TM-Flow Test Results Interpretation: A Guide to the 6 Report Sections

A TM-Flow report is not one page. It is a set of section reports, each covering a different measurement the system performs during the visit, and each printed with its own reference range beside the result. Sound TM-Flow test results interpretation starts with knowing which section you are looking at, what that section measures, and what the printed range next to the number represents. The signing physician then reads those values against the patient in front of them.

This guide walks through the six sections a practice will see, using the reference bands and marker definitions published by LD Technology, the manufacturer of the TM-Flow System, in its own result reading guidelines for the FLOW 7/CCS platform. It is written for clinicians and practice staff who already run the test and want to be fluent in the output.

One point governs everything below, and it is printed on the report itself: “All results should be considered within the clinical context of the patient’s case, symptoms, known diagnosis, findings from other diagnostic studies, current medications, treatment plan and therapies. The interpretation of the results is the responsibility of the physician who signed the report.”

What does a TM-Flow report actually contain?

The TM-Flow System is built on FDA-cleared component devices from LD Technology, and each component contributes its own section to the output. A complete visit can generate up to six distinct reports.

1. ABI final report, covering the ankle-brachial and toe-brachial indices, the sum of brachial indices, toe vasomotion, and the waveform tracings.
2. ABI post-exercise report, run when the practice performs the exercise protocol.
3. Endothelial and blood pressure report, covering photoplethysmography markers and large-artery analysis.
4. Cardiac autonomic report, covering heart rate variability and the cardiac autonomic reflex tests.
5. Sudomotor report, labeled SweatC, covering the galvanic skin response measurements at both feet.
6. Wellness assessment and plan, a lifestyle summary scored from the other markers.

Each section prints its markers in a table with four columns: the marker name, a plain-language description of what it is correlated to, the patient’s result, and the reference range with its units. The result is color-coded against that range. Most of the confusion practices report comes from reading a number without reading the range printed beside it, and that single habit fixes a large share of TM-Flow test results interpretation questions on its own.

How do you read the ABI section of a TM-Flow report?

The ABI section is the one most staff meet first. The system takes systolic pressures at both arms and both ankles, at the posterior tibial and dorsalis pedis arteries, then reports the ratio of the highest ankle pressure to the highest arm pressure for each side. It also reports a toe-brachial index from toe pressure, and two derived markers.

Rather than a single normal/abnormal split, the software grades each index against a labeled band. These are the thresholds it prints on the color bar:

Two derived markers sit underneath. The sum of brachial indices (SBI) combines the overall ABI and TBI into one figure, and the guidelines give a cutoff of 1.36. Importantly, the SBI is not available when the ABI is 1.4 or above, because that reading indicates a non-compressible artery. When that happens, the report substitutes the toe vasomotion PTG index, which measures the amplitude of vasomotion, the spontaneous rhythmic contraction and dilation of the small vessels. Its printed bands run 80, 55, 26, 20 and 15, with a stated cutoff of 26. Less vasomotion produces a lower index value.

For toe pressures specifically, the guidelines cite healing associated with a mean TBI of 0.55 to 0.60 and/or toe pressure above 30 mmHg, and non-healing associated with a TBI below 0.4 and/or toe pressure at or below 30 mmHg. That pairing is why the toe measurement matters so much in wound care and podiatry. If you want the underlying index explained on its own, see our guides to the normal ankle-brachial index range and the toe-brachial index.

What do the waveform tracings mean?

Beside the numbers, the ABI report prints two families of tracing. The volume plethysmography records show the pressure waveform at each ankle site. The photoplethysmography records show the toe waveform and its vasomotion spectral analysis.

The volume plethysmography waveforms are classified in three shapes. A triphasic signal shows a rapid systolic upstroke, a brief flow reversal and gradual forward flow. A biphasic signal keeps the upstroke and downstroke but lacks the reverse-flow component. A monophasic signal is a single slow, rounded wave with no distinct peak or reverse flow. The guidelines summarize it plainly: triphasic patterns are normal, biphasic may indicate atherosclerotic plaque or calcification, and monophasic may indicate peripheral artery disease in the lower extremities.

