2013 App Book August 2013

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Cardiovascular Credentialing International
Credentialing Cardiovascular Professionals Apply online at www.cci-online.org

2013 Examination Application & Overview
Certified Cardiographic Technician

CCT

Certified Rhythm Analysis Technician

CRAT

Registered Congenital Cardiac Sonographer
Courtesy Alta Bates Summit Center Courtesy Lancaster General Hospital

RCCS

Registered Cardiac Electrophysiology Specialist

RCES

Registered Cardiovascular Invasive Specialist
Courtesy Lancaster General Hospital

RCIS

Registered Cardiac Sonographer
Courtesy Saint Francis Hospital and Medical Center

RCS

Registered Phlebology Sonographer
Courtesy Morrison Vein Institute and Compudiagnostics Courtesy of Shands Teaching Hospital at the University of Florida

RPhS

Registered Vascular Specialist

RVS

Important – Please Read
All Applicants – Please Read This Section Before Starting Your Application Process It is extremely important for all applicants to read the entire Examination Application and Overview booklet to be fully aware of CCI’s application requirements and appropriate supporting documentation. Please note that the samples of the required supporting documentation are provided for your assistance. Please use these sample documents when having your employer, educator, or clinical advisor write your verification letters.

Application Publication Date: August 2013. This application supersedes all documentation previously released.

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Table of Contents
General Information Introduction..............................................................................................................................................................................5 CCI Credentials........................................................................................................................................................................ 5 General Information.................................................................................................................................................................6 Payment of Fees........................................................................................................................................................................6 Pre-Application Policy Pertaining to Criminal Matters........................................................................................................... 6 Applicants outside North America............................................................................................................................................6 The Testing Process Testing Objectives.....................................................................................................................................................................7 Examination Application Policies............................................................................................................................................ 7 Examination Scheduling and Sites........................................................................................................................................... 7 Examination Rescheduling...................................................................................................................................................... 7 Examination Rules................................................................................................................................................................... 7 Special Testing Accommodations............................................................................................................................................. 8 Frequently Asked Questions .................................................................................................................................................... 9 Reporting of Results................................................................................................................................................................10 CCI Code of Ethics...................................................................................................................................................................11 Application Instructions and Application Form Examination Application Instructions and Requirements.................................................................................................... 12 Examination Cancellation/Refund Policy...............................................................................................................................12 CCI Exam Application.............................................................................................................................................................13 CCI Examination Overviews Examination Overviews (Table of Contents)..........................................................................................................................16 Certified Cardiographic Technician (CCT).............................................................................................................................17 Certified Rhythm Analysis Technician (CRAT)......................................................................................................................21 Registered Congenital Cardiac Sonographer (RCCS)..............................................................................................................26 Registered Cardiac Electrophysiology Specialist (RCES)........................................................................................................30 Registered Cardiovascular Invasive Specialist (RCIS)............................................................................................................35 Registered Cardiac Sonographer (RCS)..................................................................................................................................39 Registered Phlebology Sonographer (RPhS)..........................................................................................................................44 Registered Vascular Specialist (RVS)......................................................................................................................................50 Definition of CCI Terms .........................................................................................................................................................55 Helpful Hints ......................................................................................................................................................................... 56 CCI Self Assessment Examinations ........................................................................................................................................57 Once You Have Earned Your Credential...................................................................................................................................59 Recertification Application.....................................................................................................................................................62 Societies and Associations......................................................................................................................................................63

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From the Board of Trustees & Advisors
Dear Applicant, Congratulations on your decision to become certified! This Examination Application and Overview Booklet is meant to assist you as a prospective candidate. Please take the time to read it now. Before applying, please become fully familiar with the requirements for sitting for CCI’s examination(s) and retaining your credential. Earning a CCI credential demonstrates not only fundamental knowledge, but also dedication to your professional development. Becoming certified allows you to become part of a group of more than 17,000 certified cardiovascular professionals worldwide. CCI’s credentials are internationally recognized by physicians, employers, contractors of Medicare and Medicaid services, administrators, accreditation bodies, and patients. For your convenience, you can apply for your CCI examination on the CCI web site at www.cci-online.org or by completing the application (on page 13 of this booklet) and submitting the required supporting documentation. CCI wishes you every success in the examination. If anything is unclear after reading this booklet, please call CCI at 800-326-0268 or e-mail [email protected] CCI staff will guide you through any aspect of the program that you would like explained in more detail. Sincerely, CCI Board of Trustees & Advisors

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General Information
Introduction
This publication contains information about Cardiovascular Credentialing International (CCI). It also provides the necessary information and references concerning the process by which candidates may earn certificate or registry-level credentials. IT IS VERY IMPORTANT THAT YOU READ ALL THE INFORMATION CONTAINED IN THIS BOOKLET BEFORE COMPLETING AND SUBMITTING YOUR APPLICATION. If questions arise after reading this application, please contact CCI Headquarters at 800-326-0268 or via email at [email protected] cci-online.org. Please retain this booklet and copies of all submitted materials and documentation. The application and any required documents are considered the sole responsibility of the applicant. Do not contact Pearson VUE regarding scheduling of your examination until you have received an Authorization to Test (ATT) letter from CCI.

General Information

Credentials Administered through CCI
CCI offers eight credentials which, when earned, demonstrate that the registrant holds fundamental knowledge in the particular cardiovascular specialty.

Certificate Level
CCT – Certified Cardiographic Technician • Who should apply: Professionals working in the areas of ECG, Holter monitoring, and stress testing CRAT – Certified Rhythm Analysis Technician • Who should apply: Professionals who utilize specialized monitoring equipment to analyze cardiac rhythms

Registry Level
RCCS – Registered Congenital Cardiac Sonographer • Who should apply: Professionals working in the area of pediatric and adult congenital cardiac ultrasound RCES – Registered Cardiac Electrophysiology Specialist • Who should apply: Professionals working in the area of electrophysiology RCIS – Registered Cardiovascular Invasive Specialist • Who should apply: Professionals working in the area of cardiac catheterization (invasive) RCS – Registered Cardiac Sonographer • Who should apply: Professionals working in the area of echocardiography RPhS – Registered Phlebology Sonographer • Who should apply: Professionals working in the area of phlebology ultrasound RVS – Registered Vascular Specialist • Who should apply: Professionals working in the area of vascular technology (vascular ultrasound) Credentials administered by CCI are accredited by the American National Standards Institute (ANSI) based on the ISO/IEC 17024 Accreditation Standard.

Who We Are …
CCI is a not-for-profit corporation established for the purpose of administering credentialing examinations as an independent credentialing agency. CCI began credentialing cardiovascular professionals in 1968.

Details of Required Examinations for Credentials
Credential CCT CRAT RCCS RCES Electrophysiology Registry $350 RCIS Invasive Registry $350 RCS Echocardiography Registry $350 RPhS Phlebology Registry $350 RVS Vascular Registry $350 Specialty Exam Certified Certified Congenital Cardiographic Rhythm Analysis Echocardiography Registry Specialty Exam Fee $160 $160 $350

* All exam fees include a $100 non-refundable filing fee. Other fees may include: Score Verification Request – $50; International Fee – $50; Returned Check Fee – $25; Replacement wallet cards – $10; Wall Certificates – $25. 5

General Information

General Information
General Rules
1. Candidates who fail an examination and wish to apply to sit for the same examination must complete a new application and submit the required fees. Attaching supporting documentation is not required (as long as the previously submitted supporting documentation still meets the requirements). There is a mandatory waiting period of 45 days, after the previous examination, before a new authorization to test start date is issued. The new application can be submitted prior to the conclusion of the mandatory 45-day waiting period. 2. Registrant wallet cards are provided to successful exam candidates and expire on the date of first renewal. Triennial wallet cards are provided upon renewal of credentials. 3. Maintenance of an “active status” for registry- and certificate-level credentials requires the submittal of triennial renewal dues, signature of compliance to the CCI Code of Ethics, and the completion of Continuing Education Units (CEUs) every three years. For registrylevel credentials, 36 CEUs (30 of which must be cardiovascularrelated) are required every three years. For the certificate-level credentials, 16 CEUs are required every three years. 4. An Active Status registrant may re-take a specialty examination that he or she has already passed without penalty for a recertification fee. This may occur once during a triennial (3-year) period. A passing grade will fulfill the CEU requirements for the current triennial cycle. 5. CCI sends new registrants a wallet card and lapel pin. Registrants may order a wall certificate, suitable for framing for a fee of $25 plus shipping. Go to the section in this application booklet titled “Once you have earned your credential” on page 59 or www.ccionline.org for further details. its terms. If your check is dishonored or returned for any reason, your Authorization to Test (ATT) will be suspended until payment is completed. Credentials will not be awarded to any candidate with an outstanding balance owed to CCI.

Pre-Application Policy Pertaining to Criminal Matters
Applicants with questions regarding personal criminal matters may request a pre-application to determine whether they qualify for the CCI credentialing process. CCI reserves the right to deny an application, revoke the eligibility of a candidate, or take action against any registrant who has been convicted, pled guilty, or pled nolo contendere (no contest) to an offense that is classified as a misdemeanor or felony which is directly or indirectly related to patient care or public health. Crimes which may directly or indirectly relate to patient care or public health include, but are not limited to murder; attempted murder; manslaughter; rape; attempted rape; sexual assault; sexual abuse; assault; driving while intoxicated or impaired; controlled substance abuse; and fraudulently altering medical documentation, insurance claims, and medical prescriptions. Pre-Application requests must be made by the applicant. Pre-Application requests will not be accepted from any third party, including but not limited to educational programs. A $50.00 USD fee is required at the time of Pre-Application, and this fee is non-refundable. For Pre-Application Procedures, please go to the Applicant Information Section on CCI’s website, www.cci-online.org, or contact CCI Headquarters.

Payment of Fees
Payment of fees may be made by check, money order, MasterCard, or VISA. Cash is not accepted. Applicants must not have outstanding financial obligations to CCI. All expenses related to the examinations are the responsibility of the applicant. Once a complete application is approved, the applicant will be mailed an Authorization to Test (ATT) within 15 business days after the application has been approved. An incomplete application could delay processing of the application, which in turn will delay the Authorization to Test (ATT). All exam fees include a $100 non-refundable examination filing fee for the staff resources required to review and process applications. It is CCI’s policy to deposit all examination fees at the time the application is received. If an application is not complete when submitted (invalid documentation of qualification, missing required documentation, missing signature, etc.), CCI will make electronic copies of the application and return the original application and supporting documentation with an explanation of the reason(s) for denial and return. The applicant will have 60 days to return a completed application and required documents for approval, or contact CCI Headquarters with an estimated time-schedule of when the completed application with required documents will be resubmitted by the applicant. If CCI Headquarters does not receive these documents or any communication within 60 days after the original application was returned, CCI will refund the examination fee minus a $100 filing fee.

Applicants Outside North America
Candidates applying for examination outside the United States will be assigned a candidate number. Completion of the social security section on the application is not required. Canadian applicants should enter their Canadian insurance number in the social security section of the application. All examination fees should be made payable in USD by credit card, money order or certified check. Applicants who plan to take their examination outside North America must include an additional $50 for exam delivery. This fee applies to all applicants taking their examination outside of North America.

Foreign Education Transcript Evaluators
Applicants who have completed formal education or course work at an institution in a country other than the United States must obtain a complete evaluation of foreign transcripts, degrees, and other relevant documents prior to applying for any CCI examination. The following organizations provide evaluation services:
Commission on Graduates of Foreign Nursing Schools – 3600 Market St., Suite 400, Philadelphia, PA 19104; (215) 349-8757; www.cgfns.org Educational Credential Evaluators, Inc. – 260 East Highland Ave, Suite 300, Milwaukee, WI 53202; (414) 289-3400; www.ece.org Foundation for International Services, Inc. – 19015 North Creek Pkwy, Suite 103, Bothell, WA 98011; (425) 487-2245; www.fis-web.com Global Education Group – 1205 Lincoln Road, Suite 218, Miami Beach, FL 33139; (305) 534-8746; fax (305) 534-3487; www.globaledu.com International Educational Research Foundation, Inc. – PO Box 66940, Los Angeles, CA 90066; (310) 390-6276; www.ierf.org World Education Services, Inc. – PO Box 745, Old Chelsea Station, New York, NY 10113; (212) 966-6311; www.wes.org

Check Acceptance Policy
When you pay by check you expressly authorize CCI, if your check is dishonored or returned for any reason, to electronically debit your account for the amount of the check plus a processing fee of $25 (or the legal limit), plus any applicable sales tax. The use of a check for payment is your acknowledgment and acceptance of this policy and 6

The Testing Process
Testing Objectives
The examinations developed and credentials administered by CCI are designed with the following objectives in mind: 1 . Establish fundamental assessment of a healthcare professional’s knowledge for the protection of the public. 2. Identify persons with acceptable fundamental knowledge of principles and practices of the profession and related disciplines. 3. Improve the performance in the profession by encouraging participation in a continuing education program of professional development. not have to enclose supporting documentation (as long as previously submitted documentation still meets requirements). CCI reserves the right to request additional information. 10. No information regarding an applicant’s qualification can or will be discussed via telephone, fax, or email. 11. Candidates may request one extension to their originally issued Authorization to Test (ATT). The extension will be for a period of 90 days.

Examination Overview
The examination overview is provided as a service of CCI to help candidates prepare for the examination. The overview for each examination includes the following: • An examination matrix to illustrate the general distribution of questions and the relative weight or emphasis given to a skill or content area on the examination. • A list that describes general areas of knowledge that are needed in order to perform the tasks identified. • A task list that describes the activities which a credentialed cardiovascular professional is expected to perform on the job. All examination questions are linked to these tasks. Detailed examination overviews can be found in the CCI Examination Overviews section, beginning on p.16 of this booklet, and on CCI’s website.

Examination Scheduling and Testing Sites
CCI’s credentialing examinations are administered year-round at over 230 Pearson Professional Centers (PPC) in the United States and US territories and over 3000 Pearson VUE Authorized Centers (PVTC) internationally. Examination site availability is provided when scheduling your examination with Pearson VUE. Do not contact Pearson VUE until you have received an Authorization to Test (ATT) letter from CCI. Available sites may be viewed at www.pearsonvue.com/cci.

The Testing Process

Examination Rescheduling
To reschedule your examination, contact the Pearson VUE Call Center at least two full working days in advance of your scheduled appointment. (Please see page 12 for exam cancellation/refund policy.) • Phone: Call 800-869-4102, 7:00 am to 7:00 pm, Central Standard Time, Monday through Friday (Outside of the U.S. 952-681-3789). • Internet: Go to www.pearsonvue.com/cci If you do not contact the Call Center within two working days of your testing appointment, you cannot reschedule the examination.

Examination Application Policies
Processing a complete application may take up to 15 business days. 1. A completed original application with original signature must be submitted. Faxed applications are not accepted. 2. All applications must include a clear copy of your non-expired government-issued photo identification (e.g., driver’s license, government-issued identification card, or passport photo page). Both the first and last names on your current government-issued photo identification must exactly match the first and last names you provide on the application page. 3. Applications may be sent throughout the year. 4. If an incomplete application is received, the candidate will be contacted by CCI for required information or the application will be returned with an explanation. 5. Transcripts may be forwarded under separate cover. Transcripts from institutions in countries other than the United States require U.S. evaluation. Education transcript evaluators are listed on page 6. 6. CCI will not supply an applicant’s examination information to anyone other than the applicant. Applicants have the right to appeal application qualification decisions, but cannot appeal the criteria upon which decisions are based. 7. Falsification of applicant information may result in disciplinary action or revocation of credential. 8. Special testing accommodation requests must be submitted in writing at the time of application and require supporting documentation. Please go to page 8 of this booklet or cci-online.org for details about special testing accommodations. 9. Candidates who are reapplying less than six (6) months since applying for an examination, or who are seeking recertification, do

Emergencies
If you experience the death of an immediate family member, suffer a serious illness or injury which requires hospitalization, or experience another event causing emotional distress, and such events conflict with the administration of your examination, then you may be permitted to reschedule your examination authorization window without penalty, upon approval from CCI. All such instances must be documented within three (3) days of the initially scheduled examination date and submitted in writing to CCI Headquarters.

Examination Rules
A. The only people admitted into the examination room are 1. Test Administrators 2. Authorized Candidates B. Each approved candidate must present two (2) non-expired IDs (one with a photo, both with a signature) to the proctor upon arrival at the test center. Primary IDs: • government-issued driver’s license • state/national ID card • passport • military ID (with signature) • alien registration card (green card, permanent resident visas) • employee ID • school ID 7

The Testing Process
Secondary IDs: • any ID on primary list • Social Security card • ATM card C. Candidates arriving more than 15 minutes late to the Pearson VUE examination site will not be admitted. D. Books, personal calculators, calipers, rate rulers, papers, or reference material may not be taken into the examination area. No cell phones or pagers. Note: A calculator on the computer is available for use during the examination. of approximately two hours while the registry-level examinations have a time allotment of approximately three hours.

Comments on the Exam
Each CCI examination, including individual items, contains an option where a candidate is allowed to make comments pertaining to the exam item and/or the examination as a whole. These comments are reviewed by the appropriate examination committee throughout the year. While responses to comments are not provided back to you, your comments will be used to help ensure the maintenance of CCI’s highquality examinations.

The Testing Process

E. An erasable board and marker will be provided and must be returned to the test administrator upon completion of the exam. F. No smoking, food, or drinks are permitted in the examination room. G. No examinee may leave the room without a test administrator’s permission. H. Questions concerning the content of the exam may not be answered by the test administrator. Instructions will be provided before the exam begins. If you do not understand the instructions, ask for clarification. Don’t fail the exam because you were confused about some of the instructions. I. If you need assistance during testing for any reason (other than reasons related to examination content), a test administrator will assist you. J. Candidates suspected of cheating will be referred to CCI for further investigation and possible invalidation of exam results. K. A tutorial is offered prior to the test to orient the candidate with computer-based testing. The tutorial does not affect time given to complete the examination. L. CCI and Pearson VUE reserve the right to reschedule examination dates or eligibility windows due to any unforeseen circumstance. M. In an effort to keep up with the latest security technology, starting January 4, 2010, candidates taking CCI examination through Pearson VUE will have the palm vein scanned as a form of identification. This will replace the finger-printing that was done in the past. The palm vein will be scanned by placing your hand on a small, rectangular scanner. The process is quick and non-invasive. Palm vein scanning is 10 times more reliable for identification than fingerprinting, thus prompting this change. If you have any questions regarding the palm vein scanning, please contact CCI Headquarters.

Non-Discrimination Policy
CCI abides by all federal and state laws prohibiting discrimination solely on the basis of a person’s race, color, creed, national origin, religion, age, sex, marital status or physical disability, except where a reasonable, bona fide occupational qualification exists. CCI’s policy prohibits racial or sexual harassment of any kind. This policy applies to all professionals requesting examination.

Special Testing Accommodations
CCI will provide, upon approved request, reasonable accommodations including auxiliary aids and services necessary to afford an individual with a documented disability an equal opportunity to participate in all services, programs, and activities. To request special accommodations, please provide an original letter signed by the applicant and an evaluator, qualified psychologist, physician, or other health care professional who specializes in the stated disability. This letter should include the following: 1. The specific diagnosed disability 2. The specific functional limitations 3. Impact of the functional limitations on the individual’s ability to participate in the testing activity 4. What accommodations or assistive devices, if any, would cancel or ease the impact of the disability on the candidate’s ability to participate in the examination process

Additional documentation required:
1. Verification of the evaluator, psychologist, physician, or health care professional credentials and specialty in the diagnosis of the stated disability. 2. Examples, when possible, of where special accommodations have been requested and granted. If no prior accommodations have been provided, the evaluator, psychologist, physician, or health care professional should include a detailed explanation as to why no accommodations were given in the past and why accommodations are needed now. REQUESTS FOR SPECIAL ACCOMMODATIONS AND THE REQUIRED SUPPORTING DOCUMENTATION MUST BE SUBMITTED WITH EACH APPLICATION, INCLUDING RE-EXAMINATIONS. CCI reserves the right to request additional documentation.

