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by International Certification and Educational Accreditation Foundation |
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by International Certification and Educational Accreditation Foundation |
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TEMARIO: Guía de estudio para el exámen de certificación en ultrasonido en general (el exámen se ofrece simúltaneamente en inglés y español).
NOTA: El temario es demasiado extenso..., conviene inscribirse a la brevedad para recibir TIPs sobre los
tópicos mas frecuentes y participar del curso propedéutico.
The percentage ranges that are shown are an indication of approximately how many questions on the examination may be included from that section of the outline.
I. Elementary Principles (8%-12%)
A. Nature of Ultrasound
1. Definition of sound
a. propagation of vibration
(1) compression
(2) rarefaction
2. Differentiation between audible sound and ultrasound
B. Frequency, Wavelength, Propagation Speed
1. Definition of terms
2. Relationships
C. Properties of Ultrasound Waves
1. Amplitude
2. Pressure
3. Power
4. Intensity
D. Decibels
1. Definition
a. related to intensity
b. related to amplitude
2. Numerical examples
E. Physical Units
1. Scientific notation
2. Metric notation (e.g., micro, Mega)
3. Common units
F. Measurement Dimensions
1. Distance
a. Linear
b. Circumference
2. Area
3. Volume
II. Propagation of Ultrasound through Tissues (10%-14%)
A. Speed of Sound
1. Average speed of sound in tissues
2. Range of propagation speeds in the body
a. air
b. soft tissue (average)
c. soft tissue: specific tissues (e.g., muscle, fat, parenchyma)
d. bone
B. Reflection
1. Characteristic of acoustic impedance - definition
2. Reflection and transmission at specular interfaces
a. interface size and contour (smooth or irregular)
b. dependence on angle
c. dependence on acoustic impedance mismatch
3. Scattering
a. definition of scattering
b. frequency dependence (Rayleigh scattering)
c. Interface contour (smooth or irregular)
d. contrast media
e. harmonics
C. Refraction
1. Definition of refraction
2. Dependence of angle
3. Dependence of velocity mismatch
4. Numerical example
D. Attenuation
1. Definition and sources of attenuation
a. Scattering
b. Absorption
1. heat
2. Measurement
c. Reflection
2. Typical values in soft tissue
3. Variation with frequency - numerical example
4. Effects on images
E. Useful Diagnostic Frequency Range
1. Numerical values
2. Tradeoff: penetration vs. spatial resolution
F. Terminology Associated with Image Characteristics
1. Echogenic (e.g., hyperechoic, hypoechoic, anechoic, isoechoic, etc.)
2. Homogeneity, Heterogeneity, etc.
3. Other
III. Ultrasound Transducers (17%-25%)
A. The Piezoelectric Effect
1. Definition and concept
2. Curie point
3. Piezoelectric materials
B. Transducer Construction and Characteristics
1. Thickness resonance of crystal
2. Operating (resonance) frequency
a. Crystal thickness
b. Speed of sound in crystal material
3. Frequency characteristics (spectrum)
a. Bandwidth
1. Quality factor
2. Effect of damping
b. Multi-Hertz
1. Harmonics
4. Damping
5. Matching layer-numerical example
C. Sound Beam Formation - Near Field and Far Field (Fresnel and Fraunhofer Zones)
1. Interference phenomena
a. Huygen's principle
b. diffraction (divergence)
c. Bandwidth
2. Length of near field (focal distance)
3. Shape of near field and far field
a. Beam width
b. Natural focus
4. Dependence on frequency and crystal or aperture size
D. Axial Resolution
1. Dependence on spatial pulse length/ pulse duration
2. Numerical example
3. Effect of damping
4. Transducer frequency spectrum-relation to pulse duration
5. Bandwidth
E. Lateral Resolution
1. Dependence on beam width
2. Frequency
3. Transducer size and focal characteristics
4. Range
F. Slice Thickness Resolution (Elevational Resolution)
1. Dependence on beam width
2. Transducer array and focal characteristics
3. Frequency
4. Lateral and axial resolution relationship
G. Focusing
1. Methods of focusing
a. Mechanical (internal and external)
b. Electronic (transmit and receive)
2. Focal zone characteristics
a. Focal distance (length)
b. Focal zone region
1. Maximum intensity
H. Transducer Arrays and Image Appearance
1. Mechanical and/or electronic construction
2. Multiple element construction
a. Linear array
b. Curved array
c. Annular array
d. Multi-dimensional array
3. Multiple element operation
a. Sequenced
b. Phased
c. Annular
d. Vector
e. Multi-dimensional
4. Beam Steering
a. Transmission time delays
b. Reception time delays
5. Beam focusing
a. Time delays
b. Dynamic reception focus
c. Multiple transmission foci
d. Apodization
e. Subdicing
f. Dynamic aperture
I. Transducer Care and Maintenance
IV. Pulse Echo Instruments (6%-10%)
A. Range Equation - General Concepts
B. Pulsing Characteristics
1. Pulse repetition frequency
2. Pulse repetition period
3. Pulse duration
4. Spatial pulse length
5. Duty factor
C. Transmitter (Output)
1. Effect of transmitter voltage on penetration
2. Effect of transmitter voltage on intensity and on patient exposure
D. Receiver
1. Amplification (overall gain)
2. Compensation (swept gain-TGC or DGC)
a. Attenuation with range
b. Effects on return signal and display
c. Dynamic frequency tuning
d. Harmonic processing
3. Compression
a. Dynamic range
1. Definition
2. Dynamic range (receiver)
a. Compare to other system components
b. Numerical values (dB)
4. Demodulation
a. Rectification
b. Smoothing (enveloping)
5. Rejection
V. Principles of Pulse Echo Imaging (6%-10%)
A. Principal Display Modes (A-mode, B-mode, 3-D, M-mode)
1. Definition of each mode
2. Information displayed on each mode
3. Advantages and disadvantages of each mode
B. Principles of Real-time, B-Mode Image Formation
1. Relationship between echo amplitude and B-mode display
2. Positioning of echoes
3. Harmonics
C. Scanning Speed Limitations
1. Applications of range equation and relationship to pulsing characteristics
2. Real-time systems-relationships between
a. Pulsing characteristics
b. Frame rate and time required to generate one frame
c. Number of lines per frame
d. Number of focal regions
e. Field of view (e.g., sector angle)
f. Image depth (penetration)
