The RDCS AE Exam, SPI Requirement & Logistics

RDCS Adult Echocardiography AE

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1 Introduction & Exam Overview

The RDCS AE Exam, SPI Requirement & Logistics Content Outline, Domain Weights & How to Study

2 Cardiac Anatomy

Chambers, Walls, Myocardial Layers & the 17-Segment Model Cardiac Valves & Subvalvular Apparatus Great Vessels, Pericardium, Coronary & Venous Anatomy

3 Cardiac Physiology & Hemodynamics

Cardiac Cycle, Phases & Pressure-Volume Relationships Normal Systolic & Diastolic Function Hemodynamic Principles & Response to Stress

4 Echo Modalities, Instrumentation & Contrast

2D (B-Mode) and M-Mode Imaging Spectral, Color, and Tissue Doppler Modalities Image Optimization, Artifacts, and Contrast Echocardiography

5 Standard Views, Windows & Protocol

Parasternal Long- & Short-Axis Views Apical Views Subcostal & Suprasternal-Notch Views Exam Protocol, Patient Positioning & Provocative Maneuvers

6 Quantification & Doppler Hemodynamic Calculations

Chamber Quantification: LV, LA, RA, and RV Size, Mass, and Volumes Systolic Function: Ejection Fraction Methods, Fractional Shortening & Strain Diastolic Function Grading (ASE/EACVI 2016) Core Doppler Math: Modified Bernoulli, VTI, Stroke Volume & the Continuity Equation Advanced Hemodynamics: PISA/EROA, Pressure Half-Time, dP/dt, Qp/Qs & RVSP

7 Aortic & Mitral Valve Disease

Aortic Stenosis Aortic Regurgitation Mitral Stenosis Mitral Regurgitation

8 Right-Sided, Prosthetic & Infective Valve Disease

Tricuspid & Pulmonic Valve Disease and Pulmonary Hypertension Assessment Infective Endocarditis and Vegetations Prosthetic Valves and Postoperative Evaluation

9 Ischemic Disease & Cardiomyopathies

Coronary Anatomy, Ischemic Heart Disease & Wall-Motion Abnormalities Stress Echocardiography & Myocardial Viability Mechanical Complications of Myocardial Infarction Dilated & Restrictive Cardiomyopathy Hypertrophic Cardiomyopathy, SAM & LVOT Obstruction

10 Pericardial Disease, Masses & Aorta

Pericardial Effusion & Cardiac Tamponade Constrictive Pericarditis vs. Restrictive Physiology Cardiac Masses, Tumors & Thrombi Aortic Disease: Aneurysm, Dissection & Atheroma

11 Congenital Heart Disease & Shunts

Septal Defects & Shunt Quantification Common Adult Congenital Lesions

12 Clinical Care & Safety

Patient Care, Clinical-Data Integration & Exam Protocols Bioeffects, ALARA, Infection Control & Ergonomics

The RDCS AE Exam, SPI Requirement & Logistics

Key Takeaways Explain This Topic AI

The Adult Echocardiography (AE) exam has approximately 150 multiple-choice questions, including hotspot (mark-on-image) items, administered over 3 hours plus a 5-minute survey.

AE uses a scaled score of 300-700, and candidates must score 555 or higher to pass.

The AE exam fee is $300 USD, set by ARDMS, an Inteleos council.

Candidates must also pass the Sonography Principles and Instrumentation (SPI) exam, in either order, with both exams completed within 5 years of each other, to earn the RDCS credential.

Candidates who do not pass may reapply after 3 days but must wait 60 days before retesting, with a maximum of 3 attempts in any 12-month period.

Last updated: July 2026

What the AE Exam Is

The Adult Echocardiography (AE) examination is the cardiac specialty exam administered by ARDMS (American Registry for Diagnostic Medical Sonography), a certifying council of Inteleos . Passing AE — together with the separate SPI (Sonography Principles and Instrumentation) exam — earns you the Registered Diagnostic Cardiac Sonographer (RDCS) credential with an Adult Echocardiography specialty. AE tests your clinical knowledge of cardiac anatomy, physiology, pathology, hemodynamic measurement, and instrumentation as applied to adult transthoracic echocardiography. It does not re-test general ultrasound physics — that content belongs to SPI, a separate exam with its own study guide.

Understanding the exam's logistics before you begin studying prevents two common mistakes: under-budgeting study time for a 3-hour, 150-question exam, and misunderstanding how AE and SPI relate to each other on your RDCS eligibility timeline.

