Registered Cardiovascular Invasive Specialist (RCIS)

Requires:  Passing the one-part Invasive Registry Examination

Who should apply:  Professionals working in the area of Cardiac Catheterization (Invasive)

Specialty Examination Fee:  $350

Effective July 1, 2013, Cardiovascular Credentialing International (CCI) will officially remove the RCIS1 Qualification for First Time Applicants (also referred to as the On-the-Job Training qualification) that allows applicants who ONLY have two (2) years (full-time or full-time equivalent) working in Invasive Cardiovascular Technology, at the time of application, to qualify for CCI's Invasive Registry examination. Click here for a downloadable .pdf version of the press release.


Beginning July 1, 2013 the Examination Blueprint will change to the one listed on page 41 of the 2013 Examination Application and Overview booklet. If you are testing July 1 or later, please reference this new blueprint.

RCIS 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 invasive cardiovascular technology Criteria for Applications postmarked AFTER July 1, 2013 Supporting Documentation

A graduate of a NON-programmatically accredited program in invasive cardiovascular technology 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 invasive cardiovascular technology 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.

A graduate of a diploma, associate, or baccalaureate
academic program in health science (includes, but not
limited to, cardiovascular technology, ultrasound, radiologic technology, respiratory therapy, or nursing)
One year full-time work experience in invasive cardiovascular technology
600** cardiac diagnostic/interventional procedures in
their career which is defined as work experience and/or
clinical experience gained during a formal educational


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.

Completion certificate and/or
educational transcript
Student Verification Letter
Clinical Verification Letter


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

Applicant must be a graduate of a programmatically accredited program in invasive cardiovascular technology

Completion certificate and/or educational transcript
Student Verification Letter


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

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-hour minimum under qualification RCIS5.

** If an individual’s studies were completed during a formal educational program, then those procedures completed WOULD count toward the minimum of 600 diagnostic/interventional procedures under qualification RCIS235-2013.

*** 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 Invasive Cardiovascular Technology).


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) Indicate the number of studies performed during the applicant’s employment (required for candidates applying on or after July 1, 2013).
8) Original signature of direct supervisor, who must be a MD or DO 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 or Vascular or Invasive),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 Invasive Cardiovascular Technology) 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 number of studies performed during the applicant’s clinical training (required if applying on or after July 1, 2013).
6) Indicate the time period during which the clinical hours were performed.
7) 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 hour minimum under qualification RCIS5.

Exam Overview Sunday, November 08th 2009 11:32 PM

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.

Conducting Pre-procedural Activities     11%
Conducting Intra-procedural Activities     46%
Performing Diagnostic Studies     15%
Performing Interventional Procedures     20%
Conducting Post-procedural Activities     8%
  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.

*calculation/conversion skills

*units of measurement

*shunt calculations, VOA
Medical terminology
Cardiovascular anatomy and physiology
Cardiovascular pathology and pathophysiology
Body mechanics
Regulatory and Compliance Standards
Patient care and assessment
Normal and abnormal lab values
ECG interpretation and analysis
Pharmacology and medication administration
Hemodynamic waveform recognition