3. Temporal resolution, ability to evaluate rapid motion
VI. Images, Storage, and Display (10%-14%)
A. Role of scan converter
1. Image storage
2. Scan Conversion
B. Digital Devices
1. Binary system
a. Terminology (bits, bytes, pixels)
b. Discrete nature of binary numbers
2. Steps in processing echo information
a. Analog-to-digital converter
b. Digital memory
1. Spatial resolution
a. pixels
b. matrix
c. Field of view
2. Contrast resolution
a. Size of memory
c. Digital-to-analog converter
d. Display devices
C. Preprocessing versus Postprocessing
1. Definition
2. Preprocessing functions
a. Time (depth) gain compensation
b. Logarithmic compression
c. write magnification
3. Postprocessing function
a. Freeze frame
b. Black/white inversion
c. Read magnification
d. Contrast variation
4. Preprocessing or postprocessing functions (equipment manufacturers' discretion)
a. Persistence
b. Frame averaging
c. Edge enhancement
d. Smoothing
e. Fill-in interpolation
D. Display devices
1. TV monitors
2. High resolution monitors
a. Lines and spatial resolution
b. Brightness
c. Contrast
d. Frame rate
E. Recording and Archiving Techniques
1. Video Format
a. Display (monitors)
b. Single or multi-image cameras and laser imagers
1. Photographic film
2. Emulsion film
c. Recorders
1. Fiber-optic
2. Videotape cassette
d. Printer
1. Thermal
2. Laser
2. Digital format
a. Magneto-optical disc (digital still recorder)
b. PACS (Picture Achiving and communication systems)
3. Contrast and brightness control adjustments
4. Advantages and limitations of each type
VII. Hemodynamic, Doppler, Color Flow, and Color Power Imaging (10%-14%)
A. Hemodynamics
1. Energy gradient
2. Effects of viscosity, friction, inertia
3. Pressure/flow relationships
4. Velocity
5. Steady flow vs pulsatile flow
6. Laminar versus turbulent flow
7. Effects of stenosis on flow characteristics
8. Venous resistance
9. Hydrostatic pressure
10. Pressure/volume relationship
11. Effects of respiration (phasicity)
B. Doppler Physical Principles
1. Doppler Effect
a. Principle as related to sampling red blood cell movement
b. Doppler equation
2. Factors influencing the magnitude of the Doppler shift frequency
a. Range of the Doppler shift frequency
b. Effects of beam angle, transmitted frequency, flow velocity, and flow direction
C. Doppler Instruments
1. Continuous wave and pulsed wave Doppler
a. Differences
b. Advantages and disadvantages of each
1. Aliasing (Nyquist criteria)
2. Range ambiguity
c. Instrumentation
1. Receiver
2. Demodulater
3. Wall filter for clutter rejection
4. Directional devices
2. Duplex instruments-definition and basic principles
3. Spectral analysis
a. Purpose
1. Direction
2. Velocity
3. Duration
4. Character
5. Magnitude
b. Fast Fourier transform (FFT)
c. Diagnostic measurements (indices-i.e., pulsatility, resistive)
D. Color Flow Imaging
1. Basic Principles
a. Sampling methods
b. Display of Doppler information
1. Reflector direction
2. Average velocity
3. Velocity variance
c. Advantages and limitations
2. Instrumentation
a. Autocorrelation
b. Time domain processing
c. Color field size and frame rate
1. Ensemble length (packet size, pulse packet)
2. Line density
3. Maximum depth
d. Color maps, assignment, or coding
1. Hue
2. Saturation
3. Luminance (significance, brightness, intensity)
e. Artifacts (see section VIII)
E. Color Power (Energy) Mode
1. Displayed information
2. Advantages and limitations
VIII. Artifacts (6%-10%)
A. Definition of Artifacts
B. Artifact Recognition in Performing and Interpreting Examinations
1. Echoes not representing actual interfaces
2. Missing echoes
3. Misrepresented interface location
4. Misrepresented interface amplitude
C. Artifacts Associated with Resolution and Propagation (Axial Resolution, Lateral Resolution, Section Thickness, Acoustic Speckle)
1. Definitions
2. Mechanisms of Production
3. Appearance
D. Artifacts Associated with Propagation (Reverberation, Comet-tail, Ring-down, Mirror Image, Multipath, Side Lobes, Grating Lobes, Refraction, Speed Error; and Range Ambiguity)
1. Definitions
2. Mechanisms of Production
3. Appearance
E. Artifacts Associated with Attenuation (Shadowing, Enhancement, and Focal Enhancement or Focal Banding)
1. Definitions
2. Mechanisms of Production
3. Appearance
F. Artifacts Associated with Doppler and Color Flow Instrumentation (Aliasing, Slice Thickness, Reverberation, Mirror Imaging, Ghosting or Flash, Registration, Incident Beam Angle, and Clutter)
1. Definitions
2. Mechanisms of Production
3. Appearance
G. Other (Electronic Noise, Equipment Malfunction)
1. Definitions
2. Mechanisms of Production
3. Appearance
H. Artifact Effects on Measurements (velocity or speed error and range ambiguity)
IX. Quality Assurance of Ultrasound Instruments (4%-8%)
A. General Concepts Regarding the Need for and Nature of a Quality Assurance Program
B. Methods for Evaluating Instrument Performance
1. Test objects
2. Phantoms (tissue, Doppler, flow)
C. Parameters to Be Evaluated
1. Test object
a. Dead zone
b. Axial resolution and lateral resolution (beam width)
c. Depth calibration accuracy
d. TGC characteristics
e. Uniformity
f. System sensitivity
2. Tissue equivalent (mimicking) phantom
a. Dead zone
b. Depth calibration accuracy
c. Lateral (horizontal) distance measurement accuracy
d. Axial, lateral, and section thickness (elevational) resolution
e. TGC characteristics
f. System sensitivity
g. Dynamic range
h. Contrast resolution
i. Lesion detection
3. Doppler flow, string, or belt phantoms
a. Maximum depth
b. Pulsed Doppler sample volume alignment (gate position accuracy)
c. Velocity accuracy
d. Color flow penetration
e. Image congruency test
D. Preventive Maintenance
1. Standard precautions
a. Equipment
1. Cleaning
2. Disinfecting
3. Sterilization
E. Record Keeping
F. Statistical Indices
1. Sensitivity/specificity
2. Negative/positive predictive value
3. Accuracy
X. Bioeffects and Safety (6%-10%)
A. Acoustic Output Quantities
1. Pressure
a. Units (MPa, mmHg)
b. Peak pressures (compression, rarefaction)
c. Methods of determining pressure (miniature hydrophone)
2. Power
a. Units (mW)
b. Methods of determining power (radiation force, hydrophone)
3. Intensity
a. Units (mW/cm2, W/cm2)
