Commission on Accreditation of Allied Health Education ......2017/12/01 · Diagnostic Medical...

Diagnostic Medical Sonography 1

1 2 3 4

Standards and Guidelines 5

for the Accreditation of Educational Programs in 6

Diagnostic Medical Sonography 7 8

Essentials/Standards initially adopted in 1979; revised in 1987, 1996, 2007, 2011 and 20xx by the: 9 10

American College of Cardiology 11 American College of Radiology 12

American Institute of Ultrasound in Medicine 13 American Society of Echocardiography 14

American Society of Radiologic Technologists 15 Society of Diagnostic Medical Sonography 16

Society for Vascular Surgery 17 Society for Vascular Ultrasound 18

Joint Review Committee on Education in Diagnostic Medical Sonography 19 and 20

Commission on Accreditation of Allied Health Education Programs 21 22 The Commission on Accreditation of Allied Health Education Programs (CAAHEP) accredits 23 programs upon the recommendation of the Joint Review Committee on Education in Diagnostic 24 Medical Sonography (JRC-DMS). 25 26 These accreditation Standards and Guidelines are the minimum standards of quality used in 27 accrediting programs that prepare individuals to enter the Diagnostic Medical Sonography profession. 28 Standards are the minimum requirements to which an accredited program is held accountable. 29 Guidelines are descriptions, examples, or recommendations that elaborate on the Standards. 30 Guidelines are not required but can assist with interpretation of the Standards. 31 32 Standards are printed in regular typeface in outline form. Guidelines are printed in italic typeface in 33 narrative form. 34 35

Preamble 36 37 The Commission on Accreditation of Allied Health Education Programs (CAAHEP), Joint Review 38 Committee on Education in Diagnostic Medical Sonography (JRC-DMS), the American College of 39 Cardiology, American College of Radiology, American Institute of Ultrasound in Medicine, American 40 Society of Echocardiography, American Society of Radiologic Technologists, Society of Diagnostic 41 Medical Sonography, Society for Vascular Surgery, and Society for Vascular Ultrasound cooperate to 42 establish, maintain and promote appropriate standards of quality for educational programs in 43 diagnostic medical sonography and to provide recognition for educational programs that meet or 44 exceed the minimum standards outlined in these accreditation Standards and Guidelines. Lists of 45 accredited programs are published for the information of students, employers, educational institutions 46 and agencies, and the public. 47 48 These Standards and Guidelines are to be used for the development, evaluation, and self-analysis 49 of diagnostic medical sonography programs. On-site review teams assist in the evaluation of a 50 program's relative compliance with the accreditation Standards. 51 52

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Commission on Accreditation of Allied Health Education Programs


Description of Profession 54 55 Diagnostic medical sonography is a multi-specialty profession comprised of abdominal sonography, 56 breast sonography, cardiac sonography, musculoskeletal sonography, obstetrics and gynecology 57 sonography, vascular sonography, and other emerging clinical areas. These diverse areas all use 58 ultrasound as a primary technology in their daily work. 59 60 The diagnostic medical sonographer is an individual who provides patient care services using 61 ultrasound and related diagnostic procedures. The diagnostic medical sonographer must be 62 educationally prepared and clinically competent as a prerequisite to professional practice. 63 Demonstration and maintenance of competency through certification by a nationally recognized 64 sonography credentialing organization is the standard of practice in sonography, and maintenance of 65 certification in all areas of practice is endorsed. 66 67 The diagnostic medical sonographer functions as a delegated agent of the physician and does not 68 practice independently. 69 70 Diagnostic medical sonographers are committed to enhanced patient care and continuous quality 71 improvement that increases knowledge and technical competence. 72 73 Diagnostic medical sonographers use independent, professional and ethical judgment, and critical 74 thinking to safely perform diagnostic sonographic procedures. 75 76 The diagnostic medical sonographer generally performs the following: 77 78

• Obtains, reviews, and integrates pertinent patient history and supporting clinical data to 79 facilitate optimum diagnostic results; 80

• Performs appropriate procedures and records anatomic, pathologic, and/or physiologic data 81 for interpretation by a physician; 82

• Records, analyzes, and processes diagnostic data and other pertinent observations made 83 during the procedure for presentation to the interpreting physician; 84

• Exercises discretion and judgment in the performance of sonographic and/or related 85 diagnostic services; 86

• Demonstrates appropriate communication skills with patients and colleagues; 87 • Acts in a professional and ethical manner; 88 • Facilitates communication and education to elicit patient cooperation and understanding of 89

expectations and responds to questions regarding the sonographic examination. 90 91 As a multi-specialty profession, these Standards apply to the following learning concentrations: 92 93

• Abdominal Sonography - Extended 94 • Adult Cardiac Sonography 95 • Breast Sonography 96 • Musculoskeletal Sonography 97 • Obstetrics and Gynecology Sonography 98 • Pediatric Cardiac Sonography 99 • Vascular Sonography 100

101 Programs may be developed to meet one or more of these learning concentrations. 102 103 Related diagnostic procedures may include, but not limited to, physiologic arterial testing, venous 104 ablation guidance, guidance for interventional procedures, and addition of contrast administration. 105 106 107

108 109 110


I. Sponsorship 111 112 A. Sponsoring Institution 113

114 A sponsoring institution must either award credit for the program or have an articulation 115 agreement with an accredited post-secondary institution, and must be at least one of the 116 following: 117

118 1. A post-secondary academic institution accredited by an institutional accrediting agency 119

that is recognized by the U.S. Department of Education and authorized under applicable 120 law or other acceptable authority to provide a post-secondary program, which awards a 121 minimum of a certificate/diploma at the completion of the program. 122 123

2. A hospital, clinic or medical center that is institutionally accredited and authorized under 124 applicable law or other acceptable authority to provide healthcare, which awards a 125 minimum of a certificate/diploma at the completion of the program. 126 127

3. A branch of the United States Armed Forces or other Federal agency, which awards a 128 minimum of a certificate/diploma at the completion of the program. 129

130 B. Consortium Sponsor 131

132 1. A consortium sponsor is an entity consisting of two or more members that exists for the 133

purpose of operating an educational program. In such instances, at least one of the 134 members of the consortium must meet the requirements of a sponsoring institution as 135 described in I.A. 136 137

2. The responsibilities of each member of the consortium must be clearly documented as a 138 formal affiliation agreement or memorandum of understanding, which includes 139 governance and lines of authority. 140

141 C. Responsibilities of Sponsor 142

143 The Sponsor must assure that the provisions of these Standards and Guidelines are met. 144

145 146 II. Program Goals 147 148

A. Program Goals and Outcomes 149 150

There must be a written statement of the program’s goals and learning domains consistent 151 with and responsive to the demonstrated needs and expectations of the various communities 152 of interest served by the educational program. The communities of interest that are served by 153 the program must include, but are not limited to, students, graduates, faculty, sponsor 154 administration, employers, physicians, and the public. 155 156 Program-specific statements of goals and learning domains provide the basis for program 157 planning, implementation, and evaluation. Such goals and learning domains must be 158 compatible with the mission of the sponsoring institution(s), the expectations of the 159 communities of interest, and nationally accepted standards of roles and functions. Goals and 160 learning domains are based upon the substantiated needs of health care providers and 161 employers, and the educational needs of the students served by the educational program. 162

163 B. Appropriateness of Goals and Learning Domains 164

165 The program must regularly assess its goals and learning domains. Program personnel must 166 identify and respond to changes in the needs and/or expectations of its communities of 167 interest. 168


169 An advisory committee, which is representative of at least each of the communities of interest 170 named in these Standards, must be designated and charged with the responsibility of 171 meeting at least annually, to assist program and sponsor personnel in formulating and 172 periodically revising appropriate goals and learning domains, monitoring needs and 173 expectations, and ensuring program responsiveness to change. 174

175 Advisory committee meetings may include participation by synchronous electronic means. 176

177 C. Minimum Expectations 178

179 The program must have the following goal defining minimum expectations: To prepare 180 competent entry-level sonographers in the cognitive (knowledge), psychomotor (skills), and 181 affective (behavior) learning domains for the following concentration(s) it offers: 182 183

Abdominal sonography - Extended 184 Adult cardiac sonography 185 Breast sonography 186 Musculoskeletal sonography 187 Obstetrics and gynecology sonography 188 Pediatric cardiac sonography 189 Vascular sonography. 190

191 Programs adopting educational goals beyond entry-level competence must clearly delineate 192 this intent and provide evidence that all students have achieved the basic competencies prior 193 to entry into the field. 194 195 Nothing in this Standard restricts programs from formulating goals beyond entry-level 196 competence. 197

