Table of Revisionsjrcdms.org/pdf/Proposed DMS Standards Revision_DRAFT.pdf · General Education...

Diagnostic Medical Sonography 1

Table of Revisions 1

Description of Profession

II. Program Goals

Appropriateness of Goals and Learning Domains

Minimum Expectations

III. Resources

Clinical Affiliations

Program Director Qualifications

Concentration Coordinator Qualifications

Clinical Coordinator Responsibilities

Clinical Coordinator Qualifications

Medical Advisor Qualifications

Diagnostic Medical Sonography Faculty and Instructional Staff

Didactic Faculty

Clinical Faculty

Related Professions Faculty

General Education Curriculum

Common Core Curriculum

Curriculum for Each Concentration

Student Evaluation Documentation

Appendix B, Part I: Common Core Curriculum

Demonstrate knowledge and application of ergonomic techniques.

Demonstrate knowledge and application of types and methods of infection control.

Demonstrate knowledge and application of patient care.

Demonstrate comprehension and application of medical ethics and law.


Demonstrate comprehension and application of medical and sonographic terminology.

Obtain, interpret, document, and communicate relevant information related to sonographic examinations.

Demonstrate awareness of roles and responsibilities of healthcare professions to effectively communicate and collaborate in the healthcare environment.

Identify and evaluate anatomic structures.

Demonstrate knowledge of clinical disease processes with application to sonographic and Doppler patterns.

Demonstrate knowledge, comprehension, and application of image production and optimization.

Demonstrate knowledge, comprehension, and application of biological effects.

Demonstrate knowledge of the components required for implementing a quality control and improvement program.

Demonstrate awareness of resources for professional development.

Demonstrate performance of clinical competencies

Appendix B, Part II: Adult Cardiac Learning Concentration Curriculum

Identify anatomy, anatomic variants, and sonographic appearances of normal cardiac structures.

Demonstrate knowledge of normal and cardiovascular physiology and hemodynamics.

Demonstrate knowledge of mechanisms of disease, cardiovascular pathophysiology, and hemodynamics, sonographic technique, measurements, quantitative principles, and Doppler patterns in both the normal heart and with cardiac disease.

Demonstrate knowledge and applications of the indications, utility, limitations, and technical procedures for related echocardiographic studies.

Demonstrate knowledge, application, and proficiency in the use of quantitation principles applied to echocardiographic images and flow data.

Awareness of scanning protocol and modification(s) based on the sonographic findings and the differential diagnoses.



Demonstrate proficiency in technique and application

Appendix B, Part III: Pediatric Cardiac Learning Concentration Curriculum

Identify anatomy, anatomic variants, and sonographic appearances of normal and abnormal cardiac structures (adult, pediatric, and fetal).

Demonstrate knowledge of normal cardiovascular physiology and hemodynamics.

Demonstrate knowledge of cardiovascular pathophysiology (embryology of congenital abnormalities, mechanisms of acquired disease), and hemodynamics, sonographic technique, measurements, quantitative principles, and Doppler patterns in both the normal heart and with cardiac disease.

Demonstrate knowledge and applications of the indications, utility, limitations, and technical procedures for related echocardiographic studies.

Demonstrate knowledge, application, and proficiency in the use of quantitation principles applied to echocardiographic images and flow data.

Demonstrate knowledge and application of clinical cardiology as appropriate to the fetus and patients with congenital heart disease (CHD).

Awareness of scanning protocol and modification(s) based on the sonographic findings and the differential diagnoses.


Demonstrate proficiency in the technique and application

Appendix B, Part IV: Abdominal Learning Concentration Curriculum

Identify anatomy, relational anatomy, anatomic variants, and sonographic appearances of normal anatomical structures.

Demonstrate knowledge of the physiology, pathophysiology, sonographic technique, measurements, sonographic appearances, and Doppler patterns in both normal and abnormal structures.

Demonstrate knowledge in sonographic guided procedures.


Evaluate scanning protocol and modification(s) based on the sonographic findings and the differential diagnoses.

Performance of Clinical Competencies

Demonstrate proficiency in the technique and application

Appendix B, Part V: Breast Learning Concentration Curriculum

Identify anatomy, congenital and developmental variants, and sonographic appearances of normal breast structures.

Demonstrate knowledge of the physiology and pathophysiology in both normal and abnormal breast structures.

Demonstrate knowledge of the sonographic technique, measurements, sonographic appearances, integration of data, and Doppler patterns in both normal and abnormal breast structures.

Demonstrate knowledge in interventional and intraoperative procedures.


Demonstrate knowledge of treatment options.


Appendix B, Part VI: Musculoskeletal Learning Concentration Curriculum

Define and describe sonographic characteristics of the components of the musculoskeletal system.

Demonstrate knowledge of the anisotropic effect and the ability to distinguish this artifact from normal variants and pathology.

Identify anatomical structures, nerves and vascular supply, normal sonographic appearances, normal Doppler patterns, measurements (and contralateral comparison when applicable), and changes with dynamic assessment.

Demonstrate knowledge of the physiology, pathophysiology, sonographic technique, measurements, sonographic appearances, and Doppler patterns in musculoskeletal injuries and disease processes.

Identify sonographic and Doppler patterns in clinical diseases, injury, and post-surgical changes that may occur in the following categories.


Demonstrate knowledge in sonographic guided procedures

Evaluate scanning protocol and modification(s) based on the sonographic findings and the differential diagnoses


Appendix B, Part VII: Obstetrics and Gynecologic Learning Concentration Curriculum

Identify anatomy, anatomic variants, and sonographic appearances of normal structures of the female pelvis.

Identify anatomy, anatomic variants, and sonographic appearances of normal maternal, embryonic, and fetal anatomic structures during the first, second, and third trimesters.

Demonstrate knowledge of pathology, physiology, pathophysiology, sonographic technique, measurements, sonographic appearances, and Doppler patterns in gynecologic disease processes.

Demonstrate knowledge of pathology, physiology, pathophysiology, sonographic technique, sonographic appearance, measurements, and Doppler patterns in obstetric abnormalities.

Demonstrate knowledge and understanding of the role of the sonographer in performing interventional/invasive/advanced procedures.


Demonstrate clinical competency through performance of sonographic examinations of the gravid and non-gravid pelvis with both transabdominal and endocavitary transducers, and Doppler/M-mode display modes, according to practice parameters established by national professional organizations and the protocol of the clinical affiliate/clinical education centers.


Appendix B, Part VIII: Vascular Learning Concentration Curriculum

Demonstrate knowledge of anatomy and anatomic variants of the cardiovascular system.

Demonstrate knowledge of normal and abnormal peripheral vascular physiology and hemodynamics.


Demonstrate knowledge of mechanisms of vascular diseases, vascular pathophysiology, and hemodynamic effects.

Demonstrate knowledge of sonographic appearances, sonographic techniques, measurements, and Doppler flow characteristics in both normal and abnormal vascular structures.

Demonstrate knowledge physiologic vascular testing principles and techniques.

Demonstrate knowledge and application in the use of quantitative principles applied to vascular testing.

Demonstrate knowledge in ultrasound-guided procedures.

Demonstrate knowledge of the role of ultrasound for evaluation of vascular surgical procedure or interventions, including role in planning, intra-procedural guidance/technical evaluation, and/or post-procedure assessment.

Evaluate scanning protocol and modification(s) based on patient-specific factors.

Demonstrate knowledge and application of quality assurance and statistical tests used in a vascular laboratory.


Demonstrate proficiency in technique

2


3 4 5 6 7

Standards and Guidelines 8

for the Accreditation of Educational Programs in 9

Diagnostic Medical Sonography 10 11

Essentials/Standards initially adopted in 1979; revised in 1987, 1996, 2007, and 2011 by the: 12 13

American College of Cardiology Foundation 14 American College of Radiology 15

American College of Obstetricians and Gynecologists 16 American Institute of Ultrasound in Medicine 17

American Society of Echocardiography 18 American Society of Radiologic Technologists 19

Society of Diagnostic Medical Sonography 20 Society for Vascular Surgery 21

Society for Vascular Ultrasound 22 Joint Review Committee on Education in Diagnostic Medical Sonography 23

and 24 Commission on Accreditation of Allied Health Education Programs 25

26 The Commission on Accreditation of Allied Health Education Programs (CAAHEP) accredits 27 programs upon the recommendation of the Joint Review Committee on Education in Diagnostic 28 Medical Sonography (JRC-DMS). 29 30 These accreditation Standards and Guidelines are the minimum standards of quality used in 31 accrediting programs that prepare individuals to enter the Diagnostic Medical Sonography profession. 32 Standards are the minimum requirements to which an accredited program is held accountable. 33 Guidelines are descriptions, examples, or recommendations that elaborate on the Standards. 34 Guidelines are not required, but can assist with interpretation of the Standards. 35 36 Standards are printed in regular typeface in outline form. Guidelines are printed in italic typeface in 37 narrative form. 38 39 Preamble 40 41 The Commission on Accreditation of Allied Health Education Programs (CAAHEP), Joint Review 42 Committee on Education in Diagnostic Medical Sonography (JRC-DMS), and the American College of 43 Cardiology, American College of Radiology, American College of Obstetricians and Gynecologists, 44 American Institute of Ultrasound in Medicine, American Society of Echocardiography, American 45 Society of Radiologic Technologists, Society of Diagnostic Medical Sonography, Society for Vascular 46 Surgery, and Society for Vascular Ultrasound cooperate to establish, maintain and promote 47 appropriate standards of quality for educational programs in diagnostic medical sonography and to 48 provide recognition for educational programs that meet or exceed the minimum standards outlined in 49 these accreditation Standards and Guidelines. Lists of accredited programs are published for the 50 information of students, employers, educational institutions and agencies, and the public. 51 52 These Standards and Guidelines are to be used for the development, evaluation, and self-analysis 53 of diagnostic medical sonography programs. On-site review teams assist in the evaluation of a 54 program's relative compliance with the accreditation Standards. 55 56

