Advanced Cardiac Sonographer (ACS) exam - CCI

The Advanced Cardiac Sonographer (ACS) examination is designed 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.

This computer-based exam is administered at Pearson Professional Centers. To locate a test center click here.

TESTING AVAILABILITY

Apply for the ACS exam by December 31, 2024!

The ACS examination is administered only during the months of August and February.

Application Received by CCI
July 1, 2024, to December 31, 2024
February 1, 2025, to June 30, 2025

Exam Window (date range exam can be taken)
February 1, 2025, to February 29, 2025
August 1, 2025, to August 31, 2025

EXAM FEE

The fee for the ACS examination is $450 USD. All fees include a $100 USD non-refundable fee for staff resources required to review and process applications.

TESTING TIME

The Advanced Cardiac Sonographer (ACS) exam is a three-hour, computer-based exam that contains 170 questions.

Advanced Cardiac Sonographer (ACS) Qualification Requirements

Applicants are required to meet the following criteria:

Have a high school diploma or general education diploma at the time of application.
Fulfill one (1) of the qualifications of the exam for which you are applying. See the pathways listed in the table below.
Provide typed documentation to support the qualification pathway for which you are applying. Required documentation for each qualification is listed below. CCI reserves the right to request additional information.

Qualification Pathway Tool

To determine your eligibility, use the questionnaire tool below. The qualification pathway tool will help you determine if you are eligible. It does not guarantee eligibility but serves as a guide in helping you apply for the exam.

Are you currently enrolled as a student or are you a graduate of a programmatically accredited program in advanced cardiac sonography?

yes
no

Download Resources

ACS Exam Overview

Sample Verification Letters

Choose one of the qualification pathways below

ACS1 Pathway

A graduate of a programmatically accredited program in Advanced Cardiac Sonography.

ACS1 Supporting Documentation

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

ACS2 Pathway**

A graduate of a programmatically accredited program in cardiac ultrasound/echocardiography.*
AND
Hold an active echocardiography registry credential (includes but not limited to RCS, RCCS, or RDCS)
AND
Seven (7) years of cardiac ultrasound clinical experience as a registered echocardiography sonographer. It is anticipated, but not required, that the applicant have performed a minimum of 8000 echocardiograms in their career which is defined as work experience and/or formal clinical education program.

ACS2 Supporting Documentation

A copy of a graduate certificate from the programmatically accredited educational program.
AND
Copy of wallet card showing date earned and active through date of registry credential (RCS, RCCS or RDCS)
AND
Employment verification letter which indicates time period of employment and primary duties of applicant, and clinical competence related to the field of cardiac ultrasound.

ACS3 Pathway**

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
Hold an active echocardiography registry credential (includes but not limited to RCS, RCCS, or RDCS)
AND
Seven (7) years of cardiac ultrasound clinical experience as a registered echocardiography sonographer. It is anticipated, but not required, that the applicant have performed a minimum of 8000 echocardiograms in their career which is defined as work experience and/or formal clinical education program.

ACS3 Supporting Documentation

A copy of a graduate certificate
AND
Copy of wallet card showing date earned and active through date of registry credential (RCS, RCCS or RDCS)
AND
Employment verification letter which indicates time period of employment and primary duties of applicant, and clinical competence related to the field of cardiac ultrasound.

ACS4 Pathway**

Hold an active echocardiography registry credential (includes but not limited to RCS, RCCS, or RDCS)
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 minimum of 8000 echocardiograms in their career which is defined as work experience and/or formal clinical education program.

ACS4 Supporting Documentation

Copy of wallet card showing date earned and active through date of registry credential (RCS, RCCS, or RDCS)
AND
Employment verification letter which indicates time period of employment and primary duties of applicant, and clinical 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.

Prepare to Apply for the Advanced Cardiac Sonographer (ACS) Exam

Applying for the exam will take place through your CCI online account.

To prepare, create an online profile by clicking either “CREATE AN ACCOUNT” at the top of this website or if you already have an existing profile, click “SIGN IN.”

Before starting the online submission review each of the tabs in this section and collect the following information which may be needed to complete the application.