198 III. Resources 199

200 A. Type and Amount 201

202 1. Program Resources 203 204

Program resources must be sufficient to ensure the achievement of the program’s goals 205 and outcomes. Resources must include, but are not limited to: faculty, clerical and 206 support staff; curriculum; finances; offices; classroom, laboratory, and ancillary student 207 facilities; clinical affiliates; equipment; supplies; computer resources, instructional 208 reference materials, and faculty/staff continuing education. 209 210 Support staff should be available to provide counseling or referral for problems that may 211 interfere with the student’s progress through the program. Guidance should be available 212 to assist students in understanding course content and in observing program policies and 213 practices. 214

215 2. Clinical Affiliates 216 217

Clinical affiliates must provide each student access to adequate numbers and a variety of 218 types of diagnostic medical examinations to develop clinical competency in both normal 219 and abnormal findings for the learning concentrations(s) being offered. 220 221 Programs should provide students with a variety of patient care settings in which 222 sonographic procedures are performed on in-patients and outpatients. These settings 223 may include the following: ambulatory care facilities, specialty centers, 224 emergency/trauma, intensive/critical/coronary care, surgery, angiography/cardiac 225 catheterization. 226

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The number of students assigned to the clinical affiliate should be determined by a 228 student/clinical staff ratio that ensures equitable experiences and outcomes are met. 229

230 B. Personnel 231

232 The sponsor must appoint sufficient faculty and staff with the necessary qualifications to 233 perform the functions identified in documented job descriptions and to achieve the program’s 234 stated goals and outcomes. 235

236 1. Program Director 237 238

The program director must hold an academic degree and be an appointed faculty 239 member or institutional equivalent with the sponsor. 240

241 a. Responsibilities 242

The program director must be responsible for: 243 1) the structure and daily operation of the program; 244 2) the organization, administration, periodic review and evaluation, continued 245

development, and effectiveness of program curricula; and 246 3) ensuring the effectiveness of all clinical affiliates is maintained. 247

248 Ensuring the effectiveness of clinical affiliates may be demonstrated through 249 overseeing, monitoring, and communicating with the Clinical Coordinator 250 regarding student clinical rotations, the number of cases, and completion of 251 required competencies by all students. 252

253 b. Qualifications 254

The program director must: 255 1) possess a minimum of a Baccalaureate degree; 256 2) possess the appropriate credential(s) specific to one or more of the 257

concentration(s) offered; 258 3) have documented experience in supervision, instruction, evaluation, student 259

guidance and in educational theories and techniques; and 260 4) have a minimum of two years of clinical experience as a registered sonographer 261

in the professional sonography field. 262 263

A master’s degree is preferred. 264 265 Documentation of experience in educational theories and techniques may include 266 completed college courses, seminars, or in-service sessions on topics including, 267 but not limited to, learning theory, curriculum design, test construction, teaching 268 methodology, or assessment techniques. 269

270 2. Clinical Coordinator(s) 271

272 Programs must have a faculty member or institutional equivalent designated as the 273 Clinical Coordinator. 274 275 The Clinical Coordinator(s) must be an appointed faculty member or institutional 276 equivalent with the sponsor. 277


The clinical coordinator(s) must: 280 1) be responsible for coordinating clinical education with didactic education as 281

assigned by the program director; 282 2) evaluate and ensure the effectiveness of clinical experiences for the 283

concentration(s) students are enrolled in; and 284


3) provide clinical instruction and document the evaluation and progression of 285 clinical performance leading to clinical competence. 286


The clinical coordinator(s) must: 289 1) possess an academic degree no lower than an Associate degree and at least 290

equal to that for which the graduates are being prepared; 291 2) possess the appropriate credential(s) specific to the concentration(s) that s/he 292

coordinates; 293 3) have documented experience in supervision, instruction, evaluation, student 294

guidance and in educational theories and techniques; and 295 4) have a minimum of two years of clinical experience as a registered sonographer 296

in the professional sonography field. 297 298 Documentation of experience in educational theories and techniques may include 299 completed college courses, seminars, or in-service sessions on topics including, 300 but not limited to, learning theory, curriculum design, test construction, teaching 301 methodology, or assessment techniques. 302 303 The Clinical Coordinator may also serve as the Concentration Coordinator for the 304 concentration(s) for which the Program Director does not possess an appropriate 305 credential. 306

307 3. Concentration Coordinator(s) 308 309

The Concentration Coordinator(s) must be appointed faculty member or institutional 310 equivalent with the sponsor. 311


Concentration Coordinator(s) report(s) to the Program Director and must be 314 designated and responsible for the coordination of concentration(s) for which the 315 Program Director does not possess the appropriate credential. 316


Concentration Coordinator(s) must: 319 1) possess an academic degree no lower than an Associate degree and at least 320

equal to that for which the graduates are being prepared; 321 2) possess the appropriate credential(s) specific to the concentration(s) that s/he is 322

designated to coordinate; 323 3) have documented experience in supervision, instruction, evaluation, student 324

guidance and in educational theories and techniques; and 325 4) have a minimum two years of clinical experience as a registered sonographer in 326

the professional sonography field. 327 328

Documentation of experience in educational theories and techniques may include 329 completed college courses, seminars, or in-service sessions on topics including, 330 but not limited to, learning theory, curriculum design, test construction, teaching 331 methodology, or assessment techniques. 332

333 The Concentration Coordinator may also serve as the Clinical Coordinator for the 334 concentration(s) for which the Program Director does not possess an appropriate 335 credential. 336

337 4. Medical Advisor 338


The medical advisor must provide guidance that the medical components of the 341 didactic and clinical curriculum meet current acceptable performance standards. 342

343


b. Qualifications 344 The medical advisor must be a licensed physician, certified by the American Board of 345 Medical Specialties (ABMS), with relevant experience and knowledge in diagnostic 346 medical sonography. 347

348 The medical advisor should participate in goal determination, curriculum 349 development, and outcomes assessment. 350

351 5. Faculty/Instructional Staff 352

353 All faculty must be familiar with program goals and be able to demonstrate the ability to 354 develop an organized plan of instruction and evaluation. 355


Faculty/Instructional Staff must be responsible for providing instruction, evaluation of 358 students, documentation of progress, and periodic review of course content. 359


Faculty/Instructional Staff must: 362 1) be qualified by education and experience, and be effective in teaching the 363

subjects assigned; and 364 2) possess appropriate credential(s) for the learning concentration s/he are 365

providing instruction and performing student evaluations. 366 367

6. Clinical Instructor(s) 368 369

A clinical instructor must be identified for each clinical affiliate. 370 371

a. Responsibilities 372 A clinical instructor must be available to students whenever a student is assigned to a 373 clinical setting, provide appropriate clinical supervision, and be responsible for student 374 clinical evaluation. 375


Clinical instructors must have the appropriate credential in the concentration(s) for 378 which they evaluate student performance and document required clinical 379 competencies. 380

381 C. Curriculum 382

383 The curriculum must ensure the achievement of program goals and learning domains. 384 Instruction must be an appropriate sequence of the classroom, laboratory, and clinical 385 activities. Instruction must be based on clearly written course syllabi that include a course 386 description, course objectives, methods of evaluation, topic outline, and competencies 387 required for graduation. 388 389 The program must demonstrate by comparison that the curriculum offered meets or exceeds 390 the content and competencies specified in Appendix B. 391

392 D. Resource Assessment 393

394 The program must, at least annually, assess the appropriateness and effectiveness of the 395 resources described in these Standards. The results of resource assessment must be the 396 basis for ongoing planning and appropriate change. An action plan must be developed when 397 deficiencies are identified in the program resources. Implementation of the action plan must 398 be documented, and results measured by ongoing resource assessment. 399

400 401


IV. Student and Graduate (Outcomes) Evaluation/Assessment 402 403

A. Student Evaluation 404 405 1. Frequency and purpose 406

407 Evaluation of students must be conducted on a recurrent basis and with sufficient 408 frequency to provide both the students and program faculty with valid and timely 409 indications of the students’ progress toward and achievement of the competencies and 410 learning domains stated in the curriculum. 411

412 2. Documentation 413

414 Records of student evaluations must be maintained in sufficient detail to document 415 learning progress and achievements. 416 417 Records indicating the number and type of diagnostic medical examinations performed 418 by the student, the examination findings, the extent of student supervision, and the level 419 of involvement of the student in scanning/performance must be maintained. 420 Official records or electronic equivalent used to document the progression of learning and 421 achievements must include name, credentials, and signature of the supervising 422 sonographer. 423