The toe photoplethysmography waveforms use a four-type scale instead, graded on the clarity of the dicrotic notch and the resulting arterial stiffness: type 1 normal, type 2 borderline, type 3 moderate, type 4 severe. Our explainer on pulse volume recording covers the waveform physiology in more depth.

How do you read the endothelial and blood pressure section?

This part of TM-Flow test results interpretation trips people up most, because the marker names are abbreviations. All five come from spectral analysis and the second derivative of the pulse oximeter waveform. The report prints what each one is correlated to, which is the fastest way to orient yourself.

A second, shorter table covers the upper large artery: the difference in systolic pressure between the right and left arm, flagged as an axillary stenosis risk marker with a printed range under 20 mmHg; central aortic systolic pressure (CASP) at 119 mmHg; and the peripheral augmentation index (pAIx) as a measure of aortic arterial stiffness, printed as under 75.

The endothelial section is then graded as a whole using a five-step ladder based on how many markers fall outside range. Normal range means no abnormal and no borderline results. Acceptable means no abnormal but one or more borderline. Initial steps means one abnormal result. Definite steps means two abnormal results. Advanced or severe means three or more abnormal results.

What does the cardiac autonomic section show?

This section reports seven tests, split into two heart rate variability measures taken over a two-minute resting recording and five cardiac autonomic reflex tests, known as CARTs. The structure follows the criteria published by the CAN Subcommittee of the Toronto Consensus Panel.

The two baseline HRV markers are Total Power, described on the report as the autonomic homeostatic response at rest with a printed range above 1200, and SDANN, described as autonomic component regulation at rest with a printed range of 30 ms or above.

The five reflex tests divide into parasympathetic responses, which are based on heart rate ratios during a maneuver, and sympathetic responses, which are based on blood pressure change.

Severity is then staged. Normal range means no abnormal result. Initial step means one abnormal CART, or one abnormal HRV plus one abnormal CART, or orthostatic intolerance. Definite step means two abnormal CARTs, or one HRV plus two CARTs. Advanced means three or more abnormal results, or the detection of postural orthostatic tachycardia syndrome or vasovagal syndrome. The severe stage adds a systolic pressure response to standing greater than 20 mmHg.

For background on the underlying measurement, see our guides to the heart rate variability test and autonomic nervous system testing methods.

How do you read the sudomotor (SweatC) section?

The sudomotor report measures the galvanic skin response at each foot and prints two markers per foot. The distinction between them is simply which electrode the measurement comes from, and it is the single most useful thing to know about this page.

Sweat Peak is taken from the peak amplitude at the positive electrode. The report describes it as an estimate of the quantitative sweat response to postganglionic cholinergic sympathetic stimulation. NO Peak, or nitric oxide peak, is taken from the peak amplitude at the negative electrode, and estimates the postganglionic cholinergic sympathetic vasodilatory response. The report groups the first under a C-fiber response heading and the second under a microcirculation response heading.

Read the value against the range printed in that row rather than from memory. The published guidance for this test states its normal thresholds in more than one place and the figures are not identical between them, so the range column on the patient’s own report is the reference to trust. Our sudomotor testing explainer covers what the measurement represents physiologically.

Technique matters here more than anywhere else on the report. The guidelines specify that the patient is measured lying down, to avoid the sympathetic stimulation that sitting or standing introduces, and that the room should sit between 73 and 75 degrees Fahrenheit so that sweat glands are not activated by heat or suppressed by cold. A result taken outside those conditions is difficult to compare against the printed range.

What is the wellness score, and how is it calculated?

The wellness page is the part patients look at, so it is worth understanding the arithmetic. Twelve markers are assessed, covering exercise capacity and nutrition. Each is scored as normal equals 0, borderline equals 1, and abnormal or severe equals 2. The final score is expressed as a percentage on a 0 to 20 percent scale, and the software prints a short “how to read your score” key beside it.

A score of 18 percent or above is labeled good. Below 18 and at or above 16 percent is acceptable. The bands then descend through borderline and poor to very poor at 8 percent or below. Because the scale runs to 20 rather than 100, a number like 6 percent reads far worse at a glance than patients expect, which is a useful thing to be ready to explain in the room.

The wellness page also carries a score trend chart, which stays empty until a second visit gives it something to compare against. If you are moving these outputs into a chart or a patient letter, our guide to adding TM-Flow PDF reports to your EMR chart covers the export side.