Personal contact information
Training program(s) contact information
Supporting documents from your training program(s) in PDF format
Employer contact information
Supporting documentation from your employer(s) in PDF format
Payment information

Once submitted, processing a complete application requires a minimum of 15-20 business days.

Helpful Resources

As of December 31, 2022, there are 331 Advanced Cardiac Sonographer credential holders. The pass rate for first-time test takers is 71.43%

Download Applicant Handbook

See Exam Process Graphic

Pre-Application Policy Pertaining to Criminal Matters

If you have been convicted, pled guilty, or pleaded no contest for an offense that is classified as a misdemeanor or felony, or if you have questions regarding personal criminal matters you may request a pre-application of criminal matters to determine whether you qualify for the CCI credentialing process.

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.

Download Pre-Application Criminal Matters

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 that 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.

Requests for Special 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:

The specific diagnosed disability
The specific functional limitations
Impact of the functional limitations on the individual’s ability to participate in the testing activity
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 for accommodations requests:

Verification of the evaluator, psychologist, physician, or health care professional credentials and specialty in the diagnosis of the stated disability.
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.

Advanced Cardiac Sonographer (ACS) Exam Preparation

Download ACS Exam Overview

Order Online Self-Assessment Exam

The ACS examination is designed to assess the knowledge and skills necessary to work at an advanced level in the echocardiography lab per currently accepted practices.

The examination content is based on the findings of a Job Task Analysis (JTA), which describes the overall tasks that an ACS is expected to perform on the job and general areas of knowledge that are needed to perform the tasks. A JTA is performed every 5 years for all nine of the examinations that CCI offers in order to keep exams relevant to current practices in the field. Examination content was developed by subject matter experts in the cardiovascular profession and ongoing statistical analyses were provided by testing professionals with a doctorate in Industrial and Organizational Psychology.

The lists below describe the activities that an advanced cardiac sonographer is expected to perform on the job. All examination questions are linked to these tasks. The task listing illustrates the relative weight or emphasis given to the main content areas on the examination.

Knowledge List

Acquired heart disease
Aortic Disease
Cardiac catheterization
Cardiomyopathies
Complications (e.g., post-procedural)
Cardiovascular hemodynamics
Congenital heart disease (Simple and Complex)

Contrast Echo (e.g., LVO, MCE)
Coronary and Ischemic Heart Disease
CQI and performance improvement
Diastolic Function
Educational Theory
Heart Failure and Stroke
Interventional procedures
Mitral Valve Disease

National guidelines and standards
Pathology
Pericardial disease
Right Heart Disease
Strain Echo
Systemic disease
TEE

Examination Matrix and Task List

Duties and Tasks

Approx. % of Exam

Duties and Tasks

A. Assimilating History, Clinical, and Echocardiographic Findings

Approx. % of Exam

10%

Duties and Tasks

Perform patient assessment
Integrate clinical history (signs, symptoms, medications)
Integrate prior studies (e.g., echocardiography, ECG)
Create preliminary echo report (including critical findings)
Ensure report completeness and accuracy (e.g., IAC, ASE)

Duties and Tasks

B. Assessing Cardiovascular Heart Disease

Approx. % of Exam

40%

Duties and Tasks

Assess cardiomyopathies (e.g., hypertrophic, dilated, restrictive, infiltrative, stress)
Assess cardiac masses (e.g., tumor, thrombus, artifact)
Assess coronary artery disease
Perform stress echo (ischemic and nonischemic)
Assess pericardial diseases
Assess heart failure (left and right)
Assess diseases of the aorta
Assess right heart and pulmonary hypertension
Assess systemic arterial hypertension
Assess systemic diseases
Assess diastolic function
Assess cardiac findings with special populations (e.g., athletes, pregnancy, aging, transplant)
Assess chemotherapy related therapeutic dysfunction
Assess mechanical circulatory support devices (e.g., VAD, ECMO, IABP, long- and short-term support)
Assess cardiovascular heart disease with ultrasound enhancing agents
Perform echo measurements and calculations and assess hemodynamics

