The. From the President. by Christopher M. Nelson, RN, RCIS, FSICP






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A publication of Cardiovascular Credentialing International Spring 2009

CCI Introduces

Its New Logo!

Aaron S. White, Executive Director This issue of The Pulse will be the final farewell to the old CCI logo which has represented our organization for over 35 years. As CCI moves into the next decade, the new CCI logo will stand as an easily recognizable symbol of the cardiovascular professional who we credential. In the upcoming months CCI will unveil a newly designed website with many new features and future issues of The Pulse will incorporate a similar design and layout. Our Registrants, Candidates and Applicants can rest assured that certain aspects of CCI will not be changing. CCI’s Board and National Office Staff will continue to provide industry leading service and unwavering commitment to the profession.

From the President

by Christopher M. Nelson, RN, RCIS, FSICP Well I couldn’t think of a better way to start out the new year than to debut our new logo. What do you think?! Our new look heralds some of the exciting initiatives planned for coming year. At the conclusion of CCI’s annual Board of Trustees Meeting, John Toptine officially “passed the gavel” to me and I am deeply honored to have this opportunity to serve as CCI’s new President. John has demonstrated extraordinary leadership in the past few years and I know we can count on his time and talents going forward.

In 2008, CCI administered 4,372 exams and I am proud to share that as of December 31, 2008 we are 11,973 Registrants strong; truly a record year. With those numbers we shouldn’t have any difficulty continuing our mission to educate patients, families, hospital administrators and lawmakers about the vital role qualified professionals have in the safe, accurate delivery of medical imaging procedures. It is through credentialing that we qualify professionals and support current standards of care.

At CCI’s Annual Board of Trustees meeting the Board reviewed the accomplishments of last year and solidified our goals for 2009. The fields of practice represented on the CCI Board, which includes representatives nominated by the ACC, ACCP, ASE,

BSE, SICP and SVU, have been busy with quality initiatives, education & training, advocacy and healthcare reform. Each Exam Committee meets twice a year to review the performance of their respective examination and to write new items (questions). Overall our exams are performing well and in keeping with current trends in cardiovascular care, we are planning to release two new exams this fall; one new registry exam (Cardiac Congenital Sonography) and one new certification exam in Rhythm Analysis.


Examination Development Update – Congenital

Sonography Examination ... 2 Educator’s Corner ... 3 CCI Welcomes Associate Executive Director ... 5 ASE News & Events... 5 CCI Credential Renewal ... 6 2009 SVU Annual Conference in Denver... 7 ASE’s Echo ToolboxTM ... 8



Credentialing International

Board of Trustees & Executive Staff President

Christopher M. Nelson, RN, RCIS, FSICP President Elect / Executive Exam Committee Chair

Douglas L. Passey, RCIS, RCES Treasurer

James J. Shafer, BS, RVS, RVT

Secretary / CT Exam Committee Chair Christie Hill Jordan, RCIS, RCS, RDCS, FASE

Immediate Past President John H. Toptine, RCS, RDCS, FASE Non-Invasive Echo Exam Committee Chair

Dennis K. Carney, RCIS, RCS, FASE Invasive Exam Committee Chair Erik W. Hushelpeck, RCIS, FSICP EP Exam Committee Chair

Letitia P. Esbenshade-Smith, RCES, RCIS Vascular Exam Committee Chair Claudia A. Benge, RVS, RDMS, RVT American College of Cardiology (ACC) Representative

Joseph Messer, MD, MACC

American College of Chest Physicians (ACCP) Representative

J. Nilas Young, MD

American Society of Echocardiography (ASE) Representatives

Allan L. Klein, MD, FRCP(c), FACC, FAHA, FASE

Marsha L. McIntosh, RCS, RDCS, FASE British Society of Echocardiography (BSE) Representative

Simon Ray, MD

Society of Invasive Cardiovascular Professionals (SICP) Representative Tracy Simpson, RCIS, FSICP

Society for Vascular Ultrasound (SVU) Representative

Gail Size, RVS Member At Large

Theodore C. Christman, RCIS, RCS, RDCS, RVS, RVT

Public Member Philip M. (Mel) Snyder, IV Executive Director Aaron S. White Editor of The Pulse Janet M. Punzi

The Pulse and CCI are trade names of CCI.