Evaluation Questions
All CCI credentialing examinations consist of multiple choice questions (approximately 130 for certificate-level examinations and approximately 170 for registry-level examinations). Some of the items on the examination may not be scored. These items are not identified for examination candidates at the time of testing. This is standard practice and enables CCI to evaluate questions which may be used in future examinations. These items are not scored when your examination results are calculated and thus will not affect your score. The time you have been allotted to take the examination has been determined by taking into consideration the number of scored and un-scored items. Certificate-level examinations have a time allotment 8

The Testing Process
Frequently Asked Questions
1. Are CCI Self-Assessment Exams intended to be used as a study guide? No. CCI Self-Assessment Exams are intended to be used only as an assessment tool, so that applicants/candidates can determine their strengths and weaknesses based on the subject matrix for each examination. Applicants/candidates will not receive exact question/answer combinations; only a score report broken down by the subject matrix will be returned. 2. Are there any study guides or review courses to assist me in preparation for the examination? CCI does not endorse, recommend, or create any review course or educational material. There are several sources of review material advertised in CCI’s official publication, The Pulse. Review courses offered by a variety of groups and businesses are also advertisers in The Pulse. CCI does not endorse any third-party review course, even those who may advertise in The Pulse. 3. What type of identification will I need to obtain admission to the Pearson examination site? It will be necessary to have two (2) forms of non-expired identification, including at least one (1) current, government-issued source of identification that includes a photo. A valid driver’s license with a picture and a passport are two examples of acceptable forms of identification. 4. When will I get my results? Preliminary results are delivered immediately at the Pearson Professional Center (PPC). Official results will be mailed from CCI approximately 15 business days after the examination. 5. If I must retake an examination, what is the time requirement for retaking the examination? There is a 45-day waiting period before you may re-take an examination. 6. On what dates are the examinations offered? CCI examinations are administered using a computer-based testing format, thus allowing the examinations we offer to be taken year-round based on availability at Pearson Testing Centers. 7. Where are the test sites for the examinations? The examinations offered by CCI are administered by Pearson Professional Centers, which has over 3200 sites worldwide. A complete list of Pearson test sites can be found at www.pearsonvue.com/cci. 8. What are the qualifications for the examinations? The qualifications are listed in the section titled CCI Examination Overviews, starting on page 16. 9. After I submit my application, how long will it take before I receive something back from CCI? CCI requires a minimum of 15 business days from receipt of exam application for processing. Once the application has been processed and approved, you will be mailed an Authorization to Test (ATT) letter, which will provide your 90-day testing window. 10. What is the $100 non-refundable examination filing fee? The $100 non-refundable examination filing fee is for the staff resources required to review and process applications. It is CCI’s policy to deposit all examination fees at the time the application is received. If an application is not complete when submitted (invalid documentation of qualification, missing required documentation, missing signature, etc.), CCI will make electronic copies of the application and return the original application and supporting documentation with an explanation of the reason(s) for denial and return. The applicant will have 60 days to return a completed application and required documents for approval, or contact CCI Headquarters with an estimated time-schedule of when the completed application with required documents will be resubmitted by the applicant. If CCI Headquarters does not receive these documents or any communication within 60 days after the original application was returned, CCI will refund the examination fee minus a $100 filing fee. 11. How do I schedule an examination? To schedule or reschedule your examination appointment, please contact Pearson Vue Call Center at 1-800-869-4102 or at www. pearsonvue.com/cci. 12. If I fail the examination and have to retest, do I have to pay the fee again? Yes. The full fee is required each time you take an examination.

The Testing Process

13. If I fail an examination, must I reapply to retest? When you complete your exam, you will receive an official results letter. Attached to your results letter will be an application to test. Candidates who fail an examination and wish to apply to sit for the same examination must complete a new application and submit the required fees. Attaching supporting documentation is not required as long as the previously submitted documentation still meets the specified requirements. There is a mandatory waiting period of 45 days, after the previous examination, before a new authorization to test start date is issued. The new application can be submitted prior to the mandatory 45-day waiting period. 14. How does one cover the hundreds of possible subjects listed in the detailed outlines? CCI is a credentialing agency and can’t provide recommendations on how to study. A detailed outline of each examination and popular reference materials are found in the CCI Examination Application and Overview Booklet. Applicants may also order a self-assessment exam. These exams are not intended to be study guides, but rather tools to assess the applicants’ knowledge in each of the subject categories found on the credentialing examination. 15. Will CCI’s exam qualifications be changed? Although CCI’s examination qualifications are currently under review, the qualifications may be revised and effective no sooner than January 1, 2014. 16. How long is my credential valid for after I pass my exam? A credential is active for 9-12 months after passing exam. Refer to the chart on page 60 of the 2013 CCI Application and Examination Overview Booklet. 17. Can I have an extension to test? Each applicant will be granted one 90-day extension to test. If the exam is not taken by the end of the extension period, the testing fee will be forfeited and the applicant will have to reapply to take the test. If the applicant has made an appointment with Pearson prior to requesting the extension, the appointment must be cancelled before CCI is contacted. 18. Why aren’t all the questions on the examination scored? All CCI credentialing examinations consist of 100 or more multiple choice questions. Some of the items on the examination may not be scored. These items are not identified for examination candidates at the time of testing. This is standard practice and enables CCI to evaluate questions which may be used in future examinations. These items are not scored when your examination results are calculated and thus will not affect your score. The time you have been allotted to take the examination has been determined by taking into consideration the number of scored and unscored items. 19. Does having an existing credential mean that I do not have to submit supporting documentaion with my application? No. 9

The Testing Process
Results
SAMPLE ONSITE RESULTS LETTER CCI Examination Results Certified Rhythm Analysis Technician Examination Score Report
CANDIDATE: Candidate CANDIDATE ID: 54321 REGISTRATION: 2147483647 VALIDATION: 574951121 DATE: 28-Oct-2010 SITE ID: 8675309 EXAM: 000-000

Appeals
CCI will receive (in writing) appeals to contest any adverse decisions affecting examination eligibility (for applicants), examination results (for candidates), or active status (for credential holders). The written appeal must include the stated appeal, the reason for the appeal, relevant supporting documentation and contact information of the appellant. For further information on the procedures for Appeals, please visit www.cci-online.org.

PASSING SCORE: 650   YOUR SCORE: 900   GRADE: Pass SECTION NAME: A. Complying with Governing Regulations B. Interacting with Patients and Others C. Identify Normal ECG Components and Cardiac Anatomy D. Determine Patient’s Cardiac Rhythm E. Troubleshoot ECG F. Compile ECG Results YOUR SCORE: 100% 100% 100% 100% 100% 100%

Release of Student Results
As a service to educational programs in the field of Cardiovascular Technology, CCI will, upon request, release a candidate’s examination results to their educational program. Candidates can authorize the release of their results by checking the authorization box found under the Educational Background section of the CCI Examination Application or by providing a signed authorization from the educational institution or facility. The signed authorization must include the name of the facility to which the examination results may be released. Request must be made in writing. Results will not be given over the phone.

The Testing Process

Because the number of items in each section varies, it is not possible to average the section scores in order to determine your overall percentage correct score. Please refer to the CCI Examination Application and Overview for further information. Pearson VUE’s digital embossing process is available online at www.pearsonvue. com/authenticate. Digital embossing will allow you to verify that this score report is authentic. Digital embossing preserves the integrity of this testing program, maintains the value of your certification, and eliminates the possibility of unauthorized embossing of counterfeit score reports. Registration Number: 2147483647   Validation Number: 574951121 This examination was delivered at an authorized Pearson VUE Testing Center. Thank you for choosing Pearson VUE!

Candidates will receive an official results letter approximately two to three weeks after taking their exam.

Official Examination Result Requests must include the following:
(See sample letter below.) 1) Original, official letterhead or stationery 2) Indicate the date the letter was signed by educational director 3) Candidate’s name for whom the results are being requested 4) Date of the candidates graduation from the educational program making the request 5) Signature of the educational director * All result requests must include an attached document stating the candidate’s authorization to release their examination results.

Scaled Scoring
Total scores are reported on a scale that ranges from 0 to 900. Keep in mind that CCI total scaled scores do not equal the number or percentage of questions answered correctly. A total scaled score of 650 is required to pass an exam, and the number of correct answers required to achieve a score of 650 was determined through a standardsetting (or passing score) study. CCI and panels of experts from each specialty periodically review the passing score to assure its validity.

Cath Lab University (1)
1000 College Rd. • New York, NY 10001 • (212) 555-1234
January 4, 2011 (2) CCI 1500 Sunday Drive, Suite 102 Raleigh, NC 27607 RE: Credentialing Results Cath Lab University would like to request the examination results for the following students. Each student has approved the release of this information and has signed the attached ageement. (To be provided by the school.) Student Name (3) Date of Graduation (4)

Examination Score Verification Requests
CCI does NOT hand-score exams. We can process a score verification for a fee of $50 USD. Score verification ensures that the computer counted the correct and incorrect answers appropriately but does not review the questions and answers. You must submit a written request for a score verification. Please print or type all information and include a check, money order or credit card processing fee in the amount of $50 USD. In deciding whether to have your score verified, please consider that CCI examinations are scored electronically with a high degree of accuracy. It is therefore unlikely that verification will alter your original score.

Jane Doe...........................December 2002 Mary Smith......................December 2002 Robert Mathew................June 2003 Sincerely, (5)

Elizabeth Johnson, RCIS Educational Director

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CCI Code of Ethics
It is the policy of the CCI Board of Trustees to develop and implement a code of ethics and disciplinary procedures. The Board of Trustees shall review and revise the code of ethics to remain current with changes in health care and the cardiovascular technology field of practice. The purpose of the CCI Code of Ethics is to acknowledge the applicant’s, candidate’s, and registrant’s acceptance of the responsibility and trust conferred upon it by the organization and to acknowledge that earning a CCI credential is a privilege that must be earned and maintained. The delivery of safe, competent, and ethical patient care is a responsibility of the highest order. This document sets forth the Code of Ethics to be adhered to by credentialed cardiovascular technologists awarded the CCI credentials: • Certified Cardiographic Technician (CCT) • Certified Rhythm Analysis Technician (CRAT) • Registered Congenital Cardiac Sonographer (RCCS) • Registered Cardiac Electrophysiology Specialist (RCES) • Registered Cardiovascular Invasive Specialist (RCIS) • Registered Cardiac Sonographer (RCS) • Registered Phlebology Sonographer (RPhS) • Registered Vascular Specialist (RVS) All credentialed cardiovascular technologists awarded a CCI designation shall, in their professional activities, sustain and advance the integrity and honor of the profession by adhering to this Code of Ethics. Applicants, candidates, and registrants who intentionally or knowingly violate any provision of the Code of Ethics will be subject to action by a peer review panel, which may result in revocation of the certification. 1. As a credentialed cardiovascular technologist/technician or applicant/candidate of CCI Examinations, I will place the safety, health, and protection of the patient above all other interests. 2. As a credentialed cardiovascular technologist/technician or applicant/candidate of CCI Examinations, I will demonstrate and maintain professional competence in all aspects of patient care and within the scope of practice as defined by my employer. 3. As a credentialed cardiovascular technologist/technician or applicant/candidate of CCI Examinations, I will represent my credential(s) accurately and honestly, and I will not attempt to maintain CCI credentials by fraud, deception, or artifice. 4. As a credentialed cardiovascular technologist/technician or applicant/candidate of CCI Examinations, I will not knowingly assist another person or persons in obtaining or attempting to obtain or maintain CCI credentials by fraud, deception, or artifice. 5. As a credentialed cardiovascular technologist/technician or applicant/candidate of CCI Examinations, I will uphold professional standards by adhering to defined technical protocols and diagnostic criteria established by peer review. 6. As a credentialed cardiovascular technologist/technician or applicant/candidate of CCI Examinations, I will represent my qualifications honestly and provide only those services which I am qualified to perform. 7. As a credentialed cardiovascular technologist/technician or applicant/candidate of CCI Examinations, I will defend and protect the patient’s right to privacy and confidentiality, unless required to disclose such information by law. 8. As a credentialed cardiovascular technologist/technician or applicant/candidate of CCI Examinations, I will consistently maintain and improve professional competence through regular assessment of skills, continuing education, experience, and professional training. 9. As a credentialed cardiovascular technologist/technician or applicant/candidate of CCI Examinations, I will accept responsibility for maintaining the credential by meeting renewal requirements and remaining in good standing with CCI. 10. As a credentialed cardiovascular technologist/technician or applicant/candidate of CCI Examinations, I will voluntarily report any criminal behavior resulting in a conviction of a misdemeanor or felony. 11. As a credentialed cardiovascular technologist/technician or applicant/candidate of CCI Examinations, I will avoid deceptive acts which misrepresent my academic or professional qualifications. 12. As a credentialed cardiovascular technologist/technician or applicant/candidate of CCI Examinations, I will avoid compromise of professional judgment by conflicts of interest.

CCI Code of Ethics

13. As a credentialed cardiovascular technologist/technician or applicant/candidate of CCI Examinations, I will engage only in legal arrangements and practices in the healthcare field. 14. As a credentialed cardiovascular technologist/technician or applicant/candidate of CCI Examinations, I will act in a manner free of bias with regard to religion, ethnicity, gender, age, national origin, disability, social, or economic status. 15. As a credentialed cardiovascular technologist/technician or applicant/candidate of CCI Examinations, I understand that the certificate, logo, and marks are the property of CCI and I will not misrepresent or inappropriately use the property of CCI. I agree to return the wallet card and certificate of my credentialing, upon request, to the CCI Board of Trustees. 16. As a credentialed cardiovascular technologist/technician or applicant/candidate of CCI Examinations, I will act in a professional manner in my correspondence and interaction with CCI Headquarters. 17. As a credentialed cardiovascular technologist/technician or applicant/candidate of CCI Examinations, I will uphold and follow all policies and procedures required by the CCI to remain in good standing, and I will abide by CCI’s Code of Ethics. The CCI Code of Ethics shall be enforced by the CCI Ethics and Discipline Committee.

11

Application Instructions
Examination Application Instructions and Requirements
This page leads you through a step-by-step process of filling out your application. 1. Check the appropriate box for which test you wish to take. 2. Circle the corresponding number for the qualification under which you are applying. (Qualification details can be found in the section for that exam.) 3. Check the appropriate box pertaining to whether this is your first time applying for this certification or if you are re-applying. If you are re-applying, please list the date(s) of your previous examination(s). You must supply current supporting documentation if it has been more than six (6) months since the date of your original application. 4. Please type or print legibly your social security number, your first name, middle initial, and last name. 5. Please type or print legibly your mailing address, telephone numbers, and email address. 6. Please type or print legibly your current employer’s information (if applicable). 7. Please type or print legibly your educational background (if applicable). 8. Please affix all required supporting documents. All supporting documentation should be addressed appropriately (i.e. to CCI). Supporting documentation criteria and samples can be found in the section for that exam. 9. Fill out all relevant background data on the second page of the application (page 14). 10. Complete the section concerning required fees and method of payment. 11. Read and sign the affidavit. 12. Enclose all required payments (Applicants taking examination(s) outside the North America are required to enclose an additional $50 USD international fee). 13. Enclose a clear copy of your non-expired government-issued photo identification (e.g., driver’s license, government-issued identification card, or passport photo page). 14. Your application will not be processed without all required documentation and fees. 15. Mail form, required documents, and payment to: Cardiovascular Credentialing International (CCI) 1500 Sunday Drive, Suite 102 Raleigh, NC 27607

Exam Cancellation/Refund Policy
No refunds will be made to candidates who do not show up for an examination for any reason. Failure to show for a scheduled examination will cause forfeiture of all fees. Reapplication and the resubmittal of required fees will be required to test in the future. Once an examination time has been made by the candidate, cancellation can only be made by notifying both CCI and Pearson VUE of this cancellation request. Refunds cannot be made if both parties are not notified. CCI must be notified for a request to change an examination type or eligibility window. A new ATT will then be issued. Cancellations made within one (1) working days of the test date are non-refundable. Refunds, minus $100 filing fee per exam, will be given only if above policies are followed. Applicant must submit a signed request for cancellation and refund.

Application Instructions
12

CCI Exam Application
All CCI examination applications are required to be completed by the individual applicant, not by an employer, educator, or other individual. This applies to both paper and online applications. Complete the front and back of this application and sign the affidavit before mailing to CCI. Please make a copy for your records. Application instructions are located on page 12. Please type or print legibly. Do not fax this application: original signature is required.
Examination Requested Price Qualification Number Cardiovascular Credentialing Check all that apply: For details on qualification numbers please refer to the International Exam Overview Section (starting on page 16). Circle one: q  Certified Cardiographic..............................$160...........CCT1....................CCT2........................ CCT3.........................CCT4 q  Certified Rhythm Analysis.........................$160...........CRAT1..................CRAT2...................... CRAT3......................CRAT4 q  Invasive Registry........................................$350...........RCIS4...................RCIS235-2013.......... RCIS5 q  Non-Invasive/Echo Registry.......................$350...........RCS1.....................RCS4......................... RCS235-2013............RCS5 q  Vascular Registry........................................$350...........RVS1.....................RVS4......................... RVS235-2013............RVS5 q  Electrophysiology Registry........................$350...........RCES1..................RCES4...................... RCES235-2013..........RCES5 q  Congenital Cardiac Registry.......................$350...........RCCS1-2013.........RCCS235-2013......... RCCS4.......................RCCS5 q  Phlebology Registry – Non-Physicians......$350...........RPhS1..................RPhS2...................... RPhS3.......................RPhS4 q  Phlebology Registry – Physicians..............$350...........RPhS5..................RPhS6...................... RPhS7 I am: q  Applying for this examination for the first time. q  Re-applying for this examination. Please fill out:  ➔ ➔ ➔ ➔ ➔ ➔ ➔ ➔ CCI Examinations previously taken: _______ _______ _______ Has your address changed since taking your last CCI examination?  q Yes  q  No Date of previous CCI examinations: _______ _______ _______

CCI Exam Application

Personal Information
(Application must include a clear copy of your non-expired government-issued photo identification) Social Security Number (or Canadian Insurance #) ___________-_______-______________ Birth date (month/date/year) _______/_______/_________ q Mr.  q Mrs.  q Ms.  q Dr. First Name _________________________________________ Middle Initial _____ Last Name__________________________________________ Mailing Address (include Apt #)____________________________________________________________________________________________ City ______________________________________ State ________ Postal Code__________________ Country____________________________ Home Telephone _____________________ Work Telephone _____________________ Email____________________________________________ q  Check here if you have been convicted, pled guilty, or pled nolo contendere (no contest) to an offense which is classified as a misdemeanor or felony. (If you checked this box, you are required to submit a Pre-Application to determine whether you qualify for the CCI credentialing process. See page 6 for details.)

Employment History
Fill this out if applying under a qualification that requires documentation of your experience in the specialty for which you are applying for certification. Provide the following information about your employment in Cardiovascular Technology. Employment Verification Letter must be attached – sample letters found in section specific to the credential for which you are applying. Place of Employment__________________________________________Dates of Employment: From ________/________ to ________/__________ Position/Title_________________________________________________________________________________________________________ Mailing Address_______________________________________________________________________________________________________ City ______________________________________ State ________ Postal Code__________________ Country____________________________ Supervising Physician/Supervisor Name _______________________________________ Supervisor’s Telephone______________________________ Have you had a credential or license revoked, suspended, or been denied the privilege of taking an examination?  q Yes  q No

Educational Background
Fill this out if applying under a qualification that requires supporting documentation of your educational training. College/Educational Program ___________________________________________Graduation Date _______________Degree Obtained___________ Address __________________________________________________City _________________________State ________ Postal Code__________ Program Director _____________________________________________________Telephone__________________________________________ If you are applying under a qualification that requires supporting documentation of your educational training, educational transcripts and/or completion certificate must be attached with Student Verification Letter (samples found in the section specific to the credential for which you are applying). q  I authorize CCI to release my score results to my educational program. (Print name of program director or person you authorize to receive your score results:_____________________________________________________ )

For Office Use Only
Product code/amt/qual (1)__________/___________/____________ Product code/amt/qual (2)__________/___________/____________ Product code/amt/qual (3)__________/___________/____________ ATT file______________________________ Constituent #__________________________ Approval______________________________ Payment Total_________________________ Date_________________________________ Payment Method_______________________

Application Publication Date: August 2013. This application supersedes all documentation previously released.

13

CCI Exam Application

CCI Exam Application (continued)
Information related to applicants, candidates, and registrants shall remain confidential with the exception of the publication of the registrant’s credential(s), active status, city, and state on CCI’s online directory. It is the responsibility of CCI to publish any and all sanctions imposed on registrants who are found to be in violation of CCI Code of Ethics. q  Check this box if you wish to decline having your name and other information appear in the CCI online credential verification area. This online list is provided as a means for the public/employers to locate and verify the status of a registrant’s credential(s). Personal contact information such as address, phone numbers, and emails are not provided. Checking this box does not exempt you from CCI’s policy of publishing the name of sanctioned registrants and the violations they have committed. q  As a courtesy to other cardiovascular healthcare-related organizations, CCI may at its discretion make available its list of registrants in good standing for education and employment opportunities. Check this box if you wish to decline having your name and address given to cardiovascular healthcare-related organizations.