424 B. Outcomes 425

426 1. Outcomes Assessment 427 428

The program must periodically assess its effectiveness in achieving its stated goals and 429 learning domains. The results of this evaluation must be reflected in the review and timely 430 revision of the program. 431 432 Outcomes assessments must include, but are not limited to: national credentialing 433 examination(s) performance, programmatic retention/attrition, graduate satisfaction, 434 employer satisfaction, job (positive) placement and programmatic summative measures. 435 The program must meet the outcomes assessment thresholds. 436 437 “Positive Placement” means that the graduate is employed full or part-time in the 438 profession or in a related field, or continuing his/her education or serving in the military. A 439 related field is one in which the individual is using cognitive, psychomotor, and affective 440 competencies acquired in the educational program. 441 442 “National credentialing examinations” are those accredited by the National Commission 443 for Certifying Agencies (NCCA) or American National Standards Institute 444 (ANSI). Participation and pass rates on national credentialing examination(s) 445 performance may be considered in determining whether or not a program meets the 446 designated threshold, provided the credentialing examination(s), or alternative 447 examination(s) offered by the same credentialing organization, is (are) available to be 448 administered prior to graduation from the program. Results from said alternative 449 examination(s) may be accepted, if designated as equivalent by the organization whose 450 credentialing examination(s) is (are) so accredited. 451

452 2. Outcomes Reporting 453 454

The program must periodically submit to the JRC-DMS the program goal(s), learning 455 domains, evaluation systems (including type, cut score, and appropriateness), outcomes, 456 its analysis of the outcomes, and an appropriate action plan based on the analysis. 457 458 Programs not meeting the established thresholds must begin a dialogue with the JRC-459 DMS to develop an appropriate plan of action to respond to the identified shortcomings. 460


461 462

V. Fair Practices 463 464

A. Publications and Disclosure 465 466

1. Announcements, catalogs, publications, and advertising must accurately reflect the 467 program offered. 468

469 2. At least the following must be made known to all applicants and students: the sponsor’s 470

institutional and programmatic accreditation status as well as the name, mailing address, 471 web site address, and phone number of the accrediting agencies; admissions policies 472 and practices, including technical standards (when used); policies on advanced 473 placement, transfer of credits, and credits for experiential learning; number of credits 474 required for completion of the program; tuition/fees and other costs required to complete 475 the program; policies and processes for withdrawal and for refunds of tuition/fees. 476

477 3. At least the following must be made known to all students: academic calendar, student 478

grievance procedure, criteria for successful completion of each segment of the curriculum 479 and graduation, policies for student leave of absence, exposure to bloodborne 480 pathogens, communicable diseases, and pregnancy, and policies and processes by 481 which students may perform clinical work while enrolled in the program. 482

483 4. The sponsor must maintain, and make available to the public, current and consistent 484

summary information about student/graduate achievement that includes the results of 485 one or more of the outcomes assessments required in these Standards. 486

487 The sponsor should develop a suitable means of communicating to the communities of 488 interest the achievement of students/graduates (e.g. through a website or electronic or 489 printed documents). 490

491 B. Lawful and Non-discriminatory Practices 492 493

All activities associated with the program, including student and faculty recruitment, student 494 admission, and faculty employment practices, must be non-discriminatory and in accordance 495 with federal and state statutes, rules, and regulations. There must be a faculty grievance 496 procedure made known to all paid faculty. 497

498 A procedure should be established for determining that a student's health will permit him or 499 her to meet the documented technical standards of the program. 500

501 C. Safeguards 502 503

The health and safety of patients, students, and faculty, and other participants associated 504 with the educational activities of the students must be adequately safeguarded. 505 506 All activities required in the program must be educational and students must not be 507 substituted for staff. 508 509 Diagnostic medical sonography students must be readily identifiable to patients and clinical 510 co-workers as diagnostic medical sonography students. 511

512 The program must ensure voluntary and prudent use of students or other human subjects for 513 non-clinical scanning. Students’ grades and evaluations must not be affected by participation 514 or non-participation. 515

516 517 518 519


D. Student Records 520 521

Satisfactory records must be maintained for student admission, advisement, counseling, and 522 evaluation. Grades and credits for courses must be recorded on the student transcript and 523 permanently maintained by the sponsor in a safe and accessible location. 524 525

E. Substantive Change 526 527

The sponsor must report substantive change(s) as described in Appendix A to 528 CAAHEP/JRC-DMS in a timely manner. Other substantive change(s) to be reported to JRC-529 DMS within the time limits prescribed include: 530

531 1. Added or deleted learning concentrations 532 2. Change in award (certificate, diploma, degree) granted at the completion of the program 533 3. Change in clock or credit hours for completion of a program 534 4. Change in the length of a program 535 5. Change in location or method of delivery of curriculum (ex: satellite campus, distance 536

education) 537 538

F. Agreements 539 540

There must be a formal affiliation agreement or memorandum of understanding between the 541 sponsor and all other entities that participate in the education of the students describing the 542 relationship, role, and responsibilities between the sponsor and that entity. 543 544 The delineation of responsibilities should include student supervision, benefits, liability and 545 financial arrangements, if any. The agreement should include a clause to protect students 546 and to ensure due process. 547 548 An affiliate is an institution having adequate resources to provide a broad range of 549 appropriate clinical education opportunities for students. 550 551 A clinical education center is a department, division, or other designated part of a clinical 552 affiliate having adequate resources to provide clinical education opportunities for students. 553 Multiple clinical education centers may be identified within a clinical affiliate. 554

555 556

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571 572 573

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Appendix B 575

Curriculum for Educational Programs in Diagnostic Medical Sonography 576

577 The curricular requirements are designed to demonstrate and assess knowledge progressively from 578 general education requisite content, common core, and concentration-specific theory through clinical 579 competency in preparation to become a competent entry-level sonographer. Clinical competency 580 requirements must be assessed in a diagnostic clinical affiliate. 581 582 Demonstration of knowledge may be assessed and documented in a variety of ways. Methods for 583 assessment may include, but not limited to, written exams, assignments, or lab activities. 584 Documentation of proficiency in scan techniques may occur in the simulated lab environment or 585 diagnostic clinical setting. 586 587 1. General Education Curriculum 588 589

Basic medical science and interpersonal communication education is required as a foundation for 590 the clinical role of the diagnostic medical sonographer. The following must be at the post-591 secondary/college-level education courses: 592

a. Communication 593 b. Human anatomy and physiology 594 c. Mathematics 595 d. Physics 596 597

The program and sponsor may determine which mathematics and physics, including applied 598 physics, courses will meet its needs and yield the outcomes desired of their graduates. 599

600 2. Learning Competencies Common to All Concentrations 601

602 a. Demonstrate knowledge and application of ergonomic techniques. 603

1) Industry standards and OSHA guidelines 604 2) Types of work-related musculoskeletal disorders 605 3) Role of Administration in the prevention of MSI 606 4) Role of Sonographer in the prevention of MSI 607 5) Best practices for prevention 608

a) Daily exercises in the workplace 609 b) Neutral posture 610 c) Patient transfer and assistance 611 d) Patient positioning 612 e) Equipment and accessories 613 f) Supports, tools, and devices 614 g) Transducer grip and pressure 615 h) Schedules/Workload 616 i) Workstation/work area(s) 617

618 b. Demonstrate knowledge and application of types and methods of infection control. 619

1) Personal and patient 620 a) Standard precautions 621 b) Isolation procedures 622 c) Aseptic and sterile technique 623

2) Environment 624 a) Equipment 625 b) Transducer cleaning and disinfection 626 c) Accessories 627

628 c. Demonstrate knowledge and application of patient care. 629

1) Compliance with program and clinical education facility policies and procedures 630 2) Patient Care Partnership 631


3) Patient directives 632 4) Anticipate and be able to respond to the needs of the patient 633

a) Demonstrate age-related and cultural competency 634 b) Demonstrate appropriate patient care in settings outside of the sonography 635

department. 636 5) Transport and transfer of patients with support equipment 637

a) Oxygen 638 b) Intravenous lines/pumps 639 c) Urinary catheters 640 d) Drainage tubes 641

6) Vital signs 642 7) Color 643 8) Skin integrity 644 9) Clinical history 645 10) Proper patient positioning and draping 646 11) Comfort 647 12) Privacy 648 13) IV insertion and injection with use of contrast-enhanced imaging 649 14) Basic pharmacology as related to the concentration 650 15) Post interventional procedure care and discharge 651 16) Life-threatening situations and implement emergency care as permitted by institutional 652

policy, including the following: 653 a) Pertinent patient care procedures 654 b) Principles of psychological support 655 c) Emergency conditions and procedures 656 d) First aid and resuscitation techniques 657