The Pulse is copyrighted by CCI and authoriza-tion to photocopy items for internal or personal use is granted by CCI. Opinions expressed in The Pulse are not necessarily those of the CCI Board of Trustees, its agents, editors, advertisers or anyone connected with the publication. CCI assumes no liability or responsibility for any claims, actions or damages resulting from publication of any article. CCI does not endorse nor recommend any review course or review material.

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Raleigh, NC 27607; phone: 800-326-0268; fax: (919) 787-4916; ©2009. Cardiovascular Credentialing

Examination Development

Update – Congenital Sonography


by Elaine Shea, RCIS, RCS, FASE, CCI Congenital Cardiac Task Force The population of adults with congenital heart disease (CHD) is growing. In almost every journal, almost every month, there is an article about adults with congenital heart disease, so it is an important population. The wonderful news is that patients who were seen in pediatric academic centers are now living longer and fuller lives. Therefore these pediatric patients are now being seen in the general adult cardiology community. In addition, surveys show that more infants are being diagnosed prenatally with congenital heart disease and therefore the large pediatric centers are seeing more patients with complex lesions and thus requiring the employment of more sonographers. No matter whether you come from a pediatric cardiology background or an adult cardiac sonography background, sooner or later the chances are you will see one of these individuals in your facility.

An example of the growth in congenital cardiac sonography can be seen at the Children’s Hospital of Philadelphia (CHOP). In 1996, CHOP had three sonographers and one fetal sonographer. Today CHOP has ten sonographers and three fetal sonographers and CHOP currently has employment postings for four sonographers. In 1996 CHOP’s echo lab had three rooms and performed roughly 4,500 echo studies; within the next month the staff at CHOP will move into a new lab which has ten rooms and the projection for 2009 is that CHOP will perform approximately 24,000 studies. With a growth of over 500% in 14 years, the growth in studies performed at CHOP on patients with CHD

has been significant, and this is but one example of the growth trend.

Based on factors such as the ones seen at CHOP and strong interest from the profession, the CCI Board of Trustees agreed that a need for the credentialing of sonographers in congenital echocardiography had presented itself. Thus in the latter part of the 2007 calendar year, CCI ventured in the development of a credentialing process for sonographers who work with adults with congenital heart disease. The first Congenital Cardiac Sonography Examination Task Force met in January of 2008. Since that time they have made great strides in the content development phase of the process required to construct a valid examination. This content is primarily based on the job validation survey that was completed by over 500 sonographers from 47 states the Spring of 2008.

The next phase of development of this exam and registry credential will be the completion of test items and the development of the beta exam. The beta exam will be administered to a small group of people who have expressed interest in earning this new registry credential. CCI expects to officially launch the exam by December 2009.

If you are interested in earning this registry credential, we ask that you visit or email Jerel Noel, CCI’s Examination Director, at



In future issues of The Pulse, we will be featuring articles high-lighting programs in Cardiovascular Technology and Diagnostic Medical Sonography. We encourage our Registrants in educational positions to submit articles about their programs’ history, number of students, clinical sites, etc. Please submit articles in Word format and pictures in .jpg format (300 dpi). We look forward to providing our Registrants with a glimpse of educational programs around the country.



Intermountain Medical Center

by Marsha McIntosh, RCS, RDCS, FASE

Director, Intermountain Echo/Vascular Labs

Marsha is a member of the CCI Board of Trustees and the Co-Chair of the CCI Echocardiography Registry Examination Committee.

Intermountain Medical Center is the largest hospital in Utah and the new flagship of Intermountain Healthcare. Located in the heart of the Salt Lake Valley, Intermountain Medical Center serves as a major adult referral center for six surrounding states and more than 75 regional health care institutions.

IMC opened in October, 2007, with 350 beds in the main patient tower, 80 ER beds, a dedicated heart tower, cancer center, outpatient tower and women’s center. The echo/ vascular lab at Intermountain Medical Center performed 14,000 echos and 8,000 vascular ultrasounds in 2008. We have 18 full-time cardiac sonographers and every single one of them is registered, over half of them have multiple registries. We also have eight vascular technologists, six of whom are registered, two are new grads. Due to the large volume of echos and vascular ultrasounds requested at night, we staff an echo/vascular tech from 7pm to 7am, seven days a week with a back-up tech on call. Both the echo and vascular labs are accredited by ICAEL and ICAVL


The echo lab staffs nine techs a day and each one has an assignment that rotates daily. The assignments include inpatients, outpatients, OR, NICU, stress echos, TEEs and the adult congenital clinic. Intermountain Medical Center has a large heart failure/transplant program and a large

population of LVAD patients. The vascular lab staffs five techs a day and they perform the full range of vascular studies from arterial, venous, carotids, renals and trans-cranial Doppler. This diverse range of patients gives the sonographers a nice variety of exams and allows them to become skilled in all areas of echocardiography/vascular ultrasound.

