Registered Congenital Cardiac Sonographer - CCI

The Registered Congenital Cardiac Sonographer (RCCS) examination is for professionals working in the area of pediatric and adult congenital cardiac ultrasound.

This computer-based exam is administered at Pearson Professional Centers year-round based on availability at the test centers. To locate a test center click here.

Try Our Qualification Pathway Tool

By answering the questions below this tool will help determine which exam pathway you are best qualified to take.

EXAM FEE

The fee for the RCCS examination is $365 USD. All exam fees include a $100 USD non-refundable fee for the staff resources required to review and process applications.

TESTING TIME

The Registered Congenital Cardiac Sonographer (RCCS) exam is a three-hour, computer-based exam that contains 170 questions.

Registered Congenital Cardiac Sonographer (RCCS) 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 qualifications listed in the tables below.
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 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.

Download Resources

RCCS Exam Overview

Sample Verification Letters

RCCS1 Qualification Pathway

Two years of full-time or full-time equivalent work 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 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, the medical director(s) must confirm the number of studies performed during the applicant’s employment.

Effective June 30, 2023, the RCCS1 qualification prerequisite has been sunset. First-time RCCS applicants applying on or after July 1, 2023 must select from the qualification prerequisites listed below.

RCCS1 Supporting Documents

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

RCCS235 Qualification 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
One year of full-time or full-time equivalent work 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 Supporting Documents

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

RCCS4 Qualification Pathway

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

RCCS4 Supporting Documents

Completion certificate and/or educational transcripts
AND
Student Verification Letter

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

RCCS5 Qualification Pathway

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.

IMPORTANT: If an individual’s clinical 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 RCCS5. All clinical hours must be earned in a setting in which patients are being tested or medically treated.

RCCS5 Supporting Documents

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

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

RCCS6 Qualification Pathway

Active ultrasound credential holders with six (6) months of full-time or full-time equivalent work experience in adult congenital or pediatric cardiac ultrasound. The applicant must have participated in a minimum of 100 adult congenital or pediatric 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.

RCCS6 Supporting Documents

Copy of wallet card showing date earned and active through date of ultrasound registry credential
AND
Employment Verification Letter (must confirm the number of studies performed during the applicant’s employment).

AND/OR
Clinical Experience Letter (only required for applicants submitting verification of the number of studies completed during a formal educational program)

* 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.

Apply for the Registered Congenital Cardiac Sonographer (RCCS) 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

Download CCI 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.

Registered Congenital Cardiac Sonographer (RCCS) Exam Preparation

Download RCCS Exam Overview

Order Online Self-Assessment Exam

The RCCS examination is designed to assess knowledge and skills in current practice. CCI provides an overview of the examination content including knowledge and task list.

The examination content is based on the findings of a Job Task Analysis (JTA), which describes the overall tasks that an RCCS 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 general areas of knowledge that are needed in order to perform the tasks identified. The task listing illustrates the relative weight or emphasis given to the main content areas on the examination.

Knowledge List

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

Examination Matrix and Task List for Exams Administered BEFORE January 1, 2024

Duties and Tasks

Approx. % of Exam

Duties and Tasks

A. Providing Patient Care

Approx. % of Exam

Duties and Tasks

Triage Incoming Orders
Review Indications and Appropriateness of Exam
Review Patient History
Verify Patient Identity
Perform Pre-Procedural Activities
Ensure Continuous Quality Improvement

Duties and Tasks

B. Acquiring Cardiac Images and Associated Lesions

Approx. % of Exam

48%

Duties and Tasks

Prepare for Test
Optimize Images
Acquire Left Parasternal Images
Acquire Apical Images
Acquire Subcostal Images
Acquire Suprasternal Images
Acquire Right Parasternal Images
Adapt Patient Examination

Duties and Tasks

C. Characterizing Cardiac Abnormalities

Approx. % of Exam

37%

Duties and Tasks

Perform Disease Specific Protocol
Identify Commonly Associated Lesions
Identify Less Commonly Associated Lesions
Assist with TEE
Perform Stress Echo
Perform Contrast-Enhanced Echo
Perform Agitated Saline Echo
Perform 3D Echo