17) Reporting and documentation of incidents and/or adverse reactions 658 659 d. Demonstrate knowledge of the roles and responsibilities of healthcare professions to 660

effectively communicate and collaborate in the healthcare environment. 661 1) Team development 662 2) Conflict resolution 663 3) Interprofessional communication and education 664

665 e. Demonstrate knowledge of medical ethics and law. 666

1) Patient's right to privacy based on applicable legal and regulatory standards 667 2) HIPAA 668 3) Electronic documentation and transmission 669 4) Terminology related to ethics, values, and morals 670 5) Types of law 671 6) Risk management 672 7) Medical malpractice liability coverage 673 8) Informed consent 674 9) Documentation of clinical incidents 675 10) Professional scope of practice and clinical standards 676 11) Professional code of ethics 677

678 f. Demonstrate knowledge of medical and sonographic terminology. 679

1) Definitions, abbreviations, symbols, terms, and phrases 680 2) Correlating diagnostic and imaging procedures 681 3) Sonographic appearances 682

683 g. Obtain, evaluate, document, and communicate relevant information related to 684

sonographic examinations. 685 1) Clinical information and historical facts from the patient and the medical records, which 686

may impact the diagnostic examination. 687 a) Clinical signs and symptoms 688 b) Laboratory tests 689


c) Imaging and diagnostic procedures 690 d) Oral and/or written summary of sonographic findings. 691

2) Deviation from practice parameters for the sonographic examination as required by 692 patient history or initial findings 693

3) Changes from a previous examination 694 4) Examination findings that require an immediate clinical response and notify the 695

interpreting physician. 696 697 h. Identify and evaluate anatomic structures. 698

1) Sectional anatomy 699 2) Relational anatomy 700 3) Normal sonographic appearances of organs, muscles, tissue, vascular and skeletal 701

structures 702 4) Differentiation of normal from abnormal sonographic findings 703

704 i. Demonstrate knowledge of disease processes with application to sonographic and 705

Doppler patterns. 706 1) Iatrogenic 707 2) Degenerative 708 3) Inflammatory 709 4) Traumatic 710 5) Neoplastic 711 6) Infectious 712 7) Obstructive 713 8) Congenital 714 9) Metabolic 715 10) Immunologic 716

717 j. Demonstrate knowledge and application of image production and optimization. 718

1) Sound production and propagation 719 2) Interaction of sound and matter 720 3) Instrument options and transducer selection 721 4) Principles of ultrasound instruments and modes of operation 722 5) Operator control options 723 6) Physics of Doppler 724 7) Principles of Doppler techniques 725 8) Methods of Doppler flow analysis 726 9) Hemodynamics of blood flow 727 10) Contrast-enhanced imaging 728 11) Acoustic artifacts 729 12) Emerging technologies 730 13) Image storage devices 731

732 k. Demonstrate knowledge and application of biological effects. 733

1) In-vitro and in-vivo ultrasound effects 734 2) Exposure/equipment display indices 735 3) Generally accepted maximum safe exposure levels 736 4) ALARA principle 737

a) Mechanisms that affect the mechanical and thermal indices 738 b) Techniques to decrease the mechanical and thermal indices 739

740 741

l. Demonstrate knowledge of a quality control and improvement program. 742 1) Lab accreditation 743 2) Credentialing organizations 744 3) Equipment operation and maintenance 745

a) Phantom testing 746 b) Records maintenance 747

748


m. Demonstrate awareness of resources for professional development. 749 1) Professional organizations and resources 750 2) Professional journals and on-line resources 751 3) Continuing education conferences 752 4) Clinical conferences, lectures, and in-house educational offerings 753 5) Recent developments in sonography 754 6) Research statistics and design 755

756 n. Demonstrate achievement of clinical competency through the performance of the 757

requirements to provide quality patient care and optimal examination outcome. 758 Clinical competencies must include evaluation and documentation of: 759 1) Use of proper ergonomics 760 2) Safety and infection control 761 3) Obtain clinical history and utilize information appropriately 762 4) Oral and written communication 763 5) Image optimization techniques 764 6) ALARA 765 7) Professionalism 766 8) Document sonographic findings for communication with interpreting physician 767 9) Finalize examination for permanent storage 768 10) Process for reporting of critical findings 769

770 The above competencies may be embedded within the learning concentration clinical 771 competencies. 772 773

3. Learning Competencies for the Abdominal Sonography - Extended Concentration 774 775

a. Identify anatomy, relational anatomy, anatomic variants, and sonographic 776 appearances of normal anatomical structures. 777 1) Abdominal 778

a) Abdominal wall 779 b) Adrenal glands 780 c) Aorta and branches 781 d) Biliary system 782 e) Gastrointestinal tract 783 f) Great vessels and branches 784 g) Liver 785 h) Lung/pleura 786 i) Lymphatic system 787 j) Pancreas 788 k) Peritoneal and retroperitoneal cavities 789 l) Spleen 790 m) Urinary tract 791

792 2) Extended 793

a) Extremity non-vascular 794 b) Infant hips 795 c) Neck 796 d) Neonatal/infant head 797 e) Neonatal/infant spine 798 f) Penis 799 g) Prostate 800 h) Scrotum 801 i) Superficial soft-tissue structures 802

803


b. Demonstrate knowledge of the physiology, pathophysiology, sonographic technique, 804 measurements, sonographic appearances, and Doppler patterns, where applicable, in 805 both normal and abnormal structures. 806 1) Abdominal 807

a) Abdominal wall 808 b) Adrenal glands 809 c) Aorta and branches 810 d) Biliary system 811 e) Gastrointestinal tract 812 f) Great vessels and branches 813 g) Liver 814 h) Lung/pleura 815 i) Lymphatic system 816 j) Pancreas 817 k) Peritoneal and retroperitoneal cavities 818 l) Spleen 819 m) Urinary tract 820

821 2) Extended 822

a) Extremity non-vascular 823 b) Infant hips 824 c) Neck 825 d) Neonatal/infant head 826 e) Neonatal/infant spine 827 f) Penis 828 g) Prostate 829 h) Scrotum 830 i) Superficial soft-tissue structures 831

832 c. Demonstrate knowledge in sonographic guided procedures. 833

1) Role of sonographer 834 2) Clinical information 835 3) Informed consent 836 4) Procedural time out 837 5) Transducer guidance 838 6) Sterile setup 839 7) Pre-and post-procedural documentation 840

841 d. Evaluate scanning protocol and modification(s) based on the sonographic findings 842

and the differential diagnoses. 843 1) Indications and contraindications 844 2) History and physical examination 845 3) Related imaging, laboratory, and functional testing procedures 846 4) Clinical differential diagnosis 847 5) Contrast-enhanced imaging 848 6) Role of sonography in patient management 849

850 e. Document proficiency in the scanning technique and application for: 851

1) Abdominal vascular Doppler assessment 852 a) Hepatic 853 b) Mesenteric 854 c) Renal 855

2) Gastrointestinal tract assessment 856 857

The above proficiencies may be demonstrated in a clinical setting or in a simulated environment. 858 859


f. Demonstrate achievement of clinical competency through the performance of 860 sonographic examinations of the abdomen and superficial structures, according to 861 practice parameters established by national professional organizations and the 862 protocol of the clinical affiliate. Clinical competencies must include evaluation and 863 documentation of: 864 1) Identification of anatomical and relational structures 865 2) Differentiation of normal from pathological/disease process 866 3) Image optimization techniques in grayscale 867 4) Image optimization techniques in Doppler (where applicable) 868 5) Measurement techniques 869 6) Abdominal competencies 870

a) Complete abdominal examination 871 b) Limited abdominal examination 872

(1) Aorta/IVC 873 (2) Biliary system 874 (3) Liver 875 (4) Pancreas 876 (5) Spleen 877 (6) Kidneys 878 (7) Bladder 879 (8) Pleural space 880 (9) Sonographic guided procedure (assistance) 881

7) Superficial Structures 882 a) Thyroid 883 b) Scrotum 884

885 The above structures listed under limited abdominal examination may be completed as individual 886 clinical competencies or may be incorporated with other structures/techniques as part of a limited 887 or complete examination. 888 889

4. Learning Competencies for the Adult Cardiac Sonography Concentration 890 891

a. Identify anatomy, anatomic variants, and sonographic appearances of normal cardiac 892 structures. 893 1) Embryology and fetal cardiac development 894 2) Cardiac chambers and septation 895 3) Coronary artery anatomy and distribution 896 4) Pulmonary artery and venous return 897 5) Relationships of cardiac chambers and great vessels 898 6) Valve anatomy and function 899

900 b. Demonstrate knowledge of normal and cardiovascular physiology and hemodynamics. 901

1) Ventricular systolic and diastolic function, including the influence of loading conditions, 902 filling pressures, normal intracardiac pressures, and measurement of cardiac output 903

