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CCI RCS Cheat Sheet

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Non-Imaging Responsibilities

  • 9% of exam
  • Non-Imaging Workflow Patient Safety Reporting Significant Findings

Echocardiographic Imaging

  • 24% of exam
  • Standard TTE Views Imaging Modalities Doppler Picker Image Optimization

Valvular Findings

  • 25% of exam
  • Left-Sided Valves Right-Sided Valves Valve Integration Prosthetic Valves

Anatomy, Physiology + Hemodynamics

  • 29% of exam
  • Chambers + Function Hemodynamics + Diastology Pathology Patterns Hemodynamic Equations

Ultrasound Physics

  • 13% of exam
  • Wave + Resolution Artifacts Physics Optimization Artifact Testing

Quick Facts

  • Credential CCI RCS
  • Exam 170 total items
  • Scored 150 items
  • Unscored 20 unidentified items
  • Appointment 3 hours
  • Question time 2 hours 50 minutes
  • Passing score 650/900 scaled
  • Item types Traditional + innovative
  • Delivery Pearson centers, year-round
  • Exam fee $365

Workflow Memory NO

  • History, image, integrate, communicate
  • Verify first Optimize next Escalate significant findings

RCS vs RCCS NO

CCI RCS

  • General echocardiography scope
  • Current five-domain RCS JTA
  • Congenital recognition included

CCI RCCS

  • Separate CCI credential
  • Pediatric/adult congenital focus
  • Different qualification pathway
  • Recognition does not equal RCCS

Non-Imaging Workflow NO

  • Clinical history Focus protocol
  • Prior studies Compare serial change
  • Echo order Verify request and scope
  • Ergonomics Protect patient and staff
  • Patient preparation Position, explain, instruct
  • Findings report Support reading physician
  • Significant finding Communicate promptly
  • Infection control Use universal precautions

CCI RCS vs ARDMS RDCS NO

CCI RCS

  • Issued by CCI
  • CCI qualification pathways
  • CCI renewal rules

ARDMS RDCS

  • Issued by ARDMS
  • Separate specialty examinations
  • ARDMS renewal rules
  • Similar field, different credential

Doppler Memory IM

  • PW places; CW peaks; color maps
  • PW: range CW: velocity Color: direction

PW vs CW Doppler IM

PW

  • Selects sample depth
  • Aliases above Nyquist
  • Maps obstruction level

CW

  • Captures highest velocity
  • No Nyquist aliasing
  • Lacks range resolution
  • Location vs peak velocity

Doppler + Contrast Picker IM

  • Need exact sample depth → PW Doppler ( Range specific )
  • Need highest jet velocity → CW Doppler ( No range )
  • Need flow direction map → Color Doppler
  • Need annular tissue velocity → Tissue Doppler
  • Need low-velocity flow → Lower color scale
  • Need high-velocity flow → Raise color scale
  • Need shunt screening → Agitated saline
  • Need LV border enhancement → UEA contrast

Standard TTE Views IM

  • PLAX LV, mitral, aortic anatomy
  • PSAX base Great vessels and valves
  • PSAX papillary LV wall motion
  • Apical four-chamber Chambers, mitral, tricuspid
  • Apical two-chamber Anterior and inferior walls
  • Apical three-chamber LVOT and aortic valve
  • Subcostal four-chamber Septum and pericardium
  • IVC view Size and respiratory change
  • Suprasternal view Aortic arch

Agitated Saline vs UEA IM

Agitated saline

  • Opacifies right heart
  • Screens abnormal passage
  • Needs effective provocation

UEA

  • Crosses pulmonary circulation
  • Opacifies left ventricle
  • Improves endocardial borders
  • Shunt screen vs LV enhancement

Imaging Modalities IM

  • 2D TTE Anatomy and motion
  • M-mode High temporal resolution
  • Color Doppler Flow direction map
  • PW Doppler Site-specific velocities
  • CW Doppler Highest velocity, no range
  • Tissue Doppler Myocardial velocities
  • UEA contrast Improve endocardial borders
  • Agitated saline Right-to-left shunt screening
  • Exercise echo Physiologic stress imaging
  • Pharmacologic echo Drug-induced stress imaging
  • Nonischemic stress Hemodynamic provocation
  • TEE assistance Esophageal imaging support
  • Strain imaging Myocardial deformation
  • 3D TTE/TEE Volumetric anatomy

