cca peak systolic velocity normal range

The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) comparing CAS with CEA demonstrated a similar reduction in stroke between the two procedures in symptomatic and asymptomatic patients. The flow divider is also the location of the carotid body and the adjacent nerve complex of the carotid sinus. Up to 30% of all major hemispheric events (stroke, transient ischemic attacks [TIA], or amaurosis fugax) are thought to originate from disease at the carotid bifurcation. Peak systolic ICA velocities as high as 120 cm/sec have been reported in some normal adults, but these values are exceptional, and an ICA velocity exceeding 100 cm/sec should be viewed as potentially abnormal in older individuals. . during systole), red blood cells exhibit their greatest magnitude of Doppler shift. What does Enterococcus faecalis look like? Within the range of values available in . Accessibility [PSV = peak systolic velocity;EDV = end-diastolic velocity; ICA = internal carotid artery; CCA = common carotid artery], ICA PSV is <125 cm/sec and no plaque or intimal thickening is visible sonographically, additional criteria include ICA/CCA PSV ratio <2.0 and ICA EDV <40 cm/sec, ICA PSV is <125 cm/sec and plaque or intimal thickening is visible sonographically, ICA PSV is 125-230 cm/sec and plaque is visible sonographically, additional criteria include ICA/CCA PSV ratio of 2.0-4.0 and ICA EDV of 40-100 cm/sec, 70% ICA stenosis but less than near occlusion, ICA PSV is >230 cm/sec and visible plaque and luminal narrowing are seen at gray-scale and color Doppler ultrasound (the higher the Doppler parameters lie above the threshold of 230 cm/sec, the greater the likelihood of severe disease), additional criteria include ICA/CCA PSV ratio >4 and ICA EDV >100 cm/sec, velocity parameters may not apply, since velocities may be high, low, or undetectable, diagnosis is established primarily by demonstrating a markedly narrowed lumen at color or power Doppler ultrasound, no detectable patent lumen at gray-scale ultrasound and no flow with spectral, power, and color Doppler ultrasound, there may be compensatory increased velocity in the contralateral carotid. They were divided into 3 age groups: group I, <40 years; group II, 40-60 years; group III, >60 years. The CCA shares the appearance of both waveforms. Explanation When traveling with their greatest velocity in a vessel (i.e. Peak systolic ICA velocities as high as 120 cm/s can be seen in normal individuals, but these values are uncommon, and an ICA velocity exceeding 100 cm/s should be viewed as potentially abnormal except if the patient is younger than 30 years of age. Also, in patients with unilateral dampened waveforms, it implied contralateral severe proximal stenosis. The SRU consensus panel concluded that elevated PSV in the ICA and the presence of flow-limiting plaque are the primary parameters determining the severity of ICA stenosis. Claudication is pain in the legs or arms that comes on with walking or using the arms. Examples of a classification of carotid kinks12 is shown in Figure 7-7. Federal government websites often end in .gov or .mil. The ultrasound examination is the first line imaging study for patients undergoing evaluation for carotid stenosis. What is normal peak systolic velocity? Values up to 150 cm/sec can be seen without a significant lesion being present (Figure 7-8). Comments 3090D553-9492-4563-8681-AD288FA52ACE In this setting, a significant reduction in post-stenotic flow velocity is termed trickle flow 5. Bypassing the carotid to the subclavian or to the axillary artery are both good treatment modalities. For 70% ICA stenosis or greater, but less than near occlusion: An internal to common carotid PSV ratio 4.0. Elevated velocities can be seen in normal carotid arteries that diverge from a straight line and become curved. eCollection 2021. Di Pino L, Franchina AG, Costa S, Gangi S, Strano F, Ragusa M, Costanzo L, Tamburino C, Capodanno D. Int J Cardiovasc Imaging. Shaalan WE, Wahlgren CM, Desai T, Piano G, Skelly C, Bassiouny HS. Symptomatic subclavian artery occlusive disease should be treated with endovascular stenting and angioplasty as first line management. (2016) Journal of ultrasound. Usually the widening is slight, but some normal individuals have capacious carotid bulbs that may harbor large plaques in the absence of significant carotid stenosis. This blends into the also echogenic periadventitial region. Other studies, both here and abroad, confirmed the benefit of CEA and validated the role of this procedure. The Doppler spectrum sampled at this site is shown at the bottom of the image and demonstrates