Duties and Tasks

C. Assessing Valvular Heart Disease

Approx. % of Exam

15%

Duties and Tasks

Assess aortic valve disease
Assess mitral valve disease
Assess pulmonic valve disease
Assess tricuspid valve disease
Assess prosthetic valves
Assess valvular endocarditis

Duties and Tasks

D. Evaluating Structural Heart and Interventional Procedures

Approx. % of Exam

15%

Duties and Tasks

Acquire pre-intervention qualitative and quantitative data specific to structural heart disease procedures (e.g., transcatheter valve repair, closure device, occluder device, surgical)
Acquire post-intervention qualitative and quantitative data specific to structural heart disease procedures (e.g., transcatheter valve repair, closure device, occluder device, surgical)
Evaluate surgical and transcatheter interventions
Evaluate perioperative and procedural complications
Evaluate functional effectiveness of procedure
Compare multi-modality imaging
Assist with image acquisition and recognize complications (e.g., TEE, ICE, 3D)

Duties and Tasks

E. Utilizing Advanced and Multi-Modality Imaging

Approx. % of Exam

Duties and Tasks

Perform 3D imaging
Perform strain imaging
Integrate multi-modality cardiac imaging (e.g., MRI, CT, fluoroscopy, molecular)

Duties and Tasks

F. Assessing Congenital Heart Disease

Approx. % of Exam

Duties and Tasks

Assess simple congenital heart disease pre- and post-repair (e.g., ASD, VSD, PDA, PFO, persistent left SVC, coarctation)
Assess complex congenital heart disease pre- and post-repair (e.g., TGA, ToF, TV atresia, HLHS, syndromes)

Duties and Tasks

G. Demonstrating Professional Practice

Approx. % of Exam

Duties and Tasks

Mentor fellows, students, residents, and staff
Develop and implement educational plans
Facilitate continuous quality improvement
Interpret clinical research principles
Assist with echo lab accreditation

Duties and Tasks

TOTAL

Approx. % of Exam

100%

Self-Assessment Exams

There are several options that can assist your preparation, including CCI’s Self-Assessment Examinations which can be found here.

We have prepared online self-assessment exams to help gauge your knowledge of the content areas on the exam and help determine which areas may have strengths and weaknesses. The self-assessment exam contains sample items covering the approximate proportion of subject matter to match the CCI exam matrix.

Self-assessment exams do not provide a report of missed items or specific information or feedback on incorrect responses. Once the self-assessment is complete, you will receive a performance profile that displays the percentage of correct responses in the content areas that make up the examination.

It is important to note that the results of the self-assessment exam do not guarantee or indicate individual success on the exam, nor should the self-assessment serve as the only means for preparing for the examination.

Examination Details

Test Time

The ACS examination is a three-hour (3-hour) computer-based test.

Question Types

Question types consist of 170 questions (150 scored and 20 unscored), that contain a mix of traditional and innovative item types.

Traditional multiple-choice – Only one of four possible answers is correct (e.g. A, B, C or D).
Innovative multiple responses – Two or three answers are correct from a list of four to six possible answers. The test taker will be instructed to select a certain number of correct answers (e.g. “Select two correct responses.”)
Innovative hot spot – The test taker will be instructed to click on one specific area of an image to answer the question. Only one answer (click) is necessary, but it must be in the correct location.
Innovative drag and place – The test taker will be instructed to drag a collection of labels (tokens) into specific boxes or areas on an image. The correct tokens will need to be placed in the correct boxes in order to get the question right. It’s possible that all tokens may not be used.

Scoring

The 20 unscored questions are not identified and are randomly distributed throughout the exam to gather performance data. A candidate’s exam score is based on the responses to the 150 scored questions. Two hours and fifty (50) minutes are allotted for answering the exam questions and ten (10) minutes are allotted for a pre-exam tutorial and post-exam survey.

Resources

The textbooks listed below are intended as recommended resources when preparing for the 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.