b. Spatial and temporal considerations
c. Average and peak intensities
d. Methods of determining intensity (hydrophones)
e. Common intensities
(1) SATA
(2) SPTA
(3) SPPA
(4) SPTP
4. Intensity and power values for different operating modes
B. Acoustic Output Labeling Standard
1. Thermal index
a. TIS
b. TIB
c. TIC
2. Mechanical index
C. Acoustic Exposure
1. Definition and concepts of prudent use (ALARA)
2. Methods of reducing acoustic exposure
D. Primary Mechanisms of Biologic Effect Production
1. Cavitation mechanisms: relevant acoustic parameters
2. Thermal mechanisms: relevant acoustic parameters
E. Experimental Biological Effect Studies
1. Animal studies
2. In vitro studies
3. Epidemiologic studies
a. Limitations
F. Guidelines and Regulations
1. American Institute of Ultrasound in Medicine (AIUM) Statements (e.g., mammalian, epidemiology, in vitro)
2. National Electrical Manufacturers Association (NEMA)
3. Food and Drug Administration (FDA)
G. Electrical and Mechanical Hazards
1. Patient susceptibility to electrical hazard
2. Equipment components which could present a hazard
I. Liver (16%-24%)
A. Anatomy
B. Technique
C. Laboratory values
D. Indications (including clinical symptoms, clinical correlation and associated complications)
E. Parenchymal disease
1. Focal and Diffuse abnormalities
2. Acute and Chronic processes
F. Masses
Benign and Malignant
G. Cysts
1. Simple and Complex
2. Benign and Malignant
H. Infection
Focal and Diffuse abnormalities
I. Hematomas
J. Liver transplants
Pre-surgical and Post-surgical evaluation
II. Gallbladder and Biliary Tree (10%-18%)
A. Anatomy
B. Technique
C. Laboratory values
D. Indications (including clinical symptoms, clinical correlation and associated complications)
E. Biliary dilatation
F. Masses
Benign and Malignant
G. Cholelithiasis-choledocholithiasis
H. Cholecystitis (Acute and Chronic)
III. Pancreas (6%-14%)
A. Anatomy
B. Technique
C. Laboratory values
D. Indications (including clinical symptoms, clinical correlation and associated complications)
E. Parenchymal disease
1. Focal and Diffuse abnormalities
2. Acute and Chronic processes
F. Masses
Benign and Malignant
G. Cysts
Simple and Complex, including Pseudocysts
IV. Kidneys and Urinary Tract (16%-24%)
A. Anatomy
B. Technique
C. Laboratory values
D. Indications (including clinical symptoms, clinical correlation and associated complications)
E. Renal Parenchymal Disease
1. Focal and Diffuse abnormalities
2. Chronic and Acute processes
F. Masses
Benign and Malignant, including Pseudomasses
G. Cysts
1. Simple and complex
2. Benign and Malignant
H. Infection
I. Hematomas
J. Calculi
K. Urinary tract obstruction
L. Ischemia
M. Anomalies
N. Kidney Transplants
Pre-surgical and Post-surgical evaluation
O. Urinary Bladder
Masses, Calculi, and Inflammatory processes (including evaluation of the ureters, urethra, and urachal anomalies)
V. Scrotum (3%-7%)
A. Anatomy
B. Technique
C. Laboratory Values
D. Indications (including clinical symptoms, clinical correlation and associated complications)
E. Parenchymal Disease
1. Focal and Diffuse abnormalities
2. Chronic and Acute processes, including Testicular Torsion
F. Masses
Benign and Malignant, including Cryptorchidism
G. Cysts and Fluid Collections
Acute and Chronic
H. Infection
Acute and Chronic
I. Hematoma
VI. Prostate (1%-2%)
A. Anatomy
B. Technique
C. Laboratory Values
D. Indications (including clinical symptoms, clinical correlation and associated complications)
E. Parenchymal Disease
1. Diffuse and Focal abnormalities
2. Acute and Chronic processes
F. Masses
G. Cysts
H. Infection
VII. Spleen (1%-5%)
A. Anatomy
B. Technique
C. Laboratory Values
D. Indications (including clinical symptoms, clinical correlation and associated complications)
E. Parenchymal Disease
Focal and Diffuse abnormalities
F. Masses
Benign and Malignant
G. Cysts
H. Infection
I. Hematoma
J. Infarction
VIII. Retroperitoneum (3%-7%)
A. Anatomy
B. Technique
C. Laboratory Values
D. Indications (including clinical symptoms, clinical correlation and associated complications)
E. Masses and Lymphdenopathy
Benign and Malignant
F. Hematoma
G. Adrenal Gland
1. Normal sonographic appearance
2. Benign and Malignant abnormalities
IX. Abdominal Vascular (7%-15%)
A. Anatomy
B. Technique (including Color Doppler, Power Doppler and duplex Doppler)
C. Laboratory values
D. Indications (including clinical symptoms, clinical correlation and associated complications)
E. Aneurysm
F. Thrombosis (including Portal Vein, Splenic Vein and Renal Vein Thrombosis)
G. Shunts
Arteriovenous, Porto-systemic, Surgical and Radiological
H. Doppler Spectral Waveform Analysis (including Stenosis, Thrombosis, Portal Hypertension, and Direction of flow)
I. Color Doppler and Power Doppler (including Stenosis, Thrombosis, Portal Hypertension, and Direction of flow)
X. Gastrointestinal Tract (1%-5%)
A. Anatomy
B. Technique
C. Laboratory Values
D. Indications (including clinical symptoms, clinical correlation and associated complications)
E. Infection (including Acute Appendicitis and Abscess)
F. Masses
Benign and Malignant
G. Obstruction
Small Bowel and Colon obstruction
H. Hernia
I. Peritoneal Fluid (including Inflammatory Fluid Collections)
XI. Neck (1%-3%)
A. Anatomy
B. Technique
C. Laboratory values
D. Indications (including clinical symptoms, clinical correlation and associated complications)
E. Thyroid parenchymal disease
1. Focal and Diffuse abnormalities
2. Chronic and Acute processes
F. Thyroid masses
Benign and Malignant
G. Thyroid cysts
1. Simple and Complex
2. Benign and Malignant
H. Parathyroid masses
I. Infection
J. Lymph nodes
Benign and Malignant
K. Carotid Artery and Jugular Vein
Including Sonographic Identification
XII. Abdominal wall, superficial and muscular structures(1%-5%)
A. Anatomy
B. Techniques
C. Laboratory Values
D. Indications (including clinical symptoms, clinical correlation and associated complications)
E. Masses
F. Cysts and Fluid Collections
G. Infection
H. Hematomas
I. Vessels (including Iatrogenic Vascular Injuries)
J. Musculoskeletal (including Normal and Ruptured tendons, such as Patellar and Achilles tendons, and Foreign Bodies)
K. Non-echocardiography Chest (including Pleural and Pericardial Effusions and Masses)