Exam Format At a Glance

Fact Detail
Question count ~150 multiple-choice questions, including hotspot (mark-on-image) items
Duration 3 hours, plus a 5-minute post-exam survey
Scoring scale 300-700 (scaled score)
Passing score 555
Exam fee $300 USD
Administering body ARDMS, an Inteleos council
Current blueprint Content Outline Version 24.2, effective April 25, 2025
Companion exam SPI, required within 5 years of AE, either order
Reapply after failing 3 days
Must wait before retesting 60 days
Maximum attempts 3 per 12-month period

The scaled score is not a raw percent-correct — ARDMS converts raw performance to the 300-700 scale using item-level difficulty weighting, so two candidates answering the same number of questions correctly can receive different scaled scores depending on which items they got right. Do not try to reverse-engineer "how many I can miss"; instead master content across all five domains, since weak performance in the heaviest domain (Pathology, 40%) has an outsized effect.

Hotspot (Mark-on-Image) Questions

A meaningful share of AE's ~150 items are hotspot questions : instead of choosing from four text answers, you click directly on a location within an echocardiographic still image or clip — for example, identifying a valve, a wall segment, or where to place a Doppler sample volume. Hotspot items test direct image recognition and cannot be guessed from text alone, so image-based practice is essential preparation, not optional extra.

The SPI Requirement

SPI (Sonography Principles and Instrumentation) is ARDMS's shared physics and instrumentation prerequisite exam, used across multiple specialties, not just cardiac. To earn RDCS with an AE specialty, you must pass both SPI and AE — in either order — within 5 years of each other. If you already hold another ARDMS credential (e.g., RDMS) and passed SPI while it remained active, you generally do not need to retake it to add AE, provided the 5-year window and active-status requirements are met. Many candidates pass SPI first as a foundation, then focus AE study purely on cardiac anatomy, physiology, pathology, and measurement — the approach this guide assumes. This guide covers AE content only ; general ultrasound physics is SPI's domain, covered in a separate guide.

Eligibility Pathways

ARDMS does not require one fixed path into the AE exam. It publishes several numbered Prerequisite routes, and you apply under whichever matches your education and clinical background:

Formal sonography education — graduation from a CAAHEP- or equivalent-accredited cardiac/general sonography program.

Allied-health degree or license plus structured clinical training — for example, a registered nurse, radiologic technologist, or physician who completes documented on-the-job cardiac sonography training and supervised clinical scanning hours.

On-the-job training routes — candidates without a sonography degree who accumulate a defined amount of full-time, supervised clinical cardiac ultrasound experience.

Every route also requires a completed Clinical Verification (CV) form , signed by a supervisor, documenting your hands-on scanning experience. With a current CV form already on file, your application can be approved automatically once the exam fee is paid; without one, submit the CV form with your application. Prerequisite routes and clinical-hour minimums can change between cycles, so confirm your specific route on ARDMS's official Prerequisite tool before applying — this guide covers exam content , not eligibility adjudication.

Retake Policy

If you do not pass on your first attempt:

You may reapply after 3 days .

You must wait 60 days from your prior attempt before you actually sit for the exam again.

You may attempt AE no more than 3 times within any 12-month period .

Applications are accepted year-round — there is no fixed testing-window calendar to work around.

There is no mandatory waiting period before your first attempt beyond completing eligibility requirements; the reapply/retest rules above apply only after an unsuccessful attempt.

Pass Rates — Context, Not a Target

ARDMS has published AE pass-rate data showing roughly 78% first-time pass and 71% overall pass (2023 cohort; check the current published figure rather than treating any single year as fixed). Use this only as calibration — the exam is passable with disciplined preparation but is not a formality. Let the blueprint weights in the next section, especially the 40% Pathology domain, drive your study plan rather than the pass rate itself.

How This Guide Is Organized

The remaining 11 chapters follow the V24.2 blueprint in study order: anatomy and physiology (Chapters 2-3), instrumentation and imaging views (Chapters 4-5), quantification and Doppler hemodynamics (Chapter 6), pathology in clinical clusters — valve disease, right-heart/prosthetic/infective disease, ischemic disease and cardiomyopathies, pericardial disease and masses, and congenital heart disease (Chapters 7-11) — and clinical care and safety (Chapter 12). Section 1.2, next, shows how the blueprint's domain weights should shape your study-time allocation.