Commission on Accreditation of Allied Health Education Programs


Description of Profession 57 58 Diagnostic medical sonography is a multi-specialty profession comprised of abdominal sonography, 59 breast sonography, cardiac sonography, musculoskeletal sonography, obstetrics/gynecology 60 sonography, vascular sonography, and other emerging clinical areas. These diverse areas all use 61 ultrasound as a primary technology in their daily work. 62 63 The diagnostic medical sonographer is an individual who provides patient care services using 64 ultrasound and related diagnostic procedures. The diagnostic medical sonographer must be 65 educationally prepared and clinically competent as a prerequisite to professional practice. 66 Demonstration and maintenance of competency through certification by a nationally recognized 67 sonography credentialing organization is the standard of practice in sonography, and maintenance of 68 certification in all areas of practice is endorsed. 69 70 The diagnostic medical sonographer functions as a delegated agent of the physician and does not 71 practice independently. 72 73 Diagnostic medical sonographers are committed to enhanced patient care and continuous quality 74 improvement that increases knowledge and technical competence. 75 76 Diagnostic medical sonographers use independent, professional and ethical judgment, and critical 77 thinking to safely perform diagnostic sonographic procedures. 78 79 The diagnostic medical sonographer generally performs the following: 80

Obtain, review, and integrate pertinent patient history and supporting clinical data to facilitate 81 optimum diagnostic results; 82

Perform appropriate procedures and record anatomic, pathologic, and/or physiologic data for 83 interpretation by a physician; 84

Record, analyze, and process diagnostic data and other pertinent observations made during 85 the procedure for presentation to the interpreting physician; 86

Exercise discretion and judgment in the performance of sonographic and/or other diagnostic 87 services; 88

Demonstrate appropriate communication skills with patients and colleagues; 89 Act in a professional and ethical manner; 90 Facilitate communication and education to elicit patient cooperation and understanding of 91

expectations, and responds to questions regarding the sonographic examination. 92 93

Included in this document are education standards that apply to the following learning 94 concentrations: 95 96 Adult Cardiac 97 Pediatric Cardiac 98 Abdominal 99 Breast 100 Musculoskeletal 101 Obstetric and Gynecologic 102 Vascular 103 104 I. Sponsorship 105

A. Sponsoring Institution 106 A sponsoring institution must be at least one of the following: 107

108 1. A post-secondary academic institution accredited by an institutional accrediting agency 109

that is recognized by the U.S. Department of Education, and must be authorized under 110 applicable law or other acceptable authority to provide a post-secondary program, which 111 awards a minimum of a certificate at the completion of the program. 112

2. A hospital or medical center or other governmental medical service, which is accredited 113 by a healthcare accrediting agency or equivalent that is recognized by the U.S. 114


Department of Health and Human Services, and authorized under applicable law or other 115 acceptable authority to provide healthcare, which awards a minimum of a certificate at 116 the completion of the program. 117

3. A branch of the United States Armed Forces, which awards a minimum of a certificate at 118 the completion of the program. 119

120 B. Consortium Sponsor 121

122 1. A consortium sponsor is an entity consisting of two or more members that exists for the 123

purpose of operating an educational program. In such instances, at least one of the 124 members of the consortium must meet the requirements of a sponsoring institution as 125 described in I.A. 126

2. The responsibilities of each member of the consortium must be clearly documented as a 127 formal affiliation agreement or memorandum of understanding, which includes 128 governance and lines of authority. 129

130

C. Responsibilities of Sponsor 131 The Sponsor must assure that the provisions of these Standards and Guidelines are met. 132 133

II. Program Goals 134

A. Program Goals and Outcomes 135 There must be a written statement of the program’s goals and learning domains consistent with 136 and responsive to the demonstrated needs and expectations of the various communities of 137 interest served by the educational program. The communities of interest that are served by the 138 program must include, but are not limited to, students, graduates, faculty, sponsor administration, 139 employers, physicians, and the public. 140

141 Program-specific statements of goals and learning domains provide the basis for program 142 planning, implementation, and evaluation. Such goals and learning domains must be compatible 143 with the mission of the sponsoring institution(s), the expectations of the communities of interest, 144 and nationally accepted standards of roles and functions. Goals and learning domains are based 145 upon the substantiated needs of health care providers and employers, and the educational needs 146 of the students served by the educational program. 147

148 B. Appropriateness of Goals and Learning Domains 149 The program must regularly assess its goals and learning domains. Program personnel must 150 identify and respond to changes in the needs and/or expectations of its communities of interest. 151

152 An advisory committee, which is representative of at least each of the communities of interest 153 named in these Standards, must be designated and charged with the responsibility of meeting at 154 least annually, to assist program and sponsor personnel in formulating and periodically revising 155 appropriate goals and learning domains, monitoring needs and expectations, and ensuring 156 program responsiveness to change. 157 158 Advisory committee meetings may include participation by synchronous electronic means. 159

160 C. Minimum Expectations 161 The program must have the following goal(s) defining minimum expectations: 162

163 "To prepare competent entry-level adult cardiac sonographers in the cognitive (knowledge), 164

psychomotor (skills), and affective (behavior) learning domains" and/or 165 “To prepare competent entry-level pediatric cardiac sonographers in the cognitive 166

(knowledge), psychomotor (skills), and affective (behavior) learning domains” and/or 167 "To prepare competent entry-level abdominal sonographers in the cognitive (knowledge), 168

psychomotor (skills), and affective (behavior) learning domains" and/or 169 "To prepare competent entry-level breast sonographers in the cognitive (knowledge), 170

psychomotor (skills), and affective (behavior) learning domains" and/or 171


"To prepare competent entry-level musculoskeletal sonographers in the cognitive 172 (knowledge), psychomotor (skills), and affective (behavior) learning domains" and/or 173

"To prepare competent entry-level obstetric and gynecologic sonographers in the cognitive 174 (knowledge), psychomotor (skills), and affective (behavior) learning domains" and/or 175

“To prepare competent entry-level vascular sonographers in the cognitive (knowledge), 176 psychomotor (skills), and affective (behavior) learning domains.” 177

178 Programs adopting educational goals beyond entry-level competence must clearly delineate this 179 intent and provide evidence that all students have achieved the basic competencies prior to entry 180 into the field. 181

182 Nothing in this Standard restricts programs from formulating goals beyond entry-level 183 competence. 184

185 III. Resources 186

A. Type and Amount 187 1. Program Resources 188 Program Resources must be sufficient to ensure the achievement of the program’s goals and 189 outcomes. Resources must include, but are not limited to: faculty, clerical and support staff; 190 curriculum; finances; offices; classroom, laboratory, and ancillary student facilities; clinical 191 affiliates; equipment; supplies; computer resources, instructional reference materials, and 192 faculty/staff continuing education. 193

194 Support Staff should be available to provide counseling or referral for problems that may 195 interfere with the student’s progress through the program. Guidance should be available to 196 assist students in understanding course content and in observing program policies, and 197 practices. 198

199 2. Clinical Affiliations 200 a. For all affiliations students must have access to adequate numbers and types of 201 examinations that are proportionally distributed by pathologic processes encountered in the 202 delivery of diagnostic medical sonography for the learning concentration(s) being offered. 203

204 Programs should provide students with a variety of patient care settings in which sonographic 205 procedures are performed on in-patients and outpatients. These settings may include the 206 following: Ambulatory care facilities, Specialty centers, Emergency/trauma, 207 Intensive/critical/coronary care, Surgery, Angiography/cardiac catheterization. 208 209 The number of students assigned to the clinical affiliate/clinical education center should be 210 determined by a student/clinical staff ratio not greater than one student to one appropriately 211 credentialed sonographer. 212

213 B. Personnel 214 The sponsor must appoint sufficient faculty and staff with the necessary qualifications to perform 215 the functions identified in documented job descriptions and to achieve the program’s stated goals 216 and outcomes. 217 218

1. Program Director 219 a. Responsibilities 220 The program director must be responsible for 221

1) the structure and daily operation of the program; 222 2) organization, administration, periodic review and evaluation, continued 223

development, and effectiveness of program curricula; and 224 3) ensuring the effectiveness of all clinical affiliates/clinical education centers is 225

maintained. 226 b. Qualifications 227 The Program Director must: 228

1) be an appointed faculty member or institutional equivalent; 229


2) possess a minimum of a Bachelor’s Degree; 230 3) possess the appropriate credential(s) specific to one or more of the231

concentration(s) offered.232 4) be proficient in educational theories and techniques, supervision, instruction,233

evaluation, and guidance;234 5) have obtained a minimum of two years of full-time (35 hours/week), or equivalent,235

professional clinical experience as a credentialed sonographer.236 237

A master’s degree is preferred. 238 239

Educational theories and techniques may be demonstrated by documentation of 240 completed college courses, seminars, or in-service sessions on topics including, but 241 not limited to, learning theory, curriculum design, test construction, teaching 242 methodology, or assessment techniques. 243

244 2. Concentration Coordinator245

a. Responsibilities246 The Concentration Coordinator reports to the Program Director, and must be designated247 and responsible for the instruction, curriculum, student evaluation, and assessment for248 the concentration(s) in which the Program Director does not possess the appropriate249 credential(s).250 b. Qualifications251 Concentration Coordinator must:252

1) be an appointed faculty member or institutional equivalent;253 2) an academic degree no lower than an associate’s degree and at least equal to254

that for which the graduates are being prepared;255 3) possess the appropriate credential(s) specific to the concentration(s) that they256

coordinate;257 4) be proficient in educational theories and techniques, supervision, instruction,258

evaluation, and guidance;259 5) have obtained a minimum of two years of full-time (35 hours/week) or equivalent,260

professional clinical experience as a credentialed sonographer in the261 concentration being coordinated.262

263 Educational theories and techniques may be demonstrated by documentation of 264 completed college courses, seminars, or in-service sessions on topics including, but not 265 limited to, learning theory, curriculum design, test construction, teaching methodology, or 266 assessment techniques. 267

268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286

3. Clinical CoordinatorPrograms must have a faculty member designated as the Clinical Coordinator.

a. ResponsibilitiesThe Clinical Coordinator must:

1) be responsible for coordinating clinical education with didactic education as assigned by the program director;

2) evaluate and ensure the effectiveness of clinical experiences for the concentration(s) students are enrolled in;

3) provide coordination, instruction, and documented evaluation and progression of student clinical performance for the achievement of the required clinical competencies.

b. QualificationsThe clinical coordinator(s) must:

1) be an appointed faculty member or institutional equivalent;2) an academic degree no lower than an associate’s degree and at least equal to

that for which the graduates are being prepared;3) possess the appropriate credential(s) specific to the concentration(s) that they

coordinate; 287


4) be proficient in educational theories and techniques, supervision, instruction, 288 evaluation, and guidance; 289

5) have obtained a minimum of two years of full-time (35 hours/week) professional 290 clinical experience as a credentialed sonographer. 291

292 Educational theories and techniques may be demonstrated by documentation of 293 completed college courses, seminars, or in-service sessions on topics including, but not 294 limited to, learning theory, curriculum design, test construction, teaching methodology, or 295 assessment techniques. 296