*radiation safety

*operation of
radiographic equipment



Sterile technique
Universal Precautions
Diagnostic and interventional procedures

*Cardiac procedures

*Vascular procedures

*Device implants

*Procedural indications,
contraindications and complications

Emergency procedures and equipment

The task list below describes the activities which an RCIS is expected to perform on the job.  All examination questions are linked to these tasks.
A   Conducting Pre-Procedural Activities 11%
  1 Prepare Procedure Room (set up equipment, QC, QA)  
  2 Prepare sterile table  
  3 Ensure regulatory compliance  
  4 Perform patient identification  
  5 Review patient laboratory results  
  6 Review patient medical record  
  7 Verify physician's orders  
  8 Educate patient  
  9 Verify/obtain patient consent  
  10 Start patient IV  
  11 Insert/apply urinary catheter  
  12 Transport patients to procedure room  
  13 Prepare patients for invasive procedures (premedication, pulses, dye allergies)  
B   Conducting Intra-Procedural Activities 46%
  1 Maintain patient safety and comfort  
  2 Monitor vital signs of patients (basic science, normal values, A & P)  
  2.a basic science & definitions  
  2.b A & P  
  2.c vital signs  
  3 Perform ECG rhythm analysis (rhythm ID, conduction system)  
  4 Perform 12 lead ECG analysis(infarct, bundle branch, ischemia, medication effects, tamponade)  
  5 Administer medications to patients for non-sedative purposes  
    a.  Drug calculations  
    b.  Cardiac medications (beta blockers, CCBs, ACE inhibitors, vasodilators, vasoconstrictors, antiarrhythmics)  
    c.  Thrombolytics, anticoagulants, IIb/IIIa  
    d.  Diuretics  
  6 Monitor ACT (Activated Clotting Time)  
  7 Ensure radiation safety (time, distance, shielding)  
  8 Position radiographic equipment(C arm, pan table, angles & views)  
  9 Acquire radiographic images(administer contrast)  
  10 Administer conscious sedation(levels, Aldrete, assessing effects, Versed)  
  11 Place arterial lines  
  12 Place venous lines  
  13 Flush catheters and sheaths  
  14 Perform intra-coronary injection (damping, air, ventricularization, backflow, collateral flow)  
  15 Perform cardiac outputs  
    a.  Fick  
    b.  TDCO, angiographic  
  16 Perform provocative procedures(Ergonovine)  
  17 Evaluate hemodynamic data(pressure waveforms, CO, Fick, Shunt, PVR, SVR, valve areas)  
    a.  Calculations  
    b.  Waveform analysis  
    c.  Concepts  
  18 Obtain biopsy specimens  
  19 Complete intra procedural report(document contrast, equipment, procedure log)  
  20 Respond to intra-procedural emergency situations (anaphylaxis, cardiac arrest, cardiogenic shock,tamponade, ACLS)  
  21 Give report to receiving health care team member  
C   Performing diagnostic studies 15%
  1 Perform Adult Cardiac catheterization  
    a.  RHC  
    b.  LHC  
    c.  Equipment  
  2 Perform Pediatric Cardiac catheterization (recognize congenital defects)  
  3 Perform Intra-vascular ultrasound (IVUS)  
  4 Perform Intra-cardiac echocardiography (ICE)  
  5 Perform Fractional Flow Reserve(FFR)  
D   Performing Interventional Procedures 20%
  1 Assist physicians with implant devices  
  2 Perform balloon angioplasty  
  3 Perform coronary stenting  
  4 Perform rotational atherectomy  
  5 Perform laser interventional procedures  
  6 Perform IABP insertion(intra-aortic balloon pump)  
  7 Insert and operate transvenous temporary pacemaker  
  8 Perform pericardiocentesis  
  9 Operate thrombectomy equipment (Angiojet, aspiration catheter)  
  10 Perform percutaneous left ventricular assist device (LVAD, Impella)   
  11 Perform percutaneous valvuloplasty (Inoue)  
  12 Assist with transseptal puncture  
  13 Perform peripheral vascular interventions (vena cava filters, carotids, iliacs, renals, SFA, popliteal)  
  14 Insert distal protection devices  
  15 Perform structural heart disease interventions (ASD/PFO, VSD, PDA)  
E   Conducting Post-Procedural Activities 8%
  1 Obtain femoral hemostasis with manual pressure  
  2 Obtain femoral hemostasis with collagen closure device (Duett, Angioseal, Vasoseal)  
  3 Obtain femoral hemostasis with mechanical device (Perclose, Starclose, C-clamp, Femo-stop)  
  4 Obtain radial hemostasis manually or with mechanical device (Hemoband, Radstat)  
  5 Manage access site complications  
  6 Respond to post-procedure emergency situations (Vasovagal, anaphylaxis, retroperitoneal bleed)  
  7 Educate patient (post-procedure, discharge)  
  8 Reassess patient (vital signs, check pulses)  
    Total 100%
  1. Based on the following data: O2 Consumption = 250 ml/min., AO = 21.0 vol. %, PA = 16.0 vol. %, BSA = 1.8 M2. What is the approximate cardiac output for the patient?
    1. 2.5 L/min.
    2. 4.0 L/min.
    3. 5.0 L/min.
    4. 6.0 L/min.
  2. Based on the following data: O2 Consumption = 250 ml/min., AO = 21.0 vol. %, PA = 16.0 vol. %, BSA = 1.8 M2. What is the approximate cardiac index for the patient?
    1. 2.22 L/min./M2
    2. 2.77 L/min./M2
    3. 3.00 L/min./M2
    4. 3.33 L/min./M2
  3. If T-wave sensing occurs in ventricular demand or synchronous pacing, what must be done to the programmable generator?
    1. Increase pulse width
    2. Decrease pulse width
    3. Longer refractory period
    4. A shorter refractory period
  4. If a patient had a large S-wave in lead VI and a large R-wave in V5, you might suspect:
    1. LVH
    2. IV Strain
    3. Hyperkalemia
    4. Anterior Infarction
  5. What is most likely indicated from the following oximetry samples?
    Position, Saturation %, Position, Saturation %
    SVC, 70%, RV, 86%
    IVC, 71%, PA, 86%
    Hi RA, 78%, LA, 94%
    Mid RA, 86%, LV, 94%
    Low RA, 83%, AO, 94%
    1. ASD with left to right shunt
    2. PDA with left to right shunt
    3. VSD with left to right shunt
    4. Tetralogy of Fallot with bidirectional shunt
  6. On an ECG, which of the following may indicate a loose connection of a temporary pacing wire at the pulse generator spikes?
    1. Changing in size
    2. Changing in polarity
    3. Decreasing in intervals
    4. Falling at irregular intervals
  7. Which of the following will markedly elevate right ventricular systolic pressure?
    1. Infundibular stenosis
    2. Pulmonic insufficiency
    3. Constrictive pericarditis
    4. Patent ductus arteriosus
  8. Which of the following may be caused by rapid accumulation of fluid in the pericardial sac?
    1. Subvalvular gradient
    2. Coarctation gradient
    3. Atrioventricular gradient
    4. Semilunar valve gradient
  9. A patient has a cardiac output of 5 L/min. and a heart rate of 75 beats per minute. If stroke volume remains constant, what will be the effect of an increase in heart rate to 150 beats per minute? Cardiac output would:
    1. Triple
    2. Increase to 10 L/min.
    3. Increase to 25 L/min.
    4. Increase to 22.5 L/min.
  10. Cardiac myxomas are usually located in the:
    1. Left atrium
    2. Right atrium
    3. Left ventricle
    4. Right ventricle
  11. Overdrive suppression of Torsade de Pointes and atrial flutter works by pacing the heart according to which of the following protocols:
    1. With bursts at same rate as the tachycardia
    2. 10-20 beats/minute slower than the tachycardia
    3. 10-40 beats/minute faster than the intrinsic HR
    4. With premature synchronized extra systoles Sl-S2
  12. What is the BEST indicator of the exact moment the aortic and pulmonary valves open?
    1. R wave on the ECG
    2. C wave on the atrial pressure tracing
    3. Dicrotic notch on the atrial pressure waveform
    4. Beginning of systolic rise on the arterial pressure
  13. Left ventricular mass is determined angiographically from measuring the heart wall thickness during what stage of the cardiac cycle?
    1. Mid-systole
    2. End-systole
    3. Mid-diastole
    4. End-diastole
  14. In an aortic pressure recording, a gradual upstroke with a prominent low anacrotic notch is indicative of:
    1. Aortic stenosis
    2. Aortic insufficiency
    3. Left ventricular failure
    4. Congestive heart failure
  15. Which of the following is characteristic of Tetralogy of Fallot?
    1. Greater pressure in the left ventricle
    2. A fall in pressure form the ventricle to aorta
    3. A marked difference in mean atrial pressures
    4. A fall in pressure from right ventricle to the pulmonary artery
  16. In an aortic pressure recording, a rapid upstroke with a large pulse pressure is indicative of:
    1. Mitral stenosis
    2. Aortic stenosis
    3. Aortic insufficiency
    4. Constrictive pericarditis
  17. Protection from radiation may be maximized by all but which of the following:
    1. Significantly reducing KV setting
    2. Maximizing the distance to the source
    3. Minimizing the time near the radiation source
    4. Placing absorbing material between yourself and the patient
  18. What is MOST likely indicated by the following pressures?
    RV = 26/2, PA= 25/19, LA = mean of 18, LV = 142/8, AO = 145/75?
    1. Mitral stenosis
    2. Aortic stenosis
    3. Mitral insufficiency
    4. Aortic insufficiency
  19. In cardiac tamponade, venous pressures:
    1. fall and arterial pressures rise
    2. rise and arterial pressures fall
    3. remain steady and arterial pressures fall
    4. rise and arterial pressure remains steady
  20. Which of the following typically increases to compensate for constrictive diseases which impede filling:
    1. SV
    2. Preload
    3. Afterload
    4. EDV, ESV