Our echo/vascular lab provides multiple opportunities for on-site echo education and CMEs every month. We bring in a guest speaker once a month to present an echo or vascular related topic, we have cardiovascular grand rounds once a week, we have an “Echo Challenge” once a month where interesting cases are presented and a prize is awarded, we

have bi-monthly staff meetings where peer-review and QA is performed and we daily review cases together on an informal basis with our cardiologists and vascular surgeons.

Intermountain Medical Center has 23 Philips iE33 ultrasound machines dedicated for cardiac echos and vascular ultrasounds. All of them have 3D software and 18 of them have 3D

transducers. We have five 3D TEE probes and three regular TEE probes. Siemens Syngo Dynamics is our PACS and we have 35 Syngo workstations in the heart tower. We use the full functionality of this PACS system including ADT/Ordering, modality worklists, structured reporting and results interface.

We accept clinical students from the echo and ultrasound programs at Weber State University, Salt Lake Community College and Spokane Community College. We also have a full-time research echocardiographer who participates in and coordinates all the echo-related research. Our lab is currently involved in 15 echo-related research projects. And, finally, we have several staff members who are actively involved in American Society of Echocardiography (ASE) on the executive committee, the sonographer council board and the FASE selection committee.

For more information about Intermountain Medical Center and our cardiovascular services, visit the “hospitals” link at

Intermountain Echo/Vascular Staff (L to R): Marsha McIntosh, Lisa Cannon, Jana Beck, Traci Edmunds, Ken Horton, Stephanie Nay, Mike Gonzales, Alison Martin, Valerie Thomason, Carol McIver, Eric Smith


CCI does not endorse nor recommend any review course or review material.


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I am now a card carrying RVT thanks to you concise but fully loaded review course. I will probably sit for the Physician exam next year. Prior to that I plan to take the appropriate review course you offer.

– George Edmonson, MD, RVT

It is with pleasure to let you know that I have passed my Adult Echo boards! I am now dual-credentialed - RVT and RDCS. Your seminars and study aides were instrumental to me in reaching these milestones.

– Teri Dalager, RVT, RDCS

I did it! I passed the Cardiac Principles and Instrumentation exam and passed it with confidence. I know I would not have been able to do it without the help of you, David Adams and your combined materials. All your materials are most useful and effective. I feel everything I read from you or Mr. Adams is relevant, quickly understandable, and it seems to stick.

– Clifford M. Thornton, RDCS

Thank you so much. Referring all my associates to you. Keep up the good work!

– Jean Hemry, RDCS

I successfully passed the abdominal boards this past Saturday and couldn't have done it without the help of ESP and the review course I attended. The review course that Mr. Bernhardt teaches is right on with the exam without a doubt!

– Karen Wolbach, RDMS, RT(R)(M)

Last May I took your physicians review course and today passed the test. Thanks for a good course, which proved helpful for me.

– Nancy Cantelmo, MD, RPVI

I appreciate the time that you spent on the phone with me, when we hung up I felt that I was ready to conquer the world. With your encour-agement, your advice and your belief in me, I passed my exam!

– Teresa Martinez, RDMS

I just wanted you to know my friend and I took your CCI class in June and both have passed our tests!

– Lynn Magliacano, RCS

Visit our website,, for new and exciting information .

Passion and preparation – they’re part of our philosophy . We've been consistently improving our programs for years, providing extraordinary training to our students . Our classes feature detailed yet concise course outlines, attention to current exam trends and superior instruction . From the moment our program begins, great care is taken to maximize your exam preparation experience . That's why our classes are the largest and most highly regarded .

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Ultrasound Physics Cardiovascular Science RPVI – Vascular Interpretation

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RPVI – Vascular Interpretation


RPVI – Vascular Interpretation

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CCI Welcomes Associate Executive Director

It gives us great pleasure to announce that late in the 2008 calendar year, CCI hired Mr. Jerel Noel to take the position of Associate Executive Director/ Examination Coordinator.