2) Electrophysiology and exercise physiology 904 905

c. Demonstrate knowledge of mechanisms of disease, cardiovascular pathophysiology, 906 and hemodynamics, sonographic technique, measurements, quantitative principles, 907 and Doppler patterns in both the normal heart and with cardiac disease. 908 1) Valvular heart disease 909 2) Prosthetic heart valves 910 3) Ventricular dysfunction 911 4) Diastolic dysfunction 912 5) Ischemic cardiac disease 913 6) Cardiomyopathy 914 7) Pericardial disease 915 8) Congenital heart disease 916 9) Endocarditis, neoplasms, and masses 917 10) Cardiac trauma 918


11) Pulmonary vascular disease 919 12) Diseases of the aorta and great vessels 920 13) Cardiac assist devices 921 14) Intracardiac devices 922 15) Heart transplant 923 16) Intracardiac shunt 924 17) Intracardiac pressures 925 18) Cardio-oncology 926 19) Systemic diseases 927 20) Systemic and pulmonary hypertension 928 21) Common arrhythmias and conduction abnormalities 929

930 d. Demonstrate knowledge of the indications, utility, limitations, and technical 931

procedures for related echocardiographic studies. 932 1) Transthoracic echocardiography 933 2) Stress echocardiography 934 3) Transesophageal echocardiography 935 4) Intraoperative echocardiography 936 5) Enhanced cardiac ultrasound 937 6) IV administration techniques 938 7) Three-dimensional echocardiography 939 8) Echo-guided procedures 940 9) Strain echocardiography 941 10) Speckle tracking 942 11) Cardiac ultrasound respirogram 943 12) Pharmacology 944

945 e. Demonstrate knowledge, application, and proficiency in the use of quantitation 946

principles applied to echocardiographic images and flow data. 947 1) Standard M-mode, two-dimensional, and Doppler measurements and calculations 948 2) Knowledge and understanding of normal and abnormal values for M-mode, two-949

dimensional and Doppler echocardiography 950 3) Evaluation of normal and abnormal systolic and diastolic ventricular function 951 4) Evaluation of the severity of valve stenosis and regurgitation 952 5) Evaluation of normal and abnormal prosthetic valves, assist devices and interventional 953

procedures 954 955

f. Awareness of scanning protocol and modification(s) based on the sonographic 956 findings and the differential diagnoses. 957 1) Indications and contraindications 958 2) History and physical examination 959 3) Related imaging, laboratory, and functional testing procedures 960

a) Chest X-ray 961 b) Angiography and cardiac catheterization 962 c) Electrocardiography, electrophysiologic studies, Holter monitoring 963 d) Stress testing protocols 964 e) Radionuclide studies 965 f) Cross-sectional imaging procedures 966 g) Adult interventions 967

968 4) Clinical differential diagnosis 969 5) Role of sonography in patient management 970 6) Effects of pharmacotherapy on echocardiographic findings 971

972 g. Demonstrate proficiency in technique and application of: 973

1) Quantitative principles applied to echocardiographic images and flow data 974 2) Stress echocardiography – exercise 975 3) Stress echocardiography – pharmacologic 976 4) Transthoracic enhanced echocardiogram 977


978 The above proficiencies may be demonstrated in a clinical setting or in a simulated 979 environment. 980 981

h. Demonstrate achievement of clinical competency through the performance of adult 982 cardiac sonography, according to practice parameters established by national 983 professional organizations and the protocol of the clinical affiliate. Clinical 984 competencies must include evaluation and documentation of: 985 1. Identification of anatomical and relational structures 986 2. Differentiation of normal from pathological/disease process 987 3. Image optimization and measurement techniques with: 988

a) 2D imaging 989 b) M-mode 990 c) Spectral Doppler: PW, CW and Tissue Doppler 991 d) Color flow Doppler 992 e) Use of non-imaging CW Doppler transducer 993

994 4. Adult cardiac sonography competencies 995

a) Complete transthoracic echocardiogram – Normal 996 b) Systolic dysfunction 997 c) Diastolic dysfunction 998 d) Aortic valve or aortic root pathology 999 e) Mitral valve pathology 1000 f) Right heart pathology 1001 g) Cardiomyopathy 1002 h) Pericardial pathology 1003 i) Prosthetic valve 1004 j) Coronary artery disease 1005 k) Contrast-enhanced echocardiography (observe) 1006

1007 The above may be completed as individual clinical competencies or may be incorporated with 1008 other organs as part of a limited or complete examination. 1009

1010 5. Learning Competencies for the Breast Sonography Concentration 1011 1012

a. Identify anatomy, congenital and developmental variants, and sonographic 1013 appearances of normal breast structures. 1014 1) Areolar complex/nipple 1015 2) Fibrous planes 1016

a) Skin 1017 b) Subcutaneous fat 1018 c) Mammary zone 1019 d) Retromammary space 1020 e) Muscle layers 1021 f) Rib cage and intercostal muscles 1022

3) Cooper’s ligaments 1023 4) Ductal system 1024 5) Lymph nodes 1025 6) Vasculature 1026

a) Arterial 1027 b) Venous 1028

7) Variants 1029 a) Amastia 1030 b) Amazia 1031 c) Athelia 1032 d) Polymastia 1033 e) Polythelia 1034 f) Nipple inversion/flattening 1035 g) Early ripening 1036


h) Age-related sonographic changes of breast tissue and its components 1037 1038

b. Demonstrate knowledge of physiology and pathophysiology in both normal and 1039 abnormal breast structures. 1040 1) Embryologic development 1041 2) Age-related development of the breast to involution 1042 3) Normal blood flow patterns within the breast and its components 1043 4) Lymphatic drainage 1044 5) Effect of pregnancy 1045 6) Lactation 1046 7) Male breast 1047 8) Infectious processes 1048 9) Neoplasms 1049

a) Cystic 1050 b) Benign 1051 c) Malignant 1052

10) Trauma 1053 1054

c. Demonstrate knowledge of the sonographic technique, measurements, sonographic 1055 appearances, integration of data, and Doppler patterns in both normal and abnormal 1056 breast structures. 1057 1) Scan planes 1058 2) Scan techniques 1059 3) Patient position 1060 4) Imaging techniques 1061 5) Image labeling/distance from nipple 1062 6) Image optimization 1063 7) Artifacts 1064 8) Implants 1065 9) Lymph node assessment 1066 10) Postoperative biopsy site 1067 11) BI-RADS assessment categories 1068 12) Correlation of other imaging modalities 1069 13) Spectral Doppler of the vasculature related to a mass 1070 14) Color Doppler of a mass/lesion 1071 15) Power Doppler of a mass/lesion 1072

1073 d. Demonstrate knowledge in interventional and intraoperative procedures. 1074

1) Role of sonographer in ultrasound-guided procedures and sentinel lymph node biopsy 1075 2) Clinical information 1076 3) Informed consent 1077 4) Procedural time out 1078 5) Transducer guidance 1079 6) Sterile setup 1080 7) Pre-and post-procedural documentation 1081 8) Sonography assisted procedures 1082

1083 e. Evaluate scanning protocol and modification(s) based on the sonographic findings 1084

and the differential diagnoses. 1085 1) Indications and contraindications 1086 2) History and physical examination 1087 3) Related imaging, laboratory, and functional testing procedures 1088

a) Correlation with mammography 1089 b) BIRADS 1090 c) Correlation with MRI 1091 d) Correlation with Nuclear Medicine 1092

4) Clinical differential diagnosis 1093 5) Role of sonography in patient management 1094 6) Elastography 1095


7) Role of three-dimensional sonography 1096 1097

f. Demonstrate knowledge of treatment options. 1098 1) Medical 1099 2) Surgical 1100 3) Brachytherapy 1101

1102 g. Demonstrate achievement of clinical competency through the performance of 1103

sonographic examinations of the breast, according to practice parameters established 1104 by national professional organizations and the protocol of the clinical affiliate/clinical 1105 education centers. Clinical competencies must include evaluation and documentation 1106 of: 1107 1) Identification of anatomical and relational structures 1108 2) Differentiation of normal from pathological/disease process 1109 3) Image optimization techniques in grayscale 1110 4) Image optimization techniques in Doppler (where applicable) 1111 5) Measurement techniques (where applicable) 1112 6) Breast competencies 1113

a) Targeted exam 1114 b) Lymph node evaluation 1115 c) Cystic lesion 1116 d) Solid lesion 1117 e) Doppler evaluation of mass 1118 f) Implant 1119 g) Breast interventional procedures 1120

(1) Fine needle aspiration 1121 (2) Core biopsy 1122 (3) Needle localization 1123