Stenosis vs Regurgitation VA

Stenosis

  • Restricted forward opening
  • Velocity and gradient
  • Valve area integration

Regurgitation

  • Backward valve leakage
  • Jet and flow measures
  • Chamber response integration
  • Obstruction vs backward flow

Left-Sided Valves VA

  • Aortic morphology Cusps, calcification, opening
  • AS peak velocity Best-aligned CW envelope
  • AS mean gradient Trace complete CW envelope
  • Aortic valve area Continuity equation
  • Dimensionless index LVOT VTI / AV VTI
  • Aortic regurgitation Integrate jet, flow, remodeling
  • Mitral morphology Leaflets, annulus, apparatus
  • MS planimetry Leaflet-tip short-axis
  • Mitral regurgitation Integrative severity assessment
  • Vena contracta Narrowest jet neck
  • PISA Quantitative regurgitant flow
  • Pulmonary veins MR supportive flow pattern

Right-Sided Valves VA

  • Tricuspid morphology Leaflets and coaptation
  • Tricuspid stenosis Anatomy plus inflow
  • Tricuspid regurgitation Jet plus right-heart response
  • Hepatic veins TR supportive flow pattern
  • Pulmonic morphology Valve and RVOT anatomy
  • Pulmonic stenosis Localize obstruction level
  • Pulmonic regurgitation Jet plus RV response
  • Prosthetic valve Compare valve-specific baseline
  • Endocarditis Mass, destruction, new regurgitation

Bernoulli Memory HE

  • Four times velocity squared
  • Delta P: mmHg V: m/s Alignment matters

Constriction vs Restriction HE

Constriction

  • Pericardial process
  • Respiratory septal shift
  • Expiratory hepatic reversal

Restriction

  • Myocardial process
  • Stiff ventricular filling
  • Biatrial enlargement
  • Pericardium vs myocardium

Evaluation Picker HE

  • Suspected aortic stenosis → Multiwindow CW Doppler
  • Suspected mitral regurgitation → Integrative valve assessment
  • Suspected tamponade → Collapse plus respiratory Doppler
  • Suspected pulmonary hypertension → Probability plus RV effects
  • Suspected cardiac mass → Orthogonal views
  • Suspected LV thrombus → Consider UEA
  • Serial strain comparison → Match system and loading
  • Implanted device → Trace route and effects

Chambers + Function HE

  • LV volumes Nonforeshortened biplane apicals
  • Ejection fraction Biplane disk summation
  • Regional motion Thickening plus excursion
  • LA volume Index to body size
  • RV size RV-focused apical view
  • TAPSE Longitudinal RV motion
  • RV FAC Systolic area change
  • Tricuspid S-prime RV tissue velocity
  • Global strain Longitudinal deformation
  • Serial strain Match system and physiology

Flow Memory HE

  • Area times VTI gives stroke volume
  • Area: diameter squared VTI: distance CO: SV x HR

Hemodynamics + Diastology HE

  • Mitral E wave Early ventricular filling
  • Mitral A wave Atrial contraction filling
  • Mitral e-prime Myocardial relaxation
  • E/e-prime Filling-pressure context
  • TR velocity Pulmonary-pressure clue
  • LA volume Chronic pressure burden
  • Pulmonary veins Left-atrial filling pattern
  • Hepatic veins Right-sided hemodynamic pattern
  • RAP estimate IVC plus clinical context
  • PASP estimate TR gradient plus RAP

Pathology Patterns HE

  • HCM Hypertrophy, SAM, dynamic obstruction
  • Dilated cardiomyopathy Dilation plus systolic dysfunction
  • Restrictive physiology Stiff ventricles, enlarged atria
  • Ischemia New regional motion abnormality
  • Tamponade physiology Collapse plus respiratory variation
  • Constrictive physiology Septal shift, hepatic reversal
  • Aortic dissection Confirm flap in multiple planes
  • Pulmonary hypertension Estimate probability and RV effects
  • Cardiac mass Confirm in orthogonal views
  • Congenital disease Recognize adult echo clues
  • Implanted device Trace route and complications
  • Infiltrative disease Integrate morphology and strain