Background Data
Submission of this information is voluntary. All information is confidential and is obtained to promote the recognition of the cardiovascular credential.

Age Range
q 20-29 q 30-39

q 40-49 q 50-59

q  over 60

Other Credentials (check all that apply)

Cardiovascular Experience Cardiovascular Training

q Student q  7-15 years q  over 21 years q  2-6 years q  16-20 years q On-the-Job q  Trade School (one year or less) q  College (Associate level) q  College (Baccalaureate level) q  Hospital Training Program q Other (please specify)__________________

q RN q RRT q RDMS q RT(N) q  LPN/LVN q DO q RVT q CEPS q RDCS q RT q MD q CCDS q Other (please specify)__________________

Number of Beds in Hospital

q  Less than 50 q 100-199 q  400 or more q 50-99 q 200-399

Your Primary Cardiovascular Specialty

Professional Membership (check all that apply)
q ACC-PIC q ASE q SDMS q ACCP q ASRT q SICP q ACP q HRS q SVU q ANA q SASEAP q Other (please specify)__________________ q  q  q  q  q  Community Hospital University-Affiliated Medical Center Military/Federal Hospital State/County Hospital Private Office or Clinic

Type of Facility in Which You Are Employed

q  Cardiac Catheterization/Angioplasty q Echocardiography q  EKG Stress Testing and Holter Monitors q Electrophysiology q Phlebology q  Vascular Ultrasound q  Pediatric/Congenital Ultrasound___________ q Other (please specify)__________________

Present Position Held

Current Salary Range
q  q  q  q  q  q  $10,000-14,999 $15,000-19,999 $20,000-24,999 $25,000-29,999 $30,000-34,999 $35,000-39,999

q  q  q  q  q 

$40,000-44,999 $45,000-49,999 $50,000-59,999 $60,000-69,999 over $70,000

q  Staff Technologist q Supervisor q Director/Administrator q Nurse q  Academic Instructor q Other (please specify)__________________

Fees Enclosed
Certification (CCT or CRAT) Examination ($160)............ $______________ Registry Examination ($350)............................................. $______________ International Fee ($50)...................................................... $______________ (for individuals taking examination outside of North America) TOTAL................................................................................$______________ All fees above include a non-refundable examination filing fee of $100. See page 6 for details. *Don’t forget the self-assessment examination. See pages 60-61 for details.

Method of Payment
q Check  q  Money Order  q MasterCard  q Visa Card # _____________________________________ Exp._________ Signature________________________________________________ Name as it appears on card (please print): _______________________________________________________ Falsification of information on any CCI exam application or violation of CCI policies during exam administration will void the examination process/results and cause forfeiture of all fees. In cases where credentials have been awarded, revocation may occur, and the situation may become the subject of legal action.

Affidavit
I have read all information contained in this application booklet and understand that CCI reserves the right to deny my application, revoke my eligibility if I qualify as a candidate, or take action against me if I become a registrant if documentation I provide is found to be fraudulent, misrepresenting, if I do not meet the application qualifications (including high school graduation or documentation of any conviction), or maintain the requirements for maintaining the active status of my credential. I authorize CCI and its agents, at their sole discretion, to request any and all information concerning material related to this application. I authorize CCI to communicate information regarding my application and other credential-related information to government authorities, employers, and others. I agree to comply with the CCI Code of Ethics, all rules, regulations, and policies (now existing or adopted in the future) pertaining to this application and to the standards and renewal of any credential I may receive through CCI. I hereby release and shall indemnify and hold harmless CCI, its Board of Trustees, officers, committee members, employees, and agents(hereinafter referred to, individually and collectively, as “CCI Entities”) from and against and with respect to any and all liability and claims (including but not limited to losses, costs, expenses, damages, and judgments including legal fees) that arise or allegedly arise from, with respect to, out of, or in connection with any action or omission of the CCI Entities. My agreement hereunder to indemnify and hold harmless expressly is intended to apply to any and all such liability and claims relating to any CCI examination and application therefore, and, if applicable and without limitation, the failure of CCI to issue to me a CCI credential or to renew said credential or preexisting credential awarded to me, CCI’s revocation of any credential previously issued to me, or CCI’s notification to any person of such actions taken by CCI. Applicant’s Signature________________________________________________________________Date________________________________

Please ensure that your application is signed and dated. Attach the necessary documentation and fees and mail to:
Cardiovascular Credentialing International (CCI)  •  1500 Sunday Drive, Suite 102  •  Raleigh, NC 27607  •  www.cci-online.org

14

Abbreviations
AVA �������������� Aortic Valva Area A-H �������������� From the septal atrial wave to the His Bundle wave AM �������������� Acute Marginal AO ���������������� Aorta AP ���������������� Anterior - Posterior AS ���������������� Aortic Stenosis ASD ������������� Atrial Septal Defect AV02 ������������ Arteriovenous Oxygen Difference BSA �������������� Body Surface Area CABG ����������� Coronary Artery Bypass Graft CAD ������������� Coronary Artery Disease CB ���������������� Conus Branch CHF ������������� Congestive Heart Failure Cl ����������������� Cardiac Index cm ��������������� Centimeters CO ���������������� Cardiac Output CPA �������������� Carotid Phonoangiography CVA �������������� Cerebrovascular Accident CW �������������� Continuous Wave CX ���������������� Circumflex D ������������������ Diagonal dfp ��������������� Diastolic Filling Period (per beat) dp/dt ������������ First derivative of a pressure ECG ������������� Electrocardiogram EDP ������������� End Diastolic Pressure EDV ������������� End Diastolic Volume EF ���������������� Ejection Fraction EP ���������������� Electrophysiology ESV �������������� End Systolic Volume HTN ������������� Hypertension Hgb �������������� Hemoglobin HR ��������������� Heart Rate Hz ���������������� Hertz IMA ������������� Internal Mammary Artery IPG �������������� Impedance Plethysmography IR ����������������� Current in Amperes X’s Resistance in Ohms lVC ��������������� Inferior Vena Cava Kg ���������������� Kilogram KV ��������������� Kilovoltage LA ���������������� Left Atrium LAD ������������� Left Anterior Descending LAO ������������� Left Anterior Oblique Lat ��������������� Lateral LBBB ����������� Left Bundle Branch Block LCA �������������� Left Coronary Artery L/Min ���������� Liters Per Minute LV ���������������� Left Ventricle LVEDP ��������� Left Ventricular End Diastolic Pressure LVET ������������ Left Ventricular Ejection Time LVH ������������� Left Ventricular Hypertrophy MI ���������������� Myocardial Infarction mm �������������� Millimeters mm/Hg �������� Millimeters of Mercury mm/sec ������� Millimeters per second MR ��������������� Mitral Regurgitation ms ���������������� Millisecond MS ��������������� Mitral Stenosis MV �������������� Mitral Valve MVA ������������ Mitral Valve Area OM ��������������� Obtuse Marginal OPG ������������� Occular Plethysmography PA ���������������� Pulmonary Artery PAW (P) ������� Pulmonary Artery Wedge (Pressure) PBF �������������� Pulmonary Blood Flow PCI ��������������� Percutaneous Coronary Intervention PD ���������������� Posterior Descending PDA ������������� Patent Ductus Arteriosus PEP �������������� Pre-Ejection Period Post �������������� Posterior P-P ��������������� From one P wave to the next consecutive P wave PPG ������������� Photo Plethysmography P-R ��������������� Interval measured from the onset of the P wave to the onset of the QRS PRF �������������� Pulse Recurrence/Reception Frequency PTCA ����������� Percutaneous Transluminal Coronary Angioplasty PV ���������������� Pulmonary Valve PVR ������������� Pulmonary Vascular Resistance PW ��������������� Pulsed Wave QRS ������������� Interval measured from the first deflection following the P wave to the end of the last deflection of that complex Qs ���������������� Systemic Flood Flow Q-T �������������� Interval measured from the onset of the QRS to the end of the T wave Q-Tc ������������ Q-T interval corrected for intrinsic heart rate RA ��������������� Right Atrium RAO ������������� Right Anterior Oblique RBBB ����������� Right Bundle Branch Block RCA ������������� Right Coronary Artery R-R �������������� From the R wave to the next consecutive R wave RV ���������������� Right Ventricle SA ���������������� Sino-Atrial Node SBF �������������� Systemic Blood Flow s/n ��������������� Signal to Noise Ratio SNRT ����������� Sinus Node Recovery Time Sup �������������� Superior SV ���������������� Stroke Volume SVC �������������� Superior Vena Cava SVR ������������� Systemic Vascular Resistance Sys ��������������� Systolic, systole TDCO ���������� Thermodilution Cardiac Output TI ����������������� Tricuspid Insufficiency TIA �������������� Transient Ischemic Attack sep ��������������� Systolic Ejection Period (per beat) TPA �������������� Tissue Type Plasminogen Activator TPR ������������� Total Pulmonary Resistance TR ���������������� Tricuspid Regurgitation TSR �������������� Total Systemic Resistance TV ��������������� Tricuspid Valve VCF �������������� Circumferential Fiber Shortening Velocity Vol % ����������� Volumes Percent VSD ������������� Ventricular Septal Defect V02 �������������� Oxygen Consumption

Abbreviations

Application Publication Date: August 2013. This application supercedes all documentation previously released.

15

CCI Examination Overviews
The examination overviews are provided as a service of CCI to help candidates prepare for the examination. The overview for each examination has an examination matrix, a knowledge list, and a task list.

Certified Cardiographic Technician (CCT)
Qualification Requirements........................................................................................................................................................................................... 17 Sample Letters................................................................................................................................................................................................................ 18 Exam Overview.............................................................................................................................................................................................................. 19 Sample Questions........................................................................................................................................................................................................... 20 References...................................................................................................................................................................................................................... 20

Certified Rhythm Analysis Technician (CRAT)
Qualification Requirements........................................................................................................................................................................................... 21 Sample Letters................................................................................................................................................................................................................ 22 Exam Overview.............................................................................................................................................................................................................. 23 Sample Questions........................................................................................................................................................................................................... 25 References...................................................................................................................................................................................................................... 25

Registered Congenital Cardiac Sonographer (RCCS)
Qualification Requirements........................................................................................................................................................................................... 26 Sample Letters................................................................................................................................................................................................................ 27 Exam Overview.............................................................................................................................................................................................................. 28 Sample Questions........................................................................................................................................................................................................... 29 References...................................................................................................................................................................................................................... 29

Registered Cardiac Electrophysiology Specialist (RCES)

CCI Examination Overviews

Qualification Requirements........................................................................................................................................................................................... 30 Sample Letters................................................................................................................................................................................................................ 31 Exam Overview.............................................................................................................................................................................................................. 32 Sample Questions........................................................................................................................................................................................................... 34 References...................................................................................................................................................................................................................... 34

Registered Cardiovascular Invasive Specialist (RCIS)
Qualification Requirements........................................................................................................................................................................................... 35 Sample Letters................................................................................................................................................................................................................ 36 Exam Overview.............................................................................................................................................................................................................. 37 Sample Questions........................................................................................................................................................................................................... 38 References...................................................................................................................................................................................................................... 38

Registered Cardiac Sonographer (RCS)
Qualification Requirements........................................................................................................................................................................................... 39 Sample Letters................................................................................................................................................................................................................ 40 Exam Overview.............................................................................................................................................................................................................. 41 Sample Questions........................................................................................................................................................................................................... 43 References...................................................................................................................................................................................................................... 43

Registered Phlebology Sonographer (RPhS)
Qualification Requirements........................................................................................................................................................................................... 44 Sample Letters................................................................................................................................................................................................................ 46 Exam Overview.............................................................................................................................................................................................................. 47 Sample Questions........................................................................................................................................................................................................... 48 References...................................................................................................................................................................................................................... 49

Registered Vascular Specialist (RVS)
Qualification Requirements........................................................................................................................................................................................... 50 Sample Letters................................................................................................................................................................................................................ 51 Exam Overview.............................................................................................................................................................................................................. 52 Sample Questions........................................................................................................................................................................................................... 54 References...................................................................................................................................................................................................................... 54 16

Certified Cardiographic Technician (CCT)
Qualification Requirements
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.

Qualification Prerequisite
CCT1 Currently enrolled as a student or a graduate of a cardiovascular or allied health training program.

Supporting Documentation
(see examples on page 18)

CCT1 Completion certificate OR Student Verification Letter OR Educational Transcripts CCT2 Employment Verification Letter

CCT2 Currently employed or previously employed in the field of Cardiovascular Technology or in a recognized allied health field (recognized by the American Medical Association [AMA]). CCT3 Completed requirements for a graduate or undergraduate degree from a recognized institution in a field related to science or physical health.

CCT3 Completion certificate OR Student Verification Letter OR Educational Transcripts CCT4 Employment Verification Letter

CCT4 Volunteer service in the field of Cardiovascular Technology for a minimum of two (2) years and documentation supporting full-time technical activities for a two (2) year period.

CCT
17

Certified Cardiographic Technician (CCT)
Supporting documentation should be addressed appropriately (i.e. to CCI).
1000 College Rd.  •  New York, NY 10

CV Institute (1)
001  •  (212) 5551234

Sample Student Verification Letter
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-time or part-time student. 5) Indicate the date or expected date of graduation. 6) Indicate the specialty of the educational program. 7) Original signature of direct supervisor or employer.

March 4, 2011 (2 ) CCI 1500 Sunday Drive , Raleigh, NC 2760 Suite 102 7 RE: Ms. Jane Thom pson (3) This letter has be en is enrolled as a fu sent to verify that Ms. Jane Thom ll-time (4) stude pson nt at Ms. Thompson wi ll graduate in June the CV Institute. completing the Ca of 2011 (5) after rd the time of gradua iovascular Technician (6) progra m. tion, Ms. Thomps a 12-month card on will have com At iovascular progra pleted m. Sincerely, Elizabeth Johnso n Educational Dire ctor

Elizabeth John

son (7)

Sample Employment/Volunteer Verification Letter
1) Employer’s original, official letterhead or stationery. 2) Indicate the date the letter was signed by employer/supervisor. Should not be older than six months from the date the application is received at CCI Headquarters. 3) Indicate the name of the applicant. 4) Indicate full-time 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.

123 Main St.  •  Sa n Diego, CA 9270 Januar y 4, 2011 (2 ) CCI 1500 Sunday Drive , Raleigh, NC 2760 Suite 102 7

ABC Hospital (1)
1  •  (760) 555-12 34

(3) This letter has be en been employed fo sent to verify that Mr. Jack Doe ha r over two years fu s Hospital. Mr. Doe llhas been employ time (4) at ABC ed since July 2005 Within this time(5) fra exercise stress te me, Mr. Doe has shown proficienc . sting and Holter and Event monito y in ring (6). I am sending this let Mr. Doe’s applica ter in support and endorsement tio of Technician exam n to sit for the Certified Cardiogr aphic ination. Sincerely,

RE: Mr. Jack Doe

CCT

Walter Reed, CCT, RC Clinical Superviso S r

Walter Reed (7)

18

Certified Cardiographic Technician (CCT)
Examination Matrix
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. Content Category A Conducting Pre-Procedural Activities B Performing Resting ECG (12-Lead, 15-Lead, etc.) C D E Performing Stress Tests Performing Ambulatory Monitoring (Holter, Event, Telemetry, Transtelephonic, Pacemaker, etc.) Performing Rhythm Analysis Approximate Percentage of Examination 10% 40% 20% 5% 25%

TOTAL 100%

Knowledge List
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. Size Location Layers Chambers Valves Blood flow Arteries Veins Capillaries Arterioles Venules Cardiac valve function Pressures Relationship of cardiac output to heart rate and stroke volume Control mechanisms Cardiac cycle Normal values Waveforms ECG measurement Bipolar, unipolar, and precordial leads Einthoven’s triangle and law ECG calibration methods Single- and three-channel ECG Troubleshooting ECGs Standardization Paper speed Lead placement Electrical interference Somatic tremor

Task List
The task list below describes the activities which a Cardiographic Technician is expected perform on the job. All examinations questions are linked to these tasks. Duties and Tasks % of Exam A Conducting Pre-Procedural Activities 10% 1 Receive doctor’s orders 2 Verify doctor’s orders 3 Perform universal precautions (e.g., handwashing, PPE) 4 Identify patient 5 Obtain patient consent 6 Transport patient 7 Prepare the patient (shaving, cleaning skin, etc.) 8 Identify proper landmarks 9 Collect patient demographics 10 Enter patient information into ECG machine 11 Identify patient safety hazards B Performing Resting ECG (12-Lead, 15-Lead, etc.) 40% 1 Gather supplies and equipment 2 Educate patient on procedure expectations 3 Apply electrodes to patient 4 Confirm equipment 5 Perform standard ECG 6 Perform right side 7 Analyze ECG tracing 8 Corrolate ECG morphology with anatomy and physiology Duties and Tasks % of Exam C Performing Stress Tests 20% 1 Gather supplies and equipment 2 Explain patient safety procedures 3 Perform baseline ECG 4 Obtain baseline vital signs 5 Verify stress test protocol 6 Explain protocol expectations (including demonstration of treadmill, etc.) 7 Perform stress test protocol D Performing Ambulatory Monitoring (Holter, Event, Telemetry, Transtelephonic, Pacemaker, etc.) 5% 1 Gather ambulatory monitoring supplies and equipment 2 Explain procedure to patient 3 Verify equipment functionality 4 Attach leads to patient (stress loops, pouch, etc.) 5 Explain ambulatory monitoring requirements (limitations, expectations, duration etc.) E Performing Rhythm Analysis 25% 1 Analyze obtained data 2 Correlate ECG findings (waveforms, segments, intervals, etc.) with cardiac function 3 Identify, report, and record findings TOTAL 100%

CCT

19

Certified Cardiographic Technician (CCT)
Sample Questions
1. The heart is divided into ______ chambers:
a. One b. Two c. Four d. Three

Answers
1. c  2. c  3. c  4. b  5. c

CCT References
The textbooks listed below are intended as recommended resources when preparing for examination. You may have previous or later editions of these or other references available that also present acceptable coverage of the subject matter. Any general text in cardiovascular techniques and evaluation, and cardiac patient care and management may be used. It is not necessary to use all of the texts identified. They are provided as suggestions only. CCI does not endorse or recommend any third-party review course or material. 1. Shier, David, Jackie Butler, and Ricki Lewis. Hole’s essentials of human anatomy and physiology. 9th ed. Boston: McGraw-Hill, 2006. 2. Booth, Kathryn A., and Thomas E. O’Brien. Electrocardiography for healthcare professionals. 3rd ed. New York: McGraw-Hill, 2012. 3. Dubin, Dale. Rapid interpretation of EKG’s: an interactive course. 6th ed. Tampa, Fla.: Cover Pub. Co., 2000. 4. Green, Jacqueline M., and Anthony J. Chiaramida. 12-Lead EKG Confidence a Step-by-Step Guide.. 2nd ed. New York: Springer Pub. Co., 2009. 5. Phalen, Tim, and Barbara Aehlert. The 12-lead ECG in acute coronary syndromes. 2nd ed. St. Louis: Elsevier Mosby, 2006. 6. Shier, David, Jackie Butler, and Ricki Lewis. Hole’s essentials of human anatomy and physiology. 9th ed. Boston: McGraw-Hill, 2006. 7. Wagner, Galen S., and Henry J. L. Marriott. Marriott’s practical electrocardiography. 11th ed. Philadelphia: Wolters Kluwer Health/ Lippincott Williams & Wilkins, 2008. 8. Wesley, Keith. Huszar’s basic dysrhythmias and acute coronary syndromes: interpretation and management text and 4. ed. Elsevier- Health Sciences, 2011.

2. Which of the following supplies blood to the arterial system after contraction?
a. Left atrium b. Right atrium c. Left ventricle d. Right ventricle

3. The sensitivity switch controls the:
a. Heat b. Speed c. Amplification d. ECG position

4. The little “spark” that makes the heart beat, originates in the
a. AV node b. SA node c. Purkinje fibers d. Bundle branches

5. Which of the following is a poor conductor of electric current?
a. Metal b. Blood c. Dry skin d. Body fluids A self-assessment examination is available for purchase for self-evaluation purposes. See pages 57-58 for more information.

CCT
20

Certified Rhythm Analysis Technician (CRAT)
CRAT
Qualification Requirements
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.

Qualification Prerequisite
CRAT1 Currently enrolled as a student or a graduate of a cardiovascular or allied health training program.