1124 The above may be completed as individual clinical competencies or may be incorporated with other 1125 structures/techniques as part of a limited or complete examination. 1126 1127

6. Learning Competencies for the Musculoskeletal Sonography Concentration 1128 1129

a. Define and describe the sonographic characteristics of the components of the 1130 musculoskeletal system. 1131 1) Bursae 1132 2) Cartilage 1133 3) Fascia 1134 4) Fat pads 1135 5) Ligaments 1136 6) Muscles 1137 7) Retinaculum 1138 8) Tendons 1139 9) Nerves 1140 10) Lymph nodes 1141 11) Types of joints 1142

1143 b. Demonstrate knowledge of the anisotropic effect and the ability to distinguish this 1144

artifact from normal variants and pathology. 1145 1146

c. Identify anatomical structures, nerves and vascular supply, normal sonographic 1147 appearances, normal Doppler patterns, measurements (and contralateral comparison 1148 when applicable), and changes with the dynamic assessment. 1149 1) Abdominal wall 1150 2) Shoulder 1151 3) Upper arm 1152 4) Elbow 1153 5) Forearm 1154


6) Wrist 1155 7) Hands 1156 8) Fingers 1157 9) Hip, to include groin and pelvis 1158 10) Upper leg 1159 11) Knee 1160 12) Lower leg 1161 13) Ankle 1162 14) Foot 1163 15) Toes 1164

1165 d. Demonstrate knowledge of the physiology, pathophysiology, sonographic technique, 1166

measurements, sonographic appearances, and Doppler patterns in musculoskeletal 1167 injuries and disease processes. 1168 1) Abdominal wall 1169 2) Shoulder 1170 3) Upper arm 1171 4) Elbow 1172 5) Forearm 1173 6) Wrist 1174 7) Hands 1175 8) Fingers 1176 9) Hip, to include groin and pelvis 1177 10) Upper leg 1178 11) Knee 1179 12) Lower leg 1180 13) Ankle 1181 14) Foot 1182 15) Toes 1183

1184 e. Identify sonographic and Doppler patterns in clinical diseases, injury, and post-1185

surgical changes that may occur in the following categories. 1186 1) Bone pathology 1187 2) Cartilage 1188 3) Crystal deposits 1189 4) Cystic structures 1190 5) Fluid collections 1191 6) Foreign bodies 1192 7) Hernias 1193 8) Infections 1194 9) Joint effusions 1195 10) Joint laxity/altered function 1196 11) Ligament pathology and tears 1197 12) Masses/neoplastic processes 1198 13) Muscle pathology and tears 1199 14) Neuromas 1200 15) Nerve pathology and entrapment 1201 16) Soft tissue pathology 1202 17) Subcutaneous abnormalities 1203 18) Synovitis 1204 19) Synovial proliferation 1205 20) Tendon pathology, tears, and calcifications 1206 21) Vascular malformations 1207

1208 f. Demonstrate knowledge in sonographic guided procedures 1209

1) Role of sonographer 1210 2) Clinical information 1211 3) Informed consent 1212 4) Procedural time out 1213


5) Transducer guidance 1214 6) Sterile setup 1215 7) Pre-and post-procedural documentation 1216 8) Procedures 1217

a) Ablation 1218 b) Aspiration 1219 c) Platelet-Rich Plasma (PRP) Injection 1220 d) Dry needling 1221 e) Biopsy 1222 f) Nerve mapping 1223 g) Nerve block 1224 h) Surgical planning 1225

1226 g. Evaluate scanning protocol and modification(s) based on the sonographic findings 1227

and the differential diagnoses 1228 1) Indications and contraindications 1229 2) History and physical examination 1230 3) Related imaging, laboratory, and functional testing procedures 1231 4) Clinical differential diagnosis 1232 5) Role of sonography in patient management 1233

1234 h. Demonstrate achievement of clinical competency through the performance of 1235

sonographic examinations of the musculoskeletal system, according to practice 1236 parameters established by national professional organizations and the protocol of the 1237 clinical affiliate. Clinical competencies must include evaluation and documentation of: 1238 1. Identification of anatomical and relational structures 1239 2. Differentiation of normal from pathological/disease process 1240 3. Image optimization techniques in grayscale 1241 4. Image optimization techniques in Doppler (where applicable) 1242 5. Dynamic or provocative maneuvers 1243

6. Evaluate bony surface irregularities (where applicable) 1244 a) Abdominal wall 1245

(1) Valsalva maneuver to assess for ventral hernia 1246 b) Shoulder 1247

(1) Biceps subluxation – Rotate arm in external and internal rotation 1248 (2) Supraspinatus impingement – Arm abduction 1249 (3) Acromioclavicular joint – Cross-arm maneuver 1250 (4) Posterior labrum – Rotate arm in external and internal rotation 1251

c) Elbow 1252 (1) Ulnar nerve subluxation—Flexion and extension 1253 (2) Ulnotrochlear joint--Valgus stress 1254 (3) Radiocapitellar joint – Varus stress 1255 (4) Extensor carpi ulnaris (ECU) subluxation – Pronation to supination 1256

d) Hands and fingers 1257 (1) Trigger finger—Flexion & extension 1258 (2) Stenner lesion—Valgus stress of ulnar collateral ligament 1259

e) Hip, to include groin and pelvis 1260 (1) Valsalva maneuver when to assess for inguinal or femoral hernia 1261 (2) Iliopsoas snapping—hip flexion with external rotation and abduction followed by 1262

hip extension and internal rotation 1263 (3) Iliotibial band snapping—hip flexion and extension or symptom-driven dynamic 1264

maneuver 1265 f) Knee 1266

(1) Anterior – Flexion and extension to evaluate the patellar tendon 1267 (2) Lateral – Lateral compartment joint space 1268 (3) Ankle 1269 (4) Lateral – Peroneal tendon subluxation evaluation during eversion circumduction 1270 (5) Medial – Dorsiflexion and inversion to check for tibialis posterior tendon instability 1271 (6) Posterior – Dorsiflexion/plantar flexion to evaluate the Achilles tendon 1272


g) Foot 1273 (1) Dorsiflex the 2-4 metatarsophalageal joint (MTP) to evaluate tendon movement, 1274

the integrity of the plantar plate, and for plantar tears 1275 h) Neuromuscular 1276

(1) Peripheral neuropathies 1277 (2) Compression disorders 1278

1279 The above may be completed as individual clinical competencies or may be incorporated with other 1280 structures/techniques as part of a limited or complete examination. 1281 1282

7. Learning Competencies for the Obstetrics and Gynecology Sonography 1283 Concentration 1284

1285 a. Identify anatomy, anatomic variants, and sonographic appearances of normal 1286

structures of the female pelvis. 1287 1) Pelvic muscles 1288 2) Pelvic vasculature 1289 3) Peritoneal spaces 1290 4) Reproductive organs 1291 5) Suspensory ligaments 1292 1293

b. Identify anatomy, anatomic variants, and sonographic appearances of normal 1294 maternal, embryonic, and fetal anatomic structures during the first, second, and third 1295 trimesters. 1296

1297 1) First-trimester structures 1298

a) Gestational sac 1299 b) Embryonic pole 1300 c) Yolk sac 1301 d) Early placenta 1302 e) Fetal cardiac activity 1303 f) Uterus 1304 g) Cervix 1305 h) Adnexa 1306 i) Pelvic spaces 1307 j) Multiple gestations 1308

1309 2) Second- and Third-trimester fetal and maternal structures 1310

a) Intracranial anatomy 1311 b) Face 1312 c) Thoracic cavity 1313 d) Heart 1314

(1) Position and size 1315 (2) Four-chamber view 1316 (3) LVOT and RVOT views 1317 (4) Three-vessel and three-vessel tracheal views 1318

e) Abdomen and pelvis 1319 f) Abdominal wall 1320 g) Spine 1321 h) Extremities 1322 i) External genitalia 1323 j) Amniotic fluid 1324 k) Placenta 1325 l) Umbilical cord 1326 m) Fetal cardiac activity 1327 n) Maternal cervix 1328 o) Maternal adnexa 1329 p) Multiple gestations 1330

1331


c. Demonstrate knowledge of pathology, physiology, pathophysiology, sonographic 1332 technique, measurements, sonographic appearances, and Doppler patterns in 1333 gynecologic disease processes. 1334 1) Inflammatory processes 1335 2) Congenital anomalies 1336 3) Benign uterine/adnexal masses 1337 4) Malignant uterine/adnexal masses 1338 5) Contraceptive devices 1339 6) Infertility procedures 1340 7) Post-partum 1341