Duties and Tasks

D. Processing and Communicating Preliminary Reports

Approx. % of Exam

Duties and Tasks

Perform Calculations and Post-Processing Analysis
List Findings
Communicate Critical Results
Perform Post Examination Communication

Duties and Tasks

TOTAL

Approx. % of Exam

100%

Examination Matrix and Task List for Exams Administered AFTER January 1, 2024

Duties and Tasks

Approx. % of Exam

Duties and Tasks

A. Providing Patient Care

Approx. % of Exam

Duties and Tasks

Triage Incoming Orders
Review Indications and Appropriateness of Exam
Review Patient History
Perform Pre-Procedural Activities

Duties and Tasks

B. Acquiring Cardiac Images

Approx. % of Exam

35%

Duties and Tasks

Acquire subcostal images
Acquire left parasternal images
Acquire Apical Images
Acquire Suprasternal Images
Acquire Right Parasternal Images
Optimize Images
Apply Ultrasound Physics

Duties and Tasks

C. Performing Disease Specific Examinations

Approx. % of Exam

49%

Duties and Tasks

Adapt Patient Examination
Identify Cardiac Lesions
Acquire Post-Surgical/Interventional Images (e.g. congenital heart disease repair/palliation, post-cath intervention)

Duties and Tasks

D. Acquiring Additional Echocardiographic Images

Approx. % of Exam

10%

Duties and Tasks

Assist with TEE
Perform Stress Echo
Perform Ultrasound Enhanced Agent Echo
Perform Agitated Saline Echo
Perform 3D Echo
Acquire Strain Images
Assist with Structural Heart Procedures (e.g. cath lab, BAS, devices, valves)

Duties and Tasks

E. Processing and Communicating Preliminary Reports

Approx. % of Exam

Duties and Tasks

Perform calculations and post-processing analysis
Communicate critical results
Perform post examination communication (e.g., summary of findings)

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

Exam Time

The RCCS 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 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 published on www.asecho.org/Guidelines.
Anderson, Bonita. A Sonographer’s Guide to Assessment of Heart Disease. Echotext Pty Ltd, Australia.
Armstrong, William F. and Ryan, Thomas. Feigenbaum’s Echocardiography. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Kremkau, Frederick W. Sonography Principles and Instruments. St. Louis, Mo.: Elsevier/Saunders.
Cane, Garvan C., Oh, Jae K., Seward, J. B., and Tajik, A. Jamil. The Echo Manual. Philadelphia: Wolters Kluwer.
Otto, Catherine M. Textbook of Clinical Echocardiography. Philadelphia, PA: Saunders/Elsevier.

Once Approved to Take the RCCS 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 here!

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.

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 RCCS examination is a three-hour, computer-based exam that contains 170 questions (150 scored and 20 unscored). Two (2) 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. After that period credential holders have two types of renewal with CCI:

First renewal
Second renewal/first triennial

First Renewal Requirements

New credential holders are required to pay their first renewal before the first day of the same quarter that the credential was earned but in the following year. SEE THE CHART BELOW.

For example, if the credential is earned between April 1st and June 30th, 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.

For the first renewal, there are no Continuing Education Unit (CEU) requirements, only a renewal fee, currently $165.00 USD, and a signature of compliance with the Code of Ethics must be submitted. Your date of renewal will be noted on your initial wallet card, which will be sent in your welcome packet.

Code of Ethics

Second Renewal/First Triennial Requirements

Maintaining an “active status” as a CCI credential holder requires the following three steps. Until all three are fulfilled, your credential will not be renewed.

Submit your triennial renewal fees (currently $165.00 USD)
Sign in compliance with the CCI Code of Ethics, which can be downloaded through the button above.
Complete 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.

CEU Submission

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.

When Credential is Earned*

First Renewal End Date**