Jerel has been working in Not-for-Profit management business for nearly nine years. Prior to taking over as Associate Executive Director of CCI, he was the Membership Director of the American Society of Echocardiography from 2002-2008. During his time with ASE, the membership grew from

approximately 7,500 members to 14, 000 members world-wide. During his time with ASE, Jerel was able to establish relationships in the cardiovascular community that he hopes will be useful in his new position with CCI. He also plans to work with volunteers and staff to strengthen CCI’s marketing strategy for our exams to ensure that we’re reaching our maximum target audiences. As CCI grows and the Executive Director’s responsibilities expand and recognition of the cardiovascular technology field increases, Jerel will be a crucial leader for CCI. Jerel will be working closely with the CCI Board of Trustees on the

development of new examinations and with organizations such as the American Society of Echocardiography (ASE), Society of Invasive Cardiovascular Professionals (SICP), Society for Vascular Ultrasound (SVU), Society of Diagnostic Medical Sonography (SDMS) and the American Society of Radiologic Technologists (ASRT) to promote the advancement of our field.

Jerel grew up in the North Alabama town of Florence, attended the University of Alabama and graduated with a BS in

Education. After graduation Jerel moved to Raleigh, NC where he met Deborah Holt, his bride of six months. We would like to thank Deborah for allowing us to send Jerel all across the country to Annual Meetings of many professional societies as well as to over 10 CCI Examination Committee Meetings per year. In his spare time, Jerel enjoys reading, sports, working with youth and spending time with family and friends.

We know you all join us in wishing Jerel all the best in his new role with CCI.

Register Online



The American Society

of Echocardiography/

ASE Foundation Announces

June Sonographer Registry

Review Course

ASE has specifically designed the Sonographer Registry Review Course as a preparatory course for the ARDMS and CCI Registry Examinations. Lectures will cover content related to adult echocardiography and physics with illustrative cases and will include practice exam questions for each subject area throughout the course. Each lecture will provide the essentials of topics expected to be covered on the registry examinations. The course will be held June 6, 2009, (7:15am - 5:00pm) through June 7, 2009, (7:30am - 10:30am) at the Gaylord National on the Potomac in Washington, DC. Participants are eligible for up to 11.5 hours of ASE CEU, and CCI recognizes ASE’s certificates and has agreed to honor the credit hours toward the registry requirements for sonographers. Learn more and register at under the “Education” tab. *Sonographers also attending the ASE Scientific Sessions will receive a discount on registration for this course!


CCI does not endorse nor recommend any review course or review material.










1-800-322-0737 or 1-877-625-5297

CCI Credential Renewal – March 31, 2009

On the “To Do” list for 2009 – The Board of Trustees is reviewing recommendations to restructure the Board so as to optimize efficiencies during a growth of subspecialty fields emerging in the cardiovascular profession. The Exam Committees have been challenged to determine how best to evaluate what has historically been called “Cardiac Science”—should this be tested separately or can this content be incorporated and tested as part of a single Registry Examination? Additionally the CCI Board of Trustees approved the following projects: 1) development of an on-line exam application, 2) redesign of CCI’s website, and 3) development of a Phlebology Registry Exam Taskforce (recall that Phlebology is the branch of medicine devoted to the study of veins and venous diseases and disorders).

I am excited by the enthusiasm of our staff and volunteer members. I anticipate it is going to be a tough year due to the economic downturn and it will require that all of us remain positive, focused and committed to managing vital resources. We need to seek every opportunity to streamline services and exceed expectations. As a team, we are a positive force capable of anything we set our minds and our hearts to; and with the right attitude, well, we can achieve anything.

President’s Message

continued from page 1 The expiration date for CCI credentials due to renew March

31, 2009, has passed.

If you have not completed your renewal requirements, you have a grace period until June 30, 2009, to submit CEUs, signed Code of Ethics and renewal payment.

New Registrants credentialed between April 1, 2008, and December 31, 2008, are not required to submit CEUs when they renew March 31, 2009. Submit only a signed copy of CCI’s Code of Ethics with payment of renewal fees.

The 90-day grace period is extended time to submit renewal paperwork. A late fee of $50.00 will be assessed to all registrants who submit their renewals during the grace period.

Please be aware that CEUs must have been earned during the triennial cycle. CEUs earned during grace period will not be accepted but will be credited towards your next triennial cycle.