Supporting Documentation
(see examples on page 22)

CRAT1 Completion certificate OR Student Verification Letter OR Educational Transcripts CRAT2 Employment Verification Letter

CRAT2 Currently employed or previously employed in the field of Cardiovascular Technology or in a recognized allied health field (recognized by the American Medical Association (AMA)). CRAT3 Completed requirements for a graduate or undergraduate degree from a recognized institution in a field related to science or physical health.

CRAT3 Completion certificate OR Student Verification Letter OR Educational Transcripts CRAT4 Employment Verification Letter

CRAT4 Volunteer service in the field of Cardiovascular Technology for a minimum of two (2) years and documentation supporting full-time technical activities for a two (2) year period.

21

Certified Rhythm Analysis Technician (CRAT)
CRAT
Supporting documentation should be addressed appropriately (i.e. to CCI).
1000 College Rd. 

CV Institute (1)
•  New York, NY 10 001  •  (212) 555-1234

Sample Student Verification Letter
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-time or part-time student. 5) Indicate the date or expected date of graduation. 6) Indicate the specialty of the educational program. 7) Original signature of educational director.

March 4, 2011 (2 ) CCI 1500 Sunday Drive Raleigh, NC 2760 , Suite 102 7 RE: Ms. Jane Thom pson (3) This letter has be en is enrolled as a fu sent to verify that Ms. Jane Thom llMs. Thompson wi time (4) student at the CV Insti pson tu ll completing the Ca graduate in June of 2011 (5) aft te. er the time of graduardiovascular Technician (6) prog ra a 12-month Cong tion, Ms. Thompson will have co m. At m en including 800 cli ital Cardiac Ultrasound program pleted ni echocardiography cal hours in at the ABC Children’s , Hospital lab. Sincerely,

Elizabeth Johnso n Educational Dire ctor

Elizabeth John

son (7)

Sample Employment/Volunteer Verification Letter
1) Employer’s original, official letterhead or stationery. 2) Indicate the date the letter was signed by employer/supervisor. Should not be older than six months from the date the application is received at CCI Headquarters. 3) Indicate the name of the applicant. 4) Indicate full-time 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.

123 Main St.  •  Sa n Diego, CA 9270 Januar y 4, 2011 (2 ) CCI 1500 Sunday Drive , Raleigh, NC 2760 Suite 102 7 RE: Mr. Jack Doe (3)

ABC Hospital (1)
1  •  (760) 555-12 34

This letter has be en been employed fo sent to verify that Mr. Jack Doe ha r over two years fu s Hospital. Mr. Doe ll-time (4) at AB C ha Within this time- s been employed since July 2005 (5) fra within our hospita me Mr. Doe personally monitore . d l’s telemetry unit letter in support (6). I am sending and th to sit for the Certi endorsement of Mr. Doe’s applica is fied Rhythm Analy tion examination. sis Technician Sincerely, (7) Walter Reed, CCT, CR Clinical Superviso AT r

Walter Reed

22

Certified Rhythm Analysis Technician (CRAT)
CRAT
Examination Matix
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. Content Category A. Comply with Governing Regulations B. Interact with Patients and Others C. Identify Normal ECG Components and Cardiac Anatomy D. Determine Patient’s Cardiac Rhythm E. Troubleshoot ECG F. Compile ECG Results Approximate Percentage of Examination 5% 10% 19% 55% 6% 5%

TOTAL 100%

Knowledge List
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. Regulatory and compliance standards (e.g., OSHA, HIPAA, informed consent, medical records) Medical ethics Communication with the client Communication with staff and faculty Patient safety Emergency response Basic cardiovascular anatomy and physiology Cardiac rhythm analysis and interpretation ECG troubleshooting Documentation of findings Medical terminology

23

Certified Rhythm Analysis Technician (CRAT)
CRAT
Task List
The task list below describes the activities which a Rhythm Analysis Technician is expected to perform on the job. All examination questions are linked to these tasks. Duties and Tasks A 1 2 3 4 B 1 2 3 4 5 6 7 8 Complying with Governing Regulations Obtain/maintain prescriptions/orders Maintain HIPAA compliance Obtain patient demographics Verify patient identification % of Exam 5% Duties and Tasks 3 % of Exam Identify junctional rhythm a Identify rhythms with premature junctional ectopy b Identify junctional escape rhythms c Identify accelerated junctional rhythms d Identify junctional tachycardia Recognize ventricular rhythms a Identify rhythm with premature ventricular ectopy (PVCs, couplets, triplets) b Identify idioventricular rhythms (agonal, escape, and accelerated) c Identify ventricular tachycardia d Identify ventricular fibrillation e Identify ventricular standstill Recognize asystole Recognize conduction defects a Identify first degree AV block b Identify second degree type one AV block c Identify second degree type two AV block d Identify third degree AV block 1 Identify third degree AV block with a junctional escape rhythm (narrow QRS) 2 Identify third degree AV block with a ventricular escape rhythm (wide QRS) e Identify presence of intraventricular conduction delay (bundle branch block) Determine paced events a Identify paced atrial rhythm b Identify paced ventricular rhythm c Identify AV sequential (atrioventricular) paced rhythm d Identify P-wave synchronous, ventricular paced rhythm e Identify loss of pacing capture f Identify loss of sensing g Identify failure to pace Troubleshoot ECG 6% Recognize artifact on ECG tracings a Recognize artifact on ECG tracings from wandering baseline b Recognize artifact on ECG tracings from somatic tremor, patient movement c Recognize artifact on ECG tracings from EMI/60 cycle interference Identify inappropriate electrocardiograph paper speed Identify inappropriate gain of the ECG signal Identify causes of artifact Identify lead reversals Compile ECG Results Insert preliminary findings Compare test results to past tests Respond if notification criteria are met (dispatch EMS if needed) Correlate findings with patient symptoms or risk Create patient report 5%

Interacting with Patients and Others 10% Familiarize patients regarding services Educate patients on when to call for help Educate patients on electrical hazards, broken wires Obtain patient symptoms, activities, location Service cardiac patients (customer service) Communicate with ordering physician or physician’s office Communicate with patients’ family members Communicate with other offices (scheduling, order verification, etc.) 9 Seek advice regarding findings 10 Conduct inter-departmental interactions C Identify Normal ECG Components and Cardiac Anatomy 19% 1 Identify P-wave 2 Identify and measure the PR interval 3 Identify and measure a QRS complex 4 Identify T-wave 5 Identify the standards for ECG recording. 6 Calculate the atrial rate 7 Calculate the ventricular rate 8 Identify the relationship of the atrial and ventricular rates 9 Evaluate P-P and R-R interval regularity 10 Identify the chambers of the heart 11 Identify the valves of the heart 12 Identify the conduction system of the heart D Determine Patient’s Cardiac Rhythm 55% 1 Identify sinus rhythm a Identify normal sinus rhythm b Identify sinus arrhythmia c Identify sinus tachycardia d Identify sinus bradycardia e Identify sinus arrest 2 Identify atrial rhythm a Identify wandering atrial pacemaker b Identify rhythms with premature atrial ectopy (PAC, couplets, triplets, runs, multifocal) c Identify atrial tachycardia d Identify supraventricular tachycardia e Identify atrial fibrillation (general characteristics) 1 Identify atrial fibrillation with a slow ventricular response 2 Identify atrial fibrillation with a rapid ventricular response f Identify atrial flutter 1 Identify atrial flutter with a ratio of ventricular response 2 Identify atrial flutter with a variable ventricular response 24

4

5 6

7

E 1

2 3 4 5 F 1 2 3 4 5

Total 100%

Certified Rhythm Analysis Technician (CRAT)
CRAT
Sample Questions
1. Somatic tremor artifact may be caused by
a. Switching leads b. Circuit overload c. Defective machine d. A cold, uncomfortable environment

Answers
1. d  2. d  3. b  4. c  5. c

CRAT References
The textbooks listed below are intended as recommended resources when preparing for examination. You may have previous or later editions of these or other references available that also present acceptable coverage of the subject matter. Any general text in cardiovascular techniques and evaluation, and cardiac patient care and management may be used. It is not necessary to use all of the texts identified. They are provided as suggestions only. CCI does not endorse or recommend any third-party review course or material. 1. Barold, S. Serge, and Roland X. Stroobandt. Cardiac Pacemakers and Resynchronization Step by Step an Illustrated Guide.. 2nd ed. Chichester: John Wiley & Sons, 2010. 2. Booth, Kathryn A., and Thomas E. O’Brien. Electrocardiography for healthcare professionals. 3rd ed. New York: McGraw-Hill, 2012. 3. Diehl, Tracy S., and Diane M. Allen. ECG interpretation made incredibly easy!. 5th ed. Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins, 2011. 4. Dubin, Dale. Rapid interpretation of EKG’s: an interactive course. 6th ed. Tampa, Fla.: Cover Pub. Co., 2000. 5. Ellenbogen, Kenneth A., and Mark A. Wood. Cardiac pacing and ICDs. 5th ed. Malden, Mass.: Blackwell Pub., 2008. 6. Hayes, David L., and Paul A. Friedman. Cardiac pacing, defibrillation and resynchronization: a clinical approach. 2nd ed. Chichester, West Sussex, UK: Wiley-Blackwell, 2008. 7. Huff, Jane. ECG workout: exercises in arrhythmia interpretation. 6th ed. Ambler, PA: Lippincott Williams & Wilkins, 2011. Print. 8. Kenny, Tom. The nuts and bolts of cardiac pacing. 2nd ed. Malden, Mass.: Blackwell Futura, 2008. 9. Wesley, Keith. Huszar’s basic dysrhythmias and acute coronary syndromes: interpretation and management . 4th ed. ElsevierHealth Sciences, 2011. 10. Woods, Stephanie L., and Karen S. Ehrat. The art of EKG interpretation: a self-instructional text / Stephanie L. Woods, Karen S. Ehrat. 7th ed. Dubuque, Iowa: Kendall Hunt Pub Co., 2009.

2. Which of the following arrhythmias may lead to death if asynchronous counter shock is not available?
a. Atrial tachycardia and atrial flutter b. Atrial fibrillation and bundle branch block c. Sinus tachycardia and wandering pacemaker d. Ventricular fibrillation

3. Ventricular repolarization occurs during the ______ wave on the ECG.
a. P wave b. T wave c. P-R interval d. QRS complex

4. Which waves and/or lines on the standard EKG measuring greater than 0.12 seconds may be indicative of a bundle branch block?
a. P waves b. PR intervals c. QRS complexes d. ST segments

5. Measure the asystolic period within this cardiac tracing.

a. 1.48 seconds b. 2.48 seconds c. 3.48 seconds d. 4.48 seconds

A self-assessment examination is available for purchase for self-evaluation purposes. See pages 57-58 for more information.

25

Registered Congenital Cardiac Sonographer (RCCS)
Qualification Requirements
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.

Qualification Prerequisite
RCCS1-2013
Two years of full-time or full-time equivalent on-the-job experience in cardiac ultrasound at the time of application. The applicant must have performed a minimum of 600 cardiac ultrasound studies at the time of application. (It is anticipated, but NOT required, that the susccessful candidate will have performed a minimum of 150 adult congenital/pediatric studies per year in the two years prior to submission of the application.) In the verification letter, the medical director(s) must confirm the number of studies performed during the applicant’s employment.

Supporting Documentation
(see examples on page 27)

RCCS1-2013

Employment Verification Letter (Should be not older than six months from the date the application is received at CCI Headquarters)

RCCS

RCCS235-2013

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 of full-time or full-time equivalent on-the-job experience in cardiac ultrasound at the time of application. AND Performance of a minimum of 600 cardiac ultrasound studies in the applicant’s career, which is defined as work experience and/or clinical experience gained during a formal educational program. (It is anticipated, but NOT required that the successful candidate will have performed a minimum of 150 adult congenital/pediatric studies per year in the two years prior to submission of the application.) 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.

RCCS235-2013

Completion certificate and/or educational transcripts 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)

RCCS4

A graduate of a programmatically accredited program in adult congenital or pediatric cardiac ultrasound.**

RCCS4

Completion certificate and/or educational transcripts AND Student Verification Letter

RCCS5

A graduate of a NON-programmatically accredited program in adult congenital or pediatric 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 a NON-programmatically accredited program in adult congenital or pediatric cardiac ultrasound (echocardiography) on or prior to September 1, 2013 will to be eligible to apply for their specific registry examination under this qualification pathway after they graduate.

RCCS5

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

IMPORTANT: If an individual’s studies were completed during a formal educational program, then those studies completed WOULD count toward the minimum of 600 cardiac ultrasound studies under qualification RCCS235-2013. ** 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.

26

Registered Congenital Cardiac Sonographer (RCCS)
Supporting documentation should be addressed appropriately (i.e. to CCI).

Sample Employment Verification Letter
1) Employer’s original, official letterhead or stationery. 2) Indicate the date the letter was signed by employer/supervisor. Should not be older than six months from the date the application is received at CCI Headquarters. 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) Verification of the number of ultrasound cases performed. Candidates are required to have performed a minimum of 600 cardiac ultrasound studies at the time of application. 8) Original signature of direct supervisor, who must be an MD or DO or hold an active RCCS, RCES, RCIS, RCS, RDCS, RDMS, RVS, or RVT credential.

1  •  (760) 555-1 234 January 4, 2011 (2) CCI 1500 Sunday Drive Raleigh, NC 2760 , Suite 102 7 RE: Mr. Jack Doe (3) This letter has be en employed for ove sent to verify that Jack Doe has r be cardiography lab two years full-time (4) in the ech en orator y at ABC Ch oDoe has been em ild ren ’s Ho spital. plo time-frame Mr. Do yed since July 2005 (5). Within Mr. thi ultrasound studie e personally performed over 755 s cardiac s (6) within our adult congenital lab and pediatric cas . Of these, 150 were es (7). I am sendin letter in support an to sit for the Cong d endorsement of Mr. Doe’s app g this lica enital Cardiac So Examination. nographer Regis tion try Sincerely, Walter Reed, RCS Clinical Supervisor

123 Main St.  •  Sa n Diego, CA 9270

ABC Hospital (1)

Walter Reed (8)

RCCS

1000 College Rd.  March 4, 2011 (2)

Congenital Univers
•  New York, NY 100

ity (1)

01  •  (212) 555-12 34

Sample Student Verification Letter
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) Original signature of the educational director.

CCI 1500 Sunday Drive Raleigh, NC 27607 , Suite 102 RE: Ms. Jane Thom pson (3) This letter has bee n enrolled as a full-ti sent to verify that Jane Thompso sity. Ms. Thompso me (4) student at the Congenital n is Un n completing the tra will graduate in May of 2011 (5) iverMs. Thompson wilining program. At the time of gra after du l hav e com ple ted a 12-month Co ation, Cardiac Ultrasou nge nd in at the ABC Ch program (6), including 800 clin nital ildren’s Hospital echocardiograph ical hours y lab. Sincerely,

Elizabeth Johnso n Educational Direct or

Elizabeth John

son (7)

Sample Clinical Experience Letter (gained during a formal education program)
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) Verification of the number of ultrasound cases performed. Candidates are required to have performed a minimum of 600 cardiac ultrasound studies at the time of application. 5) Indicate the time period during which the clinical hours were performed. 6) Original signature of the clinical supervisor.

123 Main St.  •  Sa n Diego, CA 9270 January 4, 2011 (2) CCI 1500 Sunday Drive , Suite 102 Raleigh, NC 2760 7 RE: Mr. John Doe (3)

ABC Hospital (1)
1  •  (760) 555-1 234

This letter has be en sent to verify that Mr. John Do performed 350 (4) e has cardiac ultrasound studies at ABC Children’s Hospital . Mr. Doe’s clinica l rotation lasted fro m January 2005 2005 (5). to June Sincerely,

Walter Reed, RCS Clinical Supervisor

Walter Reed (6)

27

Registered Congenital Cardiac Sonographer (RCCS)
Examination Matrix
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. Content Category A. Managing Workflow B. Providing Patient Care C. Acquiring Cardiac Images D. Characterizing Cardiac Abnormalities E. Processing and Communicating Preliminary Reports Approximate Percentage of Examination 3% 12% 37% 35% 13%

Total 100%

RCCS

Knowledge List
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. Abbreviations and acronyms Adjunct modalities • 3-D • Contrast • ICE • Stress • TEE ASE guidelines and standards Basic and hemodynamic calculations (e.g. volumes, gradient, ejection fraction) Basic pharmacology BLS Cardiac interventions, complications, and sequelae Cardiac rhythms Cardiovascular anatomy and physiology Cardiovascular pathophysiology Congenital heart disease Contraindications Embryology Ergonomics General anatomy and physiology HIPAA JCAHO requirements Medical ethics Medical terminology Normal, abnormal, and critical clinical values OSHA Patient assessment Pediatric acquired heart disease QA procedures Syndromes with associated cardiac lesions Ultrasound physics and instrumentation

Task List
The task list below describes the activities which a Congenital Cardiac Sonographer is expected to perform on the job. All examination questions are linked to these tasks. Duties and Tasks A 1 2 B 1 2 3 4 5 6 7 8 C 1 2 3 4 5 6 28 Managing Workflow Schedule personnel and resources Triage incoming orders Providing Patient Care Review indications/chief complaints Review patient history Verify patient identity Explain procedures Listen to patients’ concerns Provide patient comfort Perform quality control Perform patient assessment Acquiring Cardiac Images Prepare for test Optimize images Acquire left parasternal images Acquire apical images Acquire subcostal images Acquire suprasternal images % of Exam 3% 12% Duties and Tasks 7 8 D 1 2 3 4 5 6 7 8 9 E 1 2 3 4 5 Acquire right parasternal images Adapt patient examination Characterizing Cardiac Abnormalities Perform disease specific protocol Identify commonly associated lesions Identify less commonly associated lesions Assist with ICE Assist with TEE Perform stress echo Perform contrast echo Assist with epicardial echo Perform 3D echo 35% % of Exam

37%

Processing and Communicating Preliminary Reports 13% Enter patient data Perform calculations and post-processing analysis List findings Communicate critical values Perform post examination communication

TOTAL 100%

Registered Congenital Cardiac Sonographer (RCCS)
Sample Questions
1. Persistent patency of the vessel in the fetus that connects the left pulmonary artery to the descending thoracic aorta is
a. Coarctation b. Truncus arteriosis c. Patent ductus arterosis d. Peripheral pulmonic stenosis

Answers
1. c  2. c  3. b  4. d  5. c

RCCS References
The textbooks listed below are intended as recommended resources when preparing for examination. You may have previous or later editions of these or other references available that also present acceptable coverage of the subject matter. Any general text in cardiovascular techniques and evaluation, and cardiac patient care and management may be used. It is not necessary to use all of the texts identified. They are provided as suggestions only. CCI does not endorse or recommend any third-party review course or material. 1. Allen, Hugh D., David J Driscoll, Robert E Shaddy, and Timothy F Feltes. Moss and Adams’ heart disease in infants, children, and adolescents: including the fetus and young adult.. 8th ed. Philadelphia, PA: Lippincott Williams and Wilkins, 2012. 2. Chin, Alvin J., and Mark A. Fogel. Noninvasive imaging of congenital heart disease: before and after surgical reconstruction. Armonk, NY: Futura Pub. Co., 1994. 3. Eidem, Benjamin W., Frank Cetta, and Patrick W O’Leary. Echocardiography in pediatric and adult congenital heart disease: Bonus: online access to echo clips. Philadelphia: Lippincott, Williams & Wilkins, 2010. 4. Gatzoulis, Michael A., Gary D. Webb, and Piers E. F. Daubeney. Diagnosis and management of adult congenital heart disease. 2 ed. Edinburgh: Churchill Livingstone, 2010. 5. Gersony, Welton M., and Marlon S. Rosenbaum. Congenital heart disease in adults. New York: McGraw-Hill, Medical Pub. Division, 2002. 6. Perloff, Joseph K., and John S. Child. Congenital heart disease in adults. Ed. 3. ed. Philadelphia: Saunders, 2008. 7. Silverman, Norman H.. Pediatric echocardiography. Baltimore: Williams & Wilkins, 1993.

2. Displacement of the tricuspid valve leaflets from the annulus into the RV cavity is
a. Tricuspid atresia b. Tetralogy of Fallot c. Ebstein’s anomaly d. Eisenmenger’s syndrome

RCCS

3. Cortriatriatum may result from abnormal formation of the pulmonary vein into the_____.
a. Azygous vein b. Left atrium c. Coronary sinus d. Superior vena cava

4. The Jatene procedure is indicated in what type of lesion?
a. Coarctation b. Truncus arteriosis c. Tetralogy of Fallot d. D-Transposition of Great Vessels

5. Indomethacin may be indicated in the treatment of
a. Atrial septal defect b. Ventricular septal defect c. Patent ductus arteriosus d. Anomalous coronary artery A self-assessment examination is available for purchase for self-evaluation purposes. See pages 57-58 for more information.