297 4. Medical Advisor 298

a. Responsibilities 299 The Medical Advisor must provide guidance that the medical components of the didactic 300 and clinical curriculum meet current acceptable performance standards. 301 302 b. Qualifications 303 The Medical Advisor must be a licensed physician, certified by an American Board of 304 Medical Specialties (ABMS), with relevant experience and knowledge in diagnostic 305 medical sonography. 306

307 The medical advisor should participate in goal determination, curriculum development 308 and outcomes assessment. 309 310

5. Diagnostic Medical Sonography Faculty and Instructional Staff 311 Didactic faculty, clinical faculty, and clinical instructors must possess the appropriate 312 credentials for the learning concentration(s) they teach and assess. 313

314 All faculty must be familiar with program goals, be able to demonstrate the ability to 315 develop an organized plan of instruction and evaluation. 316 317 a. Didactic Faculty 318

1) Responsibilities 319 The faculty must be responsible for providing didactic content, evaluation of students, 320 documentation of progress, and periodic review of course content. 321 322 2) Qualifications 323 The faculty must be qualified by education and experience, and be effective in 324 teaching the subjects assigned. 325 326

b. Clinical Faculty 327 1) Responsibilities 328 Clinical faculty must be responsible for coordination and evaluation of clinical 329 education in the concentration(s) for which the Clinical Coordinator does not possess 330 the appropriate credentials. 331 332 2) Qualification 333 The faculty must be qualified by education and experience, and be effective in 334 assessing and documenting progression of clinical skills. 335

336 c. Clinical Instructor(s) 337 Clinical Instructor(s) must be identified for each clinical affiliate. 338

339 1) Responsibilities 340 A clinical instructor must be available to students whenever they are assigned to a 341 clinical setting, provide appropriate clinical supervision and be responsible for student 342 clinical evaluation. 343 344 2) Qualifications 345


The clinical instructor must have the appropriate credential in the concentration(s) 346 they are evaluating the student’s performance and documentation of the required 347 clinical competencies. 348 349

6. Related Professions Faculty 350 a. Responsibilities 351 Related professions faculty must provide curriculum content for general and foundational 352 knowledge required of an entry level sonographer. 353

354 b. Qualifications 355 1) possess a minimum of a master’s degree in the related field; and 356 2) be knowledgeable in course content and effective in teaching their assigned subjects, 357 and capable through academic preparation, training and experience to teach the courses 358 to which they are assigned. 359

360 C. Curriculum 361

The curriculum must ensure the achievement of program goals and learning domains. 362 Instruction must be an appropriate sequence of classroom, laboratory, and clinical activities. 363 Instruction must be based on clearly written course syllabi that include course description, 364 course objectives, methods of evaluation, topic outline, and competencies required for 365 graduation. 366 367 1. General Education Curriculum 368

Basic medical science and interpersonal communication education is required as a 369 foundation for the clinical role of the diagnostic medical sonographer. Educational content 370 must be sequenced appropriately for development of necessary skills to progress to 371 sonography specific coursework. The following general education must include: 372

373 anatomy and physiology 374 mathematics (ex: algebra, statistics) 375 general physics 376 communication skills 377

378 2. Common Core Curriculum 379 The program must demonstrate by comparison that the curriculum offered meets or exceeds 380 the content and competencies specified in Appendix B Part I. 381

382 3. Curriculum for Each Concentration 383 The program must demonstrate by comparison that the curriculum offered for the 384 concentration(s) meets or exceeds the content and competencies specified in Appendix B 385 Part II – Part VIII. 386

387 4. Master Plan 388 The master plan of education must be sufficiently detailed to provide for continuity, delivery, 389 and ongoing evaluation of the program. 390

391 D. Resource Assessment 392 The program must, at least annually, assess the appropriateness and effectiveness of the 393 resources described in these Standards. The results of resource assessment must be the basis 394 for ongoing planning and appropriate change. An action plan must be developed when 395 deficiencies are identified in the program resources. Implementation of the action plan must be 396 documented and results measured by ongoing resource assessment. 397

398 IV. Student and Graduate (Outcomes) Evaluation/Assessment 399

A. Student Evaluation 400 1. Frequency and purpose 401 Evaluation of students must be conducted on a recurrent basis and with sufficient frequency 402 to provide both the students and program faculty with valid and timely indications of the 403


students’ progress toward and achievement of the competencies and learning domains 404 stated in the curriculum. 405

406 2. Documentation 407 Records of student evaluations must be maintained in sufficient detail to document learning 408 progress and achievements. 409

410 Records indicating the number and type of procedures performed by the student, the 411 examination findings, the extent of student supervision, and the level of involvement of the 412 student in scanning/performance must be maintained and must document that all students 413 are afforded equitable clinical experiences to achieve program required competencies for the 414 learning concentration(s) offered. 415

416 Documents or electronic equivalent used for determination of progression of learning and 417 achievements must specify the sonographer who is conducting the evaluation through 418 inclusion of name, signature and their credentials. 419 420

B. Outcomes 421 1. Outcomes Assessment 422 The program must periodically assess its effectiveness in achieving its stated goals and 423 learning domains. The results of this evaluation must be reflected in the review and timely 424 revision of the program. 425 426 Outcomes assessments include, but are not limited to: national credentialing examination(s) 427 performance, programmatic retention/attrition, graduate satisfaction, employer satisfaction, 428 job (positive) placement and programmatic summative measures. The program must meet 429 the outcomes assessment thresholds. 430 431 “Positive Placement” means that the graduate is employed full or part-time in the profession 432 or in a related field; or continuing his/her education, or serving in the military. A related field is 433 one in which the individual is using cognitive, psychomotor, and affective competencies 434 acquired in the educational program. 435 436 “National credentialing examinations” are those accredited by the National Commission for 437 Certifying Agencies (NCCA) or American National Standards Institute (ANSI). Participation 438 and pass rates on national credentialing examination(s) performance may be considered in 439 determining whether or not a program meets the designated threshold, provided the 440 credentialing examination(s) or alternative examination(s) offered by the same credentialing 441 organization, is/are available to be administered prior to graduation from the 442 program. Results from said alternative examination(s) may be accepted, if designated as 443 equivalent by the same organization whose credentialing examination(s) is/are so accredited. 444

445 2. Outcomes Reporting 446 The program must periodically submit to the JRC-DMS the program goal(s), learning 447 domains, evaluation systems (including type, cut score, and appropriateness), outcomes, its 448 analysis of the outcomes and an appropriate action plan based on the analysis. 449 450 Programs not meeting the established thresholds must begin a dialogue with the JRC-DMS 451 to develop an appropriate plan of action to respond to the identified shortcomings. 452

453 V. Fair Practices 454

A. Publications and Disclosure 455 1. Announcements, catalogs, publications, and advertising must accurately reflect the 456

program offered. 457 2. At least the following must be made known to all applicants and students: the sponsor’s 458

institutional and programmatic accreditation status as well as the name, mailing address, 459 web site address, and phone number of the accrediting agencies; admissions policies 460 and practices, including technical standards (when used); policies on advanced 461 placement, transfer of credits, and credits for experiential learning; number of credits 462


required for completion of the program; tuition/fees and other costs required to complete 463 the program; policies and processes for withdrawal and for refunds of tuition/fees. 464

3. At least the following must be made known to all students: academic calendar, student 465 grievance procedure, criteria for successful completion of each segment of the curriculum 466 and graduation, policies for student leave of absence, exposure to blood borne 467 pathogens, communicable diseases, and pregnancy, and policies and processes by 468 which students may perform clinical work while enrolled in the program. 469

4. The sponsor must maintain, and make available to the public current and consistent 470 summary information about student/graduate achievement that includes the results of 471 one or more of the outcomes assessments required in these Standards. 472

473 The sponsor should develop a suitable means of communicating to the communities of interest 474 the achievement of students/graduates (e.g. through a website or electronic or printed 475 documents). 476

477 B. Lawful and Non-discriminatory Practices 478 All activities associated with the program, including student and faculty recruitment, student 479 admission, and faculty employment practices, must be non-discriminatory and in accordance with 480 federal and state statutes, rules, and regulations. There must be a faculty grievance procedure 481 made known to all paid faculty. 482 483 A procedure should be established for determining that a student's health will permit him or her to 484 meet the documented technical standards of the program. 485

486 C. Safeguards 487 The health and safety of patients, students, faculty, and other participants associated with the 488 educational activities of the students must be adequately safeguarded. 489 490 All activities required in the program must be educational and students must not be substituted 491 for staff. 492

493 The program must ensure voluntary and prudent use of students or other human subjects for 494 non-clinical scanning. Students’ grades and evaluations must not be affected by participation or 495 non-participation. 496 497 Students should be informed of and have access to the health care services provided to all other 498 students of the institution. 499

500 D. Student Records 501 Satisfactory records must be maintained for student admission, advisement, counseling, and 502 evaluation. Grades and credits for courses must be recorded on the student transcript and 503 permanently maintained by the sponsor in a safe and accessible location. 504

505 E. Substantive Change 506 The sponsor must report substantive change(s) as described in Appendix A to CAAHEP/JRC-507 DMS in a timely manner. Other substantive change(s) to be reported to JRC-DMS within the time 508 limits prescribed include: 509

510 1) Changes in clinical affiliates 511 2) Added or deleted learning concentrations 512 3) Change in key personnel 513 4) Institution's mission or objectives if these will affect the program 514 5) Addition or deletion of courses that represent a significant departure in content or in 515

method of delivery 516 6) Degree or credential level 517 7) Substantial change in clock or credit hours for successful completion of a program or in 518

the length of a program 519 8) Addition or changes of satellite campus, distance education programs, or location 520

(campus) where core curriculum DMS coursework is delivered. 521


522 F. Agreements 523 There must be a formal affiliation agreement or memorandum of understanding between the 524 sponsor and all other entities that participate in the education of the students describing the 525 relationship, role, and responsibilities between the sponsor and that entity. 526

527 The delineation of responsibilities should include student supervision, benefits, liability and 528 financial arrangements, if any. The agreement should include a clause to protect students and to 529 ensure due process. 530

531 An affiliate is an institution having adequate resources to provide a broad range of appropriate 532 clinical education opportunities for students. 533

534 A clinical education center is a diagnostic department, division, or other designated part of a 535 clinical affiliate having adequate resources to provide clinical education opportunities for students. 536 Multiple clinical education centers may be identified within a clinical affiliate. 537