Who is responsible for interpreting the report?

The report answers this itself, and it is the boundary that governs all TM-Flow test results interpretation. Each section ends with a disclaimer stating that the interpretation of the results is the responsibility of the physician who signed the report, and that all results should be read within the clinical context of the patient’s case, symptoms, known diagnosis, other diagnostic findings, current medications and current therapies.

That is reflected in the layout. Every final report carries two signature blocks, one for the interpreting physician with their NPI, and a separate one for the doctor or technician who performed the study. The software also prints a narrative interpretation box summarizing the findings in sentences, and it may note a suggested follow-up study. Treat that box as a starting point for the physician’s read, not as the conclusion.

On the coding side, the component measurements map to distinct CPT codes: 93923 for the ABI study, 95923 for sudomotor testing, and 95921 for cardiovagal heart rate variability. Our ABI CPT code 93923 billing guide covers documentation requirements in detail, and our walkthrough of how three CPT-coded studies stack from one device visit covers how the vascular and autonomic components are documented together.

What most often makes a report hard to read?

Three situations account for most of the questions practices raise about TM-Flow test results interpretation.

• A blank SBI field. This is expected behavior, not a fault. An ABI of 1.4 or above indicates a non-compressible artery, the SBI is withheld, and the toe vasomotion PTG index takes its place.
• A high ABI with a low TBI. Calcified vessels can hold the ankle index up while the toe index shows the real picture, which is exactly why the report prints both.
• A sudomotor result that moves between visits. Check position and room temperature before reading anything into the change, since the protocol specifies lying down and a 73 to 75 degree room.

For a broader orientation to the platform before you get to the output, start with our introduction to the TM-Flow System.

Frequently asked questions about TM-Flow test results interpretation

How long does a TM-Flow test take?

The test itself is short, typically completed in under ten minutes of in-office chair time. The reading is the part that rewards preparation, since a full study produces several section reports rather than a single result page.

Why does the report show a different reference range than the one I remember?

Reference ranges are printed per marker, in the range column of each table, and they vary by marker and units. Read the range on the patient’s own report rather than applying a remembered threshold from a different index.

Does the software interpret the results for the physician?

No. The software measures, color-codes each value against its reference range, and prints a narrative summary block. The report states explicitly that interpretation is the responsibility of the signing physician, read in the full clinical context of the case.

Can staff perform the test, or does it require a physician?

The report carries a separate signature line for the doctor or technician who performed the study, distinct from the interpreting physician. Supervision and delegation rules vary by payer and by state, so confirm them for your setting. We cover the question in more depth in our guide to who can perform an ABI test.

Where can our practice get training on TM-Flow test results interpretation?

HealthWright Technologies includes training and ongoing support with the systems it places. Practices can reach the team at contact@healthwrighttechnologies.com or (678) 322-7146.

Bringing it together

Confident TM-Flow test results interpretation comes down to a repeatable habit. Identify the section, read the marker description to see what it is correlated to, compare the result against the range printed in that same row, and check the staging ladder at the section level before drawing any conclusion. The measurement conditions matter, particularly for the sudomotor page, and a missing SBI is usually the system behaving correctly rather than an error.

Practices evaluating the platform, or wanting a deeper walkthrough of the output with their own staff, can review the TM-Flow System from HealthWright Technologies or contact our team to request a demonstration. HealthWright Technologies is based at 60 Bear Creek Marina Road, Mansfield, GA 30055.

Reference bands, marker definitions and disclaimer language in this article are drawn from LD Technology’s FLOW 7/CCS platform result reading guidelines. For the underlying methodology on ankle-brachial index measurement, see the American Heart Association scientific statement on measurement and interpretation of the ankle-brachial index.

This article is educational and intended for clinicians and practice staff. It does not provide medical advice and does not replace clinical judgment. Consult your healthcare provider before starting any new treatment. The TM-Flow System is built on FDA-cleared component devices manufactured by LD Technology.

CPT® is a registered trademark of the American Medical Association. CPT code references are provided for general information only and do not guarantee coverage or payment. Practices are responsible for confirming coding, coverage and documentation requirements with their payers.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis, treatment, and clinical decision-making.