29

Registered Cardiac Electrophysiology Specialist (RCES)
Qualification Requirements
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.

Supporting Documentation Qualification Prerequisite
RCES1-2013
Two years of full-time or full-time equivalent work experience in diagnostic and interventional cardiac electrophysiology. (It is anticipated, but NOT required that the successful candidate will have participated in a minimum of 200 diagnostic/ interventional cardiac electrophysiology studies and 300 device implants at the time of application.) It is recommended, but not a requirement, that the applicant have experience in the following areas: •  Diagnostic/Interventional Studies •  Advanced Mapping •  Device Implants (pacemaker, ICD, and CRT) (See examples on page 31)

RCES1-2013

Employment Verification Letter

RCES235-2013

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 electrophysiology It is anticipated, but NOT required that the successful candidate will have participated in a minimum of 200 diagnostic/ interventional cardiac electrophysiology studies and 300 device implants at the time of application in their career which is defined as work experience and/or clinical experience gained during a formal educational program.

RCES235-2013

Completion certificate and/or educational transcript AND Employment Verification Letter

RCES

It is recommended, but not a requirement, that the applicant have experience in the following areas: •  Diagnostic/Interventional Studies •  Advanced Mapping •  Device Implants (pacemaker, ICD and CRT)

RCES5

A graduate of a NON-programmatically accredited program in electrophysiology 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 electrophysiology 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.

RCES5

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

RCES4

Applicant must be a graduate of a programmatically accredited** program in electrophysiology.

RCES4

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 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 RCES5. ** 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.

30

Registered Cardiac Electrophysiology Specialist (RCES)
Supporting documentation should be addressed appropriately (i.e. to CCI).

Sample Employment Verification Letter
1) Employer’s original, official letterhead or stationery. 2) Indicate the date the letter was signed by employer/supervisor. Should not be older than six months from the date the application is received at CCI Headquarters. 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 DO or hold an active RCCS, RCES, RCIS, RCS, RDCS, RDMS, RPhS, RVS, or RVT credential.

(7) John Jones, MD Director of Electr ophysiolog y Lab

John Jones

1  •  (760) 555-1 234 November 29, 20 13 (2) CCI 1500 Sunday Drive , Raleigh, NC 2760 Suite 102 7 RE: Ms. Margaret Myers, RN (3) This letter has bee n sent to verify tha employed for ove r two years full-ti t Margaret Myers was me (4) in the car electrophysiology diac lab was employed fro oratory at ABC Hospital. Ms. My ers m July 2006 to the Pre period Ms. Myers assisted in the scr sent (5). During that ub cal procedures, op erated the intracard role for EP and surgiand ablation system iac recording sys tem diac Electrophysiol and circulated for EP cases in the Carogy Lab (6). I am letter in support the ref ore sen ding thi and to sit for CCI’s Ele endorsement of Ms. Myer’s applica s ctrophysiology Re tion gistry Exam. Sincerely,

123 Main St.  •  Sa n Diego, CA 9270

ABC Hospital (1)

1000 College Rd. 

•  New York, NY 100

EP College (1)
01  •  (212) 555-12 34

Sample Student Verification Letter
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, and the number and specialty of clinical hours accrued. 8) Original signature of the educational director.

March 4, 2013 (2) CCI 1500 Sunday Drive Raleigh, NC 27607 , Suite 102

Elizabeth Johnso n EP Program Direct or

Elizabeth John

RE: Ms. Jane Thom pson (3) This letter has bee n graduated as a ful sent to verify that Ms. Jane Thom l-ti Thompson gradu me (4) student at EP College. Ms pson ate the EP Cardiovascu d in May of 2011 (5) after comple. graduation, Ms. Th lar Technology program. At the ting tim EP training progra ompson will have completed a 12- e of clinical hours at m (6), which included a required month the 800 (7) qualification req ABC Hospital EP lab. Based on uir CC ation she will be ements, I understand that upon I’s qualified to sit for her graduRegistry Examina the Electrophysiolo tion. gy Sincerely,

RCES

son (8)

Sample Clinical Experience Letter
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 hour minimum under qualification RCES5.

EP Medical Univer sity Hopsital (1)
2344 Pacemaker Dr  •  Pittsburgh, PA 21 113 August 11, 2013 (2) CCI 1500 Sunday Drive , Suite 102 Raleigh, NC 2760 7 RE: Ms. Jane Doe (3)

John Jones, RCES , RCIS Clinical Supervisor

John Jones (6)

This letter has be en completed 800 (4) sent to verify that Ms. Jane Doe clin procedures. Ms. Jan ical hours assisting in EP e Doe’s clinical rot ation lasted from May 2011 to July 2011 (5). Sincerely,

31

Registered Cardiac Electrophysiology Specialist (RCES)
Examination Matrix
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. Content Category A. Conducting Pre-Procedural Activities B. Conducting Intra-Procedural Activities C. Conducting Post-Procedural Activities D. Performing Diagnostic Studies E. Performing Therapeutic Procedures F. Communicating with Patients and the Health Care Team Total Approximate Percentage of Examination 11% 22% 3% 28% 33% 4% 100%

Knowledge List
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. 12-lead ECG placement and interpretation Ablation physics Arrhythmia recognition and diffrential diagnosis ACLS ACT equipment operation General anatomy and physiology Basic chemistry Basic cardiac device technology Basic electronics Basic pharmacology Basic radiology Basic ultrasound Biohazardous waste disposal BLS Body mechanics Cabling connectology Calibration of equipment X-Ray camera angles Cardiac action potential Cardiac anatomy and physiology Cardiovascular pathophysiology Procedural equipment Collection and handling of lab specimens Congenital anomalies and EP (Ebstein’s, ASD, etc.) Normal and abnormal/critical lab values Defibrillation theory Device programmer operation(s) Intracardiac electrogram (EGM) interpretation Electrocautery Basic electrophysiology theory and concepts Basic cardiac device theory Equipment operation and compatability and troubleshooting Hemodynamics Hemostasis Image processing and interpretation Implantable cardiac device systems Indications for electrophysiology procedures Regulatory and legal issues (orders, consent, power of attorney, etc.) Magnetic fields Mapping concepts Mechanisms of arrhythmias Medical terminology Medication administration and dosages Monitoring equipment operations and troubleshooting MSDS Normal and abnormal vital signs Pain management Patient care and assessment Patient positioning Phlebotomy Potential complications for all procedures (symptoms, treatment, etc.) Moderate sedation Sterile techniques Stimulation protocols Universal protocol Vascular intervention procedures

RCES

32

Registered Cardiac Electrophysiology Specialist (RCES)
Task List
The task list below describes the activities which an Electrophysiology Specialist is expected to perform on the job. All examination questions are linked to these tasks. Duties and Tasks A B C Conducting Pre-Procedural Activities Prepare procedure room Prepare sterile table Perform patient identification Review patient laboratory results Review patient medical record Verify physician’s orders Verify/obtain patient consent Start patient IV Transport patient to procedure room Prepare patient for procedure Conducting Intra-Procedural Activities Maintain patient comfort Monitor patient vital signs Administer patient medications Monitor ACT (Activated Clotting Time) Acquire radiographic images Evaluate implanted ICDs and pacemakers Place central venous lines Place arterial lines Conducting Post-Procedural Activities Remove arterial and venous sheath Prepare patient for transfer to recovery Reset procedure room % of Exam 11% Duties and Tasks D E F Performing Diagnostic Studies Position diagnostic catheters Analyze EGMs Perform stimulation protocols Perform differential diagnostic techniques Perform peripheral venography Perform tilt table testing Performing Therapeutic Procedures Assist physician with peripheral venoplasty Assist with transeptal puncture Perform arrhythmia mapping Assist physician with ablation Assist physician with lead extraction Assist physician with periocardiocentisis Assist physician with internal cardiac device implant % of Exam 28%

33%

22%

3%

Communicating with the Physician and the Health Care Team 4% Summarize procedural data for physician Provide patient report Conduct patient education and training

TOTAL 100%

RCES
33

Registered Cardiac Electrophysiology Specialist (RCES)
Sample Questions
1. Phase 2 of the action potential is dependent on ___________ influx.
a. Sodium b. Calcium c. Chloride d. Potassium

Answers
1. b  2. b  3. c  4. c  5. c

RCES References
The textbooks listed below are intended as recommended resources when preparing for examination. You may have previous or later editions of these or other references available that also present acceptable coverage of the subject matter. Any general text in cardiovascular techniques and evaluation, and cardiac patient care and management may be used. It is not necessary to use all of the texts identified. They are provided as suggestions only. CCI does not endorse or recommend any third-party review course or material. 1. Ellenbogen, Kenneth A., and Bruce L. Wilkoff. Device therapy for congestive heart failure. Philadelphia: W.B. Saunders Co., 2004. 2. Ellenbogen, Kenneth A., and Mark A. Wood. Cardiac pacing and ICDs. 4th ed. Malden, Mass.: Blackwell Pub., 2005. 3. Fogoros, Richard N.. Electrophysiologic testing. 4th ed. Malden, Mass.: Blackwell Pub., 2006. 4. Hayes, David L., Paul Wang, Jonathan Sackner-Bernstein, and Samuel Asivatham. Resynchronization and defibrillation for heart failure a practical approach. 1st ed. Oxford, UK: Blackwell/Futura, 2004. 5. Hayes, David L., and Paul A. Friedman. Cardiac pacing, defibrillation and resynchronization: a clinical approach. 2nd ed. Chichester, West Sussex, UK: Wiley-Blackwell, 2008. 6. Murgatroyd, Francis D., George J. Klein, Andrew D. Krahn, Raymond Yee, and Allan Skanes. Handbook of Cardiac Electrophysiology a Practical Guide to Invasive EP Studies and Catheter Ablation.. 1st ed. London: Remedica Medical Education and Pub., 2002. 7. Opie, Lionel H.. Drugs for the heart. 7th ed. Philadelphia, PA: Saunders/Elsevier, 2009. 8. Podrid, Philip J., and Peter R. Kowey. Cardiac arrhythmia: mechanisms, diagnosis, and management. 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2001. 9. Wilber, David J., Douglas Packer, and William G. Stevenson. Catheter ablation of cardiac arrhythmias basic concepts and clinical applications. 3rd ed. Malden, Mass.: Blackwell, 2008. 10. ACLS Handbook, 2006 Revision, AHA.

2. _________________ is a Class 1b antiarrhythmic.
a. Flecainide b. Mexiletine c. Propafenone d. Procainamide

3. During LV pacing, one would expect the QRS in V1 to be mostly
a. Positive b. Biphasic c. Negative d. Isoelectric

4. Which of the following programmed settings would be the safest and most efficient for a threshold that measured 2.0v @ 0.5 ms PW?
a. 2.0 @ 1.5 ms PW

RCES

b. 2.5V @ .06 ms PW c. 4.0 V @ 0.5 ms PW d. 4.0 V @ 1.0 ms PW

5. The doctor orders isoproterenol to infuse at 3mcg/ min. If the concentration is 1 mg in 250 cc, what is the rate in cc/hour?
A. 4 cc/hour B. 12 cc/hour C. 45 cc/hour D. 60 cc/hour

A self-assessment examination is available for purchase for self-evaluation purposes. See pages 57-58 for more information.

34

Registered Cardiovascular Invasive Specialist (RCIS)
Qualification Requirements
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.

Qualifcation Prerequisite
RCIS235-2013
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) AND One year full-time work experience in invasive cardiovascular technology AND 600** cardiac diagnostic/interventional procedures 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.

Supporting Documentation
(See examples on page 36)

RCIS235-2013

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)

RCIS5

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.

RCIS5

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

RCIS4

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

RCIS4

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 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 cardiovas-cular technology, diagnostic cardiac sonography, or vascular technology.

RCIS
35

Registered Cardiovascular Invasive Specialist (RCIS)
Supporting documentation should be addressed appropriately (i.e. to CCI).
123 Main St.  •  Sa n Diego, CA 9270 October 1, 2011 (2) CCI 1500 Sunday Drive , Raleigh, NC 2760 Suite 102 7 RE: Ms. Margaret Myers, RN (3) This letter has be en sent to verify that Ms. Margaret was employed for My ove catheterization lab r 2 years full-time (4) in the car ers diac orator y at ABC Ho employed from Jul spital. Ms. Myers wa y period Ms. Myers of 2004 to August 2009. (5) Durin s g scr (6) on 625 (7) cas ubbed, monitored, and/or circu that lated es in our cardiac cath lab, and the I am sending thi refore s let of Ms. Jacob’s app ter in support and in endorseme nt lication to sit for CCI’s Invasive Re Examination. gistry Sincerely, (8) Walter Reed, MD Director of Invasi ve Cardiology

ABC Hospital (1)
1  •  (760) 555-1 234

Sample Employment Verification Letter
1) Employer’s original, official letterhead or stationery. 2) Indicate the date the letter was signed by employer/supervisor. Should not be older than six months from the date the application is received at CCI Headquarters. 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.

Walter Reed

1000 College Rd. 

Cath Lab Univers
•  New York, NY 100

ity (1)

Sample Student Verification Letter
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), and the number and specialty of clinical hours accrued. 8) Original signature of the educational director.

Elizabeth Johnso n, Educational Direct RCIS or

Elizabeth John

Januar y 4, 2011 (2) CCI 1500 Sunday Drive Raleigh, NC 27607 , Suite 102 RE: Ms. Jane Thom pson (3) This letter has bee n enrolled as a full-ti sent to verify that Ms. Jane Thom Thompson will gra me (4) student at Cath Lab Unive pson is rsit ing the Invasive Ca duate in May of 2011 (5) after com y. Ms. the time of gradu rdiovascular Technology program pletation, Ms. Thompso (6) the Cath Lab Unive n will have com . At program, includingrsity 12-month Invasive Cardiova pleted scu at the ABC Hospi 800 clinical hours (7) in invasive lar tal requirements, I un cath lab. Based on CCI’s qualificatstudies der ion sta nd that Ms. qualified to sit for the Invasive Regis Thompson is currently try Examination. Sincerely,

01  •  (212) 555-12 34

son (8)

Sample Clinical Experience Letter
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).

123 Main St.  •  Sa n Diego, CA 9270 July 11, 2011 (2) CCI 1500 Sunday Drive , Suite 102 Raleigh, NC 2760 7

ABC Hospital (1)
1  •  (760) 555-1 234

RCIS

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. 36

RE: Ms. Jane Thom pson (3) This letter has be en sent to verify that Ms. Jane Thom has completed 80 pson 0 clinical hours (4) of cardiac cathet tion training at AB erizaC Hospital. Ms. Do e “sc over 150 (5) cardia rubbed in” for c catheterization procedures under supervision and my assisted in the mo nit ori diac patients in ou ng of over 150 car r facility. Ms. Jan e Do lasted from Janua e’s clinical rotation ry 2011 to June 20 11. (6) Sincerely,

n Jones (7) John Jones, MD Director of Invasi ve Cardiology

Joh

Registered Cardiovascular Invasive Specialist (RCIS)
Examination Matrix
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. Content Category Conducting Pre-Procedural Activities Conducting Intra-Procedural Activities Performing Invasive Procedures Conducting Post-Procedural Activities Approximate Percentage of Examination 10% 40% 40% 10%

TOTAL 100%

Knowledge List
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.
Mathematics • 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 Imaging • Angiography • Radiation safety • Operation of radiographic equipment • IVUS • ICE Sterile technique Universal precautions Diagnostic and interventional procedures • Cardiac procedures • Vascular procedures • Device implants • Procedural indications, contraindications, and complications Hemostasis Emergency procedures and equipment

Task List
The task list below describes the activities which an Registered Cardiovascular Invasive Specialist is expected to perform on the job. All examination questions are linked to these tasks.
Duties and Tasks A 1 2 3 4 B 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 % of Exam Duties and Tasks C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 D 1 2 3 4 5 6 % of Exam Conducting Pre-Procedural Activities 10% Prepare procedure room (e.g., set up equipment, QC, QA) Review patient chart (e.g., lab results, consent, verifying orders, medical record) Prepare patient for procedure (e.g., patient ID/verification, start IV, educate patient) Set up sterile field (e.g., patient, procedure table, equipment) Conducting Intra-Procedural Activities 40% Monitor vital signs of patients (e.g., heart rate rhythm, blood pressure, respiratory rate, O2 saturation) Evaluate hemodynamic data (e.g., pressure waveforms, CO, Fick, Shunt, PVR, SVR, valve areas) Perform 12-lead ECG analysis (e.g., infarct, bundle branch, ischemia, tamponade) Understand pharmacologic effects of medications (e.g., ACLS, recognize side effects/adverse reactions, pain management) Monitor ACT (Activated Clotting Time) Ensure radiation safety (e.g., time, distance, shielding) Position radiographic equipment (e.g., C arm, pan table, angles & views) Acquire/interpret radiographic images (administer contrast) Administer conscious sedation (e.g., levels, Aldrete, assessing effects) Place arterial lines Place venous lines Perform intra-coronary injection Perform cardiac outputs (e.g., TDCO) Perform endomyocardial biopsy Respond to intra-procedural emergency situations (e.g., anaphylaxis, cardiac arrest, cardiogenic shock, tamponade, ACLS) Performing Invasive Procedures 40% Perform adult cardiac catheterization Perform Intra-vascular ultrasound (IVUS) Perform Intra-cardiac echocardiography (ICE) Perform Fractional Flow Reserve (FFR) Perform device implants (e.g., pacemaker, ICD) Perform coronary balloon angioplasty (including CTO devices) Perform peripheral interventions (e.g., carotids, renals, SFAs, vena cava filters) Perform coronary stenting Perform rotational atherectomy Perform laser interventional procedures Perform IABP insertion (intra-aortic balloon pump) Insert and operate transvenous temporary pacemaker Perform pericardiocentesis Perform transcatheter valve repair/replacement Perform structural heart disease interventions (e.g., ASD/PFO, VSD, PDA) Perform percutaneous valvuloplasty Operate thrombectomy equipment (e.g., Angiojet, aspiration catheter) Implant percutaneous left ventricular assist device (e.g., LVAD, Impella) Assist with transseptal puncture Insert distal protection devices Conducting Post-Procedural Activities 10% Obtain femoral hemostasis with manual pressure Obtain femoral hemostasis with collagen closure device Obtain femoral hemostasis with mechanical device Obtain radial hemostasis manually or with mechanical device Manage access site complications Respond to post-procedure emergency situations (e.g., vasovagal, anaphylaxis, retroperitoneal bleed)

RCIS

TOTAL 100%

37

Registered Cardiovascular Invasive Specialist (RCIS)
Sample Questions
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?
a. 2.5 L/min. b. 4.0 L/min. c. 5.0 L/min. d. 6.0 L/min.

Answers
1. c  2. b  3. c  4. a  5. a

RCIS References
The textbooks listed below are intended as recommended resources when preparing for examination. You may have previous or later editions of these or other references available that also present acceptable coverage of the subject matter. Any general text in cardiovascular techniques and evaluation, and cardiac patient care and management may be used. It is not necessary to use all of the texts identified. They are provided as suggestions only. CCI does not endorse or recommend any third-party review course or material. 1. Aehlert, Barbara. ECGs made easy. 4th ed. St. Louis: Mosby, 2009. 2. Baim, Donald S., and William Grossman. Grossman’s cardiac catheterization, angiography, and intervention. 7th ed. Philadelphia: Lippincott Williams & Wilkins, 2006. 3. Daily, Elaine Kiess, and John Speer Schroeder. Techniques in bedside hemodynamic monitoring. 5th ed. St. Louis: Mosby, 1994. 4. Darovic, Gloria Oblouk. Hemodynamic monitoring: invasive and noninvasive clinical application. 3rd ed. Philadelphia: W.B. Saunders Co., 2002. 5. Kern, Morton J.. The cardiac catheterization handbook. 4th ed. Philadelphia, PA: Mosby, 2003. 6. Safian, Robert D., and Mark Freed. The manual of interventional cardiology. 3rd ed. Royal Oak, Mich.: Physicians’ Press, 2001. 7. Watson, Sandy, and Kenneth A. Gorski. Invasive cardiology: a manual for cath lab personnel. 3rd ed. Sudbury, MA: Jones and Bartlett Learning, 2011.

