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Examination Overview

ACS ­– Advanced Cardiac Sonographer

The Advanced Cardiac Sonographer (ACS) credential was developed in response to a need to
create a career track for sonographers who practice at an advanced level in the echocardiography
laboratory. The ACS is committed to improving lab quality and efficiency through preparing
preliminary echo assessments; performing advanced echocardiograms; mentoring fellows,
students, residents, and staff; developing and implementing educational plans; facilitating
continuous quality improvement; and coordinating cardiac ultrasound research.

CCI Announces New Pricing and Testing Window for

Advanced Cardiac Sonographer (ACS) Examination
The ACS examination is administered only during the earlier an application is submitted the better the chance of
months of August and February each year. obtaining the preferred exam date, time, and location for
Examination Window testing during the desired exam window. All testing must be
Application Received by CCI (date range exam can be taken) completed before the exam window closes. The exam will
remain closed until a new exam window opens.
July 1, 2020 to December 31, 2020 February 1, 2021 to
February 28, 2021 Candidates who are unable to take the exam on their
February 1, 2021 to June 30, 2021 August 1, 2021 to scheduled date can reschedule within the testing window.
August 31, 2021 There is no charge for rescheduling if done two full working
days in advance of their scheduled appointment.
To be authorized to sit for the ACS exam, applicants must If candidates do not reschedule the exam within two
complete the following: working days, they must either take their scheduled exam
or forfeit their exam fees.
• Register for the exam through the CCI website
(www.cci-online.org) Candidates may elect to defer their unscheduled or
• Provide all supporting documentation cancelled exam eligibility to the following testing window.
Candidates are only permitted to defer their exam eligibility
• Pay exam fee ($450.00 USD)
one time.
Examination fees are subject to CCI’s refund policy. Please
The preliminary examination results letter/score report
refer to the CCI Applicant Handbook for more details.
will continue to be provided onsite to the test-taker upon
Once approved, candidates will receive their Authorization completion of the exam. Candidates will receive their
To Test (ATT) that provides instructions on how to official results from CCI approximately two to three weeks
schedule their exam. The examination will be administered after taking their exam.
at Pearson Testing centers. Scheduling of testing
Please refer to the CCI Applicant Handbook for CCI’s
appointments will continue to be done directly with
application policies and procedures.
Pearson and is on a first-come, first-served basis. The
Advanced Cardiac Sonographer (ACS)
This Examination Overview booklet is meant to assist you as a prospective candidate of the Advanced Cardiac Sonographer (ACS)
credentialing program. It provides an overview of the Qualification Requirements and Examination Content. For more details on CCI
policies, the testing process, and procedures to submit an application, please visit www.cci-online.org/acs to download the CCI Applicant
Handbook which contains the application. Examination fee is $450 USD. All exam fees include a $100 USD non-refundable filing fee.

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

Qualification Prerequisite Supporting Documentation

ACS1 ACS1
A graduate of a programmatically accredited program in Advanced Cardiac Sonography. A copy of a graduate certificate
AND
Student verification letter from the Advanced Cardiac
Sonography educational program director.

ACS2 ** ACS2
A graduate of a programmatically accredited program in cardiac ultrasound/ A copy of a graduate certificate from the programmatically
echocardiography.* accredited educational program.
AND AND
Hold an active echocardiography registry credential (includes but not limited to RCS, Copy of wallet card showing date earned and active
RCCS, or RDCS) through date of registry credential (RCS, RCCS or RDCS)
AND AND
Seven (7) years of cardiac ultrasound clinical experience as a registered Employment verification letter which indicates time period
echocardiography sonographer. It is anticipated, but not required, that the applicant of employment and primary duties of applicant, and clinical
have performed a minimum of 8000 echocardiograms in their career which is defined as competence related to the field of cardiac ultrasound.
work experience and/or formal clinical education program.

ACS3 ** ACS3
A graduate of a diploma, associate, or baccalaureate academic program in health A copy of a graduate certificate
science (including, but not limited to, cardiovascular technology, ultrasound, radiologic
technology, respiratory therapy, or nursing) AND
AND Copy of wallet card showing date earned and active
through date of registry credential (RCS, RCCS or RDCS)
Hold an active echocardiography registry credential (includes but not limited to RCS,
RCCS, or RDCS) AND
AND Employment verification letter which indicates time period
of employment and primary duties of applicant, and clinical
Seven (7) years of cardiac ultrasound clinical experience as a registered competence related to the field of cardiac ultrasound.
echocardiography sonographer.

ACS4 ** ACS4
Hold an active echocardiography registry credential (includes but not limited to RCS,
RCCS, or RDCS) Copy of wallet card showing date earned and active
through date of registry credential (RCS, RCCS, or RDCS)
AND
AND
Ten (10) years of cardiac ultrasound clinical experience as a registered echocardiography
sonographer. It is anticipated, but not required, that the applicant have performed a Employment verification letter which indicates time period
minimum of 8000 echocardiograms in their career which is defined as work experience of employment and primary duties of applicant, and clinical
and/or formal clinical education program. competence related to the field of cardiac ultrasound.

* 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.
** It is CCI’s goal to advance the standards for all cardiovascular professionals. CCI recognizes that the future demands for advanced-level sonographers
will result in the need for additional education for sonographers who wish to earn the Advanced Cardiac Sonographer credential. CCI will continue to
review the qualification prerequisites for candidates applying for the ACS examination. Through collaboration with the professional societies, educators,
and the cardiac sonography community CCI will establish minimum educational standards for the Advanced Cardiac Sonographer credentialing program.

Publication Date: June 2022. This document supersedes all documentation previously released.