Appendix A 538 539

Application, Maintenance and Administration of Accreditation 540 541

A. Program and Sponsor Responsibilities 542 1. Applying for Initial Accreditation 543

a. The chief executive officer or an officially designated representative of the sponsor 544 completes a “Request for Accreditation Services” form The “Request for 545 Accreditation Services” form can be found online via the CAAHEP website at 546 www.caahep.org. The form can be completed on-line and submitted directly to the 547 JRC-DMS via the CAAHEP website (preferred); completed on-line, printed, signed 548 and mailed to the JRC-DMS; or it can be printed as a blank form, completed, 549 signed and mailed to: 550

551 JRC-DMS 552

6021 University Blvd. Suite 500 553 Ellicott City, MD 21043 554

555 Note: There is no CAAHEP fee when applying for accreditation services; however, 556

individual committees on accreditation may have an application fee. 557 558

b. The program undergoes a comprehensive review, which includes a written self-559 study report and an on-site review. 560

561 The self-study instructions and report form are available from the JRC-DMS. The on-site 562 review will be scheduled in cooperation with the program and JRC-DMS once the self-study 563 report has been completed, submitted, and accepted by the JRC-DMS. 564

565 2. Applying for Continuing Accreditation 566

a. Upon written notice from the JRC-DMS, the chief executive officer or an officially 567 designated representative of the sponsor completes a “Request for Accreditation 568 Services” form. 569

570 The “Request for Accreditation Services” form can be found online via the CAAHEP 571 website at www.caahep.org. The form can be completed on-line and submitted 572 directly to the JRC-DMS via the CAAHEP website (preferred); completed on-line, 573 printed, signed and mailed to the JRC-DMS; or it can be printed as a blank form, 574 completed, signed and mailed to: 575

576 JRC-DMS 577

6021 University Blvd. Suite 500 578 Ellicott City, MD 21043 579

580 b. The program may undergo a comprehensive review in accordance with the 581

policies and procedures of the JRC-DMS. 582 583

If it is determined that there were significant concerns with the on-site review, the sponsor 584 may request a second site visit with a different team. 585 586 After the on-site review team submits a report of its findings, the sponsor is provided the 587 opportunity to comment in writing and to correct factual errors prior to the JRC-DMS 588 forwarding a recommendation to CAAHEP. 589

590 3. Administrative Requirements for Maintaining Accreditation 591

a. The program must inform the JRC-DMS and CAAHEP within a reasonable period 592 of time (as defined by the JRC-DMS and CAAHEP policies) of changes in chief 593 executive officer, dean of health professions or equivalent position, and required 594 program personnel (Refer to Standard III.B.). 595

596

http://www.caahep.org/


b. The sponsor must inform CAAHEP and the JRC-DMS of its intent to transfer 597 program sponsorship. To begin the process for a Transfer of Sponsorship, the 598 current sponsor must submit a letter (signed by the CEO or designated individual) 599 to CAAHEP and the JRC-DMS that it is relinquishing its sponsorship of the 600 program. Additionally, the new sponsor must submit a “Request for Transfer of 601 Sponsorship Services” form. The JRC-DMS has the discretion of requesting a 602 new self-study report with or without an on-site review. Applying for a transfer of 603 sponsorship does not guarantee that the transfer of accreditation will be granted. 604

605 c. The sponsor must promptly inform CAAHEP and the JRC-DMS of any adverse 606

decision affecting its accreditation by recognized institutional accrediting agencies 607 and/or state agencies (or their equivalent). 608

609 d. Comprehensive reviews are scheduled by the JRC-DMS in accordance with its 610

policies and procedures. The time between comprehensive reviews is determined 611 by the JRC-DMS and based on the program’s on-going compliance with the 612 Standards, however, all programs must undergo a comprehensive review at least 613 once every ten years. 614

615 e. The program and the sponsor must pay JRC-DMS and CAAHEP fees within a 616

reasonable period of time, as determined by the JRC-DMS and CAAHEP 617 respectively. 618

619 f. The sponsor must file all reports in a timely manner (self-study report, progress 620

reports, annual reports, etc.) in accordance with JRC-DMS policy. 621 622 g. The sponsor must agree to a reasonable on-site review date that provides 623

sufficient time for CAAHEP to act on a JRC-DMS accreditation recommendation 624 prior to the “next comprehensive review” period, which was designated by 625 CAAHEP at the time of its last accreditation action, or a reasonable date 626 otherwise designated by the JRC-DMS. 627

628 Failure to meet any of the aforementioned administrative requirements may lead to 629 administrative probation and ultimately to the withdrawal of accreditation. CAAHEP will 630 immediately rescind administrative probation once all administrative deficiencies have been 631 rectified. 632

633 4. Voluntary Withdrawal of a CAAHEP- Accredited Program 634 635 Voluntary withdrawal of accreditation from CAAHEP may be requested at any time by the 636 Chief Executive Officer or an officially designated representative of the sponsor writing to 637 CAAHEP indicating: the desired effective date of the voluntary withdrawal, and the location 638 where all records will be kept for students who have completed the program. 639

640 5. Requesting Inactive Status of a CAAHEP- Accredited Program 641 642 Inactive status may be requested from CAAHEP at any time by the Chief Executive Officer or 643 an officially designated representative of the sponsor writing to CAAHEP indicating the 644 desired date to become inactive. No students can be enrolled or matriculated in the program 645 at any time during the time period in which the program is on inactive status. The maximum 646 period for inactive status is two years. The sponsor must continue to pay all required fees to 647 the JRC-DMS and CAAHEP to maintain its accreditation status. 648 649 To reactivate the program, the Chief Executive Officer or an officially designated 650 representative of the sponsor must notify CAAHEP of its intent to do so in writing to both 651 CAAHEP and the JRC-DMS. The sponsor will be notified by the JRC-DMS of additional 652 requirements, if any, that must be met to restore active status. 653 If the sponsor has not notified CAAHEP of its intent to re-activate a program by the end of the 654 two-year period, CAAHEP will consider this a “Voluntary Withdrawal of Accreditation.” 655


B. CAAHEP and Committee on Accreditation Responsibilities – Accreditation 656 Recommendation Process 657 658

1. After a program has had the opportunity to comment in writing and to correct factual errors 659 on the on-site review report, the JRC-DMS forwards a status of public recognition 660 recommendation to the CAAHEP Board of Directors. The recommendation may be for any of 661 the following statuses: initial accreditation, continuing accreditation, transfer of sponsorship, 662 probationary accreditation, withhold accreditation, or withdraw accreditation. 663

664 The decision of the CAAHEP Board of Directors is provided in writing to the sponsor 665 immediately following the CAAHEP meeting at which the program was reviewed and voted 666 upon. 667

668 2. Before the JRC-DMS forwards a recommendation to CAAHEP that a program be placed 669 on probationary accreditation, the sponsor must have the opportunity to request 670 reconsideration of that recommendation or to request voluntary withdrawal of accreditation. 671 The JRC-DMS reconsideration of a recommendation for probationary accreditation must be 672 based on conditions existing both when the committee arrived at its recommendation as well 673 as on subsequent documented evidence of corrected deficiencies provided by the sponsor. 674

675 The CAAHEP Board of Directors’ decision to confer probationary accreditation is not subject 676 to appeal. 677

678 3. Before the JRC-DMS forwards a recommendation to CAAHEP that a program’s 679 accreditation be withdrawn or that accreditation be withheld, the sponsor must have the 680 opportunity to request reconsideration of the recommendation, or to request voluntary 681 withdrawal of accreditation or withdrawal of the accreditation application, whichever is 682 applicable. The JRC-DMS reconsideration of a recommendation of withdraw or withhold 683 accreditation must be based on conditions existing both when the JRC-DMS arrived at its 684 recommendation as well as on subsequent documented evidence of corrected deficiencies 685 provided by the sponsor. 686 687

The CAAHEP Board of Directors’ decision to withdraw or withhold accreditation may be 688 appealed. A copy of the CAAHEP “Appeal of Adverse Accreditation Actions” is enclosed with 689 the CAAHEP letter notifying the sponsor of either of these actions. 690

691 At the completion of due process, when accreditation is withheld or withdrawn, the sponsor’s 692 Chief Executive Officer is provided with a statement of each deficiency. Programs are eligible 693 to re-apply for accreditation once the sponsor believes that the program is in compliance with 694 the accreditation Standards. 695

696 Any student who completes a program that was accredited by CAAHEP at any time during 697 his/her matriculation is deemed by CAAHEP to be a graduate of a CAAHEP-accredited 698 program. 699


Appendix B Part I 700 Common Core Curriculum 701

702 Learning Competencies Common to Each Concentration 703

704 Demonstrate knowledge and application of ergonomic techniques. 705

Industry standards and OSHA guidelines 706 Types of work related musculoskeletal injuries (MSI) 707 Best practices for prevention 708 Personal fitness 709

o Daily exercises in the workplace 710 o Supports, tools, and devices 711 o Patient positioning 712 o Equipment and accessories (machine, tables, chairs, monitor) 713 o Transducer 714 o Workstation/work area(s) 715 o Lighting 716 o Workload 717

Role of Administration in prevention of MSI 718 Role of Sonographer in prevention of MSI 719

720 Demonstrate knowledge and application of types and methods of infection control. 721

Personal and patient 722 o Standard precautions 723 o Isolation procedures 724 o Aseptic and sterile technique 725

Environment 726 o Equipment 727 o Transducer cleaning and disinfection 728 o Accessories 729

730 Demonstrate knowledge and application of patient care. 731

Compliance with program and clinical education facility policies and procedures 732 Patient Bill of Rights 733 Patient directives 734 Anticipate and be able to respond to the needs of the patient: 735

o Demonstrate age related and cultural competency 736 o Demonstrate appropriate care in clinical environments outside of the sonography lab 737

Transport and transfer of patients 738 Special considerations 739

o Oxygen 740 o Intravenous lines/pumps 741 o Urinary catheters 742 o Drainage tubes 743 o Evaluation of patient 744

Vital signs 745 Color 746 Skin integrity 747 Clinical history 748 Proper patient positioning and draping 749 Comfort 750 Privacy 751 Protocols for IV insertion and injection with use of contrast enhanced imaging 752 Basic pharmacology as related to the concentration 753 Contrast media 754 Life-threatening situations and implement emergency care as permitted by employer 755

procedure, including the following: 756 o Pertinent patient care procedures 757


o Principles of psychological support 758 o Emergency conditions and procedures 759 o First aid and resuscitation techniques 760

Reporting and documentation of incidents and/or adverse reactions 761 762 Demonstrate comprehension and application of medical ethics and law. 763