Hemodynamic Equations HE

  • Pressure gradient Delta P = 4V squared
  • Circle area 0.785 x diameter squared
  • Stroke volume Area x VTI
  • Cardiac output SV x heart rate
  • Ejection fraction EDV minus ESV / EDV
  • Aortic valve area LVOT SV / AV VTI
  • RVSP 4 x TRV squared + RAP
  • Flow ratio Qp / Qs

Artifact vs Pathology PH

Artifact

  • Changes with settings
  • Violates expected anatomy
  • May disappear orthogonally

Pathology

  • Persists across views
  • Respects anatomy
  • Has physiologic support
  • Test before labeling

Image Optimization PH

  • Image too dark → Increase gain carefully
  • Far field too dark → Adjust TGC
  • Poor penetration → Lower frequency
  • Need finer detail → Raise frequency ( Penetration cost )
  • Motion looks choppy → Raise frame rate
  • Frame rate too low → Reduce depth/sector/foci
  • Suspected artifact → Change view/settings
  • Foreshortened apex → Find true apical window

Wave + Resolution PH

  • Soft-tissue speed 1540 m/s
  • Wave equation c = frequency x wavelength
  • Higher frequency Better detail, less penetration
  • Axial resolution Half spatial pulse length
  • Lateral resolution Beam width
  • Temporal resolution Frame rate
  • Focal zone Narrowest beam
  • PRF Limited by depth
  • Nyquist limit PRF / 2
  • Doppler angle Parallel gives highest velocity

Artifacts PH

  • Reverberation Repeated deeper echoes
  • Mirror image Duplicated across reflector
  • Acoustic shadow Signal loss behind reflector
  • Enhancement Brighter behind weak attenuator
  • Side lobe Off-axis echo misplaced
  • Dropout Angle-dependent missing echoes
  • PW aliasing Shift exceeds Nyquist
  • Color blooming Excess gain paints tissue
  • 3D stitching Beat-to-beat seam

Physics Optimization PH

  • Overall gain All received echoes
  • TGC Depth-specific amplification
  • Depth Just beyond target
  • Sector width Narrower raises frame rate
  • Focal zones Fewer raises frame rate
  • Color scale Match target velocity
  • Wall filter Reject low-frequency clutter
  • Spectral gain Reveal dense envelope
  • Sweep speed Improve timing detail
  • Contrast MI Limit routine bubble destruction

Common Traps

Scaled score

  • 650 scaled points ≠ Not 65 percent

Unscored items

  • 20 items unidentified ≠ Treat every item seriously

Color jet size

  • Eccentric jets may appear small ≠ Integrate multiple severity measures

Low-gradient stenosis

  • Gradient depends on flow ≠ Check valve area and flow

Pulmonary hypertension

  • Echo estimates probability ≠ Catheterization defines hemodynamics

Congenital scope

  • RCS recognizes congenital findings ≠ RCCS tests congenital specialty

Apparent mass

  • Confirm orthogonal views ≠ Exclude structures and artifacts

Precise wrong measurement

  • Alignment comes first ≠ Reacquire before tracing

Last Minute

  • 1. Weights: 9 / 24 / 25 / 29 / 13
  • 2. RCS is not RCCS
  • 3. CCI RCS is not RDCS
  • 4. 170 total; 150 scored
  • 5. 650 scaled; not 65 percent
  • 6. PW localizes; CW captures peak
  • 7. Optimize before measuring
  • 8. Use multiple acoustic windows
  • 9. Integrate valve severity measures
  • 10. Foreshortening distorts volumes and strain
  • 11. Echo estimates PH probability
  • 12. Communicate significant findings promptly
  • 13. Delta P = 4V squared

CCI RCS Registered Cardiac Sonographer

  • Practice Questions 120 questions Study Guide 63 topics Cheat Sheet 121 facts Flashcards 50 cards Videos 1 video Blogs 1 blog Free CE Podcast