XIII. Instrumentation (1%-2%)
A. Techniques
B. Transducers
C. Machine settings
D. Image recording
E. Artifacts
F. Quality Assurance
G. Harmonic Imaging
1. Physics and clinical applications
XIV. Invasive Procedures (1%-2%)
A. Pre-procedure preparation (including Informed Consent and Procedure set up)
B. Procedural related issues
C. Indications (including clinical symptoms, clinical correlation and associated complications)
I. Breast instrumentation and technique (20%)
A. System setup
B. Transducers
C. Grayscale
D. Doppler (Color and Power)
1. Pressure
2. Set-up
E. Physical exam
F. Mammographic correlation (location and features)
G. Annotation
H. Standoff pads
I. Scan planes
J. Compressibility
K. Echo-palpation
L. Artifact
M. Positioning
N. Indications
II. Normal anatomy (20%)
A. Ducts (TDLU)
B. Fibrous planes
C. Skin
D. Superficial fascia
E. Mammary zone
F. Deep Fascia
G. Pectoralis
H. Ribs
I. LN’s (internal mammary, axillary, intramammary)
J. Mammo Vs U/S appearance
K. Pregnancy induced changes
L. Involutional changes
III. Benign vs. Malignant Features (25%)
A.Sharpness of Margins
B. Contour of margins
C. Border thickness and echogenicity
D. Shape/orientation
E. Echogenicity
F. Heterogeneity
G. Compressibility
H. Vascularity
I. Effects on Fibrous Planes
J. Effects on Ducts
K. Calcifications
L. Lymph nodes
M. Skin thickening
IV. Specific Lesions—Benign (10%)
A. Cyst—simple, complex, debris, thick fluid, wall, through
B. Transmission
C. Sebaceous Cyst
D. Fibrocystic nodules
E. Fibroadenoma
F. Papilloma
G. Lipoma
H. Hamartoma
I. Inflammation & Infection—abscess, mastitis, edema
J. Traumatic changes—fat necrosis, seroma, scarring
K. Gynecomastia
V. Specific Lesions—Malignant (10%)
A. DCIS/LCIS
B. Invasive Lesions- ductal, lobular, colloid, medullary, multifocal
C. Phyllodes
D. Lymphoma
E. Metastasis
VI. Other (10%)
A. MRI appearance: implant leakage, cancer, nodes
B. Ductography
C. Sentinel Node Procedure
D. Histology
E. Implants
VII. Invasive Procedures (5%)
A. Localizations
B. Core Biopsy
C. FNA
D. Mammotomy
E. Abbi
F. Cyst Aspiraton
I. Anatomy of the Heart (Review) (4%-8%)
A. Chambers and Related Septa
B. Valves and Related Apparatus
C. Arterial-Venous System
D. Conduction System
E. Layers
F. Relational Anatomy
II. Basic Embryology (1%-3%)
A. Primitive Heart Tube
1. Formation from primitive vascular tube
2. Sinus venosus
3. Cardiac loop
4. Aortic arches
5. Septation
6. Valve formation
B. Comparison of Fetal and Postnatal Circulation
III. Congenital Defects (1%-3%)
A. Abnormalities of Septation
B. Abnormal Vasculature and Resulting Lesions
C. Persistence of Normal Fetal Communication
D. Valvular Anomalies
IV. Cardiac Physiology (5%-15%)
A. Electrophysiology and the Conduction System
1. Propagation of electrical activity
2. Excitation contraction coupling
B. Mechanical Considerations and Events
1. Frank Starling law (length-tension relationship)
2. Force-velocity relationship
3. Interval-strength relationship
4. Valve opening and closure
C. Phases of the Cardiac Cycle (Electromechanical Events)
1. Passive filling phase (ventricular diastole)
2. Atrial systole (p-wave on EKG; late diastole)
3. Isovolumic contraction
4. Ventricular ejection
5. Isovolumic relaxation
D. Left Ventricular Function: Indicators and Normal Values
1. Stroke volume
2. Ejection fraction
3. Cardiac output
E. Pulmonary vs. Systemic Circulation: Differences (e.g., Pressure, Oxygen Content, etc.) and Similarities (e.g., Volumes)
F. Intracardiac Pressures and Principles of Flow
1. Normal values
2. Changes during the cardiac cycle and relation to valve opening/closure
G. Maneuvers Altering Cardiac Physiology (e.g., Position)
H. Normal Heart Sound Generation and Timing
I. Cardiovascular Circulation
1. Normal metabolic needs and their variations
2. Component parts of the circulation
3. Control mechanisms
4. Coronary circulation
5. Properties of blood: composition
V. Cardiac Evaluation Methods (5%-15%)
A. Symptoms of Cardiac Diseases and Common Causes
B. Physical Examination and Signs
1. General physical appearance and patient history
2. Correlation of auscultatory findings
a. normal heart sounds
b. abnormal heart sounds and common causes
c. murmurs, timing, location, intensity, character, grading
C. EKG
1. Basic principles and waveforms
2. Common abnormalities: basic pattern recognition
3. Exercise and pharmacologic stress testing: basic principles
D. Phonocardiography: Basic Principles and Waveforms
E. Cardiac Catheterization
1. Basic concepts of hemodynamic recordings
2. Determination of cardiac output
3. Oximetry
4. Coronary angiography
5. Evaluation and definition of gradients (e.g., peak-to-peak, mean, etc.)
6. Recognition of pressure wave forms in common disease states
F. Other Diagnostic Modalities - Correlation to Echocardiography
1. Chest x-ray
2. Nuclear cardiology
3. Phonocardiography
G. Relation of Cardiac Events as Recorded on ECG, Phonocardiogram, Pressure Tracings, etc.
H. Correlation and Integration of Information Obtained with Echocardiography and Various Methods of Cardiac Evaluation
I. Superimposed Respiratory Tracing
J. Knowledge of CPR Techniques
VI. Principles of Cardiac Hemodynamics (5%-15%)
A. Blood Flow Dynamics
1. Factors affecting blood flow (e.g., viscosity, cell number, etc.)
2. Laminar Flow: definition, characteristics, and types
3. Disturbed flow: definition, characteristics (vortices, turbulence, etc.)
4. Relationships between pressure and velocity: Bernoulli principles and equations used
B. Effects of Abnormal Pressures and Loading, Volume Concepts
1. Heart failure and shock
2. Valvular stenosis
3. Valvular regurgitation
4. Shunts
5. Pulmonary disease
6. Pericardial disease
7. Cardiomyopathies
VII. Elementary Principles (4%-8%)
A. Nature of Ultrasound: Definitions, Propagation, Difference from Audible Sound
B. Frequency, Wavelength, Propagation Speed: Definitions and relationships
C. Properties of Sound Waves (e.g., Amplitude, Pressure, etc.)
D. Decibels: Definition, Relationships to Amplitude, and Intensity
E. Physical Units
1. Scientific notation
2. Engineering notation (e.g., micro vs. Mega)
3. Common units
VIII.Propagation of Ultrasound Through Tissues (4%-8%)