Patient's right to privacy based on applicable legal and regulatory standards 764 HIPAA 765 Electronic documentation and transmission 766 Terminology related to ethics, values, and morals 767 Types of law 768 Risk management 769 Medical malpractice liability coverage 770 Informed consent 771 Documentation of clinical incidents 772 Professional scope of practice and clinical standards 773 Professional code of ethics 774

775 Demonstrate comprehension and application of medical and sonographic terminology. 776

Definitions, abbreviations, symbols, terms, and phrases 777 Correlating diagnostic and imaging procedures 778 Sonographic appearances 779 780

Obtain, interpret, document, and communicate relevant information related to sonographic 781 examinations. 782

Clinical information and historical facts from the patient and the medical records, which may 783 impact the diagnostic examination. 784

o Clinical signs and symptoms 785 o Laboratory tests 786 o Imaging and diagnostic procedures 787 o Oral and/or written summary of sonographic findings. 788

Deviation from practice parameters for the sonographic examination as required by patient 789 history or initial findings 790

Interval changes from a previous examination 791 Examination findings that require immediate clinical response and notify the interpreting 792

physician. 793 794

Demonstrate awareness of roles and responsibilities of healthcare professions to effectively 795 communicate and collaborate in the healthcare environment. 796

Team development 797 Conflict resolution 798 Interprofessional communication and education 799

800 Identify and evaluate anatomic structures. 801

Sectional anatomy 802 Relational anatomy 803 Normal sonographic appearances of tissue, muscles and skeletal structures 804 Differentiation of normal from abnormal sonographic findings 805

806 Demonstrate knowledge of clinical disease processes with application to sonographic and 807 Doppler patterns. 808

Iatrogenic 809 Degenerative 810 Inflammatory 811 Traumatic 812 Neoplastic 813 Infectious 814


Obstructive 815 Congenital 816 Metabolic 817 Immunologic 818

819 Demonstrate knowledge, comprehension, and application of image production and 820 optimization. 821

Sound production and propagation 822 Interaction of sound and matter 823 Instrument options and transducer selection 824 Principles of ultrasound instruments and modes of operation 825 Operator control options 826 Physics of Doppler 827 Principles of Doppler techniques 828 Methods of Doppler flow analysis 829 Hemodynamics of blood flow 830 Contrast enhanced imaging 831 Acoustic artifacts 832 Emerging technologies (3-D, elastography, strain) 833 Image storage devices 834

835 Demonstrate knowledge, comprehension, and application of biological effects. 836

In-vitro and in-vivo ultrasound effects 837 Exposure/equipment display indices 838 Generally accepted maximum safe exposure levels 839 ALARA principle 840

o Mechanisms that affect the mechanical and thermal indices 841 o Techniques to decrease the mechanical and thermal indices 842

843 Demonstrate knowledge of the components required for implementing a quality control and 844 improvement program. 845 Lab accreditation 846 Credentialing organizations 847 Equipment operation and maintenance 848

o Phantom testing 849 o Records maintenance 850

851 Demonstrate awareness of resources for professional development. 852

Professional organizations and resources 853 Professional journals and on-line resources 854 Continuing education conferences 855 Clinical conferences, lectures, and in-house educational offerings 856 Recent developments in sonography 857 Research statistics and design 858

859 Demonstrate performance through clinical competencies 860

Use of proper ergonomics 861 Safety and infection control 862 Obtain and apply clinical history 863 Oral and written communication 864 Image optimization techniques 865 ALARA 866 Professionalism 867 Document sonographic findings for communication with interpreting physician 868 Finalize examination for permanent storage 869 Process for reporting of critical findings 870

871


The above competency skills can be embedded within the specific scanning competencies. 872


Appendix B, Part II 873 Adult Cardiac Concentration Curriculum 874

875 Identify anatomy, anatomic variants, and sonographic appearances of normal cardiac 876 structures. 877

Embryology and fetal cardiac development 878 Cardiac chambers and septation 879 Coronary artery anatomy and distribution 880 Pulmonary artery and venous return 881 Relationships of cardiac chambers and great vessels 882 Valve anatomy and function 883

884 Demonstrate knowledge of normal and cardiovascular physiology and hemodynamics. 885

Ventricular function, including influence of loading conditions and measurement of cardiac 886 output 887

Electrophysiology and exercise physiology 888 889 Demonstrate knowledge of mechanisms of disease, cardiovascular pathophysiology, and 890 hemodynamics, sonographic technique, measurements, quantitative principles, and Doppler 891 patterns in both the normal heart and with cardiac disease. 892

Valvular heart disease 893 Prosthetic heart valves 894 Ventricular dysfunction 895 Ischemic cardiac disease 896 Cardiomyopathy 897 Pericardial disease 898 Congenital heart disease 899 Cardiac endocarditis, neoplasms and masses 900 Cardiac trauma 901 Pulmonary vascular disease 902 Diseases of the aorta and great vessels 903 Cardiac assist devices 904 Heart transplant 905 Intracardiac shunt 906 Intracardiac pressures 907 Systemic diseases 908 Systemic and pulmonary hypertension 909 Common arrhythmias and conduction abnormalities 910

911 Demonstrate knowledge and applications of the indications, utility, limitations, and technical 912 procedures for related echocardiographic studies. 913

Transthoracic echocardiography 914 Stress echocardiography 915 Transesophageal echocardiography 916 Intraoperative echocardiography 917 Enhanced cardiac ultrasound (transpulmonary agents, agitated saline, contrast media) 918 IV administration techniques 919 Three-dimensional echocardiography 920 Echo-guided procedures 921 Strain echocardiography 922 Speckle tracking 923 Cardiac ultrasound respirogram 924 Pharmacology 925

926


Demonstrate knowledge, application, and proficiency in the use of quantitation principles 927 applied to echocardiographic images and flow data. 928

Standard M-mode, two-dimensional, and Doppler measurements and calculations 929 Knowledge and understanding of normal and abnormal values for M-mode, two-dimensional 930

and Doppler echocardiography 931 Evaluation of normal and abnormal systolic and diastolic ventricular function 932 Evaluation of the severity of valve stenosis and regurgitation 933 Evaluation of normal and abnormal prosthetic valves, assist devices and interventional 934

procedures 935 936 Awareness of scanning protocol and modification(s) based on the sonographic findings and 937 the differential diagnoses. 938

Indications and contraindications 939 History and physical examination 940 Related imaging, laboratory, and functional testing procedures 941

o Chest X-ray 942 o Angiography and cardiac catheterization 943 o Electrocardiography, electrophysiologic studies, Holter monitoring 944 o Stress testing 945 o Radionuclide studies 946 o Tomographic imaging procedures (CT, MRI) 947 o Adult interventions (for intracardiac shunt, valvular heart disease, assist devices, 948

aortic disease) 949 Clinical differential diagnosis 950 Role of ultrasound in patient management 951 Effects of pharmacotherapy on echocardiographic findings 952

953 Demonstrate performance of clinical competencies 954 955

Demonstrate clinical competency through performance of adult cardiac sonography, 956 according to practice parameters established by national professional organizations and the 957 protocol of the clinical affiliate/clinical education centers. 958 959 Clinical competencies must include evaluation and documentation of: 960

Identification of anatomical and relational structures 961 Differentiation of normal from pathological/disease process 962 Image optimization and measurement techniques with: 963

o 2D imaging 964 o M-mode 965 o Spectral Doppler: PW, CW and Tissue Doppler 966 o Color flow Doppler 967 o Use of non-imaging CW Doppler transducer 968

Adult cardiac sonography competencies 969 o Complete transthoracic echocardiogram – Normal 970 o Complete transthoracic echocardiogram – Systolic dysfunction 971 o Complete transthoracic echocardiogram – Diastolic dysfunction 972 o Complete transthoracic echocardiogram – Aortic valve and aortic root pathology 973 o Complete transthoracic echocardiogram – Mitral valve pathology 974 o Complete transthoracic echocardiogram – Right heart pathology 975 o Complete transthoracic echocardiogram – Cardiomyopathy 976 o Complete transthoracic echocardiogram – Pericardial pathology 977 o Complete transthoracic echocardiogram – Prosthetic valve (normal and abnormal) 978 o Complete transthoracic echocardiogram – Coronary artery disease (acute coronary 979

artery disease and chronic coronary artery disease) 980 o Complete transthoracic echocardiogram – Enhanced echocardiography (agitated 981

saline, contrast agents) 982 o Complete transthoracic echocardiogram – Cardioembolic source evaluation (normal 983

and abnormal) 984


o Transesophageal echocardiography – Instrumentation of equipment (assist) 985 986 The above list can be completed as individual clinical competencies or can be incorporated with other 987 organs as part of a limited or complete examination. 988 989 Demonstrate proficiency in technique and application of: 990

(The following examinations or principles can be demonstrated in a clinical setting or in a simulated 991 environment.) 992

Quantitative principles applied to echocardiographic images and flow data 993 Stress echocardiography – exercise (treadmill and/or bicycle stress). 994 Stress echocardiography – pharmacologic 995


Appendix B, Part III 996 Pediatric Cardiac Concentration Curriculum 997 998

Identify anatomy, anatomic variants, and sonographic appearances of normal and abnormal 999 cardiac structures (adult, pediatric, and fetal). 1000

Embryology and fetal cardiac development 1001 Cardiac chambers and septation 1002 Valve anatomy and dynamics 1003 Coronary artery anatomy 1004 Relationships of cardiac chambers and great vessels 1005 Mediastinal structures 1006 Arch anatomy 1007 Pulmonary artery and venous anatomy 1008 Systemic venous return 1009

1010 Demonstrate knowledge of normal cardiovascular physiology and hemodynamics. 1011

Electrophysiology 1012 Fetal circulation 1013 Transitional physiology 1014 Ventricular function (systolic and diastolic) 1015 Pulmonary and systemic circulation 1016 Exercise physiology 1017

1018 Demonstrate knowledge of cardiovascular pathophysiology (embryology of congenital 1019 abnormalities, mechanisms of acquired disease), and hemodynamics, sonographic technique, 1020 measurements, quantitative principles, and Doppler patterns in both the normal heart and with 1021 cardiac disease. 1022

Congenital heart disease (CHD) 1023 o Situs abnormalities 1024 o Defects in cardiac septation 1025 o Abnormalities in atrial-ventricular connections 1026 o Ventricular hypoplasia 1027 o Ventricular Inflow anomalies 1028 o Abnormalities in ventriculoarterial connection 1029 o Ventricular outflow anomalies 1030 o Abnormalities within cardiac chambers 1031 o Vascular abnormalities (arterial and venous) 1032 o Abnormalities within thorax 1033 o Abnormal vascular (arterial and venous) connections 1034 o Postoperative repair/treatment 1035 o Diseases of the aorta and great vessels 1036 o Valvular abnormalities 1037 o Pericardial abnormalities 1038 1039

