Registered Cardiac Sonographer (RCS)

Requires:  Passing the one-part Non-Invasive/Echocardiography Registry Examination.

Who should apply:  Professionals working in the area of Non-Invasive Echocardiography

Specialty Examination Fee: $350

RCS Navigation

All applicants must meet the following criteria:

1. Have a high school diploma or general education diploma at the time of application.

2. Fulfill one (1) of the qualifications of the exam for which you are applying. See qualifications listed in the tables below.

3. Provide typed documentation to support the qualification under which you are applying. Required documentation for each qualification is listed below. CCI reserves the right to request additional information.

 

Criteria for graduates of  NON-programmatically accredited programs in cardiac ultrasound (echocardiography) Criteria for Applications postmarked AFTER July 1, 2013 Supporting Documentation
  RCS1-2013
Two years of full-time or full-time equivalent experience in cardiac ultrasound. The applicant must have participated in a minimum of 600** cardiac ultrasound studies at the time of application.

 

In the verification letter, the medical director(s) must confirm the number of studies performed during the applicant’s employment.

RCS1-2013
Employment Verification Letter
(must confirm the number of studies performed during the applicant’s
employment).

RCS5
A graduate of a NON-programmatically accredited program in cardiac ultrasound (echocardiography) which has a minimum of one year of specialty training and includes a minimum of 800 clinical hours in the specialty in which the examination is being requested.

Students enrolled in NON-programmatically accredited program in cardiac ultrasound (echocardiography) with a start date prior to September 1, 2013 will be eligible to apply for their specific registry examinations under this current qualification pathway after they graduate.

RCS235-2013
A graduate of a diploma, associate, or baccalaureate  academic program in health science (including, but not limited to, cardiovascular technology, ultrasound, radiologic technology, respiratory therapy, or nursing)
AND
One year full-time work experience in cardiac 
ultrasound (echocardiography) 
AND
Performance of a minimum of 600** cardiac ultrasound studies in their career, which is defined as work experience and/or clinical experience gained during a formal educational program.
 
In the verification letter(s) the medical director(s) and/or program director(s) must confirm the number of studies performed during the applicant’s employment and/or during the academic program.

RCS5
Completion certificate and/or
educational transcript
AND
Student Verification Letter
AND
Clinical Experience Letter

 

RCS235-2013
Completion certificate and/or
educational transcript
AND
Employment Verification Letter
AND
Clinical Experience Letter (only required for applicants submitting verification of the number of studies completed during a formal
educational program)

  RCS4
Applicant must be a graduate of a programmatically accredited program in cardiac ultrasound (echocardiography).

RCS4
Completion certificate and/or educational transcript
AND
Student Verification Letter

 

Students applying to take examination prior to graduation will be required to submit this documentation.

 

IMPORTANT: If an individual’s studies were completed after graduation or if the hours are not a requirement for their educational program, then those hours WOULD NOT count toward the 800-hour minimum under qualification RCS5.
** If an individual’s clinical hours were obtained during a formal educational program, then those procedures completed WOULD count toward the minimum of 600 cardiac ultrasound procedures under qualification RCS235-2013.
*** An accredited program is accredited by an agency recognized by the Council for Higher Education Accreditation (CHEA), United States Department of Education (USDOE), or Canadian Medical Association (CMA) that specifically conducts programmatic accreditation for cardiovascular technology, diagnostic cardiac sonography, or vascular technology.

 

Click here for sample Employment Verification Letter, Student Verification Letter and Clinical Verification Letter (Graduates of Non-accredited Programs in Cardiac Medical Sonography (Echocardiography)).

CCI requires the Employment Verification Letter contain the following:

1) Employer’s original, official letterhead or stationery.
2) Indicate the date the letter was signed by employer/supervisor.
3) Indicate the name of the applicant.
4) Indicate full- or part-time employment.
5) Indicate the time period of employment.
6) Indicate the primary duties of applicant, related to the field of cardiovascular technology.
7) Original signature of direct supervisor, who must be a MD or hold an active RCCS, RCES, RCIS, RCS, RDCS, RDMS, RPhS, RVS or RVT credential.

CCI requires the Student Verification Letter contain the following:

1) Educational program’s original, official letterhead or stationery.
2) Indicate the date the letter was signed by educational director.
3) Indicate the name of the applicant.
4) Indicate full- or part-time student.
5) Indicate the date or expected date of graduation.
6) Indicate the specialty of the educational program.
7) For Non-programmatically accredited educational programs, indicate the
program length, program specialty (Echo),the number and specialty of clinical hours accrued.
8) Original signature of the educational director.