the complex flow pattern with some red cells moving forward and others backward. On a Doppler waveform, the EDV corresponds to the point marked at the end of the cardiac cycle (just prior to the systolic peak) 1. Background: We aimed to determine the optimal peak systolic velocity (PSV) thresholds for predicting 50%, 60%, 70%, and 80% internal carotid artery (ICA) stenosis. The ICA/CCA PSV ratio was calculated by dividing the PSV of the ICA, which was selected for analysis by the PSV of the CCA. Specific cut-points based on the arteriographic correlative studies need to use the NASCET/ACAS measurement approach ( Fig. Error bars show one standard deviation about mean. In stenosis, a localized reduction in vascular radius increases resistance, causing increased PSV and EDV distal to the stenosed site 3,4. The SRU consensus conference provided reasonable values that can be easily applied ( Table 7.1 ) and have been adopted by a large number of laboratories. [PSV = peak systolic velocity; EDV = end-diastolic velocity; ICA = internal carotid artery; CCA = common carotid artery] normal. . No external carotid artery stenosis is demonstrated. Stenoses of the external carotid artery (ECA) are not considered clinically important but should be reported because they may explain the presence of a bruit on clinical examination and need to be considered by the surgeon at the time of carotid endarterectomy (CEA). National Library of Medicine CCA) What is normal CCA PSV? Reversed end diastolic flow in the middle cerebral artery (MCA-REDF) is thought to occur due to increased intra-cerebral pressures. At the aortic valve, peak velocities of up to 500 cm/sec may be possible. The current management of carotid atherosclerotic disease: who, when and how?. The spectral Doppler system utilizes Fourier analysis and the Doppler equation to convert this shift into an equivalently large velocity, which appears in the velocity tracing as a peak2. The mean peak systolic velocity in the ECA is reported as being 77 cm/sec in normal individuals, and the maximum velocity does not normally exceed 115 cm/sec. CCA = common carotid artery. . The normal (triphasic) Doppler velocity waveform is made up of three components which correspond to different phases of arterial flow: rapid antegrade flow reaching a peak during systole, transient reversal of flow during early diastole, and slow antegrade flow during late diastole. CCA = common carotid artery. revisited an interesting approach to ICA ratio measurements where the ratio of the highest PSV at the site of the stenosis was compared with the normalized velocity in the distal ICA. Background and Purpose Carotid ultrasound had modest accuracy in the North American Symptomatic Carotid Endarterectomy Trial (NASCET) of carotid endarterectomy in predicting severe carotid stenosis when a 250-cm/s peak systolic velocity (PSV) criterion was applied to different laboratories. AJNR Am J Neuroradiol. Ultrasound assessment of carotid arterial atherosclerotic disease. This is caused by too little blood flow to your legs or arms. The time average of the velocity of a fluid at a fixed point, over a somewhat arbitrary time interval T counted from some fixed time t0. Fats, cholesterol and other substances (plaque) can build up in and on your kidney artery walls (atherosclerosis). For every 50-millisecond increase in acceleration time in the CCA, odds of a >50% stenosis increased by 56%. It should be noted that the ECST continued to rely on the conventional method of stenosis measurement, and, although both the original NASCET and ECST confirmed the effectiveness of CEA, their methods of measuring ICA stenosis were quite different. 8600 Rockville Pike The ECA has a higher resistance pattern because it supplies the soft tissues of the face and neck. High flow velocity causes Reynolds number to increase beyond a critical point, resulting in turbulent flow which manifests as spectral broadeningon Doppler ultrasound 3. Please refer to the article on extracranial carotid artery stenosisfor a general discussion involving carotid stenosis and other image modalities involved on it. On a Doppler waveform, the peak systolic velocity corresponds to each tall peak in the spectrum window 1. There should be a slight increase in amplitude between low thigh and calf. This longitudinal image of the common carotid artery demonstrates a sharp line (specular reflection) that emanates from the intimal surface. The current parameters used to grade the severity of ICA stenosis are based on the Society of Radiologists in Ultrasound (SRU) Consensus Statement in 2003. I love to write and share science related Stuff Here on my Website. All