Acquired heart disease 1040 o Valvular heart disease 1041 o Ischemic cardiac disease 1042 o Cardiomyopathy 1043 o Pericardial disease 1044 o Cardiac endocarditis, neoplasms and masses 1045 o Cardiac trauma 1046 o Pulmonary vascular disease 1047 o Systemic and pulmonary hypertension 1048 o Infection of native structures and devices 1049

1050


Demonstrate knowledge and applications of the indications, utility, limitations, and technical 1051 procedures for related echocardiographic studies. 1052

Stress echocardiography 1053 Transesophageal echocardiography 1054 Intraoperative echocardiography 1055 Enhanced cardiac ultrasound (agitated saline) 1056 IV administration techniques 1057 Three-dimensional echocardiography 1058 Echo-guided procedures 1059 Strain echocardiography 1060 Targeted obstetric exam 1061

1062 Demonstrate knowledge, application, and proficiency in the use of quantitation principles 1063 applied to echocardiographic images and flow data. 1064

Standard M-mode, two-dimensional, and Doppler measurements and calculations 1065 (normalized based on body surface area, and/or other biometric measurements for the fetus) 1066

Knowledge and understanding of normal and abnormal values for M-mode, two-dimensional 1067 and Doppler echocardiography 1068

Evaluation of normal and abnormal systolic and diastolic ventricular function 1069 Evaluation of the severity of valve stenosis and regurgitation 1070 Knowledge of normal and abnormal sonographic appearances of peripheral vascular 1071

anatomy (i.e., branches of pulmonary artery, branches of aortic arch) 1072 Calculation of Qp:Qs ratio 1073 Miscellaneous measurements specific to patient history 1074

1075 Demonstrate knowledge and application of clinical cardiology as appropriate to the fetus and 1076 patients with congenital heart disease (CHD). 1077

Relationship of echocardiography to history and physical examination (including indications 1078 for echocardiography) - diagnostic approach to CHD 1079

Acquired heart disease and noncardiac disease and effects of systemic diseases on 1080 cardiovascular anatomy and physiology 1081

Differential diagnosis as it relates to the echocardiographic examination 1082 Cardiac arrhythmias 1083 Genetic syndromes and chromosomal anomalies associated with CHD 1084 Cardiovascular surgery and interventional cardiology 1085 Post-operative repair evaluation 1086 Current and future approaches to caring for the fetus, pediatric and adult patient with CHD 1087

1088 Awareness of scanning protocol and modification(s) based on the sonographic findings and 1089 the differential diagnoses. 1090

Indications and contraindications 1091 History and physical examination 1092 Related imaging, laboratory, and functional testing procedures 1093

o Chest X-ray 1094 o Angiography and cardiac catheterization 1095 o Electrocardiography, electrophysiologic studies, Holter monitoring 1096 o Stress testing 1097 o Radionuclide studies 1098 o Tomographic imaging procedures (CT, MRI) 1099 o Fetal /Pediatric/Adult interventions for congenital heart disease 1100

● Clinical differential diagnosis 1101 ● Role of ultrasound in patient management 1102 ● Pharmacology 1103

1104


Demonstrate performance of clinical competencies 1105 1106 Demonstrate clinical competency through performance of pediatric cardiac sonography 1107 according to practice parameters established by national professional organizations and the 1108 protocol of the clinical affiliate/clinical education centers. 1109 1110 Clinical competencies must include evaluation and documentation of: 1111

Identification of anatomical and relational structures 1112 Differentiation of normal from pathological/disease process 1113 Image optimization and measurement techniques with: 1114

o 2D imaging 1115 o M-mode 1116 o Spectral Doppler: PW, CW and Tissue Doppler 1117 o Color flow Doppler 1118 o Use of non-imaging CW Doppler transducer 1119

Pediatric cardiac sonography competencies 1120 o Complete transthoracic pediatric echocardiography examinations - Normal 1121 o Complete transthoracic pediatric echocardiography examinations - Abnormal 1122 o Complete transthoracic echocardiogram – Patent foramen ovale and atrial septal 1123

defect 1124 o Complete transthoracic echocardiogram – Ventricular septal defect 1125 o Complete transthoracic echocardiogram – Patent ductus arteriosus 1126 o Complete transthoracic echocardiogram – Detailed coronary artery origins 1127

(anomalous or normal) 1128 o Complete transthoracic echocardiogram – Conotruncal defect 1129 o Complete transthoracic echocardiogram – Left heart structural heart disease 1130 o Complete transthoracic echocardiogram – Right heart structural heart disease 1131 o Complete transthoracic echocardiogram – Valvular disease 1132 o Complete transthoracic echocardiogram – Cardiomyopathy 1133 o Complete transthoracic echocardiogram – Pericardial disease 1134 o Complete transthoracic echocardiogram – Repaired structural heart disease 1135 o Transesophageal echocardiography – Instrumentation of equipment (assist) 1136 o Fetal echocardiogram assessment – Situs 1137 o Fetal echocardiogram assessment – Four chamber view 1138 o Fetal echocardiogram assessment – Three vessel view 1139 o Fetal echocardiogram assessment – Ductal and Aortic Arch 1140

1141 The above list can be completed as individual clinical competencies or can be incorporated with other 1142 organs as part of a limited or complete examination. 1143 1144 Demonstrate proficiency in the technique and application of: 1145

(The following examinations or principles can be demonstrated in a clinical setting or in a simulated 1146 environment.) 1147

Quantitation principles applied to echocardiographic images and flow data 1148 Calculation of Qp:Qs ratio 1149


Appendix B, Part IV 1150 Abdominal Learning Concentration Curriculum 1151

1152

Identify anatomy, relational anatomy, anatomic variants, and sonographic appearances of 1153 normal anatomical structures. 1154

● Abdominal wall 1155 ● Adrenal glands 1156 ● Aorta and branches 1157 ● Biliary system 1158 ● Gastrointestinal tract 1159 ● Great vessels and branches 1160 ● Liver 1161 ● Lung/pleura 1162 ● Lymphatic system 1163 ● Pancreas 1164 ● Peritoneal and retroperitoneal cavities 1165 ● Spleen 1166 ● Urinary tract 1167 ● Extremity (e.g.: popliteal fossa) 1168 ● Neck (thyroid, parathyroid, salivary, lymph nodes, masses) 1169 ● Penis 1170 ● Prostate 1171 ● Scrotum 1172 ● Soft-tissue 1173

1174

Demonstrate knowledge of the physiology, pathophysiology, sonographic technique, 1175 measurements, sonographic appearances, and Doppler patterns in both normal and abnormal 1176 structures. 1177

● Abdominal wall (hernia) 1178 ● Adrenal glands 1179 ● Aorta and branches 1180 ● Biliary system 1181 ● Gastrointestinal tract (e.g.: appendix, bowel, bowel wall, intussusception, pyloric stenosis) 1182 ● Great vessels and branches 1183 ● Liver 1184 ● Lung/pleura (e.g.: thoracentesis, effusion, empyema) 1185 ● Lymphatic system 1186 ● Organ transplant 1187 ● Pancreas 1188 ● Peritoneal and retroperitoneal cavities 1189 ● Spleen 1190 ● Urinary tract 1191 ● Extremity (e.g.: Baker’s cyst, foreign body) 1192 ● Neck (thyroid, parathyroid, salivary, lymph nodes, masses) 1193 ● Penis 1194 ● Prostate 1195 ● Scrotum 1196 ● Soft-tissue (e.g.: foreign body, lipoma, edema, hematoma) 1197

1198

Demonstrate knowledge in sonographic guided procedures. 1199 ● Role of sonographer 1200 ● Clinical information (e.g.: imaging, lab values) 1201 ● Informed consent 1202 ● Procedural time out 1203 ● Transducer guidance 1204 ● Sterile set up 1205 ● Pre and post procedural documentation 1206

1207


Evaluate scanning protocol and modification(s) based on the sonographic findings and the 1208 differential diagnoses. 1209

Indications and contraindications 1210 History and physical examination 1211 Related imaging, laboratory, and functional testing procedures 1212 Clinical differential diagnosis 1213 Contrast enhanced imaging 1214 Role of ultrasound in patient management 1215

1216 Demonstrate performance of clinical competencies 1217 1218 Demonstrate clinical competency through performance of sonographic examinations of the 1219 abdomen and superficial structures, according to practice parameters established by national 1220 professional organizations and the protocol of the clinical affiliate/clinical education centers. 1221 1222 Clinical competencies must include evaluation and documentation of: 1223

Identification of anatomical and relational structures 1224 Differentiation of normal from pathological/disease process 1225 Image optimization techniques in gray scale 1226 Image optimization techniques in Doppler (where applicable) 1227 Measurement techniques 1228 Abdominal and superficial competencies 1229

o Aorta/IVC 1230 o Biliary system 1231 o Liver 1232 o Pancreas 1233 o Spleen 1234 o Kidneys 1235 o Bladder 1236 o Pleural space 1237 o Sonographic guided procedure (assistance) 1238 o Thyroid 1239 o Scrotum 1240

1241 The above list can be completed as individual clinical competencies or can be incorporated with other 1242 structures/techniques as part of a limited or complete examination. 1243 1244 Demonstrate proficiency in the technique and application of: 1245

(The following examinations can be demonstrated in a clinical setting or in a simulated environment.) 1246

Doppler abdominal vasculature 1247 Gastrointestinal tract (e.g.: appendix, bowel, pylorus, stomach) 1248


Appendix B, Part V 1249 Breast Learning Concentration Curriculum 1250 1251 Identify anatomy, congenital and developmental variants, and sonographic appearances of 1252 normal breast structures. 1253

Areolar complex/nipple 1254 Fibrous planes 1255

o Skin 1256 o Subcutaneous fat 1257 o Mammary zone 1258 o Retromammary space 1259 o Muscle layers 1260 o Rib cage and intercostal muscles 1261

Cooper’s ligaments 1262 Ductal system 1263 Vasculature 1264

o Arterial 1265 o Venous 1266

Lymph nodes 1267 Amastia 1268 Amazia 1269 Athelia 1270 Polymastia 1271 Polythelia 1272 Nipple inversion/flattening 1273 Early ripening 1274 Age-related sonographic changes of breast tissue and its components 1275

1276 Demonstrate knowledge of the physiology and pathophysiology in both normal and abnormal 1277 breast structures. 1278

