*All Registry Level candidates must either pass or be granted exemption from the Cardiovascular Science Examination in addition to passing the specific Registry Level Examination before being awarded a registry level credential (RCIS, RCS, or RVS).

Cardiovascular Science Examination: $185 (Click here to be directed to that section)

Self Assessment Booklets can be ordered for all CCI examinations. An order form can be found on the last page of the Application.

For More Info:

Examination Matrix

CONTENT CATEGORY AND APPROX. PERCENTAGE OF EXAM

Detailed Outline

A. Anatomy and Physiology
Anatomic location and physiology of:

I. Arterial
   a. Aorta
       1. ascending
       2. descending
       3. branches
    b. Lower extremity arteries
    c. Upper extremity arteries
    d. Abdominal vasculature
    e. Cerebral extracranial arteries
II. Venous
    a. Abdominal venous system
       (vena cava, portal, mesenteric and renal veins)
    b. Lower extremity veins (deep, superficial and perforators)
    c. Upper extremity veins (deep and superficial)

B. Patient Assessment

I. Obtaining patient history
    a. Chronic arterial occlusive disease
    b. Acute arterial occlusive disease
    c. Cold sensitivity
    d. Hypertension
    e. Ischemia
    f. Stroke
    g. Diabetes
    h. Hyperlipidemia
     i. Transient symptoms
     j. Previous surgery
     k. Previous or related Non-invasive testing
     l. Chronic venous insufficiency
    m. Acute vein thrombosis
    n. Related medication
    o. Cardiac history and surgery

II. Obtaining Risk Factors
    a. Age
    b. Smoking
    c. Trauma
    d. Previous DVT
    e. Bed-rest patient
    f. Carcinoma
    g. Diabetes
    h. Hypertension
    i. Hyperlipidemia
    j. Recent surgery
    k. Pregnancy
    l. Birth control pills
    m. Varicose veins
    n. Obesity
    o. Cardiac disease
III. Indications for Arterial and Venous Non-invasive Procedures
IV. Signs and Symptoms
V. Physical Examination
    a. Skin changes
    b. Palpating for pulses and aneurysms
    c. Lymphedema
    d. Venous ulcerations
    e. Auscultation for bruits
    f. Pulses

C. Disease States

I. Venous Disease
    a. Pathology
        1. peripheral venous diseases
        2. central venous diseases
    b. Preliminary information
        1. acute deep vein thrombosis
        2. chronic venous insufficiency
    c. Interpretation of venous disease with non-invasive testing
        1. Diagnostic indications/values
        2. Diagnostic criteria
        3. Limitations of interpretation
    d. Discerning pathology and artifact
    e. Valvular disease
    f. Thrombosis
        1. Location
        2. Characteristics
    g. Ambulatory hypertension
    h. AV fistula

II. Arterial Disease
    a. Pathology of peripheral vascular disease
    b. Pathology of central arterial disease
    c. Preliminary information
        1. Acute arterial disease
        2. Chronic arterial disease
    d. Interpretation of arterial disease with non-invasive testing
        1. Diagnostic indications/values
        2. Diagnostic criteria
        3. Limitations of interpretation
    e. Discerning pathology and artifact
    f. Atherosclerosis
    g. Hematomas
    h. Embolism
    j. Entrapment syndromes
    k. Atriovenous fistulas
       1. Thoracic outlet syndrome
   m. Raynaud’s syndrome
   n. Arteritis

III. Cerebrovascular Disease
   a. Pathology of the cerebrovascular system
   b. Interpretation of cerebrovascular disease with non-invasive testing
       1. Diagnostic indications/values
       2. Diagnostic criteria
       3. Limitations of interpretation
   c. Discerning pathology and artifact
   d. Atherosclerosis
   e. Hemorrhage
    f. Morphology
   g. Ulceration
   h. Masses and aneurysms
    i. Stenosis
    j. Embolism
   k. Subclavian steal
      1. Stroke

D. Evaluation of Blood Flow

I. Venous
   a. Normals – Venous Flow
       1. Hemodynamics
         a. Peripheral
         b. Central
      2. Portal vein flow
b. Flow Patterns in Venous Disease
      1. Acute
      2. Chronic
c. Interpretation of abnormal flow patterns
d. Collateral circulation
e. Non-invasive Venous Testing
     1. Continuous wave Doppler
     2. Duplex imaging
       a. 13-mode
       b. Doppler
       c. Color
f. Patient positioning
g. Transducer positioning