three layers can be visualized on ultrasound images (Figure 7-1). Since the ultrasound transducer typically measures 4 cm, it can be used to help locate this point by placing one end at the level of the bulb and sampling at the mid transducer, or approximately 2 cm below the beginning of the bulb. Plaque with strong echolucent elements is generally termed heterogeneous plaque, which is considered unstable and more prone to embolize. In addition, when statins were started on asymptomatic patients prior to CEA, the incidence of perioperative stroke and early cognitive decline also decreased. The normal range of the ICA/CCA ratio was defined in 2966 symptomatic or contralateral carotid arteries with 0% to 49% stenosis. For that reason, ICA/CCA PSV ratio measurements may identify patients who, for hemodynamic reasons (e.g., low cardiac output, tandem lesions), have velocities that fall outside the expected norm for either PSV or EDV. 0 In others, magnetic resonance angiography (MRA) or computed tomographic angiography (CTA) may be performed in combination with sonography in cases where significant luminal narrowing is identified on the ultrasound examination or when the sonographic results are equivocal. Results: Examples of measurements are shown. Prevalence and morphological changes of carotid kinking and coiling in growth: an echo-color Doppler study of 2856 subjects between aged 0 to 96years. Peak systolic velocity (Doppler ultrasound). Average peak and mean blood velocities were 66 and 11 cm/sec in the ascending aorta, 57 and 10 cm/sec in the pulmonary artery, 28 and 12 cm/sec in the superior vena cava, and 26 and 13 cm/sec in the inferior vena cava. Hathout GM, Fink JR, El-saden SM et-al. This article focus on internal carotid artery (ICA) stenosis, reporting both criteria: the one published by Society of Radiologists in Ultrasound 2 and the Sonographic NASCET Index 1. Hathout etal. Therefore one should always consider the gray-scale and color Doppler appearance of the carotid segment in question including the plaque burden and visual estimates of vessel narrowing to determine whether all diagnostic features (both visual and velocity data) of a suspected stenosis are concordant. ICA PSV is <125 cm/sec and no plaque or intimal thickening is visible sonographically. The majority of stenotic lesions occur in the proximal internal carotid artery (ICA); however, other sites of involvement in the carotid system may or may not contribute to significant neurologic events. In the 1990s, many large, well-controlled, multicenter trials both in North America and Europe confirmed the effectiveness of CEA in preventing stroke in patients with ICA stenoses as compared with optimized medical therapy. J. Vasc. Carotid Ultrasound: An elevated peak systolic velocity (psv) would suggest a narrowing of the carotid artery, however this is only one of the criteria used to determine t. Read More. Doppler blood flow velocity measurements should be obtained from the proximal and distal CCA and the proximal, mid, and distal ICA. We provide reference data for the V(ICA)/V(CCA) ratios for the peak systolic velocity (PSV), mean velocity (MV), and end-diastolic velocity (EDV) measured in a large group of healthy subjects. Portnova GV, Maslennikova AV, Proskurnina EV. 5. FOIA Usually, heart blockage in the moderate range does not cause significant limitation to blood flow and so does not cause symptoms. [PSV = peak systolic velocity; EDV = end-diastolic velocity; ICA = internal carotid artery; CCA = common carotid artery] normal. The CCA is imaged from the supraclavicular notch where the transducer is angled as inferiorly as possible to see its proximal extent. (2003) Radiographics : a review publication of the Radiological Society of North America, Inc. 23 (5): 1315-27. Middle cerebral artery peak systolic velocity (cm/s) cubic polynomial that was specied as two components,a xed and a random one. (Reprinted with permission from the Radiological Society of North America: Grant EG, Duerinckx AJ, El Saden S, etal. PSV is by far the most commonly used parameter because it is easily obtained and highly reproducible. This leads to a loss of the key lumen-intima interface. Normal arterial wall anatomy. 1. 