A. Speed of Sound
1. Average speed of sound in tissue
2. Range of propagation speeds in the body
3. Speeds in specific tissues (e.g., muscle, bone, fat)
B. Principles Related to Reflection
1. Characteristic acoustic impedance: definition
2. Reflection and transmission at specular interfaces
3. Scattering
C. Principles Related to Refraction
D. Principles Related to Attenuation
E. Useful Diagnostic Frequency Range
IX. Ultrasound Transducers (5%-10%)
A. The Piezoelectric Effect
B. Transducer Construction and Characteristics
C. Sound Beam Formation: Near and Far Fields (Fresnel and Fraunhofer Zones)
D. Focusing
1. Methods of focusing and steering
2. Focal zone characteristics
E. Beam Width and Lateral Resolution
F. Pulse Duration and Axial Resolution
G. Transducer Types
1. Multiple elements and their arrangements
2. Mechanical sector scanners
3. Single crystals
4. Rationale for selection (frequency, focal characteristics, etc.)
X. Pulse Echo Instruments (3%-7%)
A. Output Power Control
B. Receiver Overall Gain
C. Receiver Swept Gain (TGC)
D. Reject
E. Dynamic range
F. Compression
G. Magnification (or zoom)
H. Focal zone(s)
I. Filters
XI. Principles of Pulse Echo Imaging (5%-10%)
A. Principal Display Modes (A-mode, B-mode)
B. Principles of B-mode Image Formation
C. Identification of Major Types of Imaging Equipment
D. Scanning Speed Limitations
1. Applications of range equation and relationship to pulsing characteristics
2. Pulsing characteristics (e.g., PRF)
3. Frame rate and time needed to generate one frame
4. Number of lines per frame
5. Field of view (e.g., sector angle)
6. Depth to be imaged
XII. Images, Storage, and Display (1%-5%)
A. General Role and Use of Scan Converters and Digital Memories
B. Basic Concepts of Digital Systems
C. Image Storage, Resolution, and Field of View
D. Display Devices and Controls
E. Postprocessing
F. Recording Techniques (e.g., Videotape, Stripchart, etc.)
G. Display Contrast and Brightness
XIII. Doppler (10%-20%)
A. Basic Principles
1. Doppler effect: principle as related to sampling red blood cell movement
2. Scattering (from red blood cells)
a. frequency dependence
b. strength of emitted signal vs. returned signal
3. Doppler equation
a. range of Doppler shift frequencies - audible
b. factors influencing magnitude of Doppler shift and special relationships
(1) transducer frequency
(2) angle of beam incidence
(3) flow velocity
B. Spectral Analysis
1. Fast Fourier Transform (FFT)
2. Spectral display (visual and audio)
a. axis identification (e.g., frequency and time)
b. assignment of gray shades represented on the spectrum
c. components of the spectrum
d. effect of wall filtering and gains
3. Spectral broadening
a. influence of sample volume size
b. flow disturbances
4. Spectral artifacts (aliasing, mirroring, etc.)
C. Continuous Wave Doppler
1. Transducer configurations
2. Lack of range resolution (range ambiguity)
3. High velocity measurement capability
D. Pulsed Doppler
1. Transducers
2. Range discrimination
a. sample volume(s)
b. resolution compared to imaging resolution
3. Aliasing
a. pulse repetition frequency
b. Nyquist frequency limit
c. maximum depth
d. baseline position
E. Color Flow Imaging
1. Sampling methods
2. Fundamental variables
a. packet size
b. line density
c. maximum depth
d. frame rate
e. echo vs. color threshold
3. Evaluation of frequency content
a. methods of separating frequencies (e.g., autocorrelation algorithm)
(1) mean frequency
(2) variance
4. Color maps
5. Artifacts (aliasing, ghosting, reverberation, dropout)
6. Limitations
F. Roles and Limitations of Each Doppler Modality
XIV. Image Features and Artifacts (1%-5%)
A. Artifacts: Definition, Role of Recognition in Performing & Interpreting Exams, Understanding Mechanism, and Appearance
B. Reverberation, Refraction and Other Artifacts (e.g., Beam Width, Electronic Noise)
C. Shadowing and Enhancement
D. Measurements of Dimensions from Images (e.g., area)
E. Artifacts Affecting Measurement
XV. Quality Assurance of Ultrasound Instruments (1%-3%)
A. General Concepts Regarding the Need and Nature of a Quality Assurance Program
B. Quality Assurance Evaluation Parameters and Methods
C. Preventive Maintenance
D. Record Keeping
XVI.Bioeffects and Safety (2%-6%)
A. Dosimetric Quantities (Units and Definitions)
1. Relationship between pressure, intensity, power, and area
2. Typical values for diagnostic equipment used in echocardiography in all modes of operation
B. Acoustic Exposure
1. Definition
2. Factors affecting and methods of reducing acoustic exposure
3. Primary mechanisms of biological effect production
C. American Institute of Ultrasound in Medicine Statements
D. Electrical and Mechanical Hazards
I. Embryology (1%-5%)
A. Timing of heart formation
B. Teratogenic insults
C. Atrial septal components
D. Endocardial cushion
E. d- and l-looping
II. Indications (1%-5%)
A. Maternal
B. Fetal
C. Environmental
III. Incidence of congenital heart disease (5-10%)
A. General population
B. Heredity
C. Chromosomal
D. Syndromes
E. Extracardiac anomalies
IV. Timing of the fetal echocardiographic exam (1%-5%)
A. American Institute of Ultrasound in Medicine Standards
V. Standard sonographic views (10%-20%)
A. Position/Situs
1. Cardiac Axis
2. Cardiac Position
B. Two-dimensional heart views
1. Four-chamber
a. Apical
b. Subcostal
2. Long axis of the aorta (Left ventricular outflow tract)
3. Long axis of the pulmonary artery (Right ventricular outflow tract)
4. Short axis of the ventricles
5. Short axis of the great arteries
6. Aortic arch
7. Ductal arch
8. Five-chamber view
9. Three-vessel view
10. Inferior vena cava/Superior vena cava
C. Doppler Hemodynamics (Pulsed / Color)
1. Regurgitation
2. Stenosis
3. Intracardiac shunts
4. Dysrhythmias
D. M-mode
1. Dysrhythmias
2. Ventricular function
3. Color
VI. Normal fetal heart anatomy (8%-12%)
A. Size
B. Venous connections
1. Superior vena cava
2. Inferior vena cava
3. Pulmonary veins