CCI requires the Clinical Verification Letter (Graduates of Non-accredited Programs in Cardiac Medical Sonography (Echocardiography)) contain the following:

1) Clinical Site’s original, official letterhead or stationery.
2) Indicate the date the letter was signed by the clinical supervisor.
3) Indicate the name of the applicant.
4) Indicate the number of clinical hours.
5) Indicate the time period during which the clinical hours were performed.
6) Original signature of the clinical supervisor.
IMPORTANT: If an individual’s clinical hours were obtained after graduation or if the hours are not a requirement for their educational program, then those hours WOULD NOT count toward the 800 minimum under qualification RCS5.

Exam Overview Friday, November 06th 2009 9:46 AM





This examination matrix is provided to illustrate the general distribution of questions and the relative weight or emphasis given to a skill or content area on the examination.






General Policies, Procedures and Standards 7%


Perform echocardiographic examinations 38%


Perform specialized echocardiographic techniques 13%


Pathophysiology of Cardiovascular Diseases/Therapeutic Measures 42%


Total 100%




The list below describes general areas of knowledge that are needed in order to perform the tasks identified.  This knowledge will apply across multiple tasks.
Basic Life Support (BLS)
Basic math skills (formulas, exponents, decimals, scientific notation)
Basic pharmacology
Cardiac abnormalities
Cardiac embryology
Cardiovascular anatomy
Electrophysiology
General anatomy
Hemodynamics
HIPAA (Health Insurance Portability and Accountability Act)
History & physical
Medical ethics
Medical terminology
Pathophysiology
Physiologic maneuvers
Physiology

QA procedures
Recognize basic cardiac anatomy obtained using other imaging modalities
Safety practices for patients and staff
Ultrasound instrumentation
Ultrasound physics
Ultrasound modalities:
  *3-D

  *Doppler (Spectral, Tissue and Color)
  *Contrast

  *M-mode

  *Stress testing (pharmacological and physiologic)
  *TEE

Universal Precautions/infection control




The task list below describes the activities which an RCS is expected to perform on the job.  All examination questions are linked to these tasks.




    NR Duties and Tasks % of Exam
A   General Policies, Procedures and Standards 7%
  1 Ensure Universal Precautions and sterile techniques  
  2 Respond to emergency situations  
  3 Maintain competency and Quality Assurance  
  4 Pre-procedure Activities  
  4a Manage Workflow  
  4b Prepare the ultrasound room and equipment for the examination  
  4c Determine the indication for the examination  
  4d Perform limited history and physical (e.g., height, weight, physiologic monitoring)  
  4e Prepare the patient for examination  
  4f Informed consent  
  4g Basic ECG, rhythm identification  
  5 Post-Procedure Activities  
  5a Manage data flow and images  
  5b Document findings  
  5c Communicate with the health care team  
  5d Maintain equipment, supplies and patient areas  
B   Perform echocardiographic examinations 38%
  1 Understand ultrasound physics and instrumentation  
  1a Physical properties of ultrasound  
  1b Acoustical properties of tissue  
  1c Doppler instrumentation  
  1d 2D instrumentation  
  1e Transducers  
  1f Artifacts  
  1g Resolution (e.g., axial, lateral, temporal, spatial)  
  2 Understand imaging views (transducer position, planes, anatomy)  
  2a Left Parasternal  
  2b Apical  
  2c Subcostal  
  2d Suprasternal  
  2e Right Parasternal  
  2f Nonstandard  
  3 Define normal anatomy, physiology and hemodynamics  
  3a 2-D, M mode, anatomy and physiology  
  3b Doppler (Spectral, Color Flow, Tissue)  
  3c Measurements and calculations  
  4 Utilize physiologic maneuvers  
  4a Valsalva, gripping, squatting  
  4b Respiration control  
  5 Practice proper ergonomics  
C   Perform specialized echocardiographic techniques 13%
  1 Assist with TEE  
  1a Recognize structures on TEE  
  1b Maintain TEE probe  
  2 Perform stress echocardiography  
  2a Exercise stress echo  
  2b Pharmacologic stress echo  
  3 Perform contrast echocardiography  
  3a Contrast agents  
  3b Start, maintain and/or remove IV's  
  3c Image optimization and artifacts  
  3d Indications, warnings and contraindications  
  4 Identify current and emerging technologies  
  4a Intracardiac echo (ICE)  
  4b 3D TEE  
  4c 3D TTE  
  4d Color tissue Doppler imaging (includes strain & strain rate)  
  4e Speckle imaging  
  4f Interventional procedures (e.g., valvuloplasty, biopsies)  
  4g Other imaging modalities (e.g., MRI, CT, Nuclear)  
D   Pathophysiology of Cardiovascular Diseases/Therapeutic Measures 43%
  1 Evaluate pathophysiology in images and modify examination to answer the clinical question  
  1a Heart failure  
  1b Valvular heart disease  
  1c Ischemic heart disease  
  1d Cardiomyopathies  
  1e Pericardial diseases  
  1f Cardiac masses  
  1g Diseases of the aorta  
  1h Systemic and pulmonary hypertension  
  1i Compensatory mechanisms  
  1j Therapeutic measures and interventions for acquired diseases.  
  2 Recognize common congenital abnormalities  
  2a 2D  and Doppler (segmental approach)  
  2b Embryology  
  2c Interventions for congenital abnormalities  
    Total 100%