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?
a. 2.22 L/min./m2 b. 2.77 L/min./m2 C. 3.00 L/min./m2 d. 3.33 L/min./m2

3. Which of the following hemodynamic pressures would be used to check for mitral stenosis?
a. LV systolic & Aortic systolic b. LV systolic & PCW c. LVedp & PCW d. LVedp & Aortic diastolic

4. If a patient had a large S-wave in lead VI and a large R-wave in V5, you might suspect:
a. LVH b. IV Strain c. Hyperkalemia d. Anterior Infarction A self-assessment examination is available for purchase for self-evaluation purposes. See pages 57-58 for more information.

5. What is most likely indicated from the following oximetry samples?
Position SVC IVC Hi RA Mid RA Low RA Saturation% 70% 71% 78% 86% 83% Position RV PA LA LV AO Saturation% 86% 86% 94% 94% 94%

RCIS

a. ASD with left to right shunt b. PDA with left to right shunt c. VSD with left to right shunt d. Tetralogy of Fallot with bidirectional shunt

RCIS

38

Registered Cardiac Sonographer (RCS)
RCS
Qualification Requirements
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.

Qualification Prerequisite
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.

Supporting Documentation
(See examples on page 40)

RCS1-2013

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

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.

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)

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.

RCS5

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

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 hours 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.

RCIS

39

Registered Cardiac Sonographer (RCS)
RCS
Supporting documentation should be addressed appropriately (i.e. to CCI).
123 Main St.  •  Sa n Diego, CA 9270 January 4, 2011 (2) CCI 1500 Sunday Drive , Raleigh, NC 2760 Suite 102 7 RE: Mr. Jack Doe (3) This letter has be en sent to verify that Jack Doe has employed for ove been r tw diography labora o years full-time (4) in the echoca tor y at ABC Child ren’s Hospital. Mr rhas been employed . Do frame Mr. Doe pe since July 2005 (5). Within this tim e rsonally perform eed echocardiogram s within our lab (6) (scanned) 625 (7) . Sincerely,

ABC Hospital (1)
1  •  (760) 555-1 234

Sample Employment Verification Letter
1) Employer’s original, official letterhead or stationery. 2) Indicate the date the letter was signed by employer/supervisor. Should not be older than six months from the date the application is received at CCI Headquarters. 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. 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.

Walter Reed, MD Director of Cardi ology

Walter Reed (8)

1000 College Rd. 

Ultrasound Institut
•  New York, NY 100

e (1)

01  •  (212) 555-12 34

Sample Student Verification Letter
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), and the number and specialty of clinical hours accrued. 8) Original signature of the educational director.

Elizabeth Johnso n, RC Educational Direct IS or

Elizabeth John

March 4, 2011 (2) CCI 1500 Sunday Drive , Raleigh, NC 2760 Suite 102 7 RE: Ms. Jane Thom pson (3) This letter has be en sent to verify that is enrolled as a ful l-time (4) studen Ms. Jane Thompson t Institute. Ms. Th ompson will gradu at the Ultrasound ate after completing the Cardiac Ultras in May of 2011 (5) ou time of graduation nd program. At the , 12-month Cardiac Ms. Thompson will have completed Ult a a required 850 clin rasound program (6) that includ es ica Hospital echocardi l hours (7) completed at the AB C ography lab. Sincerely,

son (8)

Sample Clinical Experience Letter
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. (Required if applying under RCS5.) 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 RCS5. 40

ital (1) 123 Main St.  •  Sa n Diego, CA 9270 1  •  (760) 555-1 234 January 4, 2011 (2)
CCI 1500 Sunday Drive , Suite 102 Raleigh, NC 2760 7 RE: Mr. John Doe (3)

ABC Children’s Ho

sp

This letter has be en performed 800 (4) sent to verify that Mr. John Doe ha s clinical hours of training at ABC Ch car ildren’s Hospital. diac ultrasound Within this timefr Mr. Doe persona lly performed (sc anned) 150 (5) ech ame, diograms. ocarMr. Doe’s clinica l rotation lasted fro m January 2005 2005 (6). to June Sincerely,

Walter Reed, RCS Clinical Supervisor

Walter Reed (7)

Registered Cardiac Sonographer (RCS)
RCS
Examination Matrix
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. Content Category General Policies, Procedures, and Standards Perform Echocardiographic Examinations Perform Specialized Echocardiographic Techniques Pathophysiology of Cardiovascular Diseases/Therapeutic Measures Approximate Percentage of Examination 7% 38% 13% 42%

TOTAL 100%

Knowledge List
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 and 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

41

Registered Cardiac Sonographer (RCS)
RCS
Task List
The task list below describes the activities which a Registered Cardiac Sonographer is expected to perform on the job. All examination questions are linked to these tasks. Duties and Tasks A 1 2 3 4 % of Exam Duties and Tasks C 1 2 3 % of Exam General Policies, Procedures, and Standards 7% Ensure universal precautions and sterile techniques Respond to emergency situations Maintain competency and quality assurance Pre-procedure activities a Manage workflow b Prepare the ultrasound room and equipment for the examination c Determine the indication for the examination d Perform limited history and physical (e.g., height, weight, physiologic monitoring) e Prepare the patient for examination f Informed consent g Basic ECG, rhythm identification Post-procedure activities a Manage data flow and images b Document findings c Communicate with the health care team d Maintain equipment, supplies, and patient areas Perform Echocardiographic Examinations Understand ultrasound physics and instrumentation a Physical properties of ultrasound b Acoustical properties of tissue c Doppler instrumentation d 2 D instrumentation e Transducers f Artifacts g Resolution (e.g., axial, lateral, temporal, spatial) Understand imaging views (transducer position, planes, anatomy) a Left parasternal b Apical c Subcostal d Suprasternal e Right parasternal f Nonstandard Define normal anatomy, physiology, and hemodynamics a 2-D, M mode, anatomy, and physiology b Doppler (spectral, color flow, tissue) c Measurements and calculations Utilize physiologic maneuvers a Valsalva, gripping, squatting b Respiration control Practice proper ergonomics 38% Perform Specialized Echocardiographic Techniques 13% Assist with TEE a Recognize structures on TEE b Maintain TEE probe Perform stress echocardiography a Exercise stress echo b Pharmacologic stress echo Perform contrast echocardiography a Contrast agents b Start, maintain, and/or remove IVs c Image optimization and artifacts d Indications, warnings, and contraindications Identify current and emerging technologies a Intracardiac echo (ICE) b 3 D TEE c 3 D TTE d Color tissue Doppler imaging (includes strain and strain rate) e Speckle imaging f Interventional procedures (e.g., valvuloplasty, biopsies) g Other imaging modalities (e.g., MRI, CT, nuclear)

4

5

B 1

2

3

D Pathophysiology of Cardiovascular Diseases/ 42% Therapeutic Measures 1 Evaluate pathophysiology in images and modify examination to answer the clinical question a Heart failure b Valvular heart disease c Ischemic heart disease d Cardiomyopathies e Pericardial diseases f Cardiac masses g Diseases of the aorta h Systemic and pulmonary hypertension i Compensatory mechanisms j Therapeutic measures and interventions for acquired diseases. 2 Recognize common congenital abnormalities a 2 D and Doppler (segmental approach) b Embryology c Interventions for congenital abnormalities Total 100%

4 5

42

Registered Cardiac Sonographer (RCS)
RCS
Sample Questions
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.

Answers
1. d  2. b  3. d  4. a

RCS References
The textbooks listed below are intended as recommended resources when preparing for examination. You may have previous or later editions of these or other references available that also present acceptable coverage of the subject matter. Any general text in cardiovascular techniques and evaluation, and cardiac patient care and management may be used. It is not necessary to use all of the texts identified. They are provided as suggestions only. CCI does not endorse or recommend any third-party review course or material. 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. All new ASE Guidelines published on www.asecho.org/Guidelines. 3. Armstrong, William F., Thomas Ryan, and Harvey Feigenbaum. Feigenbaum’s echocardiography. 7th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2010. 4. Braunwald, Eugene, Douglas P. Zipes, and Peter Libby. Heart disease: a textbook of cardiovascular medicine. 9th ed. Philadelphia: Saunders, 2011. 5. Edelman, Sidney K.. Understanding ultrasound physics. 3rd ed. Woodlands, Tex.: ESP, 2005. 6. Kremkau, Frederick W., and Flemming Forsberg. Sonography principles and instruments. 8th ed. St. Louis, Mo.: Elsevier/Saunders, 2011. 7. Miele, Frank R.. Ultrasound physics & instrumentation. 4th ed. Forney, TX: Miele Enterprises, 2006. 8. Oh, Jae K., J. B. Seward, and A. Jamil Tajik. The echo manual. 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2006. 9. Otto, Catherine M.. The practice of clinical echocardiography. 3rd ed. Philadelphia, PA: Saunders/Elsevier, 2007. 10. Otto, Catherine M.. Textbook of clinical echocardiography. 4th ed. Philadelphia, PA: Saunders/Elsevier, 2009. Print. 11. Reynolds, Terry, and Pamela Kidd. The echocardiographer’s pocket reference. 2nd ed. Phoenix, Ariz: School of Cardiac Ultrasound, 2000. 12. Reynolds, Terry, Yan Peng, and Patricia Dubovec. The pediatric echocardiographer’s pocket reference. 3rd ed. Phoenix, Ariz.: School of Cardiac Ultrasound, Arizona Heart Institute, 2002.

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

A self-assessment examination is available for purchase for self-evaluation purposes. See pages 57-58 for more information.

43

Registered Phlebology Sonographer (RPhS)
Qualification Requirements
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.

Qualifications: Non Physician Applicants
Qualification Prerequisite
RPhS1 Hold an active RVS or RVT credential plus six (6) months (full-time or full-time equivalent) of diagnostic ultrasound employment experience in venous disease at the time of application. AND 36 CEUs in last four (4) years documented in venous disease, ultrasound diagnosis, or vascular anatomy.

Supporting Documentation
(See examples on page 46)

RPhS1 Employment Verification Letter (from a supervising physician or credentialed lab director) AND verification of status as “ACTIVE” from (example: copy of registrant card) AND CME Documentation (See page 61 for required format) RPhS2 Completion certificate and/or educational transcripts AND Employment Verification Letter AND CME Documentation (See page 61 for required format)

RPhS

RPhS2 An associate degree or equivalent college hours (62 semester hours) in health, science, natural science, nursing, engineering, or any primary science and one (1) year (full-time or full-time equivalent) diagnostic ultrasound employment experience in venous disease. AND 36 CEUs in last four (4) years documented in venous disease, ultrasound diagnosis, or vascular anatomy RPhS3 A baccalaureate degree in health, science, natural science, nursing, engineering, or any primary science and six (6) months (full-time or full-time equivalent) of diagnostic ultrasound employment experience in venous disease at the time of application. AND 36 CEUs in last four (4) years documented in venous disease, ultrasound diagnosis, or vascular anatomy RPhS4 Two years (full-time or full-time equivalent) employment experience in diagnostic ultrasound in venous disease at the time of application. AND 36 CEUs in last four (4) years documented in venous disease, ultrasound diagnosis, or vascular anatomy

RPhS3 Completion certificate and/or educational transcripts AND Employment Verification Letter AND CME Documentation (See page 61 for required format)

RPhS4 Employment Verification Letter AND CME Documentation (See page 61 for required format)

44

Registered Phlebology Sonographer (RPhS)
Qualification Requirements
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.

Qualifications: Non Physician Applicants
Qualification Prerequisite
RPhS5 Valid license to practice medicine at the time of application AND Hold certification through the American Board of Venous and Lymphatic Medicine or hold an active RVS, RVT, or RPVI credential AND Diagnostic ultrasound experience in venous disease indicated by performing or directly supervising a minimum of 150 venous studies within the two years prior to the application.

Supporting Documentation
(See examples on page 46)

RPhS5 Copy of Medical License AND Verification of status as “ACTIVE” from appropriate credentialing agency (example-copy of registrant card) AND Notarized letter from a supervising physician, credentialed lab director, or office manager that verifies the number of venous studies performed or directly supervised and the period of time during which the studies were performed. (Physicians in solo practices may sign off on their own letters.) RPhS6 Copy of Medical License AND Notarized letter from a supervising physician, credentialed lab director, or office manager that verifies the number of venous studies performed or directly supervised and the period of time during which the studies were performed. (Physicians in solo practices may sign off on their own letters.) RPhS7 Copy of Medical License AND Completion certificate and/or educational transcripts AND Notarized letter from program director/supervisor that verifies the program’s length, the number of studies, and the period during which the studies were performed.

RPhS

RPhS6 Valid license to practice medicine at the time of application AND Diagnostic ultrasound experience in venous disease indicated by performing or directly supervising a minimum of 200 venous studies within the two years prior to the application.

RPhS7 Valid license to practice medicine at the time of application AND Completion of a residency or fellowship that includes specialized clinical training in phlebology ultrasound performance and interpretation. Performance or direct supervision of a minimum of 200 venous ultrasound studies during the training program.

45

Registered Phlebology Sonographer (RPhS)
Supporting documentation should be addressed appropriately (i.e. to CCI).
123 Main St.  •  San Diego, CA 927

ABC Vein Clinic (1)
01  •  (760) 555-12 34

Sample Employment Verification Letter (Non-Physicians)
1) Employer’s original, official letterhead or stationery. 2) Indicate the date the letter was signed by employer/supervisor. Should not be older than six months from the date the application is received at CCI Headquarters. 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 an MD or DO or hold an active RCCS, RCES, RCIS, RCS, RDCS, RDMS, RPhS, RVS or RVT credential.

Januar y 4, 2010 (2) CCI 1500 Sunday Drive Suite 102 Raleigh, NC 27607 RE: Ms. Donna Jac obs (3) This letter has bee n sent to verify tha t Ms. Donna Jacob was employed for s ove ultrasound labora r two years full-time (4) in the tor y at ABC Vein Clinic. Ms. Jacob employed from Jul s was y 1999 to August 2001. (5) Within year time-frame this Ms. Jacobs person ally performed ven twoultrasounds within ous our lab. (6) I am sending this letter support and end orsement of Ms. in Jacob’s applicatio CCI’s Phlebology n to sit for Registry Exam. Sincerely,

RPhS

illiams (7) Janet Williams, RV S, RPhS Clinical Superviso r

Janet W

123 Main St.  •  San Diego, CA 927 January 4, 2010 (2)

ABC Hospital (1)
01  •  (760) 555-12 34

Sample Clinical Experience Letter (Physicians)
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 venous ultrasound studies. 5) Indicate the time period during which the studies were performed. 6) Original signature of the lab director, supervising physician, or office manager. (Physicians in solo practice may sign off on their own letters.) 7) Letter must be notarized.

CCI 1500 Sunday Dri ve, Suite 102 Raleigh, NC 27607 RE: Dr. Danielle Smi th (3) This letter has bee n sent to verify that our records indicat Smith performed or directly superv e that Dr. Danielle ised the followin ultrasound studies g number of ven over the previous ous two years: Year (5) Number of Studies (4) 2008 100 2009 150 Dr. Smith has bee n with ABC Vein Clinic since Janu ary 2005. q  I certify that the number of stud ies provided above not rounded and are exact number /or estimates. (Ple s and are ase check box.) Sincerely, (6)

Janet Williams, RVS Lab Director

Janet William s

Sworn and subscri bed to before me on (date): (7) ____________ ____________ __________ ____________ ____________ __________ Signature of Not ary Public

Notar y Seal

1000 College Rd.

Vein University Ho
• New York, NY 100

(1) 01 • (212) 555-12

spital

34

Sample Resident/Fellow Letter
1) Program’s original, official letterhead or stationery. 2) Indicate the date the letter was signed 3) Indicate the name of the applicant. 4) Indicate the date or expected date of completion. 5) Indicate the program length, program specialty, and the number of venous ultrasound studies performed and/or supervised during training. 6) Original signature by Division or Department Head or Fellowship Training Director. 7) Letter must be notarized.

Januar y 4, 2010 (2) CCI 1500 Sunday Dri ve, Suite 102 Raleigh, NC 27607 RE: Dr. Jane Tho mpson (3) This letter serves to confirm that Dr. Thompson succes fellowship trainin sfully completed g at our institution between the dates December 31, 200 of Januar y 1, 200 9. (4) 7 and Our laborator y rec ords indicate tha t Dr. Thompson per vised a total of 230 formed and/or sup venous ultrasound erstudies during trai q I certify that ning. (5) the number of stu dies provided abo are not rounded ve are exact num and/or estimates. ber (Please check box s and .) Sincerely,

(3) John Jones, MD Director of Fellows hip Training Sworn and subscr ibed to before me on (date): (7) ____________ ____________ ____________ ____________ ____________ ____________ Signature of Not ary Public

John Jones

Notar y Seal

46

Registered Phlebology Sonographer (RPhS)
Examination Matrix
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. Content Category A. Maintain Information, Facility, and Safety B. Diagnose Patients C. Perform Diagnostic Test D. Treat Patients Non-Surgically E. Treat Patients Surgically Total Approximate Percentage of Examination 10% 20% 30% 12% 28% 100%

Knowledge List
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. Regulatory and Compliance Standards (e.g. OSHA, HIPAA, informed consent, medical records) Medical ethics Medical terminology General anatomy Cardiovascular anatomy and physiology (normal and abnormal) Venous anatomy, physiology, and pathophysiology Vascular hemodynamics Venous disease process and progression Diagnosis and treatment of lymphatic disease Basic math and statistical skills (formulas, exponents, decimals, scientific notation) Basic pharmacology History and physical • Vascular signs and symptoms • Risk factors (family history, genetics) • CEAP classification • Pre- and post-treatment Basic Life Support (BLS) Safety practices for patients and staff • Universal precautions/infection control • Sterile procedure • Ergonomics Ultrasound physics • Ultrasound instrumentation • Ultrasound modalities (e.g., spectral Doppler, color Doppler, B-mode) Vascular anomalies and normal variances Nonsurgical interventions (e.g., medications, risk factor modification) • Sclerotherapy (visual and ultrasoundguided) • Compression therapy • Physical therapy Open-surgical venous procedures Minimally-invasive venous procedures • Thermal ablation • Phlebectomy Other testing modalities (e.g., CT, MR, plethysmography) Exam correlation with other imaging modalities Complications of venous treatment

RPhS

47

Registered Phlebology Sonographer (RPhS)
Task List
The task list below describes the activities which a Registered Phlebology Sonographer is expected to perform on the job. All examination questions are linked to these tasks. Duties and Tasks A 1 2 3 4 5 6 7 8 B 1 2 3 4 5 6 7 C 1 2 3 Maintain Information, Facility, and Safety Perform universal precautions Triage patient status Inspect electromechanical equipment Perform preventive maintenance Optimize workspace Implement continuous quality improvement Secure patient information Archive medical records Diagnose Patients Obtain patient information Perform patient history Perform physical exam Establish differential diagnoses Design diagnostic plan Analyze patient data Evaluate post-treatment status Perform Diagnostic Test Confirm indications for study Position patient Select appropriate equipment % of Exam 10% Duties and Tasks 4 5 6 7 8 9 10 D 1 2 3 4 5 E 1 2 3 4 Select appropriate transducer Select instrumentation settings Perform study protocol Document exam findings Store test images Consult unusual or abnormal findings Give patient discharge instructions Treat Patients Non-Surgically Provide conservative treatment Perform visual sclerotherapy Provide compression therapy Treat lymphedema Arrange physical therapy Treat Patients Surgically Obtain informed consent Perform open surgical procedure Perform minimally invasive treatment Perform ultrasound guided procedures 12% % of Exam

20%

RPhS

28%

30%

Total 100%

Sample Questions
1. Pulsatility on pulse doppler is consistent with
a. AV fistula b. Iliac occlusion c. Patent foramen ovale d. Great saphenous vein aneurysm

4. When performing a venous Duplex Ultrasound exam, the sensitivity and specificity in detecting reflux are increased when the patient is in what position?
a. Supine b. Standing c. Decubitus d. Trendelenburg

2. Ultrasound guided foam sclerotherapy
a. Is less effective than liquid sclerotherapy b. Is commonly used for telangiectasia and reticular veins less than 2mm in diameter c. Is frequently associated with neurologic side effects d. Is effective in the treatment of incompletely ablated saphenous veins

5. 2D/Greyscale imaging is used during a venous duplex ultrasound to_____________.
a. Check for reflux b. Visualize vessels and possible echogenic material within the vessels c. Check for vein patency d. Detect decreased or absent flow

3. Spectral Doppler reveals phasic venous flow in the right common femoral vein and aphasic flow in the left common femoral vein. What is the MOST LIKELY pathologic finding?
a. Left iliac vein stenosis b. Right iliac vein stenosis c. Left femoral vein stenosis d. Right femoral vein stenosis

Answers:
1. a  2. d  3. a  4. b  5. b

48

Registered Phlebology Sonographer (RPhS)
RPhS References
The textbooks listed below are intended as recommended resources when preparing for examination. You may have previous or later editions of these or other references available that also present acceptable coverage of the subject matter. Any general text in cardiovascular techniques and evaluation, and cardiac patient care and management may be used. It is not necessary to use all of the texts identified. They are provided as suggestions only. CCI does not endorse or recommend any third-party review course or material. 1. Bergan, John J., and Cynthia K. Shortell. Venous ulcers. Amsterdam: Elsevier Academic Press, 2007. 2. Caggiati, A, Bergan, J., Gloviczki, P, et al. Nomenclature of the veins of the lower limb: Extensions, refinements, and clinical application, J of Vasc Surg 2005; 41: 719-24 3. Caggiati, A, Bergan, J., Gloviczki, P, et al. Nomenclature of the veins of the lower limb: An international interdisciplinary consensus statement, J of Vasc Surg 2002; 36: 416-22 4. Fronek, Helane. American College of Phlebology: Fundamentals of Phlebology Venous Disease for Clinicians Venous Disease for Clinicians, 2nd ed. London: Royal Society of Medicine Press, 2007. 5. Goldman, Mitchel P., John Bergan, and Jean-Jerome Guex. Sclerotherapy treatment of varicose and telangiectatic leg veins, 5th ed. Edinburgh: Mosby, 2011. A self-assessment examination is available for purchase for self-evaluation purposes. See pages 57-58 for more information. 6. Netter, Frank H., and Carlos A. G. Machado. Netter’s atlas of the human body, 4th ed. Hauppauge, N.Y.: Barron’s, 2006. 7. Ridgway, Donald P. Introduction to vascular scanning: a guide for the complete beginner, 3rd ed. Pasadena, Calif.: Davies, 2004. 8. Shadeck, Michael. Duplex and Phlebology. Idelson-Gnocchi Publishers, 1994. 9. Size, Gail P, Lozanski, Laurie, Russo, Troy. Inside Ultrasound’s Vascular Reference Guide, 1st ed. Inside Ultrasound, Inc., 2013. 10. Weiss, Robert A., Craig Feied, and Margaret A. Weiss. Vein diagnosis and treatment: a comprehensive approach. New York: McGraw-Hill, Health Professions Division, 2001. 11. Zwiebel, William J., and John S. Pellerito. Introduction to vascular ultrasonography, 5th ed. Philadelphia, Pa.: Saunders, 2005. 12. Joseph Zygmunt; Olivier Pichot; Tracie Dauplaise. Practical Phlebology: Venous Ultrasound, 1st ed. CRC Press, 2013.