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Advanced Cardiac Sonographer (ACS)
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 Approximate % of Exam

A. Assimilating History, Clinical, and Echocardiographic Findings 10%
B. Assessing Cardiovascular Heart Disease 40%
C. Assessing Valvular Heart Disease 15%
D. Evaluating Structural Heart and Interventional Procedures 15%
E. Utilizing Advanced and Multi-Modality Imaging 9%
F. Assessing Congenital Heart Disease 4%
G. Demonstrating Professional Practice 7%
TOTAL 100%

Task List
The task list below describes the activities which an Advanced Cardiac Sonographer is expected to perform on the job. All examina-
tion questions are linked to these tasks.

Duties and Tasks Approx. % of Exam Duties and Tasks Approx. % of Exam

A Assimilating History, Clinical, and 10% D Evaluating Structural Heart and 15%
Echocardiographic Findings Interventional Procedures
1 Perform patient assessment 1 Acquire pre-intervention qualitative and quantitative data
2 Integrate clinical history (signs, symptoms, medications) specific to structural heart disease procedures (e.g., transcath-
3 Integrate prior studies (e.g., echocardiography, ECG) eter valve repair, closure device, occluder device, surgical)
4 Create preliminary echo report (including critical findings) 2 Acquire post-intervention qualitative and quantitative data
specific to structural heart disease procedures (e.g., transcath-
5 Ensure report completeness and accuracy (e.g., IAC, ASE) eter valve repair, closure device, occluder device, surgical)
3 Evaluate surgical and transcatheter interventions
B Assessing Cardiovascular Heart Disease 40%
4 Evaluate perioperative and procedural complications
1 Assess cardiomyopathies (e.g., hypertrophic, dilated, restrictive, 5 Evaluate functional effectiveness of procedure
infiltrative, stress) 6 Compare multi-modality imaging
2 Assess cardiac masses (e.g., tumor, thrombus, artifact) 7 Assist with image acquisition and recognize complications
3 Assess coronary artery disease (e.g., TEE, ICE, 3D)
4 Perform stress echo (ischemic and nonischemic)
5 Assess pericardial diseases E Utilizing Advanced and Multi-Modality Imaging 9%
6 Assess heart failure (left and right) 1 Perform 3D imaging
7 Assess diseases of the aorta 2 Perform strain imaging
8 Assess right heart and pulmonary hypertension 3 Integrate multi-modality cardiac imaging (e.g., MRI, CT,
9 Assess systemic arterial hypertension fluoroscopy, molecular)
10 Assess systemic diseases
11 Assess diastolic function F Assessing Congenital Heart Disease 4%
12 Assess cardiac findings with special populations 1 Assess simple congenital heart disease pre- and post-repair
(e.g., athletes, pregnancy, aging, transplant) (e.g., ASD, VSD, PDA, PFO, persistent left SVC, coarctation)
13 Assess chemotherapy related therapeutic dysfunction 2 Assess complex congenital heart disease pre- and post-repair
14 Assess mechanical circulatory support devices (e.g., TGA, ToF, TV atresia, HLHS, syndromes)
(e.g., VAD, ECMO, IABP, long- and short-term support)
15 Assess cardiovascular heart disease with ultrasound enhancing G Demonstrating Professional Practice 7%
agents
16 Perform echo measurements and calculations and assess 1 Mentor fellows, students, residents, and staff
hemodynamics 2 Develop and implement educational plans
3 Facilitate continuous quality improvement
C Assessing Valvular Heart Disease 15% 4 Interpret clinical research principles
1 Assess aortic valve disease 5 Assist with echo lab accreditation
2 Assess mitral valve disease
TOTAL 100%
3 Assess pulmonic valve disease
4 Assess tricuspid valve disease
5 Assess prosthetic valves
6 Assess valvular endocarditis

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Advanced Cardiac Sonographer (ACS)
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.
Acquired heart disease Contrast Echo (e.g., LVO, MCE) National guidelines and standards
Aortic Disease Coronary and Ischemic Heart Disease Pathology
Cardiac catherization CQI and performance improvement Pericardial disease
Cardiomyopathies Diastolic Function Right Heart Disease
Complications (e.g., post procedural) Educational Theory Strain Echo
Cardiovascular hemodynamics Heart Failure and Stroke Systemic disease
Congenital heart disease (Simple and Interventional procedures TEE
Complex) Mitral Valve Disease

ACS References
The resources 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. Publications and Reports of the American Society of 4. Weyman, Arthur. Principles and Practice of Echocardiography,
Echocardiography (ASE), Raleigh, NC. All new ASE Guidelines 2nd ed. Lippincott Williams & Wilkins, 1994.
published on www.asecho.org/Guidelines.
5. Klein, Allan, Asher, Craig. Clinical Echocardiography Review:
2. Anderson, Bonita. A Sonographer’s Guide to the Assessment of A Self-Assessment Tool. Lippincott Williams & Wilkins.
Heart Disease. MGA Graphics.
6. Morrison, G. R., Ross, S.M., Kalman, H.K. & Kemp, J.E. (2011).
3. Armstrong, William F., Thomas Ryan, and Harvey Feigenbaum. Designing Effective Instruction (6th ed.). Somerset, NJ:
Feigenbaum’s Echocardiography. Philadelphia: Wolters Kluwer John Wiley.
Health/Lippincott Williams & Wilkins.

Online Self-Assessment Practice Examinations are available for purchase for self-evaluation purposes. It is important to note
that the results of the self-assessment exam do not guarantee or indicate individual success on the CCI exam, nor should the self-
assessment serve as the only means for preparing for the CCI examination. To order the self-assessment examinations online
visit www.cci-online.org.

CCI Applicant Handbook is required reading prior to applying for a CCI exam. Included is important information regarding the
application policies, CCI procedures, and the testing process. Download at www.cci-online.org/applicanthandbook.