1. c 5. a 9. b 13. d 17. a
2. b 6. d 10. a 14. a 18. a
3. c 7. a 11. c 15. d 19. b
4. a 8. c 12. d 16. c 20. b

  1. Student Manual for Basic Life Support, American Heart Association.
  2. Textbook of Advanced Cardiac Life Support, American Heart Association.
  3. Cardiac Catheterization and Angiography, 6th edition, Grossman, William, Lea and Febiger, Philadelphia, PA.
  4. Techniques in Bedside Hemodynamic Monitoring, 5th edition, Elaine Daily, RN, BS, and John Schroed, MDCV, 1994, Mosby Co., Washington, DC.
  5. Cardiac Arrhythmias: Electrophysiologic Techniques and Management, 1st edition, Dreifus, L.S., 1985; F.A. Davis Co., Philadelphia, PA.
  6. Cardiac Catheterization Handbook, 3rd edition, Morton Kern, MD, 1999, C.V. Mosby, St. Louis, Missouri.
  7. Texts of Basic Electronics, Mathematics, CPR, Anatomy, Physiology and Nursing Care of the Cardiovascular Patient.
  8. The Manual of Intervention Cardiology, 2nd Edition, Mark Freed, MD, Cindy Grimes, MD, Robert D. Safian, MD 1996, Physicians Press, Birmingham, Michigan
  9. Invasive Cardiology: A Manual for Cath Lab Personnel, Sandy Watson, Physicians Press, Birmingham, Michigan.
  10. OSHA Regulations, 2002.
  11. ECG Made Easy, 3rd Edition, Barbara Aehlert, 2005.
  12. Hemodynamic Monitoring, 3rd Edition, Gloria Darovic, 2002.
  13. Handbook of Cardiovascular and International Radiology, Krishna Kandarpa, 1988.
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