RPhS
49

Registered Vascular Specialist (RVS)
Qualification Requirements
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.

Qualification Prerequisite
RVS1-2013
Two years of full-time or full-time equivalent work experience in vascular ultrasound. The applicant must have performed a minimum of 600** vascular ultrasound studies at the time of application. It is recommended, but not required, that the applicant have experience in the following areas: • Carotid duplex ultrasound • Peripheral arterial duplex • Transcranial Doppler • Venous duplex ultrasound • Peripheral arterial physiologic • Visceral vascular duplex ultrasound In the verification letter the medical director(s) must confirm the number of studies performed during the applicant’s employment.

Supporting Documentation
(See examples on page 51)

RVS1-2013

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

RVS235-2013

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 vascular ultrasound AND Performance of a minimum of 600** vascular ultrasound studies in their career, which is defined as work experience and/or clinical experience gained during a formal educational program. It is recommended, but not required, that the applicant have experience in the following areas: • Carotid duplex ultrasound • Peripheral arterial duplex • Transcranial Doppler • Venous duplex ultrasound • Peripheral arterial physiologic • Visceral vascular duplex ultrasound

RVS235-2013

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)

RVS

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.

RVS5

A graduate of a NON-programmatically accredited program in vascular ultrasound 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 vascular ultrasound 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.

RVS5

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

RVS4

Applicant must be a graduate of a programmatically accredited*** program in vascular ultrasound.

RVS4

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 RVS5. ** If an individual’s clinical hours were obtained during a formal educational program, then those procedures completed WOULD count toward the minimum of 600 vascular ultrasound studies under qualification RVS235-2013. *** 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.

50

Registered Vascular Specialist (RVS)
Supporting documentation should be addressed appropriately (i.e. to CCI).
123 Main St.  •  Sa n Diego, CA 9270 January 4, 2011 (2) CCI 1500 Sunday Drive , Raleigh, NC 2760 Suite 102 7 RE: Donna Jacob s (3) This letter has be en sent to verify that Ms. Donna Jac was employed for obs ove lar ultrasound lab r two years full-time (4) in the vascuorator y at ABC Ho employed from Jul spital. Ms. Jacobs was y two-year time-fram 1999 to August 2001 (5). Within thi (7) vascular ultras e Ms. Jacobs personally performed s ounds within ou r lab (6). I am sen 625 this letter in suppo din rt plication to sit for and endorsement of Ms. Jacob’s g apCCI’s Vascular Re gistry Exam. Sincerely,

ABC Hospital (1)
1  •  (760) 555-1 234

Sample Employment Verification Letter
1) Employer’s original, official letterhead or stationery. 2) Indicate the date the letter was signed by employer/supervisor. Should not be older than six months from the date the application is received at CCI Headquarters. 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. 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.

Janet Williams, RV S Clinical Supervisor

Janet William

s (8)

1000 College Rd. 
March 4, 2011 (2)

CV Institute (1)
•  New York, NY 100 01  •  (212) 555-12 34

Sample Student Verification Letter
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) Original signature of the educational director. 8) For non-programmatically accredited educational programs, indicate the program length, program specialty (echo or vascular or invasive), and the number and specialty of clinical hours accrued.

CCI 1500 Sunday Dri ve, Suite 102 Raleigh, NC 27607 RE: Ms. Jane Thom pson (3) This letter has bee n sent to verify tha as a full-time (4) t Jane Thompson stu is will graduate in Ma dent at the CV Institute. Ms. Thom enrolled pson y of 2011 (5) afte r completing the Sonography (6) pro Vas gra cular Thompson will hav m. At the time of graduation, Ms . e completed a 12which includes 800 month education al program, clinical hours at the ABC Hospital cath lab. Based on CCI’s qua lification requirem Johnson is curren ents, I understan tly qualified to sit d for the Cardiovas that Ms. Examination and cular Science afte for the Invasive Reg r her graduation she will be qua lified to sit istr y Examination . Sincerely,

RVS

Elizabeth Johnso n, RC Educational Direct IS or

Elizabeth John

son (7)

Sample Clinical Experience Letter
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 from their educational program, then those hours WOULD NOT count toward the 800-hour minimum under qualification RVS5.

123 Main St.  •  Sa n Diego, CA 9270 January 4, 2011 (2) CCI 1500 Sunday Drive , Suite 102 Raleigh, NC 2760 7 RE: Mr. John Doe (3)

ABC Children’s Ho

spital (1) 1  •  (760) 555-1 234

This letter has be en sent to verify that Mr. John Do performed 800 clin e has ical hours (4) of vascular ultrasou training at ABC Ho nd spital. Within thi s time, Mr. Doe pe ally performed 15 rson0 (5) vascular ult rasounds. Mr. Doe’s clinica l rotation lasted fro m January 2005 2005. (6) to June Sincerely,

Walter Reed, RVS Clinical Supervisor

Walter Reed (7)

51

Registered Vascular Specialist (RVS)
Examination Matrix
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. Content Category A. Prepare the Ultrasound System/Equipment for the Examination B. Prepare the Patient for Examination C. Perform Diagnostic Examinations D. Perform Vascular Protocols (includes test indications, interpreting clinical and test results, and recognizing associated pathology and intervention findings) E. Manage Data Acquired During Examinations and Create Preliminary Reports F. Professional Practices Approximate Percentage of Examination 7% 7% 18% 51% 9% 8%

TOTAL 100%

Knowledge List
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. Regulatory and compliance standards Medical ethics Medical terminology General anatomy Cardiovascular anatomy and physiology Vascular hemodynamics Disease process and progression Basic math skills (formulas, exponents, decimals, scientific notation) Basic statistics Basic pharmacology History and physical • Vascular signs and symptoms • Risk factors (family history, genetics) Patient care and assessment Basic Life Support (BLS) Safety practices for patients and staff Universal precautions/infection control Specific policies and procedures (e.g., department, hospital) Ultrasound physics • Ultrasound instrumentation • Ultrasound modalities (e.g., Doppler, color Doppler, B-mode, contrast) Vascular anomalies and normal variances Vascular nonsurgical interventions (e.g., medications, risk factor modification) Vascular surgical interventions (current and past) Imaging modalities (e.g., CT, MR) Exam correlation with other imaging modalities

RVS

52

Registered Vascular Specialist (RVS)
Task List
The task list below describes the activities which an RVS is expected to perform on the job. All examination questions are linked to these tasks. Duties and Tasks A 1 2 3 4 5 6 7 B 1 2 3 4 5 6 7 C 1 2 3 4 5 6 7 8 9 % of Exam Duties and Tasks Peripheral Arterial 8 Perform upper extremity arterial duplex 9 Perform lower extremity arterial duplex 10 Perform bypass graft surveillance 11 Perform resting ABI 12 Perform exercise ABI 13 Perform upper & lower segmental pressures 14 Perform PVR and Doppler waveforms 15 Perform PPG - ARTERIAL Peripheral Venous 16 Perform upper extremity venous duplex 17 Perform lower extremity venous duplex 18 Perform saphenous vein mapping 19 Perform venous insufficiency testing 20 Perform ultrasound guided RF/Laser ablation 21 Perform PPG - VENOUS Special Procedures 22 Perform dialysis access mapping 23 Perform psuedoaneurysm intervention 24 Perform penile pressures 25 Perform reactive hyperemia 26 Perform laser Doppler 27 Perform TCPO2 28 Perform vascular imaging with contrast 29 Perform intra-operative duplex 30 Perform endovascular ultrasound 31 Perform mammary artery mapping (IMA) 32 Perform cold/heat challenge 33 Perform thoracic outlet maneuvers 34 Perform Allen’s test 35 Perform radial artery mapping E 1 2 3 4 5 6 7 8 F 1 2 3 4 Manage Data Acquired During Examinations and Create Preliminary Reports Review images and findings Analyze data (qualitative and quantitative) and interpret findings Input data into report and send for finalization Complete billing functions as appropriate Communicate with the health care team (results, patient needs, etc.) Notify medical staff of abnormal/critical results Maintain confidentiality Manage data flow and images Professional Practices Maintain equipment and patient areas Ensure standard/universal precautions/sterile techniques Respond to emergency situations Maintain competency and quality assurance % of Exam (13%) Prepare the Ultrasound System/Equipment 7% for the Examination Set up equipment (turn on, select presets, enter patient data) Select transducers Disinfect equipment Position the equipment, adjust height of table/bed, chair Apply gel to transducer (understand reasons for, physics) Adjust preliminary control settings Manage work flow Prepare the Patient for Examination 7% Greet patient and verify patient demographics and ID Educate patient/family about the procedure and determine needs Position the patient Adjust environment (lighting, temperature, mood) Inform patient about how to obtain results and direct them to next destination Remove and replace dressings, medical devices as appropriate Determine the clinical question Perform Diagnostic Examinations 18% Obtain patient height, weight, blood pressure Capture optimal images based on probe placement and instrumentation Select imaging planes and reposition patient as needed Define anatomy and hemodynamics Select imaging modality Interpret images and modify examination to answer the clinical question Measure and quantify findings (how to) Instruct patient to perform physiologic maneuvers Assess urgency of findings

(12%)

(7%)

RVS

9%

D Perform Vascular Protocols 51% (includes test indications, interpreting clinical and test results, and recognizing associated pathology and intervention findings) Abdominal (7%) 1 Perform renal duplex 2 Perform mesenteric/splenic 3 Perform abdominal aorta 4 Perform hepatoportal duplex Cerebrovascular (12%) 5 Perform lower extremity arterial duplex 6 Perform TCI duplex 7 Perform transcranial doppler

8%

Total 100%

53

Registered Vascular Specialist (RVS)
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

RVS References
The textbooks listed below are intended as recommended resources when preparing for examination. You may have previous or later editions of these or other references available that also present acceptable coverage of the subject matter. Any general text in cardiovascular techniques and evaluation, and cardiac patient care and management may be used. It is not necessary to use all of the texts identified. They are provided as suggestions only. CCI does not endorse or recommend any third-party review course or material. 1. AbuRahma, Ali F., and John J. Bergan. Noninvasive vascular diagnosis a practical guide to therapy. 2nd ed. London: Springer, 2006. 2. Belanger, Ann. Vascular Anatomy and Physiology: An Introductory Text. 1st ed. Pasadena, CA: Davies Inc, 1990. 3. Daigle, Robert J.. Techniques in noninvasive vascular diagnosis: an encyclopedia of vascular testing. 3rd ed. Littleton, CO: Summer Pub., 2008. 4. Edelman, Sidney K.. Understanding ultrasound physics. 3rd ed. Woodlands, Tex.: ESP, 2005. 5. Foley, W. Dennis. Color doppler flow imaging. Boston: Andover Medical Publishers, 1991. 6. Gray, Henry, Susan Standring, Harold Ellis, and B. K. B. Berkovitz. Gray’s anatomy: the anatomical basis of clinical practice.. 40th ed. Edinburgh: Elsevier Churchill Livingstone, 2009. 7. Hennerici, M., and Doris Heusler. Vascular diagnosis with ultrasound: clinical reference with case studies. 2nd rev. ed. Stuttgart: Thieme, 2005. 8. Kremkau, Frederick W., and Flemming Forsberg. Sonography principles and instruments. 8th ed. St. Louis, Mo.: Elsevier/Saunders, 2011. 9. Miele, Frank R.. Ultrasound physics & instrumentation. 4th ed. Forney, TX: Miele Enterprises, 2006. 10. Netter, Frank H., and Carlos A. G. Machado. Netter’s atlas of the human body. Hauppauge, N.Y.: Barron’s, 2006. 11. Rumwell, Claudia, and Michalene McPharlin. Vascular technology: an illustrated review. 4th ed. Pasadena, Calif.: Davies Pub., 2009. 12. Thrush, Abigail, and Timothy Hartshorne. Vascular ultrasound: how, why, and when. 3rd ed. Edinburgh: Churchill Livingstone, 2010. 13. Zierler, R. Eugene. Standness’s duplex scanning in vascular disorders. 4th ed. Philadelphia, Pa.: Lippincott Williams & Wilkins, 2009. 14. Zwiebel, William J., and John S. Pellerito. Introduction to vascular ultrasonography. 5th ed. Philadelphia, Pa.: Saunders, 2005.

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

RVS

b. External iliac c. Greater Saphenous d. 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

A self-assessment examination is available for purchase for self-evaluation purposes. See pages 57-58 for more information.

54

Definition of CCI Terms
Accredited Educational Program ���������������������������������Program 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 conducts programmatic accreditation. Active Status ��������������������������Registrants who have paid triennial renewal fees and have met continuing education requirements. Applicant �������������������������������Person(s) applying for examination(s), who has not yet successfully completed a CCI examination. ATT �����������������������������������������“Authorization to Test” confirmation and instructions on how to schedule your examination with Pearson VUE. The ATT will also define the 90-day window in which an examination may be scheduled and taken by the candidate. CAAHEP ���������������������������������Commission on Accreditation of Allied Health Education Programs, an independent accreditation agency established for the purpose of reviewing and accrediting allied health education programs. (www.caahep.org) Candidate �������������������������������Applicants who have met examination qualification criteria and have been authorized to schedule an examination. CBT �����������������������������������������Computer-Based Testing. Certificate Level ��������������������Refers to the CCT or CRAT examinations. CEU �����������������������������������������Continuing Education Unit. CCI requires each Registrant to accrue a set quantity of CEUs each triennial cycle. See section “Maintaining Your Credential’s Active Status” (page 62) for further details. Clinical Hour �������������������������Clinical hours, for the purposes of CCI’s qualifications, are defined as the hours spent by an individual (student), while enrolled in an educational program, spent performing “hands-on” studies/procedures. Clinical hours can be either/ both internal or external but must be a requirement for graduation from/completion of the educational program. Equivalent College Hours �����Sixty-two (62) semester hours. Course work must be in health, science, natural science, nursing, engineering, or other primary science area. Extension �������������������������������An applicant can be granted one extension to their eligibility window per examination. If the applicant does not take the examination before the end of second eligibility window, the applicant’s examination fee will be forfeited, and applicant must reapply to take the examination. Full-Time Equivalent ������������ Working a minimum of 35 hours per week or 1820 hours per year in the specialty area for which the examination request is made. If working part time, requirements are prorated. For example, someone working ten hours per week would meet the requirement for hours in 182 weeks (or three and a half years). Inactive Status �����������������������Registrants who have not maintained triennial renewal fees or continuing education requirements. Incomplete Application ��������Any examination request made on any form other than a current original application or examination request, which does not include the necessary fees, qualification documents, selections, or signature. In-the-Field ����������������������������Full-time teaching, researching, providing, managing, and supervising patient care and diagnosis in cardiovascular medicine. See definition of full-time equivalent. JRC-CVT ��������������������������������� Joint Review Committee in Cardiovascular Technology: the specific committee under CAAHEP designated for Cardiovascular Technology. This committee is directly responsible for the establishment of the Educational Essentials and Guidelines for Cardiovascular Technology. JRC-DMS �������������������������������� Joint Review Committee in Diagnostic Medical Sonography: the specific committee under CAAHEP designated for Diagnostic Medical Sonography. This committee is directly responsible for the establishment of the Educational Essentials and Guidelines for Diagnostic Medical Sonography. Pearson VUE ��������������������������Third-party organization which manages CBT facilities where CCI examinations are administered. PPC �����������������������������������������Pearson Professional Center, locations at which Pearson VUE conducts the examination. Recertification �����������������������Re-examination of a specialty examination successfully taken in the past. May be requested once every three years. Recertification meets the CEU requirement for your specialty every three years. Registrants ����������������������������Candidates who have successfully completed the entire examination process and have been awarded a credential. Registry Level ������������������������Refers to RCCS, RCES, RCIS, RCS, RPhS, or RVS examinations. Working Days ������������������������ Working days are considered Monday through Friday. Weekend days, Saturday and Sunday, are not considered working days. Routine hours of operation for “Working Days” is 8:45 am to 4:45 pm, Eastern Standard Time (EST). Application Publication Date: August 2013. This application supercedes all documentation previously released. 55

Definition of CCI Terms

Helpful Hints

Helpful Hints
The Day of the Examination
1. Remember to bring two non-expired IDs (one with a photo, both with a signature) to the proctor upon arrival at the test center. Primary IDs: • government-issued driver’s license • state/national ID card • passport • military ID (with signature) • alien registration card (green card, permanent resident visas) • employee ID • school ID Secondary IDs: • any ID on primary list • Social Security card • ATM card 2. Plan to arrive at the test center 15 minutes early. 3. In the remaining minutes before the test begins, relax. This is a good time to reassure yourself that you will do well on the exam. Remind yourself that you have carefully studied the material and that you have the ability to perform well and to make correct choices on the exam. Use the mental resources that work for you to reinforce that you will do well. 6. Questions will be presented individually, one per screen. If you are a fast reader, force yourself to slow down and read each question thoroughly. See all the words. The ability to read carefully is very important to your ability to understand the question. Read all choices before selecting your answer. Even if you think you have identified the correct answer, read the others. 7. All questions on the exam are multiple choice. If you do not immediately know the correct answer, elimination of one or more of the possible choices is a useful technique. There is no penalty for guessing. Therefore, if you can narrow the possible choices, you will significantly increase the probability of selecting the correct answer. 8. If you are unsure or question the answer you have given, you will be allowed to “mark for review” any question. This will allow you, at any time during the time allowed for the exam, to go back and review the “marked for review” items. 9. You may skip any question during the exam and go on to the next question. At any time during the exam or at the end or the exam, you may go back and answer any unanswered questions. 10. You should answer all questions that you are sure of first, then go back and answer questions that you have skipped or “marked for review.” Do not spend too much time on any question. Each question is weighted equally in scoring. Answer the questions you know for sure first! 11. Think shallow! The questions on the examination are not designed as trick questions to fool the candidate. Although you are reading very carefully, do not read more into a question than is written. Do not agonize over each answer trying to imagine every exception or hidden meaning. Accept the questions and responses at face value as they are written. 12. Do not worry about the time limit. You will normally have more than enough time to carefully read and answer all of the questions, even if you are a slow reader. You may want to check the remaining time occasionally (shown on the computer screen) and pace yourself accordingly. Understand that the other test-takers around you are most likely not taking the same exam and start at different times. Do not be distracted by others finishing their exams. 13. When you have finished all test questions, you may have time to review those items you have skipped or “marked for review.” The computer will allow you to do this easily and efficiently. When you go back, remember that your initial response is most likely correct. You should be certain that you are correct before changing a response. Do not use this time to “second guess” either yourself or the questions. 14. If you begin to get nervous any time during the examination, talk to yourself! Sounds silly, but it works. Repeat to yourself: “I do not need to rush, there’s plenty of time.” “I will think about that after the exam is over.” “I can pass the exam without answering this specific question.” Anything that will help you stay calm will help you do well.