C. Atria and septum
D. Atrioventricular valves
E. Ventricles and septum
F. Outflow tracts
G. Semilunar valves
H. Great arteries
1. Pulmonary artery
2. Aorta
3. Ductal arch
I. Pericardium
J. Other
VII. Normal fetal heart physiology (4%-8%)
A. Heart rate
B. Blood flow and cardiac output
C. In-utero shunts
1. Ductus venosus
2. Foramen ovale
3. Ductus arteriosus
D. Series circulation
VIII. Structural heart anomalies (35%-55%)
A. Cardiac malposition
1. Levocardia
2. Dextrocardia
3. Mesocardia
4. Levoposition
5. Dextroposition
B. Enlarged heart
1. Dilated cardiomyopathy
2. Hypertrophic cardiomyopathy
a. Type I diabetes mellitus
b. Syndromes
C. Venous abnormalities
1. Bilateral superior vena cava
2. Interrupted inferior vena cava with azygous continuation
3. Pulmonary venous abnormalities
a. Total anomalous pulmonary venous connection
b. Partial anomalous pulmonary venous connection
c. Pulmonary vein stenosis
D. Atria and septum
1. Atrial septal defect
a. Primum
b. Secundum
c. Sinus venosus
d. Unrooted coronary sinus
2. Dilated coronary sinus
a. Left superior vena cava to coronary sinus
b. Anomalous veins to coronary sinus
c. Right atrial obstruction
3. Cor triatriatum
4. Eustachian valve
5. Restrictive foramen ovale
E. Atrioventricular valves
1. Tricuspid valve
a. Atresia
b. Stenosis
c. Regurgitation
(1). Ebstein anomaly
d. Dysplasia
2. Mitral valve
a. Atresia
b. Stenosis
(1). Parachute
(2). Supravalvular mitral ring
c. Regurgitation
(1). Cleft
F. Ventricles and septum
1. Ventricular septal defect
a. Membranous
b. Muscular
c. Inlet
d. Outlet
e. Atrioventricular septal defect
2. Endocardial fibroelastosis
3. Tumors
a. Rhabdomyoma
b. Other
G. Semilunar valves
1. Pulmonary valve
a. Atresia
b. Stenosis
c. Insufficiency
d. Absence
2. Aortic valve
a. Atresia
b. Stenosis
c. Regurgitation
d. Absence
H. Great arteries
1. Transposition of the great arteries
a. d-Transposition of the great arteries
b. l-Transposition of the great arteries
2. Truncus arteriosus
3. Coarctation of the aorta
4. Interrupted aortic arch
5. Ductal constriction
a. Premature
b. Pharmacologic
c. Tetralogy of Fallot
d. Subaortic stenosis
e. Double outlet right ventricle
I. Pericardium
1. Pericardial effusion
2. Pericardial tumor
J. Complex cardiac anomalies
1. Single ventricle
2. Hypoplastic left heart syndrome
3. Hypoplasia of the right ventricle
4. Double inlet left ventricle
5. Heterotaxy
K. Miscellaneous
1. Echogenic intracardiac focus
IX. Dysrhythmias (5%-10%)
A. Bradyarrhythmias
1. Congenital heart block
2. Blocked ectopic beats
B. Tachyarrhythmias
1. Supraventricular tachycardia
2. Atrial flutter
3. Ventricular tachycardia
C. Ectopy
1. Premature atrial contractions
2. Premature ventricular contractions
X. Acquired pathology (1%-5%)
A. Metabolic/Endocrine
1. Type I diabetes mellitus
2. Phenylketonuria
3. Collagen vascular disease
4. Hyperthyroidism
B. Infection
1. TORCH
2. Parvovirus
C. Twin-to-twin transfusion
D. Intrauterine growth restriction
E. Drugs
XI. Miscellaneous (1%-5%)
A. Hydrops fetalis
B. Extracardiac anomalies
C. Syndromes
I. Physics & Instrumentation (1%-5%)
A. Effects of Bone on Ultrasonic Energy
B. Effect of Transducer Frequency on Image Quality
C. Bone Induced Artifacts
D. Effect of Instrument Controls on Image Quality
II. Technique in Neurosonography (10%-20%)
A. Rationale for Selection of Modality, Instrument, and Transducer for a Specific Examination
1. Neonate
2. Intraoperative
B. Scan-Plane Selection and Identification
C. Adjustment of Instrument Controls
D. Recognition of Normal Anatomic Structures and Landmarks
1. Cerebellum
2. Cerebrum
3. Brain stem
4. Spinal cord
5. Ventricular system
E. Examination Protocol
F. Normal Dimensions and Measurement Techniques
G. Sterile Technique in Intraoperative Examination
H. Transcranial Doppler Techniques
III. Anatomy & Physiology (30%-40%)
A. Bones of the Os Cranium
B. Fontanelles and External Landmarks
C. Gross Topographical Anatomy
1. Cerebellum
2. Cerebrum
3. Brain stem
4. Spinal cord
D. Membranous Partitioning of the Intracranial Space
E. Intra- and Extracranial Vascular Structures
1. Watershed areas
2. Normal vascular structures
3. ECMO effects
F. Gray/White Matter Organization of the Brain and Cord
G. The Ventricular System
H. Origin, Flow, and Reabsorption of the Cerebrospinal Fluid
I. Principal Functional Tracts of the Central Nervous System
IV. Recognition of Pathology and Differential Diagnosis (40%-50%)
A. Midline Displacements
B. Space-occupying Lesions and Mass Effects in the Brain
C. Inflammatory Lesions
D. Ventricular Enlargement
E. Intra- and Extracranial Hemorrhage
F. Atrophic Lesions
G. Congenital Lesions
H. Brain Swelling (Edema)
I. Lesions of the Spine
J. Tethering of the Spine
K. Vascular Abnormalities
L. Trauma
V. Medical Care of the Neonate During Scanning (1%-3%)
A. Temperature Maintenance
B. Asepsis and Infection Control
C. Scanning the Neonate on a Respirator
D. Care of the Neonate with IVís
E. Seizure Precautions
I. Obstetrics (Total 50%-60%)
A. First Trimester (6%-8%)
1. Gestational sac
2. Yolk Sac
3. Embryo (normal physiologic development/sonographic appearance
4. Ovaries (corpus luteum)
5. Cul-de-sac
6. Pregnancy failure
7. Ectopic pregnancy
B. Second/Third Trimester (Normal Anatomy) (8%-12%)
1. Cranial
2. Spine
3. Heart
4. Thorax
5. Abdomen
a. gastrointestinal
b. genitourinary
c. general
6. Extremities
7. Fetal Position
8. Other
C. Placenta (1%-5%)
1. Development
2. Position
3. Anatomy
4. Membranes
5. Umbilical cord
6. Abruption
7. Previa
8. Masses & lesions
9. Maturity/grading
10. Doppler
11. Physiology
12. Accreta
D. Assessment of Gestational Age (2%-6%)
1. Gestational sac
2. Embryonic size/crown-rump length
3. Biparietal diameter
4. Femur length
5. Abdominal circumference
6. Head circumference
7. Transcerebellar measurements
8. Binocular measurements
9. Cephalic indices
10.Fetal lung maturity
11. Other
E. Complications (6%-10%)
1. Intrauterine growth retardation