Publications and Reports of the American Society of Echocardiography (ASE), Raleigh, NC. All new ASE Guidelines are published on www.asecho.org/Guidelines.
Oh, Jae K., J. B. Seward, and A. Jamil Tajik. The Echo Manual. 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2006.
Otto, Catherine. Practice of Clinical Echocardiography. 4th ed. Elsevier Health Sciences, 2012.
Anderson, Bonita. A Sonographer’s Guide to the Assessment of Heart Disease, 1st ed. MGA Graphics, 2013.
Gillam, Linda, and Otto, Catherine. Advanced Approaches in Echocardiography. 1st ed. Elsevier Health Sciences, 2011.
Armstrong, William F., Thomas Ryan, and Harvey Feigenbaum. Feigenbaum’s echocardiography. 7th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2010.
Weyman, Arthur. Principles and Practice of Echocardiography, 2nd ed. Lippincott Williams & Wilkins, 1994.
Klein, Allan, Asher, Craig. Clinical Echocardiography Review: A Self-Assessment Tool, 1st ed. Lippincott Williams & Wilkins, 2011.
Popham, W.J. (2000). Modern educational measurement: Practical guidelines for educational leaders (3rd ed.). Boston: Allyn and Bacon.
Morrison, G. R., Ross, S.M., Kalman, H.K. & Kemp, J.E. (2011). Designing effective instruction (6th ed.). Somerset, NJ: John Wiley.
Brassard, Michael, and Diane, Ritter, The Memory Jogger II, Goal/QPC, 1994 (nice compact QI resource)
George, Michael L., John Maxey, David T. Rowlands, and Mark Price, The Lean Six Sigma Pocket Toolbook: A Quick Reference Guide to nearly 100 Tools for Improving Quality, Speed, and Complexity, New York: McGraw-Hill, 2005.
Shea, Gordon F.: Mentoring: A Practical Guide. Menlo Park, CA: Crisp Publications, 1997.
Jacobsen, Kathryn H. Introduction to Health Research Methods. 1st Ed. Jones and Bartlett Learning, 2011.

Once Approved to Take the ACS Exam Your 90-day Window Begins!

You will be sent, via email, an Authorization to Test (ATT) within 2 business days after your application has been approved. Consider your 90-day eligibility window to take the examination, now open. The ATT provides instructions and details for scheduling your test date and location.

NEXT STEPS:

Once you have received an Authorization to Test (ATT) from CCI, then you may contact Pearson VUE to schedule your exam. Available sites may be viewed at www.pearsonvue.com/cci.
CCI’s credentialing examinations are administered year-round at over 230 Pearson Professional Centers (PPC) in the United States and US territories and over 3,000 Pearson VUE Authorized Test Centers (PVTC) internationally. Examination site availability is provided when scheduling your examination with Pearson VUE.

Learn more about our exam process steps!

If you need to reschedule your examination:

Contact Pearson VUE at least two full working days in advance of your scheduled appointment. Call (800) 869-4102, 7:00 am to 7:00 pm, Central Standard Time, Monday – Friday. Outside the U.S.: (952) 681-3789) or www.pearsonvue.com/cci
If you do not contact Pearson VUE two working days in advance of your scheduled appointment you cannot reschedule the examination.
Click here to review CCI’s exam cancellation/refund policy on our FAQ page

To request an extension or refund:

Candidates may request one extension to their originally issued Authorization to Test (ATT). The extension will be for a period of 90 days.
To request an extension or refund, sign into your CCI account.
Select Cancel Exam.
Select which exam to cancel.
Select the type of cancellation (extension or refund), enter the cancellation reason, and submit the cancellation for review.

If the exam is not taken by the end of the extension period, the testing fee will be forfeited, and the applicant will need to reapply to take the test. If the applicant has made an appointment with Pearson prior to requesting the extension, the appointment must be canceled before CCI is contacted for an extension or refund.

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 in writing and sent to CCI headquarters within three (3) days of the initially scheduled examination date.

Exam Day is Here!