If renewal requirements are not completed by June 30, 2009, credential’s status will become Inactive and registrants will be

required to retest to become active again. Registrants who hold RCS, RVS or RCIS credentials will not be required to retake the Cardiovascular Science exam, only the Registry exam. Submitting CEUs from an approved site does not mean that they are automatically accepted. Registrants who hold Registry credentials need to submit 36 CEUs, 30 of which must cardiovascular related CEUs to complete the renewal process. Please refer to List of Approved Providers on our website, www.

Applicants may retake the Registry exam at any time during their triennial, with no penalty, to satisfy their CEU requirement, at a reduced cost. Exam must be completed and passed before end of triennial cycle.

A copy of the CCI Code of Ethics can be downloaded from our website by clicking on Registrants, Code of Ethics.

We urge our registrants who have not submitted the required CEUs, Code of Ethics form and renewal payment to do so prior to June 30, 2009, to avoid retesting.



2009 SVU Annual Conference in Denver

Online registration is open now at!

The 2009 SVU Annual Conference at the Vascular Annual Meeting 2009 will be held June 11-13 at the Colorado Convention Center, with various Pre-Conference courses /sessions being held on Wednesday, June 10, also at the Colorado Convention Center.

The SVU Pre-Conference sessions you won’t want to miss are:

• Strategies for a Profitable Vascular Lab Course (full-day with a separate course brochure and separate online registration)

• ICAVL Accreditation Workshop (3 hours)

• Educate the Educators Session (4 hours)

• Diagnosis & Current Treatment Options for Chronic Venous Insufficiency Session (4 hours)

SVU will be meeting again in 2009 in conjunction with the Society for Vascular Surgery (SVS). The combined VAM 2009 exhibition will offer more than 100 exhibitors and will be held in the Colorado Convention Center. Along with the launch of several new products, meeting attendees will be able to experience all of the latest technologies and services at the exhibition.

SVU is also offering an exciting and comprehensive schedule of scientific sessions, two days of early morning tutorials, three days of Lunch with the Experts sessions, the annual SVU Business Meeting, a Government Relations Update session, and a special Technical Showcase session on Saturday morning offering the latest in arterial physiologic, carotid, venous, and TCD. In addition, there is a special SVS/SVU Joint Session on Friday afternoon on “Duplex Ultrasound of the Carotid Arteries: Beyond Velocities.”

The complete 2009 SVU Annual Conference Preliminary Program is listed online on the SVU website AC page, so don’t forget to check the Annual Conference website page to see the AC program schedule by day before making your 2009 AC registration.

SVU has secured a block of rooms at the nearby Curtis Hotel, SVU’s headquarters hotel. Make your reservations by May 9, 2009, to receive the special SVU room rate of $199 single/double plus tax. This unique boutique hotel is a short block from the Colorado Convention Center, making it a quick walk to the conference sessions on Thursday - Saturday.

For further information on SVU’s 2009 Annual Conference, as well as annual conference registration and hotel reservation forms, go to the SVU website at

CCI does not endorse nor recommend any review course or review material.





Save Time and Money on Lab Accreditation

with ASE’s Echo ToolBox™

Over 200 labs nationwide are using Echo ToolBoxTM(ETB) to reduce the time spent on lab accreditation, resulting in money saved and a more seamless and successful navigation through the accreditation application.

ETB is an innovative, Web-based product developed by the American Society of Echocardiography (ASE) in January of 2008 to enhance lab quality and facilitate the accreditation process. As lab accreditation is becoming a requirement for reimbursement by more payers, it is important to begin the accreditation process as soon as possible. One payer, United Healthcare, is requiring that labs be accredited by the fourth quarter of 2009.

ETB can help your lab get a head start on the accreditation process and allow you to meet one of the upcoming deadlines: May 1, August 1 or November 1. ETB helps to streamline the process and reduce the time it takes to complete the Interso-cietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL) application. In addition, ETB offers

“wizards” to walk labs through creating policies and protocols, identifies gaps in the lab’s application and improves your lab’s ability to meet ICAEL minimum standards.

To learn more about ETB, view a step-by-step demonstration video or read what users are saying about the program, please visit:

Going to ACC.09?

Visit ETB at Booth #2666 for a live demonstration of how ETB works to help streamline the accreditation process for your lab.

1500 Sunday Drive, Suite 102 Raleigh, NC 27607





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