1342 d. Demonstrate knowledge of pathology, physiology, pathophysiology, sonographic 1343

technique, sonographic appearance, measurements, and Doppler patterns in obstetric 1344 abnormalities. 1345 1) First trimester complications 1346 2) Congenital anomalies 1347 3) Genetic syndromes 1348 4) Growth abnormalities 1349 5) Multiple gestation complications 1350 6) Viability 1351 7) Amniotic fluid 1352 8) Placenta 1353 9) Umbilical cord 1354 10) Fetal monitoring 1355 11) Effects of maternal conditions 1356

1357 e. Demonstrate knowledge and understanding of the role of the sonographer in 1358

performing interventional/invasive/advanced procedures. 1359 1) Infertility procedures 1360 2) Amniocentesis 1361 3) Chorionic villus sampling 1362 4) Fetal therapy 1363 5) Nuchal translucency 1364 6) Sonohysterography 1365 7) Three-dimensional obstetric and gynecologic sonography 1366

1367 f. Evaluate scanning protocol and modification(s) based on the sonographic findings 1368

and the differential diagnoses. 1369 1) Indications and contraindications 1370 2) History and physical examination 1371 3) Related imaging, laboratory, and functional testing procedures 1372 4) Clinical differential diagnosis 1373 5) Role of sonography in patient management 1374 1375

g. Demonstrate achievement of clinical competency through the performance of 1376 sonographic examinations of the gravid and non-gravid pelvis with both 1377 transabdominal and endocavitary transducers, and Doppler/M-mode display modes, 1378 according to practice parameters established by national professional organizations 1379 and the protocol of the clinical affiliate. Clinical competencies must include evaluation 1380 and documentation of: 1381 1) Identification of anatomical and related structures 1382 2) Differentiation of normal from pathological/disease process 1383 3) Image optimization techniques in grayscale 1384 4) Image optimization techniques in Doppler and M-mode (where applicable) 1385 5) Knowledge and application of ALARA 1386 6) Measurements as applicable 1387 7) Gynecology competencies 1388

a) Complete pelvic sonogram 1389 b) Vagina/cervix/uterus 1390


c) Posterior and anterior cul-de-sac 1391 d) Adnexa, including ovaries and fallopian tubes 1392

8) Obstetrical competencies 1393 a) First-trimester obstetric structures: 1394

(1) Gestational sac 1395 (2) Embryonic pole 1396 (3) Yolk sac 1397 (4) Fetal cardiac activity 1398 (5) Placenta 1399 (6) Uterus 1400 (7) Cervix 1401 (8) Adnexa 1402 (9) Pelvic spaces 1403

b) Second- and Third-trimester fetal and maternal structures 1404 (1) Intracranial anatomy 1405 (2) Face 1406 (3) Thoracic cavity 1407 (4) Heart 1408

(a) Position and size 1409 (b) Four-chamber view 1410 (c) LVOT and RVOT views 1411 (d) Three-vessel and three-vessel tracheal views 1412

(5) Abdomen 1413 (6) Abdominal wall 1414 (7) Spine 1415 (8) Extremities 1416 (9) Amniotic fluid 1417 (10) Placenta 1418 (11) Umbilical cord 1419 (12) Fetal cardiac activity 1420 (13) Maternal cervical length 1421 (14) Maternal adnexa 1422

c) Biophysical profile 1423 1424 The above may be completed as individual clinical competencies or may be incorporated with other 1425 structures/techniques as part of a limited or complete examination. 1426 1427 8. Learning Competencies for the Pediatric Cardiac Sonography Concentration 1428 1429

a. Identify anatomy, anatomic variants, and sonographic appearances of normal and 1430 abnormal cardiac structures (adult, pediatric, and fetal). 1431 1) Embryology and fetal cardiac development 1432 2) Cardiac chambers and septation 1433 3) Valve anatomy and dynamics 1434 4) Coronary artery anatomy 1435 5) Relationships of cardiac chambers and great vessels 1436 6) Mediastinal structures 1437 7) Arch anatomy 1438 8) Pulmonary artery and venous anatomy 1439 9) Systemic venous return 1440 1441

b. Demonstrate knowledge of normal cardiovascular physiology and hemodynamics. 1442 1) Electrophysiology 1443 2) Fetal circulation 1444 3) Transitional physiology 1445 4) Ventricular function 1446 5) Pulmonary and systemic circulation 1447 6) Exercise physiology 1448

1449


c. Demonstrate knowledge of cardiovascular pathophysiology (embryology of congenital 1450 abnormalities, mechanisms of acquired disease), and hemodynamics, sonographic 1451 technique, measurements, quantitative principles, and Doppler patterns in both the 1452 normal heart and with cardiac disease. 1453 1) Congenital heart disease (CHD) 1454

a) Situs abnormalities 1455 b) Defects in cardiac septation 1456 c) Abnormalities in atrial-ventricular connections 1457 d) Ventricular hypoplasia 1458 e) Ventricular Inflow anomalies 1459 f) Abnormalities in ventriculoarterial connection 1460 g) Ventricular outflow anomalies 1461 h) Abnormalities within cardiac chambers 1462 i) Vascular abnormalities 1463 j) Abnormalities within thorax 1464 k) Abnormal vascular connections 1465 l) Postoperative repair/treatment 1466 m) Diseases of the aorta and great vessels 1467 n) Valvular abnormalities 1468 o) Pericardial abnormalities 1469 1470

2) Acquired heart disease 1471 a) Valvular heart disease 1472 b) Ischemic cardiac disease 1473 c) Cardiomyopathy 1474 d) Pericardial disease 1475 e) Cardiac endocarditis, neoplasms, and masses 1476 f) Cardiac trauma 1477 g) Pulmonary vascular disease 1478 h) Systemic and pulmonary hypertension 1479 i) Infection of native structures and devices 1480

1481 d. Demonstrate knowledge and applications of the indications, utility, limitations, and 1482

technical procedures for related echocardiographic studies. 1483 1) Stress echocardiography 1484 2) Transesophageal echocardiography 1485 3) Intraoperative echocardiography 1486 4) Contrast-enhanced ultrasound 1487 5) IV administration techniques 1488 6) Three-dimensional echocardiography 1489 7) Echo-guided procedures 1490 8) Strain echocardiography 1491 9) Targeted obstetric exam 1492 1493

e. Demonstrate knowledge, application, and proficiency in the use of quantitation 1494 principles applied to echocardiographic images and flow data. 1495 1) Standard M-mode, two-dimensional, and Doppler measurements and calculations 1496

(normalized based on body surface area, and/or other biometric measurements for the 1497 fetus) 1498

2) Knowledge and understanding of normal and abnormal values for M-mode, two-1499 dimensional and Doppler echocardiography 1500

3) Evaluation of normal and abnormal systolic and diastolic ventricular function 1501 4) Evaluation of the severity of valve stenosis and regurgitation 1502 5) Knowledge of normal and abnormal sonographic appearances of peripheral vascular 1503

anatomy 1504 6) Calculation of Qp:Qs ratio 1505 7) Miscellaneous measurements specific to patient history 1506

1507


f. Demonstrate knowledge and application of clinical cardiology as appropriate to the 1508 fetus and patients with congenital heart disease (CHD). 1509 1) Relationship of echocardiography to history and physical examination, including 1510

indications for echocardiography - diagnostic approach to CHD 1511 2) Acquired heart disease and noncardiac disease and the effects of systemic diseases on 1512

cardiovascular anatomy and physiology 1513 3) Differential diagnosis as it relates to the echocardiographic examination 1514 4) Cardiac arrhythmias 1515 5) Genetic syndromes and chromosomal anomalies associated with CHD 1516 6) Cardiovascular surgery and interventional cardiology 1517 7) Post-operative repair evaluation 1518 8) Current trends of caring for the fetus, pediatric and adult patient with CHD 1519

1520 g. Awareness of scanning protocol and modification(s) based on the sonographic 1521

findings and the differential diagnoses. 1522 1) Indications and contraindications 1523 2) History and physical examination 1524 3) Related imaging, laboratory, and functional testing procedures 1525

a) Chest X-ray 1526 b) Angiography and cardiac catheterization 1527 c) Electrocardiography, electrophysiologic studies, Holter monitoring 1528 d) Stress testing 1529 e) Radionuclide studies 1530 f) Tomographic imaging procedures 1531 g) Fetal /Pediatric/Adult interventions for congenital heart disease 1532

4) Clinical differential diagnosis 1533 5) Role of sonography in patient management 1534 6) Pharmacology 1535

1536 h. Demonstrate proficiency in the technique and application of: 1537

1) Quantitation principles applied to echocardiographic images and flow data 1538 2) Calculation of Qp:Qs ratio 1539