A few tips for our test-takers:

Be well-rested, hydrated and be sure to eat a meal or snack
Give yourself enough time to get to the test center, and park
Bring the proper IDs with you, details below
Read all test instructions and candidate rules thoroughly
Take your time and read exam questions carefully

Important to note, the only people admitted into the examination room are:

Test Administrators
Authorized Candidates

Identification (ID) Requirements

The first and last name that the candidate uses to register must match exactly the first and last name on both of the IDs that are presented on test day.
All IDs required must be issued by the country in which the candidate is testing. If the candidate does not have a qualifying primary ID issued from the country they are testing in, an International Travel Passport from their country of citizenship is required, along with a secondary ID.
Candidates are required to present two forms of original (no photocopies), valid (unexpired) IDs; one form as a primary ID (government issued with name, recent recognizable photo, and signature) and one form as a secondary ID (with at least a name and signature, or name and recent recognizable photo).

Primary ID:

International Travel Passport
Driver’s license
Military ID (including spouse & dependents)
Identification card (national/state/province identity card)
Alien registration card (green card, permanent resident, visa)
Local language ID (not in Roman characters) – accepted only if issued from the Country the Candidate is testing in

Secondary ID:

Any ID containing at least name and signature, or name and recent recognizable photo that meets the above ID requirements

Click here to view Pearson VUE ID Policy

Exam Questions, Comments, and Scoring

The ACS examination is a three-hour, computer-based exam that contains 170 questions (150 scored and 20 unscored). Two hours and fifty (50) minutes are allotted for answering the exam questions and ten (10) minutes are allotted for a tutorial and post-exam survey.

A candidate’s exam score is based on the responses to the 150 scored questions. 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.

Each question is shown with four possible answers, only one of which is the correct or best answer. Unscored questions are not identified and are randomly distributed throughout the exam. This is standard practice and enables CCI to evaluate questions that may be used in future examinations.

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 high-quality examinations.

Interpreting Results

Here’s what you can expect after taking the exam

Exam takers will receive an unofficial score report onsite at the Pearson VUE testing center. This will provide a total score, pass/fail status, and a breakdown report of the percentage of questions answered correctly in each content area.
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 standard-setting (or passing score) study. CCI and panels of experts from each specialty periodically review the passing score to assure its validity.
You will receive an official results letter, certificate, and wallet card from CCI headquarters approximately 15 business days after taking an exam.

Score Verification

If you would like a score verification, there is a processing 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. 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.

You must submit a written request for 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.
Send your request to: CCI at 3739 National Drive, Suite 202, Raleigh, NC 27612

Maintaining Credentials

A credential is active for 9-12 months after passing a CCI exam. As a new credential holder, there are two types of renewal with CCI: your first renewal and your second renewal/first triennial.

First Renewal

New credential holders 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 Continuing Education Unit (CEU) requirements for the first renewal; only a renewal fee, currently $165.00 USD, and a signature of compliance with the Code of Ethics must be submitted. This date will be noted on your initial wallet card, which will be sent in your welcome packet.

Download the Code of Ethics

Second Renewal/First Triennial Renewal

Maintenance of an “active status” for CCI credential holders requires the following three steps. Until all three are fulfilled, your credential will not be renewed.

The submission of triennial renewal fees (currently $165.00 USD)
Signature of compliance to the CCI Code of Ethics, which can be downloaded through the button above.
The completion of Continuing Education Units (CEUs)* every three years.
- The total number of CEUs required in a triennial cycle for a Certificate-Level (CCT and CRAT) is sixteen (16) CEUs.
- The total number of CEUs required in a triennial cycle for an Advanced-Level (ACS) is thirty-six (36) CEUs.
- The total number of CEUs required in a triennial cycle for a Registry-Level (CES, RCIS, RCS, RCCS, RPhS, and RVS) is thirty-six (36) CEUs.

For the advanced and registry levels, thirty (30) of these CEUs must be cardiovascular-related. The remaining 6 or fewer CEUs can be on any topic as long as it is from one of the approved providers.

Wallet cards are provided to successful exam candidates and expire on the date of the first renewal. Triennial wallet cards are provided upon the second renewal of credentials.

CEU Submission

Registrant wallet cards are provided to successful exam candidates and expire on the date of the first renewal. Triennial wallet cards are provided upon renewal of credentials.

When Credential is Earned*

First Renewal End Date**