1.  While performing two-dimensional echocardiography, you discover what appears to be a large thrombus in the left ventricle. The patient states that she just can’t wait to speak with her doctor and that any information you could supply would be a big relief to her. You should inform the patient that
a. Her nurse is the only person qualified to discuss the results of her test.
b. There is a large thrombus in the main pumping chamber of her heart and surgery is definitely necessary.
c. You do see a small abnormality in her echocardiogram, but it is not something she should concern herself with.
d. You cannot interpret her echocardiogram, but assure her that her doctor will be reviewing it as soon as possible.

 

2.  A 90-year-old man is scheduled for a transesophageal echocardiogram. As a preoperative measure, his doctor has given him 25mg of Demoral. Upon entry to the laboratory, his breathing is shallow, and he is unresponsive. After notifying the physician, which of the following medications would be MOST useful for counteracting the effects of the narcotic given?
a. Versed
b. Narcan
c. Oxygen
d. Valium

3. During the holding phase of the Valsalva maneuver, which of the following occurs?

a. Increased cardiac output
b. Decreased intrathoracic pressure
c. Increased venous return to the heart
d. Decreased venous return to the heart

4. A patient comes to the non-invasive laboratory for an exercise stress test. While you are preparing him for the examination, he complains of chest pain that radiates down his left arm. Before the physician can be notified, the patient converts to ventricular tachycardia, lapses to an unconscious state, and has no palpable pulse. According to ACLS guidelines, the sonographer should
a. Begin CPR
b. Administer intracardiac epinephrine
c. Defibrillate the patient at 360 watts/second
d. Prepare an external pacemaker for immediate use

Answers
1. d 2. b 3. d 4. a

 

  1. Any general text on nursing management and care of the cardiac patient.
  2. Publications and Reports of the American Society of Echocardiography (ASE), Raleigh, NC
    1. American Society of Echocardiography –Educational Outline for Echocardiography, 4th Edition, 1993.
    2. Report of the American Society of Echocardiography (ASE), 1980, Committee on Nomenclature and Standards in 2D Echocardiography.
    3. Report of the ASE Committee on Nomenclature and Standards; 1982, on the Identification of Myocardial Wall Segments.
    4. Report of the ASE Committee: Stress Echocardiography.
    5. Report of the ASE Committee, 1984, on Contrast Echocardiography.
    6. Report of the ASE Doppler Standards and Nomenclature Committee, 1984, on Recommendations for terminology and display of Doppler Echocardiography.
    7. Publication: Digital Signal and Image Processing in Echocardiography.
    8. Publication: Transesophageal Echocardiography. Journal of the American Society of Echocardiography, September/October, 1989.
    9. Publication: Recommendations for Quantitation of the Left Ventricle by Two-Dimensional Echocardiography. ASE Committee on Standards, subcommittee on Quantitation of Two-Dimensional Echocardiograms, 1989, Journal of the American Society of Echocardiography, September/October.
  3. Heart Disease, 5th Edition, Braunwald, Eugene, 1996, W. B. Saunders, Philadelphia, PA.
  4. Congenital Heart Disease in Infants, Children, and Adolescents, 5th Edition, Part II, Congenital Defects. Fink, B. W., 1991, The Williams and Wilkins, Co., Baltimore, MD.
  5. Echocardiography, 5th Edition, Feigenbaum, H.,1994, Mosby Yearbook, St. Louis, Missouri.
  6. Diagnostic Ultrasound: Physical Principles and Exercises, 4th Edition, Kremkau, E.W., 1993, W.B. Saunders, Philadelphia, PA.
  7. The Echo Manual, Oh, Jae, et al, 1998, The Williams and Wilkins, Co., Baltimore, MD.
  8. Otto, Catherine M., 1997, The Practice of Clinical Echocardiography, Otto, Catherine M., 1997, W. B. Saunders Company, Philadelphia, PA.
  9. The Echocardiographer’s Pocket Reference, Reynolds, Terry, 1993, Arizona Heart Institute Foundation, Phoenix, Arizona.
  10. Ultrasound Physics and Instrumentation, 4th Edition, Miele, Frank, 2007 Pegasus Lectures or Essentials of Ultrasound Physics:  The Board Review Book, Miele, Frank, 2008 Pegasus Lectures
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