17 In every case, the sample gate in the ICA was positioned at the point of the maximum velocity change. ICA/CCA velocity ratios varied, depending on the CCA measurement location. On a Doppler waveform, the peak systolic velocity corresponds to each tall "peak" in the spectrum window 1. Please enable it to take advantage of the complete set of features! Since the trigonometric ratio that relates these values is the cosine function, it follows that the angle of insonation should be maintained at 60o1,2. Triphasic arterial flow is considered normal in peripheral arteries and monophasic flow is considered abnormal 7. As discussed in Chapter 3, the Doppler spectral waveforms are almost always altered in the region of the bulb (see Figure 7-4), a reflection of the complex flow dynamics that occur at this location.6, Peak systolic ICA velocities as high as 120 cm/sec have been reported in some normal adults, but these values are exceptional, and an ICA velocity exceeding 100 cm/sec should be viewed as potentially abnormal in older individuals. However, the peak systolic velocity can vary between 41 and 64 cm/s ( Table 9.2 ). ), have velocities that fall outside the expected norm for either PSV or EDV. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Moderate (50% to 69%) internal carotid artery (, Receiver Operating Characteristic (ROC) curves for three Doppler velocity measurements to detect 70% or greater internal carotid artery (ICA) stenosis: peak systolic velocity (PSV =, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Ultrasound Assessment of Carotid Stenosis, Ultrasound Assessment of Carotid Stenosis, Carotid Sonography: Protocol and Technical Considerations, Normal Findings and Technical Aspects of Carotid Sonography, Ultrasound Assessment of Lower Extremity Arteries, Ultrasound Assessment of the Vertebral Arteries. High-frequency sound waves help your doctor see the arteries and kidneys and check their function. When traveling with their greatest velocity in a vessel (i.e. Reference article, Radiopaedia.org (Accessed on 01 May 2023) https://doi.org/10.53347/rID-9404. The true ICA has parallel walls above (distal to) the sinus. J Vasc Surg. What is the ICD-10-CM code for skin rash. After endarterectomy, the lumen-intima interface is less prominent at the surgical site because the intima has been removed. Can you you explain peak systolic velocity in right internal carotid artery 61.9 and 80.7 in left internal carotid? The upper reference limit for the ratio can serve as an aid in the . Brachial artery PSVs range from 50 to 100 cm/s. The innermost layer abutting the lumen is the. B, This transverse video shows the zone of flow reversal (blue; arrow) in the proximal ICA at end diastole. However, to measure the exact flow velocity, we cannot rely on color Doppler imaging; we need pulsed wave Doppler. Normal ICA PSV is <125 cm/sec and no plaque or intimal thickening is visible sonographically Additional criteria include ICA/CCA PSV ratio <2.0 and ICA EDV <40 cm/sec Less Then 50% ICA Stenosis ICA PSV is <125 cm/sec and plaque or intimal thickening is visible sonographically Additional criteria include ICA/CCA PSV ratio <2.0 and ICA EDV <40 cm/sec ICA velocities decrease with age, reaching typical values between 60 and 90 cm/sec for ages 60 years and above.9,10 Blood flow velocities vary with physiologic state of the individual, being higher with exercise than at rest. The structure above these two branches is a partly collapsed internal jugular vein (IJV). ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Would you like email updates of new search results? Considerable patient-to-patient variability occurs in ECA flow velocity in normal individuals because pulsatility varies considerably from one person to another since some individuals have a sharply spiked systolic peak, while others have a more blunted peak. As such, Doppler thresholds taken from studies that did not use the NASCET method of measurement should not be used. I love to write and share science related Stuff Here on my Website. The diastolic component of the waveform also shows typical differences with the ICA having the highest diastolic component, the external the lowest, and the CCA an appearance somewhere in the middle. A normal ICA will have no branches and usually a lower resistance waveform. The transition between media and adventitia also corresponds to the external elastic lamina as seen on pathologic studies. We compared the performance of two independent laboratories using similar equipment (ATL-HDI Ultramark 9 . The peak systolic velocity is increased 30% to 100% compared with the adjacent proximal segment. Both stents and surgery are highly effective treatments and often help symptoms improve. Diagnostic algorithm implementing the inter-common carotid artery ( CCA) peak systolic velocity ( PSV) ratio in the vascular laboratory. The black (relatively echolucent) region peripheral to this reflection represents the media of the artery (arrowhead). Modified from Grant EG, Benson CB, Moneta GL, etal. The most noteworthy normal flow disturbance occurs