				0.00103	0.00301	0.34
	2 angles	56	0.00949	0.00205	4.73		34		−0.00231	0.00275	0.84		37
		57	0.00829	0.00152	4.14				−0.00025	0.00300	0.09
		58	0.00978	0.00197	4.63				−0.00222	0.00291	0.76
	3 angles	59	0.00858	0.00162	4.95		38	53	−0.00113	0.00298	0.38
	4 angles	60	0.01057	0.00214	4.94		37	52	−0.00154	0.00311	0.50

Table VII. Overall ranking of the ultrasound protocols based on summation of the transformed rank scores (mean common CIMT and mean maximum CIMT into quintile scores; overall rank scores into sixtile scores) for the RADIANCE 1 and RADIANCE 2 study. Ranking for all protocols (for CCA top 4; for MeanMax top 8, and for all the top 10).

				RADIANCE 1			RADIANCE 2
Segments	Walls	Angles	Approach	Mean common CIMT	Mean maximum CIMT	Overall	Mean common CIMT	Mean maximum CIMT	Overall
CCA	FW & NW	1 angle	1
			2						21
			3	15
			4
			5				15		23
		2 angles	6	19		24	18
			7	17		22
			8	15		22	19		24
		3 angles	9	20		24	15		22
		4 angles	10			23	16		21
	FW	1 angle	11
			12
			13
			15						20
		2 angles	16			21
			17
			18						22
		3 angles	19
		4 angles	20			22
CCA & BIF	FW & NW	1 angle	21
			22
			23
			24
			25
		2 angles	26		16
			27					16
			28
		3 angles	29		16
		4 angles	30		16
	FW	1 angle	31
			33
			34
			35
		2 angles	36
			37
			38
		3 angles	39
		4 angles	40
CCA & BIF & ICA	FW & NW	1 angle	41		16
			42
			43		16
			44
			45		17
		2 angles	46		17			17
			47		17			16
			48		17			18
		3 angles	49		16			19	20
		4 angles	50		16			17	20
	FW	1 angle	51
			52
			53
			54
			55
		2 angles	56
			57
		3 angles	59					16
		4 angles	60					16

CIMT = carotid intima-media thickness; CCA=common carotid artery segment; BIF = bifurcation segment; ICA = internal carotid artery segment; NW = near wall, FW = far wall.