Hints on Taking an Examination
1. Your examination will be delivered using a computer. This is generally referred to as computer-based testing or CBT. Remember that CBT does not require that you be proficient in using a computer. It is literally as easy as using an ATM. 2. You will be given instructions by the proctor when you check in for the exam. Then, you will be offered a tutorial by the computer before you begin testing. Even if you have previously taken CBT exams, it is suggested that you take the time to take the tutorial. This time will not reduce the amount of time you will be allowed to take the exam. 3. The proctor will not be allowed to answer questions relating to questions, answers, or definitions on the exam. In fact, the proctor will most likely have little or no knowledge of the subject matter. However, the proctor will be available at any time during the testing period to answer questions regarding the administration of the test, the test center, or your personal needs. 4. A calculator will be provided as a “pop-up” on the computer. An erasable board and pen will be provided at the test center. An area will be provided in which you can leave personal items outside of the testing room. 5. It is useful for some test-takers to begin the testing session by writing from memory such things as acronyms, formulas, or charts on the erasable board for use later in the exam.

56

CCI Self-Assessments
About Self-Assessment Examinations
Self-Assessment Examinations can be ordered using the form on the next page or by visiting www.cci-online.org. CCI’s Self-Assessment Examinations are available to take online at www.cci-online.org. The cost for the online exam is $55. The examinations are composed of approximately ____ questions that are to be used for self evaluation purposes with regards to a CCI examination. These questions will help you become familiar with the format and subject content for your future examination.

Results Matrix
Questions Questions Answered Percentage Subject Category in Category Correctly Score Subject Category 1 .............. 20 ................. 20 ................100% Subject Category 2 .............. 20 ................. 18 .................90% Subject Category 3 .............. 20 ................. 10 .................50% Subject Category 4............... 20 .................. 8 ..................40% Subject Category 5............... 20 ................. 16 .................80% Overall ............................... 100................. 72..................72%

Self-Assessment Examinations should not be used as your only reference or as a study guide!
The questions are categorized by subject category, similar to the subject matrix on which the credentialing examination is based. The credentialing examination you are preparing to take will have more than 100 questions. The questions on the actual examination are randomized in the order in which they are presented. The online versions of the Self-Assessment Examinations offer immediate score results. For the online self-assessments, you will receive back a results matrix similar to the one at right. *PLEASE NOTE: You will not receive specific question/answer combinations.

CCI Self Assessments
57

Self-Assessment Examinations Order Form
Developed from registry and certification examinations given over the past five years through CCI, these selfassessment examinations offer a resource and preparation for credentialing examinations. These examinations offer you a means of assessing your performance before taking the credentialing examination. Self-assessment exams are available to take online at www.cci-online.org or in a paper/pencil format that is mailed directly to your preferred address and include a “bubble sheet” to write your answers on. This order form may be copied. Online examinations are $55.00 (It’s recommended but not required that these be ordered online at www.cci-online.org using a valid MasterCard or VISA for payment.) Paper/pencil examinations are $45.00 plus $4.95 Shipping and Handling (per paper pencil exam) Remember: You will not receive specific question/answer combinations. Self-assessments are not meant to be used as a study guide.
Cardiovascular Credentialing International

CCI Self Assessments

Shipping Information
First Name __________________________________ Middle Initial __________ Last Name_________________________________ Mailing Address (include Apt #)_________________________________________________________________________________ City ______________________________________ State ________ Postal Code _______________ Country____________________ Telephone __________________________ Email (required for online Self-Assessments)______________________________________

Examination Request
Please check all examinations you are ordering: Examination Online Total CCT q  $55 ______ CRAT q  $55 ______ RCCS q  $55 ______ RCES q  $55 ______ RCIS q  $55 ______ RCS q  $55 ______ RPhS q  $55 ______ RVS q  $55 ______ = = = = = = = = $______________ $______________ $______________ $______________ $______________ $______________ $______________ $______________

EXAMINATION TOTAL  =  $______________ TOTAL ENCLOSED  =  $______________

Payment
q Check  q  Money Order  q MasterCard  q Visa Card # _____________________________________________________________________________ Expiration Date__________ Signature_________________________________________________________________________________________________ Name as it appears on card (please print)___________________________________________________________________________

Mail or fax this order form with payment to CCI Headquarters, Attn: CCI Self-Assessment
Cardiovascular Credentialing International (CCI)  •  1500 Sunday Drive, Suite 102  •  Raleigh, NC 27607 Fax (919) 787-4916  •  (919) 861-4539  •  (800) 326-0268  •  www.cci-online.org

For Office Use Only
Payment Total ______________________ Order Number __________________________________ Customer Number______________________________________

58

Once You Have Earned Your Credential
Sample Lapel Pin and Wallet Card
Replacement lapel pins and wallet cards may be requested at a cost of $10 each.

Cardiovascular Credentialing International
Mary Smith Credentials: RVS Status: A through: 03/31/2013 Issue Date: 3/31/2010 Reg. ID: 00012345

Once You Have Earned Your Credential

Credentialing Cardiovascular Professionals

Registrants may order a wall certificate suitable for framing for the price of $25, plus shipping.

C

Credentialing Inte r a l u rna asc v tio o i na hereby certifies that d ar
Mary Smith
has met certain standards and qualifications through examination to be recognized as a

l

Certified Cardiographic Technician
Registrant Since December 1, 2012 Registry Number 00012345 Credential Active Until September 30, 2013

#0777

____________________________________ James Shafer – President

59

Once You Have Earned Your Credential
Maintaining Your Credential’s Active Status
As a new CCI registrant, there are two types of renewals with CCI: your first renewal and your second renewal, which will be your first triennial renewal.

First Renewal
New registrants are required to pay their first renewal before the first day of the same quarter (when the credential was earned) the following year. For example, if the credential is earned between the dates of April 1st and June 30th, then your first renewal would be due on or before March 31st of the following year. After completing the first renewal, credentials are renewed every three years. There are no CEU requirements for the first renewal; only a renewal fee, currently $150.00 USD, and a signature of compliance to the Code of Ethics must be submitted. This date will be noted on your original wallet card.

Second Renewal/First Triennial Renewal
Maintenance of an “active status” for Registry- and Certificate-Level credentials requires the submission of triennial renewal dues (currently $150.00 USD), signature of compliance to the CCI Code of Ethics, and the completion of Continuing Education Units (CEUs) every three years. These three steps are required, and until all three are fulfilled, your credential will not be renewed. Review the following chart to determine when your first and second renewals would occur. Second Renewal Cycle – When credential is earned… First Renewal End Date when CEUs are due January 1 to March 31, 2013 December 31, 2013 December 31, 2016 April 1 to June 30, 2013 March 31, 2014 March 31, 2017 July 1 to September 30, 2013 June 30, 2014 June 30, 2017 October 1 to December 31, 2013 September 30, 2014 September 30, 2017

Submitting evidence of required CEUs (36 for registry-level registrants and 16 for certificate-level registrants)

Once You Have Earned Your Credential

• Registrants with registry-level credentials are required to earn 36 contact hours every triennial cycle, 30 of which must be cardiovascular-related. • Registrants with certificate-level credentials are required to earn 16 contact hours every triennial cycle. If you hold multiple certificate-level credentials, the requirement is 16 hours. • If you hold multiple credentials, the CEU requirement is the maximum contact hours for the credential(s) that you hold. For example, if you hold the CCT and the RCS credentials, you are required to earn 36 total contact hours every triennial cycle, 30 of which must be cardiovascularrelated. If you hold the CCT and CRAT credentials, you are required to earn 16 contact hours every triennial cycle. • Passing a CCI recertification examination during your current triennial cycle will satisfy the CEU requirements for your current triennial cycle. (Passing recertification examination does not substitute the triennial renewal fees.) For an application, go to page 62. • Only college credits that are approved by one of the following entities will be accepted. It is the registrant’s responsibility to obtain the appropriate certificate with CE approval.

CEUs must be obtained from one of the following CCI-approved CE activities
• Category 1 – Continuing Medical Education (CME) Units from Accredited Sponsors of the Accreditation Council for Continuing Medical Education (ACCME), • Category A – contact hours from Accredited Providers of Continuing Education in Nursing by the American Nurses Credential Center (ANCC) or one of its Accredited Approvers, • Category A – contact hours from organizations that utilize the American Registry of Radiologic Technologists(ARRT) Recognized Continuing Education Evaluation Mechanism (RCEEM), 60

• Continuing Education Contact Hours from a Board of Registered Nursing (BRN) – approved Continuing Education Providers (CEPs) Examples of organizations that provide CCIapproved CE activities:
• Alliance of Cardiovascular Professionals (ACVP) • American Academy of Physician Assistants (AAPA) • American Association of Critical Care Nurses (AACCN) • American Association of Medical Assistants (AAMA) • American College of Cardiology (ACC) • American College of Phlebology (ACP) • American College of Chest Physicians (ACCP)

• American Heart Association (AHA) • American Medical Association (AMA) • American Society of Echocardiography (ASE) • American Society of Radiologic Technology (ASRT) • Association of Vascular and Interventional Radiographers (AVIR) • Heart Rhythm Society (HRS) • Society of Cardiac Angiography and Intervention (SCAI) • Society of Diagnostic Medical Sonography (SDMS) • Society of Invasive Cardiovascular Professionals (SICP) • Society of Vascular Ultrasound (SVU)

Once You Have Earned Your Credential
Credential Renewal Policy
All CEU certificates must contain the following information:
1. The registrant’s name 2. The date of the Continuing Education Program 3. The name of the Continuing Education Program 4. The name of the accrediting body 5. The name of the CEU provider 6. The number of CEUs or CMEs awarded Please see page 60 for further details. 2. Fax – CEU Dedicated Fax Line: (919) 882-8787. Use the CCI CEU Fax Cover Sheet for all submissions. The cover sheet can be downloaded online at www.cci-online.org. All renewal requirements are due by renewal end date. If requirements are not received by renewal end date, registrants are granted a 90-day grace period to submit all requirements to our office, and a $50 late fee will be assessed. The grace period is not to be used to earn CEUs. Any credits earned during the grace period WILL NOT be accepted. All CEU credits must have been earned within the triennial cycle.

Appeals
CCI will receive (in writing) appeals to contest any adverse decisions affecting examination eligibility (for applicants), examination results (for candidates), or active status (for credential holders). The written appeal must include the stated appeal, the reason for the appeal, relevant supporting documentation and contact information of the appellant. For further information on the procedures for Appeals, please visit www.cci-online.org.

CEUs may be submitted by mail or fax:
1. Mail – Please mail copies of CEU certificates to: Attn: CCI, Registrant Services 1500 Sunday Drive, Suite 102 Raleigh, NC 27607

Once You Have Earned Your Credential

The American Society of

Certificate of Attendance
<First Name> <Las Echocardiography certifi t Name>

es that

has participated in the ed ucational activity entitle d “23rd Annual ASE Scient ific Sessions, June 30-July 3, 2012, National Harbor, MD.” The activity was designa ted for 31.0 AMA PRA ca tegory 1 credits. Number of hours at tended: <Hours>
__________________ _________________ Mary Alice Dilday, Associa te Executive Director 2100 Gateway Centre Blv d, Suite 310, Morrisville, NC 27560
61

Examination Application for Active Credential Holders Earning CEU*
*Taking examination in lieu of continuing education credits
Complete this application and sign the affidavit before mailing to CCI. Please make a copy for your records. Please type or print legibly. Do not fax this application: original signature is required. Passing a CCI recertification during your current triennial cycle will satisfy the CEU requirements for your current triennial cycle. Examination Requested Price Check all that apply: q  Certified Cardiographic............................ $120 q  Certified Rhythm Analysis....................... $120 q  Invasive Registry...................................... $300 q  Non-Invasive/Echo Registry..................... $300 q  Vascular Registry...................................... $300 q  Electrophysiology Registry...................... $300 q  Congenital Cardiac Registry..................... $300 q  Phlebology Registry................................. $300

Please ensure that your application is signed and dated. Supporting documentation is not required.

Cardiovascular Credentialing International 1500 Sunday Drive, Suite 102 Raleigh, NC 27607 (919) 861-4539  •  800-326-0268 www.cci-online.org

Has your address changed since taking your last CCI examination?  q Yes  q No

Personal Information
Social Security Number (or Canadian Insurance #) _______________-___________-____________________ Birth date (month/date/year) _______/_______/_________ q Mr.  q Mrs.  q Ms.  q Dr. First Name _________________________________________________ Middle Initial _____ Last Name________________________________________________ Mailing Address (include Apt #)__________________________________________________________________________________________________________ City ______________________________________________________ State ________ Postal Code__________________ Country__________________________ Home Telephone ______________________________ Work Telephone ______________________________ Email________________________________________ q  Check here if you have been convicted, pled guilty, or pleded nolo contendere (no contest) to an offense which is classified as a misdemeanor or felony. (If you checked this box, you are required to submit a Pre-Application to determine that you qualify for the CCI credentialing processing process see page 6 for details).

Employment History
Please provide the following information about your employment in Cardiovascular Technology. Place of Employment________________________________________________________Dates of Employment: From ________/________ to ________/__________ Position/Title_______________________________________________________________________________________________________________________ Mailing Address_____________________________________________________________________________________________________________________ City ______________________________________________________ State ________ Postal Code__________________ Country__________________________ Supervising Physician/Supervisor Name ____________________________________________________ Supervisor’s Telephone_______________________________

Fees Enclosed
Registry Examination ($300).................................................................$____________ Certification (CCT or CRAT) Examination ($120)................................$____________ International Fee ($50)..........................................................................$____________ (for individuals currently residing outside of North America) TOTAL....................................................................................................$____________ All fees above include a non-refundable examination filing fee of $100.

Method of Payment
q Check  q  Money Order  q MasterCard  q Visa Card # ___________________________________________ Exp.__________ Signature_______________________________________________________ Name as it appears on card (please print):________________________________ Falsification of information on any CCI exam application or violation of CCI policies during exam administration will void the examination process/results and cause forfeiture of all fees. In cases where credentials have been awarded, revocation may occur, and the situation may become the subject of legal action.

Affidavit

Recertification Application

I have read all information contained in this application booklet and understand that CCI reserves the right to deny my application, revoke my eligibility if I qualify as a candidate, or take action against me if the documentation I provide is found to be fraudulent, misrepresenting, if I do not meet the application qualifications (including high school graduation or documentation of any conviction), or maintain the requirements for maintaining the active status of my credential. I authorize CCI and its agents, at their sole discretion, to request any and all information concerning material related to this application. I authorize CCI to communicate information regarding my application and other credential related information to government authorities, employers, and others. I agree to comply with the CCI Code of Ethics, all rules, regulations, and policies (now existing or adopted in the future) pertaining to this application, and to the standards and renewal of any credential I may receive through CCI. I hereby release and shall indemnify and hold harmless CCI, its Board of Trustees, officers, committee members, employees, and agents(hereinafter referred to, individually and collectively, as “CCI Entities”) from and against and with respect to any and all liability and claims (including but not limited to losses, costs, expenses, damages, and judgments including legal fees) that arise or allegedly arise from, with respect to, out of, or in connection with any action or omission of the CCI Entities. My agreement hereunder to indemnify and hold harmless expressly is intended to apply to any and all such liability and claims relating to any CCI examination and application therefore, and, if applicable and without limitation, the failure of CCI to issue to me a CCI credential or to renew said credential or pre-existing credential awarded to me, CCI’s revocation of any credential previously issued to me, or CCI’s notification to any person of such actions taken by CCI. Applicant’s Signature________________________________________________________________Date_______________________________________________

For Office Use Only

Product code/amt/qual (1)__________/___________/____________ Product code/amt/qual (2)__________/___________/____________ Product code/amt/qual (3)__________/___________/____________

ATT file______________________________ Cust #________________________________ Approval______________________________ Payment Total__________________________ Date_________________________________ Payment Method________________________

Application Publication Date: August 2013. This application supersedes all documentation previously released.

62

Societies and Associations

Join Societies and Get Involved!
CCI supports the professional triad: professional organizations, personnel credentialing, and educational programs. As a CCI registrant, you are neither a member nor a licensee. Licensing is required by law and, when required, will allow licensees to practice the particular profession in a certain geographic area. Recently, there are a small number of states that have enacted licensure and utilize CCI’s credentials in the license process. A state board will administer the licensing examinations or oversee the licensing requirements. Credentials are administered and governed by independent certification bodies, and the holding of a credential proves that you have a fundamental knowledge in the particular specialty. Membership in a professional society or association will require payment of dues in return for benefits such as conferences, continuing education, professional development, and advancement of the field. The best way to stay connected to what is happening in your field is to join your professional society and get involved! These societies ensure the advancement and recognition of your field, as well as protect the professionals working within the field.

American College of Cardiology – Partners in Care (ACC-PIC)
www.cardiosource.org/pic The ACC is transforming cardiovascular care and improving heart health through continuous quality improvement, patient-centered care, payment innovation, and professionalism. The ACC invites cardiovascular technologists, including sonographers, electrophysiology specialists, invasive specialists, and vascular specialists, to become Partners in Care (PIC) members of the ACC. Applicants must be certified by Cardiovascular Credentialing International (CCI) and have two or more years of experience in their field. For RCCS, RCES, RCIS, RCS, and RVS.

South Atlantic Society of Electrophysiology for Allied Professionals (SASEAP)
www.saseap.org The SASEAP is the largest professional society for electrophysiology (EP) professionals in the Southeast United States. It was formed to provide education and a venue for information exchange. SASEAP’s mission is to advance education for allied professionals such as nurses, radiation technologists, cardiovascular technologists, and pharmacists in the growing field of EP. For RCES.

Society for Vascular Ultrasound (SVU)
www.svunet.org The SVU is the only professional organization completely dedicated to the advancement of noninvasive vascular technology used in the diagnosis of vascular disease. The Society’s success for 35 years is based on the involvement of a diverse membership of vascular ultrasound professionals, including vascular technologists, sonographers, echocardiographers, vascular surgeons, physicians, nurses, vascular lab technical directors, and other allied healthcare professionals. For RCCS, RCS, RPhS, and RVS.

American College of Phlebology (ACP)
www.phlebology.org The ACP is the premier association for physicians and allied health professionals working in the field of venous disease, including such disorders as varicose and spider veins, venous ulcers, and DVT. Comprised of more than 2,000 vein care professionals, the ACP offers vein treatment education and training with the goal of improving the quality of patient care. For RPhS and RVS.

American Society of Echocardiography (ASE)
www.asecho.org The ASE is the largest global organization for cardiovascular ultrasound imaging, setting practice standards and guidelines. Comprised of over 15,000 physicians, sonographers, nurses, and scientists, ASE is a strong voice providing guidance, expertise, and education to its members with a commitment to improving the practice of ultrasound and imaging of the heart and cardiovascular system for better patient outcomes. For RCCS, RCS, and RVS.

Society of Diagnostic Medical Sonography (SDMS)
www.sdms.org The SDMS was founded in 1970 to promote, advance, and educate its members and the medical community in the science of Diagnostic Medical Sonography. SDMS offers 60 free SDMS CME credits specifically for cardiovascular sonographers and currently serves over 12,800 cardiovascular sonographer members. For RCCS, RCS, RPhS, and RVS.

Heart Rhythm Society (HRS)
www.hrsonline.org The HRS is the leading professional association representing the allied specialties of cardiac pacing and electrophysiology, providing members with educational courses and products, practice management tools, career and networking resources, advocacy for favorable governmental policies, and more. For RCES.

Society of Invasive Cardiovascular Professionals (SICP)
www.sicp.com The SICP is a non-profit organization that promotes and advances the field of invasive cardiovascular technology. For RCES and RCIS.

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Cardiovascular Credentialing International 1500 Sunday Drive, Suite 102 Raleigh, NC 27607 www.cci-online.org

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