a. symmetrical
b. asymmetrical
c. nonstress test
d. biophysical profile
e. Doppler flow studies
2. Multiple gestations
a. diamniotic
b. monoamniotic
c. complications
3. Maternal illness
a. gestational diabetes
b. diabetes mellitus
c. hypertension
d. other
4. Antepartum
a. preterm labor
b. premature rupture of membranes
c. RH isoimmunization
d. cervix related
e. other
5. Fetal therapy
a. fetal blood sampling/transfusion
b. other
6. Postpartum
a. hemorrhage
b. infection
c. caesarean section
d. other
F. Amniotic Fluid (1%-5%)
1. Assessment
2. Polyhydramnios
3. Oligohydramnios
4. Fetal pulmonic maturity studies
G. Genetic Studies (1%-3%)
1. Maternal serum testing
2. Amniotic fluid testing
3. Chorionic villus sampling
4. Dominate/recessive risk occurrence
H. Fetal Demise (0%-3%)
I. Fetal Abnormalities (10%-15%)
1. Cranial
2. Facial
3. Neck
4. Neural tube
5. Abdominal wall
6. Thoracic
7. Genitourinary
8. Gastrointestinal
9. Skeletal
10. Cardiac
11. Syndromes
12. Other
J. Coexisting Disorders (0%-3%)
1. Leiomyoma
2. Cystic
3. Trophoblastic disease
4. Solid/mixed
5. Myometrial contraction
6. Other
II. Gynecology (Total 40%-50%)
A. Normal Pelvic Anatomy (10%-15%)
1. Uterus
a. corpus
b. endometrium
c. cervix
d. vagina
2. Ovaries
3. Fallopian tubes
4. Supporting structures
5. Cul-de-sac
6. Vasculature
7. Doppler flow
8. Gynecology related studies
a. gastrointestinal
b. genitourinary
B. Physiology (6%-15%)
1. Menstrual cycle
2. Pregnancy tests
3. Human chorionic gonadotropin (hCg)
4. Fertilization
C. Pediatric (1%-5%)
1. Precocious puberty
2. Hematometra/hematocolpos
3. Sexual ambiguity
4. Other
D. Infertility/Endocrinology (2%-6%)
1. Contraception
2. Causes
3. Medications and treatment
4. Ovulation induction (follicular monitoring)
5. ART (Assisted Reproductive Technology), GIFT, IVF, ZIFT
E. Postmenopausal (6%-10%)
1. Anatomy
2. Physiology
3. Therapy
a. hormonal replacement
4. Pathology
a. hyperplasia
b. polyps
c. endometrial cancer
d. ovarian cancer
e. other
F. Pelvic Pathology (6%-10%)
1. Congenital uterine malformation
2. Uterine masses
3. Ovarian masses
4. Endometriosis
5. Polycystic ovarian disease
6. Inflammatory disease
7. Doppler flow studies
8. Gynecology related studies
a. gastrointestinal
b. genitourinary
9. Other
G. Extra-pelvic Pathology Associated with Gynecology (1%-3%)
1. Ascites
2. Liver metastasis
3. Hydronephrosis
4. Other
III. Patient Care Preparation/Technique (Total 1%-5%)
A. Review Charts
B. Explain Examinations
C. Supine Hypotensive Syndrome
D. Bioeffects
E. Infectious Disease Control
F. Scanning Techniques
G. Artifacts
H. Physical Principles
I. Instrumentation and Ultrasound Physics (12-18%)
A. Doppler equation
B. Continuous-wave/Pulsed wave Doppler
C. Spectral waveform analysis
D. Color/Power Doppler
E. B-mode imaging
F. Artifacts
II. Extracranial Cerebrovascular (22-28%)
A. Carotid/vertebral
B. Brachiocephalic vessels
III. Intracranial Cerebrovascular (1-4%)
A. Transcranial Doppler
IV. Peripheral Venous – Upper and Lower Extremity (17-23%)
A. Physiologic Testing (plethysmography)
B. Duplex Imaging
V. Peripheral Arterial – Upper and Lower Extremity (12-18%)
A. Physiologic Testing (segmental pressures/plethysmography)
B. Duplex Imaging
VI. Visceral Vascular (7-13%)
A. Aorta
B. Mesenteric/Renal
C. Hepatic/portal
D. Liver/Kidney transplants
VII. Special Testing (5-11%)
A. Aortic endografts
B. Intraoperative assessment
C. Graft surveillance
D. Dialysis grafts
VIII. Quality Assurance and Ultrasound Safety (2-8%)
A. Test validation
B. Bioeffects of ultrasound
I Ultrasound Physics (35%-45%)
A. Definition of Sound (6%-10%)
1. Sound vs. ultrasound
2. Propagation velocity
3. Frequency
4. Wavelength
5. Frequency vs. depth
6. Frequency ranges
B. Propagation of Sound in Tissue (6%-10%)
1. Speed of sound through tissue: air, bone, soft tissue
2. Speed of sound through blood
3. Acoustic impedance
4. Reflection
5. Refraction
6. Absorption
7. Attenuation
C. Transducers: Ultrasound (6%-10%)
1. Piezoelectric effect
2. Transducer characteristics
3. Sound beam characteristics
a. effect of beam diameter on resolution
b. effect of transducer frequency on beam characteristics
c. beam focusing
d. near field
e. far field
4. Lateral resolution
5. Axial resolution
6. Mechanical transducers
7. Electronic transducers
D. Doppler Signal Processing (6%-10%)
1. Doppler effect
2. Doppler frequency shift
3. Effect of transmitting frequency on Doppler frequency shift
4. Effect of insonation angle on Doppler frequency shift
5. Reflector speed (velocity)
6. Extracting the Doppler signal
7. Audible Doppler signal analysis
8. Analog Doppler waveform generation
9. Spectral display characteristics
10. Sample volume size
11. Aliasing
E. Doppler Instruments (6%-10%)
1. Continuous wave instruments
2. Pulsed wave instruments
3. Bidirectional Doppler
4. Unidirectional Doppler
5. Color flow
6. Transcranial
II. Ultrasonic Imaging (15%-25%)
A. Imaging Principles (10%-14%)
1. A-mode: definition
2. B-mode: definition
3. Real-time: definition
4. Gray scale display
5. Dynamic range
6. Frame rate
7. Scan converter
8. Gain
9. Time gain compensation
10. Recording techniques
a. multi-imaging camera
b. video tape
c. thermal video printer
d. digital storage
11. Duplex instrumentation
12. Image resolution
B. Imaging Artifacts (6%-10%)
1. Artifact: definition
2. Origin of artifacts: technique
3. Origin of artifacts: instrumentation
4. Enhancement
5. Multiple reflections
6. Reverberation
7. Shadowing
8. Refraction
III. Physiology & Fluid Dynamic (10%-20%)
A. Arterial Hemodynamics (7% -11%)
1. Energy gradient
2. Effects of viscosity, friction, inertia
3. Pressure/flow relationships
a. Poiseuille’s law
b. Bernoulli’s principle
4. Velocity
5. Steady flow vs. pulsatile flow
6. Effects of stenosis on flow characteristics
a. direction, turbulence, disturbed flow
b. velocity acceleration
c. entrance/exit effects
d. diameter reduction
e. peripheral resistance