1540 The above proficiencies may be demonstrated in a clinical setting or in a simulated environment. 1541

1542 i. Demonstrate achievement of clinical competency through the performance of pediatric 1543

cardiac sonography according to practice parameters established by national 1544 professional organizations and the protocol of the clinical affiliate. Clinical 1545 competencies must include evaluation and documentation of: 1546 1) Identification of anatomical and relational structures 1547 2) Differentiation of normal from pathological/disease process 1548 3) Image optimization and measurement techniques with: 1549

a) 2D imaging 1550 b) M-mode 1551 c) Spectral Doppler: PW, CW and Tissue Doppler 1552 d) Color flow Doppler 1553 e) Use of non-imaging CW Doppler transducer 1554

4) Pediatric cardiac sonography competencies 1555 a) Complete transthoracic examination - Normal 1556 b) Patent foramen ovale or atrial septal defect 1557 c) Ventricular septal defect 1558 d) Patent ductus arteriosus 1559 e) Conotruncal defect (repaired or unrepaired) 1560 f) Left heart structural/valvular disease 1561 g) Right heart structural/valvular disease 1562 h) Repaired structural heart disease 1563

1564 The above may be completed as individual clinical competencies or may be incorporated with 1565 other organs as part of a limited or complete examination. 1566

1567


9. Learning Competencies for the Vascular Sonography Concentration 1568 1569

a. Demonstrate knowledge of anatomy and anatomic variants of the cardiovascular 1570 system. 1571 1) Heart 1572

a) Chambers 1573 b) Valves 1574 c) Vessels 1575

2) Pulmonary circulation 1576 3) Vessel structure 1577

a) Arteries 1578 b) Veins 1579 c) Capillaries 1580

4) Aorta and branches 1581 5) Cerebrovascular 1582 6) Hepatoportal venous 1583 7) Mesenteric arterial system 1584 8) Peripheral arterial 1585 9) Peripheral venous 1586 10) Renal vessels 1587 11) Vena cava and iliac veins 1588

1589 b. Demonstrate knowledge of normal and abnormal peripheral vascular physiology and 1590

hemodynamics. 1591 1) Principles of pressure, flow, and resistance 1592 2) Pulsatile flow 1593 3) Laminar and non-laminar flow patterns 1594 4) Poiseuille’s law 1595 5) Bernoulli’s principle 1596 6) Reynold’s number 1597 7) Cardiac influence on flow 1598 8) Occlusive diseases 1599 9) Collateral circulation 1600 10) Exercise and hyperemia 1601 11) Systemic diseases and other conditions 1602 12) Venous physiology, valve function, calf pump 1603

1604 c. Demonstrate knowledge of mechanisms of vascular diseases, vascular 1605

pathophysiology, and hemodynamic effects. 1606 1) Aneurysm and pseudoaneurysm 1607 2) Arterial embolism 1608 3) Arteriovenous fistulae and shunts 1609 4) Atherosclerosis 1610 5) Congenital anomalies 1611 6) Fibromuscular dysplasia 1612 7) Genetic disorders 1613 8) Iatrogenic injury 1614 9) Infection 1615 10) Intimal hyperplasia 1616 11) Ischemia 1617 12) Neoplasia 1618 13) Organ transplantation 1619 14) Pharmacologic alterations 1620 15) Portal hypertension 1621 16) Systemic hypertension 1622 17) Trauma 1623 18) Vascular entrapment and extrinsic compression 1624 19) Vascular malformations 1625 20) Vasculitis 1626


21) Vasospastic disorders 1627 22) Venous thromboembolism 1628 23) Venous valvular disorders 1629

1630 d. Demonstrate knowledge of sonographic appearances, sonographic techniques, 1631

measurements, and Doppler flow characteristics in both normal and abnormal 1632 vascular structures. 1633 1) Aorta and branches 1634 2) Cerebrovascular 1635 3) Hepatoportal venous 1636 4) Mesenteric arterial system 1637 5) Peripheral arterial 1638 6) Peripheral venous 1639 7) Renal vessels 1640 8) Vena cava and iliac veins 1641

1642 e. Demonstrate knowledge of physiologic vascular testing principles and techniques. 1643

1) Continuous-wave and pulse Doppler 1644 2) Pressure measurements, including ankle/brachial index 1645 3) Pneumoplethysmography (pulse volume recording) 1646 4) Segmental pressure and waveform analysis 1647 5) Exercise treadmill testing 1648 6) Photoplethysmography (PPG), arterial and venous 1649 7) Air plethysmography, venous 1650 8) Laser Doppler, including skin perfusion pressure measurements 1651

1652 f. Demonstrate knowledge and application in the use of quantitative principles applied to 1653

vascular testing. 1654 1) Acceleration time 1655 2) Ankle/brachial pressure ratios 1656 3) Aorta/renal ratios 1657 4) Area and diameter reduction measurements 1658 5) Digit/brachial indices 1659 6) Velocity change across stenosis for grading arterial lesions 1660 7) Pulsatility index 1661 8) Resistive index 1662 9) Segmental pressures, including digits 1663 10) Velocity ratios 1664 11) Venous reflux time 1665 12) Volume flow 1666

1667 g. Demonstrate knowledge in ultrasound-guided procedures. 1668

1) Role of sonographer 1669 2) Clinical information 1670 3) Informed consent 1671 4) Procedural time out 1672 5) Sterile technique 1673 6) Pre- and post-procedure documentation 1674 7) Superficial vein ablation 1675 8) Use of thrombin injection for pseudoaneurysm treatment 1676

1677 h. Demonstrate knowledge of the role of ultrasound for evaluation of vascular surgical 1678

procedures or interventions, including a role in planning, intra-procedural 1679 guidance/technical evaluation, and/or post-procedure assessment. 1680 1) Angioplasty 1681 2) Atherectomy 1682 3) Coil embolization 1683 4) Dialysis fistula/graft 1684 5) Embolectomy 1685


6) Endarterectomy 1686 7) Endovascular aortic aneurysm repair (EVAR) 1687 8) Endovenous ablation 1688 9) Inferior vena cava filter 1689 10) Patch angioplasty 1690 11) Stents 1691 12) Synthetic grafts 1692 13) Thrombolysis and thrombectomy 1693 14) Trans-jugular intrahepatic porto-systemic shunt 1694 15) Vein bypass grafts 1695

1696 i. Evaluate scanning protocol and modification(s) based on patient-specific factors. 1697

1) History, including indication, prior vascular procedures 1698 2) Physical examination and assessment of patient-specific factors 1699 3) Contraindications 1700 4) Related imaging, laboratory, and functional testing procedures 1701 5) Clinical differential diagnosis 1702 6) Role of ultrasound in patient management 1703 7) Pharmacology 1704

1705 j. Demonstrate knowledge and application of quality assurance and statistical tests used 1706

in a vascular laboratory. 1707 1) Correlations of clinical findings and other imaging examinations 1708 2) Accuracy 1709 3) Sensitivity 1710 4) Specificity 1711 5) Positive predictive value 1712 6) Negative predictive value 1713 7) Quality improvement program components, including test appropriateness, evaluation of 1714

the technical quality and compliance with protocols 1715 1716

k. Demonstrate proficiency in the technique of: 1717 1) Intracranial cerebrovascular 1718 2) Upper extremity and digital arterial physiologic testing 1719 3) Upper extremity arterial duplex 1720 4) Palmar arch 1721 5) Lower extremity and digital arterial physiologic testing 1722 6) Lower extremity exercise testing 1723 7) Vessel mapping 1724 8) Visceral vascular 1725

1726 The above proficiencies may be demonstrated in a clinical setting or in a simulated environment. 1727

1728 l. Demonstrate achievement of clinical competency through the performance of 1729

sonographic examinations of the vascular system according to practice parameters 1730 established by national professional organizations and the protocol of the clinical 1731 affiliates. Clinical competencies must include evaluation and documentation of: 1732 1) Identification of anatomical and relational structures 1733 2) Differentiation of normal from pathological/disease process 1734 3) Image optimization in grayscale, color Doppler and spectral Doppler 1735 4) Measurement techniques 1736 5) Vascular competencies 1737

a) Extracranial cerebrovascular including vertebral vessels 1738 b) Aortoiliac duplex 1739 c) Ankle and brachial pressures/ABI 1740 d) Lower extremity arterial duplex 1741 e) Lower extremity venous duplex 1742 f) Lower extremity venous insufficiency testing 1743 g) Upper extremity venous duplex 1744


1745 The above may be completed as individual clinical competencies or may be incorporated with other 1746 structures/techniques as part of a limited or complete examination. 1747

1748

Commission on Accreditation of Allied Health Education ......2017/12/01 · Diagnostic Medical...

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