● Embryologic development 1279 ● Normal blood flow patterns within the breast and its components 1280 ● Lymphatic drainage 1281 ● Age-related development of the breast to involution 1282 ● Male breast 1283 ● Effect of pregnancy 1284 ● Lactation 1285 ● Infectious processes 1286 ● Neoplasms 1287

o Cystic 1288 o Benign 1289 o Malignant 1290

● Trauma 1291 1292

Demonstrate knowledge of the sonographic technique, measurements, sonographic 1293 appearances, integration of data, and Doppler patterns in both normal and abnormal breast 1294 structures. 1295

● Scan planes (longitudinal/transverse, radial/antiradial) 1296 ● Scan techniques (palpation, standoff pad, fremitus) 1297 ● Patient position (supine, oblique, upright) 1298 ● Imaging techniques (quadrants, clock face) 1299 ● Image labeling/distance from nipple 1300 ● Image optimization 1301 ● Artifacts 1302 ● Implants 1303 ● Lymph node assessment 1304 ● Postoperative biopsy site 1305 ● BI-RADS assessment categories 1306


● Correlation of other imaging modalities (mammogram, MRI) 1307 ● Spectral Doppler of the vasculature related to a mass 1308 ● Color Doppler of a mass/lesion 1309 ● Power Doppler of a mass/lesion 1310

1311 Demonstrate knowledge in interventional and intraoperative procedures. 1312

● Role of sonographer in ultrasound guided procedures and sentinel lymph node biopsy 1313 ● Clinical information (Ex: imaging, lab values) 1314 ● Informed consent 1315 ● Procedural time out 1316 ● Transducer guidance 1317 ● Sterile set up 1318 ● Pre and post procedural documentation 1319 ● Sonography assisted procedures 1320

1321 Evaluate scanning protocol and modification(s) based on the sonographic findings and the 1322 differential diagnoses. 1323

● Indications and contraindications 1324 ● History and physical examination 1325 ● Related imaging, laboratory, and functional testing procedures 1326

o Correlation with mammography 1327 o BIRADS 1328 o Correlation with MRI 1329 o Correlation with Nuclear Medicine 1330

● Clinical differential diagnosis 1331 ● Role of sonography in patient management 1332 ● Elastography 1333 ● 3-D/4-D 1334

1335 Demonstrate knowledge of treatment options. 1336

Medical 1337 Surgical 1338 Brachytherapy 1339

1340 Demonstrate performance of clinical competencies 1341 1342 Demonstrate clinical competency through performance of sonographic examinations of the 1343 breast, according to practice parameters established by national professional organizations 1344 and the protocol of the clinical affiliate/clinical education centers. 1345 1346 Clinical competencies must include evaluation and documentation of: 1347

Identification of anatomical and relational structures 1348 Differentiation of normal from pathological/disease process 1349 Image optimization techniques in gray scale 1350 Image optimization techniques in Doppler (where applicable) 1351 Measurement techniques (where applicable) 1352 Breast competencies 1353

o Breast - complete 1354 o Breast - targeted 1355 o Breast with lymph node evaluation 1356 o Breast with cystic lesion 1357 o Breast with solid lesion 1358 o Breast with intravascular lesion (Doppler evaluation) 1359 o Breast with implant 1360 o Breast interventional procedure – FNA 1361 o Breast interventional procedure – core biopsy 1362 o Breast interventional procedure – needle localization 1363 o Breast elastogram 1364


1365 The above list can be completed as individual clinical competencies or can be incorporated with other 1366 structures/techniques as part of a limited or complete examination. 1367


Appendix B, Part VI 1368 Musculoskeletal Learning Concentration Curriculum 1369 1370 Define and describe sonographic characteristics of the components of the musculoskeletal 1371 system. 1372

Bursae 1373 Cartilage 1374 Fascia 1375 Fat pads 1376 Ligaments 1377 Muscles 1378 Retinaculum 1379 Tendons 1380 Nerves 1381 Lymph nodes 1382 Types of joints 1383

1384 Demonstrate knowledge of the anisotropic effect and the ability to distinguish this artifact 1385 from normal variants and pathology. 1386 1387 Identify anatomical structures, nerves and vascular supply, normal sonographic appearances, 1388 normal Doppler patterns, measurements (and contralateral comparison when applicable), and 1389 changes with dynamic assessment. 1390

Abdominal wall 1391 Shoulder 1392 Upper arm 1393 Elbow 1394 Forearm 1395 Wrist 1396 Hands 1397 Fingers 1398 Hip (to include groin and pelvis) 1399 Upper leg (Thigh) 1400 Knee 1401 Lower leg (Calf) 1402 Ankle 1403 Foot 1404 Toes 1405

1406 Demonstrate knowledge of the physiology, pathophysiology, sonographic technique, 1407 measurements, sonographic appearances, and Doppler patterns in musculoskeletal injuries 1408 and disease processes. 1409

Abdominal wall 1410 Shoulder 1411 Upper arm 1412 Elbow 1413 Forearm 1414 Wrist 1415 Hands 1416 Fingers 1417 Hip (to include groin and pelvis) 1418 Upper leg (Thigh) 1419 Knee 1420 Lower leg (Calf) 1421 Ankle 1422 Foot 1423


Toes 1424 1425 Identify sonographic and Doppler patterns in clinical diseases, injury, and post-surgical 1426 changes that may occur in the following categories. 1427

Bone pathology (fractures and erosions) 1428 Cartilage 1429 Crystal deposits 1430 Cystic structures 1431 Fluid collections 1432 Foreign bodies 1433 Hernias 1434 Infections 1435 Joint effusions 1436 Joint laxity/altered function 1437 Ligament pathology and tears 1438 Masses/neoplastic processes 1439 Muscle pathology and tears 1440 Neuromas 1441 Nerve pathology and entrapment 1442 Soft tissue pathology 1443 Subcutaneous abnormalities 1444 Synovitis 1445 Synovial proliferation 1446 Tendon pathology, tears, and calcifications 1447 Vascular malformations 1448

1449 Demonstrate knowledge in sonographic guided procedures 1450

Role of sonographer 1451 Clinical information (Ex: imaging, lab values) 1452 Informed consent 1453 Procedural time out 1454 Transducer guidance 1455 Sterile set up 1456 Pre and post procedural documentation 1457 Procedures (therapeutic and/or diagnostic) 1458

o Ablation 1459 o Aspiration 1460 o Platelet-Rich Plasma (PRP) Injection 1461 o Dry needling 1462 o Biopsy 1463 o Nerve mapping 1464 o Nerve block 1465 o Surgical planning 1466

1467 Evaluate scanning protocol and modification(s) based on the sonographic findings and the 1468 differential diagnoses 1469

Indications and contraindications 1470 History and physical examination 1471 Related imaging, laboratory, and functional testing procedures 1472 Clinical differential diagnosis 1473 Role of ultrasound in patient management 1474

1475 Demonstrate performance of clinical competencies 1476 1477


Demonstrate clinical competency through performance of sonographic examinations of the 1478 musculoskeletal system, according to practice parameters established by national 1479 professional organizations and the protocol of the clinical affiliate/clinical education centers. 1480 1481 Clinical competencies must include evaluation and documentation of: 1482

Identification of anatomical and relational structures 1483 Differentiation of normal from pathological/disease process 1484 Image optimization techniques in gray scale 1485 Image optimization techniques in Doppler (where applicable) 1486 Dynamic or provocative maneuvers 1487 Musculoskeletal competencies 1488

o Abdominal wall 1489 Valsalva maneuver to assess for ventral hernia 1490

o Shoulder 1491 Biceps subluxation – Rotate arm in external and internal rotation 1492 Supraspinatus impingement – Arm abduction 1493 Acromioclavicular joint – Cross-arm maneuver 1494 Posterior labrum – Rotate arm in external and internal rotation 1495

o Elbow 1496 Ulnar nerve subluxation (posterior and medial evaluation)—Flexion and 1497

extension 1498 Ulnotrochlear joint--Valgus stress 1499

o Radiocapitellar joint-- Varus stress Wrist 1500 Extensor carpi ulnaris (ECU) subluxation – Pronation to supination 1501

o Hands & Fingers 1502 Trigger finger—Flexion & extension 1503 Stenner lesion—Valgus stress of ulnar collateral ligament 1504

o Hip (to include groin and pelvis) 1505 Valsalva maneuver when to assess for inguinal or femoral hernia 1506 Iliopsoas snapping—hip flexion with external rotation and abduction (frog-leg 1507

position) followed by hip extension and internal rotation 1508 Iliotibial band snapping—hip flexion and extension or symptom driven 1509

dynamic maneuver 1510 o Knee 1511

Anterior – Flexion and extension to evaluate the patellar tendon 1512 Lateral – Lateral compartment joint space (varus stress) 1513 Ankle 1514 Lateral – Peroneal tendon subluxation evaluation during eversion 1515

circumduction 1516 Medial – Dorsiflexion and inversion to check for tibialis posterior tendon 1517

instability 1518 Posterior – Dorsiflexion/plantar flexion to evaluate the Achilles tendon 1519

o Foot 1520 Dorsiflex the 2-4 metatarsophalageal joint (MTP) to evaluate tendon 1521

movement, integrity of the plantar plate, and for plantar tears 1522 1523 The above list can be completed as individual clinical competencies or can be incorporated with other 1524 structures/techniques as part of a limited or complete examination. 1525


Appendix B, Part VII 1526 Obstetrics and Gynecologic Learning Concentration Curriculum 1527

1528 Identify anatomy, anatomic variants, and sonographic appearances of normal structures of 1529 the female pelvis. 1530

Pelvic muscles 1531 Pelvic vasculature 1532 Peritoneal spaces 1533 Reproductive organs 1534 Suspensory ligaments 1535

1536 Identify anatomy, anatomic variants, and sonographic appearances of normal maternal, 1537 embryonic, and fetal anatomic structures during the first, second, and third trimesters. 1538

1539 1st trimester structures 1540

Gestational sac 1541 Embryonic pole 1542 Yolk sac 1543 Fetal cardiac activity 1544 Uterus 1545 Cervix 1546 Adnexa 1547 Pelvic spaces 1548 Multiple gestations (zygocity, chorionicity, amnionicity) 1549

1550 2nd and 3rd trimester fetal and maternal structures 1551

Intracranial anatomy 1552 Face 1553 Thoracic cavity 1554 Heart 1555 Abdomen 1556 Abdominal wall 1557 Spine 1558 Extremities 1559 Placenta 1560 Umbilical cord 1561 Cervix 1562 Amniotic fluid 1563 Ovaries 1564 Multiple gestations (zygocity, chorionicity, amnionicity) 1565