f. collateral effects
g. effects of exercise
h. occlusion
B. Venous Hemodynamics (4%-8%)
1. Venous resistance
2. Hydrostatic pressure
3. Pressure/volume relationship
4. Effects of edema
5. Effects of muscle pump mechanism
a. at rest
b. contraction
c. relaxation
C. Other (0%-3%)
1. Arteriovenous fistula (traumatic, congenital, access dialysis)
2. Trauma (pseudoaneurysm)
IV. Physical Principles (15%-25%)
A. General (3%-7%)
1. Energy
2. Power
3. Graphical recording
4. Calibration
5. AC/DC coupling
6. Units of measure
B. Tissue Mechanics/Pressure Transmission (1%-5%)
1. Venous occlusion by limb positioning
2. Superficial venous occlusion by tourniquets
3. Volume changes by blood inflow/outflow
4. Arterial occlusion by cuffs
C. Plethysmography (1%-5%)
1. Displacement (pneumatic cuff)
2. Photoplethysmography
3. Oculoplethysmography-pressure
D. Pressure Measurements (6%-10%)
1. Legs
2. Arms
E. Other (0%-3%)
1. Skin temperature
2. Transcutaneous oximetry
V. Ultrasound Safety & Quality Assurance (3%-7%)
A. Instrument Performance (2%-6%)
1. Evaluation of image quality
2. Evaluation of Doppler quality
3. Preventive maintenance
B. Biological Effects (0%-3%)
1. Minimizing exposure time
2. Mechanisms of production
3. Scientific data
4. Preventing electrical hazards
I.Cerebrovascular (25%-35%)
A. Anatomy, Physiology and Hemodynamics (1%-5%)
1. Aortic arch
2. Upper extremity
3. Cervical carotid
4. Vertebral
5. Intracranial (circle of Willis)
B. Mechanisms of disease (1%-5%)
1. Risk factors
2. Atherosclerosis
3. Dissection
4. Thromboembolic
5. Subclavian steal
6. Carotid body tumor
7. Fibromuscular dysplasia
8. Neointimal hyperplasia
C. Signs and symptoms (1%-5%)
1. Transient symptoms
2. Stroke
3. Physical exam (neurologic, bruits, bilateral brachial pressures)
D. Testing (20%-25%)
1. Noninvasive (patient positioning, technique, interpretation, capabilities and limitations)
a. Duplex imaging (B-mode, Doppler, color Doppler)
(1). Stenosis
(2). Occlusion
(3). Intraoperative
b. Transcranial Doppler
2. Miscellaneous diagnostic tests (methods, interpretation, limitations) (1%-3%)
a. Arteriography
b. MR angiography
c. CT
3. Treatment/followup(1%-5%)
a. Medical (pharmacological, risk reduction, lifestyle modification)
b. Endovascular(angioplasty, stent)
c. Surgical
II. Venous (25%-35%)
A. Anatomy (Deep, superficial and perforating), Physiology and Hemodynamics (1%-5%)
1. Upper extremity
2. Lower extremity
3. Central (vena cava, innominate/brachiocephalic)
4. Venous wall and valves
B. Mechanisms of disease (2%-7%)
1. Risk factors
2. Acute venous thrombosis
a. Deep
b. Superficial
3. Chronic deep venous obstruction
4. Chronic venous valvular insufficiency (primary, secondary)
5. Varicose veins
6. Congenital
7. Pulmonary embolism
C. Signs and symptoms (1%-3%)
1. Acute
2. Chronic (skin changes, lymphedema, ulceration)
D. Testing (upper and lower extremity) (20%-25%)
1. Noninvasive (patient positioning, technique, interpretation, capabilities and limitations)
a. Acute venous thrombosis
(1). Duplex imaging (B-mode, Doppler, color Doppler)
(2). Continuous wave
b. Chronic venous insufficiency/obstruction
(1). Duplex imaging (B-mode, Doppler, color Doppler)
(2). Reflux plethysmography (air, photo)
2. Venography (methods, interpretation, capabilities, limitations) (0%-3%)
3. Treatment (1%-5%)
a. Anticoagulation
b. Thrombolytic therapy
c. Vena caval filter
d. Support hose
e. Surgical
III. Peripheral Arterial (20%-30%)
A. Anatomy, Physiology and Hemodynamics (1%-5%)
1. Aortic arch
2. Upper extremity
3. Abdominal aorta
4. Lower extremity
5. Microscopic
B. Mechanism of disease (1%-5%)
1. Risk factors
2. Atherosclerosis
3. Embolism
4. Aneurysm
5. Nonatherosclerotic lesions (arteritis, vasospastic disorders, dissection, entrapment syndromes)
C. Signs and symptoms (1%-5%)
1. Chronic disease (claudication, rest pain, tissue loss)
2. Acute arterial occlusion (thrombosis, emboli)
3. Vasospastic disorders
4. Physical examination (skin changes, pulse palpation, auscultation)
D. Testing (upper and lower extremity) (15%-20%)
1. Noninvasive (patient positioning, technique, interpretation, capabilities, limitations)
a. Doppler evaluation (analogue, spectral waveforms)
(1). Qualitative interpretation
(2). Quantitative interpretation (pulsatility index, acceleration time)
b. Pressures
(1).Ankle/brachial index
(2). Segmental pressures
(3). Exercise testing
(4). Reactive hyperemia
c. Plethysmography
(1). Volume pulse recording
(2). Photoplethysmography (digital pressures and cold stress)
d. Duplex imaging (B-mode, Doppler, color Doppler)
(1). Stenosis
(2). Occlusion
(3). Aneurysm
(4). Bypass graft (intraoperative, post-operative surveillance)
2. Miscellaneous diagnostic tests (methods, interpretation, limitations) (1%-3%)
a. Arteriorgraphy
b.MR angiography
c. CT
3. Treatment (1%-5%)
a. Medical (pharmacologic, lifestyle modification)
b. Endovascular (angioplasty, stent)
c. Surgical (endarterectomy, bypass)
IV. Abdomen/visceral (5%-15%)
A. Anatomy, Physiology and Hemodynamics (1%-3%)
1. Arterial (celiac, mesenterics, renals, hepatic)
2. Venous (vena cava, renal, portal, mesenteric)
B. Mechanisms of disease (0%-3%)
1. Risk factors
2. Renovascular hypertension
3. Mesenteric ischemia
4. Portal hypertension
C. Signs and symptoms
D. Testing (3%-10%)
1. Duplex imaging
2. Angiography
E. Treatment (1%-3%)
V. Miscellaneous conditions/tests (5%-15%)
A. Preoperative vein mapping (2%-5%)
B. Pseudoaneurysms, arteriovenous fistulae (2%-5%)
C. Dialysis access (0%-3%)
D. Organ transplants (renal, liver) (0%-1%)
E. Impotence testing (0%-1%)
F. Preoperative arterial mapping (radial, epigastric, mammary) (1%-3%)
G. Temporal arteritis (0%-1%)
H. Thoracic outlet syndrome (0%-3%)
I. Trauma (1%-3%)
VI. Quality assurance (3%-5%)
A. Statistics (2%-4%)
1. Sensitivity/specificity
2. Positive and negative predictive value
3. Accuracy
B. Patient safety (1%-3%)
1. Infection control
2. Medical emergencies