at the carotid bifurcation (Figures 7-4 and. no financial relationships to ineligible companies to disclose. For ICA/CCA Peak Systolic Velocity ratio, use the highest PSV in the internal carotid artery and . At the aortic valve, peak velocities of up to 500 cm/sec may be possible. Low resistance vessels (e.g. The SRU criteria were derived from multiple studies reflecting different velocity parameters including the PSV, the ratio of PSV in the ICA to that in the ipsilateral distal CCA (i.e., the ICA PSV/CCA PSV ratio), and end-diastolic velocity (EDV). Check for errors and try again. At the aortic valve, peak velocities of up to 500 cm/sec may be possible. If you have subclavian artery disease, you have a higher chance of developing this buildup in other arteries throughout your body, which can lead to a heart attack, chest pain, stroke or cramping (claudication) in the legs. Conversely, blood flow velocities in the ICA contralateral to a high-grade stenosis or occlusion may be higher than expected if the vessel is the major supplier of collateral blood flow around the circle of Willis. Peak systolic velocity (PSV) is an index measured in spectral Doppler ultrasound. This study proposed the incorporation of distal ICA flow velocity information on the conventional carotid Doppler study improving the diagnostic accuracy of PSV 1. deceleration spectral broadening with a peak systolic velocity (PSV) <125 cm/s, pansystolic spectral broadening with a PSV <125 cm/s, pansystolic spectral broadening with a PSV of >125 cm/sand, end diastolic velocity (EDV) <110 cm/s or ICA/CCA PSV ratio >2 but <4, pansystolic spectral broadening with PSV >270 cm/s, complete occlusion: no flow; terminal thump. %%EOF Rimmele DL, Borof K, Wenzel JP, Jensen M, Behrendt CA, Waldeyer C, Schnabel RB, Zeller T, Debus ES, Blankenberg S, Gerloff C, Thomalla G. Atheroscler Plus. The blue area in the carotid bulb and proximal internal carotid artery represents the normal flow reversal zone. Become a Gold Supporter and see no third-party ads. With ACAS and NASCET, the degree of stenosis is measured by relating the residual lumen diameter at the stenosis to the diameter of the distal ICA. The degree to which the carotid arteries widen at the carotid bulb varies from one individual to another. This leads to a loss of the key lumen-intima interface. The ICA (located inferiorly and to the right) is typically larger than the external carotid artery (located to the left and upward; ECA). This approach mimics the method of measurement used in the NASCET. {"url":"/signup-modal-props.json?lang=us"}, Weerakkody Y, Murphy A, Deng F, et al. The ICA Doppler spectrum typically shows a low-resistance pattern. This is better appreciated on the far wall than for the near wall of the CCA.2 There is a close correlation between histology and ultrasound-based measurements of the intima-media thickness.1,3. What does ICA CCA mean? My thesis aimed to study dynamic agrivoltaic systems, in my case in arboriculture. Secondary parameters such as elevated EDV in the ICA and elevated ICA/CCA PSV ratios further support the diagnosis of ICA stenosis if present. Carotid stenosis is a progressive narrowing of the carotid arteries in a process called atherosclerosis. The CCA is an elastic artery, whereas the ICA is a muscular artery. Ultrasound assessment of carotid arterial atherosclerotic diseasehas become the first choice for carotid artery stenosisscreening, permitting the evaluation of both the macroscopic appearance of plaques as well as flow characteristics in the carotid artery. As discussed in, Peak systolic ICA velocities as high as 120 cm/sec have been reported in some normal adults, but these values are exceptional, and an ICA velocity exceeding 100 cm/sec should be viewed as potentially abnormal in older individuals. Blood flow is not always laminar in nondiseased vessels since the artery segment has to be straight in order for the conditions of laminar flow to apply. However, the standard deviations around each of these average velocity values are quite large, suggesting that Doppler velocity measurements cannot predict the exact degree of vessel narrowing ( Fig. 2021 Feb;37(2):479-484. doi: 10.1007/s10554-020-02014-0. At the time the article was last revised Andrew Murphy had The outermost echogenic (white) area is the adventitia of the artery. The ACAS (Asymptomatic Carotid Atherosclerosis Study) also showed a reduction in incident stroke for asymptomatic patients with 60% or more stenotic lesions but, like the moderate range of stenoses in the NACSET, there was only a 5.8% reduction over 5 years. %PDF-1.6 % The peak systolic velocity is more than double the velocity in the proximal segment. The ECA has a very pulsatile appearance during systole and early diastole that is due to reflected arterial waves from its branches. Normal human peak systolic blood flow velocities vary with age, cardiac output, and anatomic site. Disclaimer. Anatomy of the carotid bifurcation; intima-media thickness (IMT) protocol. (2013) Interactive cardiovascular and thoracic surgery. 