1566 Demonstrate knowledge of pathology, physiology, pathophysiology, sonographic technique, 1567 measurements, sonographic appearances, and Doppler patterns in gynecologic disease 1568 processes. 1569

Inflammatory processes 1570 Congenital anomalies (e.g., vaginal, Mullerian duct, chromosomal) 1571 Benign uterine/adnexal masses 1572 Malignant uterine/adnexal masses 1573 Contraceptive devices 1574 Infertility procedures 1575 Post-partum 1576

1577 Demonstrate knowledge of pathology, physiology, pathophysiology, sonographic technique, 1578 sonographic appearance, measurements, and Doppler patterns in obstetric abnormalities. 1579

First trimester complications 1580 Congenital anomalies 1581


Genetic syndromes 1582 Growth abnormalities 1583 Multiple gestation complications 1584 Viability 1585 Amniotic fluid 1586 Placenta 1587 Umbilical cord 1588 Fetal monitoring 1589 Effects of maternal conditions 1590

1591 Demonstrate knowledge and understanding of the role of the sonographer in performing 1592 interventional/invasive/advanced procedures. 1593

Infertility procedures 1594 Fetal therapy 1595 Three-dimensional obstetric and gynecologic sonography 1596 Sonohysterography 1597

1598 Evaluate scanning protocol and modification(s) based on the sonographic findings and the 1599 differential diagnoses. 1600

Indications and contraindications 1601 History and physical examination 1602 Related imaging, laboratory, and functional testing procedures 1603 Clinical differential diagnosis 1604 Role of sonography in patient management 1605

1606 Demonstrate performance of clinical competencies 1607 1608 Demonstrate clinical competency through performance of sonographic examinations of the 1609 gravid and non-gravid pelvis with both transabdominal and endocavitary transducers, and 1610 Doppler/M-mode display modes, according to practice parameters established by national 1611 professional organizations and the protocol of the clinical affiliate/clinical education centers. 1612 1613 Clinical competencies must include evaluation and documentation of: 1614

Identification of anatomical and related structures 1615 Differentiation of normal from pathological/disease process 1616 Image optimization techniques in gray scale 1617 Image optimization techniques in Doppler and M-mode (where applicable) 1618 Knowledge of ALARA 1619 Measurements as applicable 1620

1621 GYN competencies: 1622

o Vagina/Cervix/Uterus 1623 o Posterior and anterior cul-de-sac 1624 o Adnexa, including ovaries and fallopian tubes 1625 o Pelvic suspensory structures 1626

Obstetrical competencies: 1627 o 1st trimester obstetric structures: 1628

Gestational sac 1629 Embryonic pole 1630 Yolk sac 1631 Uterus 1632 Cervix 1633 Adnexa 1634 Pelvic spaces 1635 Fetal cardiac activity (m-mode or cineloop) 1636

o 2nd and 3rd trimester fetal structures: 1637 Intracranial anatomy 1638 Face 1639


Thoracic cavity 1640 Heart 1641 Abdomen 1642 Abdominal wall 1643 Spine 1644 Extremities 1645 Placenta 1646 Umbilical cord 1647 Amniotic fluid 1648 Fetal cardiac activity (m-mode or cineloop) 1649 Cervix 1650 Adnexa 1651 Biophysical profile 1652

1653 The above list can be completed as individual clinical competencies or can be incorporated with other 1654 structures/techniques as part of a limited or complete examination. 1655


Appendix B, Part VIII 1656 Vascular Learning Concentration Curriculum 1657 1658 Demonstrate knowledge of anatomy and anatomic variants of the cardiovascular system. 1659

Heart 1660 o Chambers 1661 o Valves 1662 o Vessels 1663

Pulmonary circulation 1664 Vessel structure 1665

o Arteries 1666 o Veins 1667 o Capillaries 1668

Aorta and branches 1669 Cerebrovascular (extra-cranial and intra-cranial) 1670 Hepatoportal venous 1671 Mesenteric arterial system 1672 Peripheral arterial (upper and lower extremities) 1673 Peripheral venous (upper and lower extremities) 1674 Renal vessels 1675 Vena cava and iliac veins 1676

1677 Demonstrate knowledge of normal and abnormal peripheral vascular physiology and 1678 hemodynamics. 1679

Principles of pressure, flow, and resistance 1680 Pulsatile flow 1681 Laminar and non-laminar flow patterns 1682 Poiseuille’s law 1683 Bernoulli’s principle 1684 Reynold’s number 1685 Cardiac influence on flow 1686 Occlusive diseases 1687 Collateral circulation 1688 Exercise and hyperemia 1689 Systemic diseases and other conditions 1690 Venous physiology, valve function, calf pump 1691

1692 Demonstrate knowledge of mechanisms of vascular diseases, vascular pathophysiology, and 1693 hemodynamic effects. 1694

Aneurysm and pseudoaneurysm 1695 Arterial embolism 1696 Arteriovenous fistulae and shunts 1697 Atherosclerosis 1698 Congenital anomalies 1699 Fibromuscular dysplasia 1700 Genetic disorders 1701 Iatrogenic injury 1702 Infection 1703 Intimal hyperplasia 1704 Ischemia 1705 Neoplasia 1706 Organ transplantation 1707 Pharmacologic alterations 1708 Portal hypertension 1709 Systemic hypertension 1710 Trauma 1711 Vascular entrapment and extrinsic compression 1712


Vascular malformations 1713 Vasculitis 1714 Vasospastic disorders 1715 Venous thromboembolism 1716 Venous valvular disorders (venous insufficiency) 1717

1718 Demonstrate knowledge of sonographic appearances, sonographic techniques, 1719 measurements, and Doppler flow characteristics in both normal and abnormal vascular 1720 structures. 1721

Aorta and branches 1722 Cerebrovascular (extra-cranial and intra-cranial) 1723 Hepatoportal venous 1724 Mesenteric arterial system 1725 Peripheral arterial (upper and lower extremities) 1726 Peripheral venous (upper and lower extremities) 1727 Renal vessels 1728 Vena cava and iliac veins 1729

1730 Demonstrate knowledge physiologic vascular testing principles and techniques. 1731

Continuous wave and pulse Doppler 1732 Pressure measurements, including ankle/brachial index 1733 Pneumoplethysmography (pulse volume recording) 1734 Segmental pressure and waveform analysis 1735 Exercise treadmill testing 1736 Photoplethysmography (PPG), arterial and venous 1737 Air plethysmography, venous 1738 Laser Doppler, including skin perfusion pressure measurements 1739

1740 Demonstrate knowledge and application in the use of quantitative principles applied to 1741 vascular testing. 1742

Acceleration time 1743 Ankle/brachial pressure ratios 1744 Aorta/renal ratios 1745 Area and diameter reduction measurements 1746 Digit/brachial indices 1747 Velocity change across stenosis for grading arterial lesions 1748 Pulsatility index 1749 Resistive index 1750 Segmental pressures (including digits) 1751 Velocity ratios 1752 Venous reflex time 1753 Volume flow 1754

1755 Demonstrate knowledge in ultrasound-guided procedures. 1756

Role of sonographer 1757 Clinical information (e.g. prior imaging, indication for procedure, relevant laboratory values) 1758 Informed consent 1759 Procedural time out 1760 Sterile technique 1761 Pre- and post-procedure documentation 1762 Superficial vein ablation 1763 Use of thrombin injection for pseudoaneurysm treatment 1764

1765 Demonstrate knowledge of the role of ultrasound for evaluation of vascular surgical 1766 procedure or interventions, including role in planning, intra-procedural guidance/technical 1767 evaluation, and/or post-procedure assessment. 1768

Angioplasty 1769


Atherectomy 1770 Coil embolization 1771 Dialysis fistula/graft 1772 Embolectomy 1773 Endarterectomy 1774 Endovascular aortic aneurysm repair (EVAR) 1775 Endovenous ablation 1776 Inferior vena cava filter 1777 Patch angioplasty 1778 Stents 1779 Synthetic grafts 1780 Thrombolysis and thrombectomy 1781 Trans-jugular intrahepatic porto-systemic shunt 1782 Vein bypass grafts 1783

1784 Evaluate scanning protocol and modification(s) based on patient-specific factors. 1785

History (including indication, prior vascular procedures) 1786 Physical examination and assessment of patient-specific factors 1787 Contraindications 1788 Related imaging, laboratory, and functional testing procedures 1789 Clinical differential diagnosis 1790 Role of ultrasound in patient management 1791 Pharmacology 1792

1793 Demonstrate knowledge and application of quality assurance and statistical tests used in a 1794 vascular laboratory. 1795

Correlations of clinical findings and other imaging examinations 1796 Accuracy 1797 Sensitivity 1798 Specificity 1799 Positive predictive value 1800 Negative predictive value 1801 Quality improvement program components (including test appropriateness, evaluation of 1802

technical quality and compliance with protocols) 1803 1804

Demonstrate performance of clinical competencies 1805 1806 Demonstrate clinical competency through performance of sonographic examinations of the 1807 vascular system according to guidelines established by national professional organizations 1808 and the protocol of the clinical affiliates/clinical education centers. 1809 1810 Clinical competencies must include evaluation and documentation of: 1811

Identification of anatomical and relational structures 1812 Differentiation of normal from pathological/disease process 1813 Image optimization in gray scale, color Doppler and Spectral Doppler 1814 Measurement techniques 1815 Vascular competencies: 1816

o Brachial systolic and diastolic blood pressure by auscultation 1817 o Ankle/brachial pressure measurements with Doppler flow detector and calculation 1818 o Extracranial cerebrovascular including vertebral vessels 1819 o Aortoiliac duplex 1820 o Upper extremity arterial duplex 1821 o Lower extremity arterial duplex 1822 o Upper extremity venous duplex 1823 o Lower extremity venous duplex 1824

Lower extremity venous insufficiency testing 1825 1826


Demonstrate proficiency in technique of: 1827

(The following examinations can be demonstrated in a clinical setting or in a simulated environment.) 1828

Evaluation of vasospasm 1829 Intracranial cerebrovascular (transcranial Doppler) 1830 Upper extremity and digital physiologic testing (VPR, segmental pressures, CW Doppler) 1831 Palmar arch 1832 Lower extremity and digital physiologic testing (VPR, segmental pressures, CW Doppler) 1833 Lower extremity exercise testing 1834 Vessel mapping 1835 Visceral vascular (renal artery, mesenteric/splanchnic, hepatoportal) 1836

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