II. Arterial
a. Normals – Arterial Flow
    1. Hemodynamics
      a. Central
      b. Peripheral
      c. Abdominal
b. Waveforms
   1. Spectral
   2. Analog
c. Flow Patterns
   1. Normal
   2. Abnormal
d. Pressures
  1. Lower extremities
  2. Upper extremities
e. Non-invasive Arterial Testing
  1. Continuous wave Doppler
  2. Duplex imaging
     a. 13-mode
     b. Doppler
     c. Color
f. Patient positioning
g. Transducer positioning
h. Criteria for diagnosis of hemodynamically significant disease

III. Cerebrovascular Disease
a. Normal hemodynamics
b. Abnormal flow
c. Waveform analysis
d. Systolic and diastolic velocities
e. Criteria for diagnosis
f. Non-invasive Cerebrovascular Testing
  1. Duplex imaging
     a. Bmode
     b. Doppler
     c. Color
g. Patient positioning
h. Transducer positioning

E. Advanced Techniques

I. Transcranial Doppler
a. Techniques
b. Indications
c. Flow velocities in the intracranial arteries
  1. Normal
  2. Abnormal
  3. Direction of flow

F. Vascular Surgery/Intervention

I. Carotid Endarectomy
a. Intraoperative survey
b. Postoperative survey

II. Bypass Grafts
a. Types
b. Flow patterns
   1. Normal
   2. Abnormal
c. Preoperative assessment

III. Percutaneous Intervention
a. Angioplasty
b. Stents

IV. Venography
a. Methods
b. Interpretation

V. Arteriography
a. Methods
b. Interpretation

G. Physics and Instrumentation

I. Transducers
a. Characteristics
b. Piezoelectric effect
c. Beam focusing
d. Near field
e. Farfield
f. Mechanical transducers
g. Phased array transducers
h. Lateral resolution
i. Axial resolution
j. Elements
k. Beam steering

II. Sound Propagation
a. Speed of sound now
   1. Tissue
   2. Air
3. Blood
b. Reflection
c. Refraction
d. Absorption
e. Attenuation
f. Impedance
g. Scattering
h. Interfaces

III. Definitions
a. Frequency
b. Wavelength
c. A-mode
d. Bmode
e. M-mode
f. Bandwidth
g. Hertz
h. Power
i. Range
j. Velocity

IV. Laws
a. Ohm’s law
b. Poiseuille’s law
c. Bernoulli’s

V. Doppler Instrumentation
a. Pulsed wave
b. Continuous wave
c. Signal processing
  1. Integral time analysis
  2. Decibel gain
  3. Digital signal
  4. Dynamic range
  5. Fast Fourier transformation
  6. Post scan processing
  7. Scan converters
  8. Time gain compensation
  9. Zero crossing detector

VI. Hemodynamics
a. Venous resistance
b. Arterial pressure
c. Turbulent flow disturbance
d. Velocity acceleration
e. Diameter reduction
f. Aliasing

Sample Questions

1 . What mechanism is primarily responsible for returning blood to the heart while walking:
a. Gravity
b. Venous valves
c. Skeletal muscle
d. Arterial pressure

2. A TIA of the left anterior hemisphere of the brain will MOST likely affect:
a. Entire body
b. Left side of the body
c. Right side of the face
d. Right side of the body

3. Intracranial circulation is a:
a. Low-flow, low resistance system
b. Low-flow, high resistance system
c. High-flow, low resistance system
d. High-flow, high resistance system

4. Failure to produce augmentation of a Doppler signal in the common femoral vein following thigh compression suggests obstruction of what vein?
a. Popliteal
b. External iliac
c. Greater Saphenous
d. Superficial Femoral

5. Which of the following factors has the greatest effect on resistance to laminar flow through a blood vessel?
a. Vessel radius
b. Vessel length
c. Blood velocity
d. Blood viscosity

Answers
1. c  2. d   3. c   4. d   5. a

References

1. Diagnostic Ultrasound, Principles and Instrumentation, 4th edition, Kremkau, Frederick W., 1993, 
    Orlando, FL: W.B. Saunders, Inc.
2. Introduction to Vascular Ultrasonography, 4th edition, Zwiebel, William J., 2000, New York, NY: W.B.
    Saunders, Inc.
3. Color Doppler Flow Imaging, Foley, W. Dennis, 1991, Churchill Livingstone.
4. Applications of Non-Invasive Vascular Techniques, Gerlock, Amil J., Giyanam, Vischan L., and Krebs,
    Carol, 1992, Churchill Livingstone.
5. Transcranial Doppler, Newell, David W, and Aaslid, Rune, 1992, J. F. Lippincott.
6. Peripheral Vascular Sonography “A Practical Guide,” Polak Joseph F., 1992, W.B. Saunders.
7. The Textbook of Medical Physiology, 10th edition, Guyton, A.C., 2000, W.B. Saunders.