2005;26 (1): 68-75. Although the so-called NASCET method may not truly reflect the degree of luminal narrowing at the site of stenosis, this method has the advantage of minimizing interobserver error. On the left, there is no elevation of peak systolic velocity with a normal ICA/CCA ratio of 0.84. The sharp kinks (30 degrees or less) are likely to cause marked, and therefore pathologic, pressure drops (see Video 7-3). The following criteria were approved in 2021 7. The ICA and the ECA are then imaged. These are some common normal peak systolic velocities: Peripheral artery stenosis is considered significant when the diameter reduction is 50% or greater, which corresponds to 75% cross sectional area reduction. Unauthorized use of these marks is strictly prohibited. The bulb is defined as being the zone of dilatation of the common carotid artery (CCA) to the level of the flow divider (the junction of internal carotid artery [ICA] and external carotid artery [ECA]). Ultrasound is the only imaging technique used in many facilities for selecting patients who might undergo carotid endarterectomy or stenting. A historical end-diastolic cut-point PSV 140cm/s derived from the University of Washington criteria is still used for the presence of 80% stenosis despite the fact that the threshold was measured on non-NASCET graded arteriograms. Example of Sensitivity and Specificity for Internal Carotid Artery Peak Systolic Velocity Cut Points Corresponding to a 70% Diameter Stenosis. Peak systolic velocities in the CCA tend to parallel the values in the ICAs. Peak systolic velocity (PSV) is an index measured in spectral Doppler ultrasound. The innermost layer abutting the lumen is the intima, or endothelial lining of the artery. The carotid ultrasound examination begins with the patient supine and neck slightly extended with the head turned to the opposite side if needed ( Fig. Carotid artery stenting (CAS) is the alternative treatment for stenosis that became widely available after the year 2000. Epub 2008 Jun 30. With the advent of statin (HMG-CoA reductase inhibitors) therapy, studies demonstrated a decreased risk of major vascular events such as stroke and that more aggressive statin treatment further decreased that risk by an additional 16%. AbuRahma AF, Abu-Halimah S, Bensenhaver J, Dean LS, Keiffer T, Emmett M, Flaherty S. J Vasc Surg. There is normal antegrade . Carotid artery stenosis: gray-scale and Doppler US diagnosis-Society of Radiologists in Ultrasound Consensus Conference. (C) Spectral Doppler suggests a 50% to 69% stenosis based on mildly elevated peak-systolic velocity ( PSV = 139 cm/s) and end diastolic velocity ( EVD = 60 cm/s). If the narrowing of the carotid artery is between 50 and 70 percent and you have symptoms, your doctor will consider surgery in some cases. Due to the controversy surrounding the definition of biphasic, there is disagreement about whether biphasic flow is normal 2. The blue area in the carotid bulb and proximal internal carotid artery represents the normal flow reversal zone. (2019). These elevated velocities, are also associated with different degrees of coiling of the artery ultimately leading to kinking. The two transition zones between the lumen and the intima and between the media and adventitia produce two parallel echogenic lines, with an intervening zone of low echoes that corresponds to the media. We provide reference data for the V ICA /V CCA ratios for the peak systolic velocity (PSV), mean velocity (MV), and end-diastolic velocity (EDV) . Radiographics. Ninety-four percent of patients with subclavian steal have a systolic blood pressure that is 20 mm Hg or more, which is lower on the affected arm (the mean difference between the arms is 45 mm Hg in affected patients). The CCA is an elastic artery, whereas the ICA is a muscular artery.4 The region of the ICA sinus is of mixed characteristics between a muscular and an elastic artery.5. The Doppler spectrum sampled at this site is shown at the bottom of the image and demonstrates the complex flow pattern with some red cells moving forward and others backward.

Best Places Abroad To Retire For A Single Man, What Hemisphere Is Rhossili Bay In, John Haywood Louise Mandrell, Holsworthy Army Barracks Open Day, Articles C