CCI RCS Exam: The Complete Guide (2026)
Last Updated: January 2026 | Reading Time: 20 minutes
Quick Summary: The CCI RCS (Registered Cardiac Sonographer) exam is a 165-question, 3-hour test that validates your competency in adult echocardiography. Administered by Cardiovascular Credentialing International (CCI), this credential demonstrates expertise in cardiac imaging, valvular assessment, and hemodynamic evaluation. This guide covers everything you need: exam format, content domains, 10 free practice questions, registration steps, and proven study strategies.
Table of Contents
What is the RCS Exam?
Why the RCS is Challenging
The RCS is often considered one of the more challenging exams because:
- Comprehensive scope: The exam covers everything from basic echo views to complex hemodynamic calculations and pathology recognition
- Clinical integration: Questions require you to apply knowledge to real-world clinical scenarios, not just recall facts
- Heavy emphasis on valvular disease: 25% of the exam focuses on valvular findings, requiring detailed knowledge of stenosis, regurgitation, and prosthetic valves
- Hemodynamic calculations: You must be comfortable with pressure gradients, valve areas, and cardiac output calculations
RCS Exam Format & Structure
Understanding the exam format helps you prepare strategically:
| Aspect | Details |
|---|---|
| Total Questions | Approximately 170 multiple-choice |
| Time Limit | 3 hours (180 minutes) |
| Passing Score | 650 (on a 200-900 scale) |
| Format | Multiple choice questions with echocardiographic images |
| Testing Centers | PSI (in-person or online proctoring) |
| Exam Fee | $365 (as of 2026) |
Understanding the 5 Content Domains
The RCS exam is divided into 5 content domains, each weighted differently. Knowing these weights helps you prioritize your study time.
Content Domain Weights
Question estimates based on total question count. Focus study time proportionally.
Study tip: Spend the most time on the largest domain—it makes up the biggest portion of your exam.
Domain 1: Preparing for Echocardiographic Procedure (5%)
Approximately 9 questions
Domain 2: Performing Echocardiographic Imaging (24%)
Approximately 41 questions
Domain 3: Evaluating Valvular Echocardiographic Findings (25%)
Approximately 43 questions
Domain 4: Evaluating Anatomy, Physiology, and Hemodynamics (29%)
Approximately 49 questions
Domain 5: Applying the Physics of Ultrasound (13%)
Approximately 22 questions
Bernoulli Equation: Pressure Gradient = 4V²
Continuity Equation: A1 × V1 = A2 × V2
Stroke Volume = LVOT Area × LVOT VTI
Cardiac Output = Stroke Volume × Heart Rate
1. Aortic Valve Area (AVA) = (LVOT Area × LVOT VTI) / AV VTI
2. PISA radius method for regurgitant volume
3. Pressure Half-Time (PHT) for mitral stenosis: MVA = 220/PHT
4. E/A ratio for diastolic function assessment
5. E/e' ratio for LV filling pressures
Free RCS Practice Test Questions
Test your knowledge with these sample RCS exam questions. Answers and explanations are provided below.
Question 1
A patient presents with severe aortic stenosis. Using the simplified Bernoulli equation, what is the peak pressure gradient if the peak velocity across the aortic valve is 5 m/s?
Question 2
Which echocardiographic view is best for evaluating the left atrial appendage for thrombus?
Question 3
What E/e' ratio is generally indicative of elevated left ventricular filling pressures?
Question 4
During a stress echocardiogram, which finding would indicate a positive test for ischemia?
Question 5
What is the normal mitral valve area in an adult?
Question 6
In hypertrophic cardiomyopathy (HCM), systolic anterior motion (SAM) of the mitral valve causes:
Question 7
Which Doppler modality should be used to accurately measure high-velocity jets across a stenotic aortic valve?
Question 8
A dilated cardiomyopathy patient has an LVOT diameter of 2.0 cm and LVOT VTI of 15 cm. What is the stroke volume?
Question 9
What is the primary echocardiographic finding in cardiac tamponade?
Question 10
Which measurement is used to calculate the TAPSE (Tricuspid Annular Plane Systolic Excursion)?
Answer Key with Explanations
Using the simplified Bernoulli equation (Pressure Gradient = 4V²), when V = 5 m/s: Gradient = 4 × (5)² = 4 × 25 = 100 mmHg. This represents severe aortic stenosis.
The left atrial appendage is best visualized with transesophageal echocardiography (TEE), specifically the mid-esophageal views. Transthoracic echo has limited visualization of the LAA due to its anterior location.
An E/e' ratio > 14 suggests elevated LV filling pressures. E/e' < 8 indicates normal filling pressures, while 8-14 is considered indeterminate and requires additional parameters for assessment.
A positive stress echo for ischemia shows new or worsening wall motion abnormalities at peak stress compared to rest. Normal response is hyperdynamic (increased) wall motion with stress.
Normal mitral valve area is 4.0-6.0 cm². Mild stenosis is 1.5-2.5 cm², moderate stenosis is 1.0-1.5 cm², and severe stenosis is < 1.0 cm².
SAM of the mitral valve leaflet in HCM causes dynamic left ventricular outflow tract (LVOT) obstruction. This creates a pressure gradient in the LVOT that increases with decreased preload or increased contractility.
Continuous-wave (CW) Doppler must be used for high-velocity jets because it has no aliasing (no Nyquist limit). Pulsed-wave Doppler aliases at velocities above the Nyquist limit, making it unsuitable for measuring severe stenosis.
Stroke Volume = LVOT Area × LVOT VTI. LVOT Area = πr² = π × (1.0)² = 3.14 cm². SV = 3.14 × 15 = 47.1 mL. This is below normal (typically 60-100 mL), consistent with dilated cardiomyopathy.
Cardiac tamponade shows right atrial collapse during ventricular systole and RV diastolic collapse due to elevated pericardial pressure. Additional findings include respiratory variation in mitral/tricuspid inflow and IVC plethora.
TAPSE is measured using M-mode through the lateral tricuspid annulus in the apical four-chamber view. It measures the longitudinal excursion of the annulus during systole. Normal TAPSE is > 17 mm; values < 17 mm indicate RV dysfunction.
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RCS Exam Scoring & Pass Rate
Current Pass Rates
According to official data, the RCS first-time pass rate is approximately Not publicly reported. This makes it one of the more challenging exams.
Why Pass Rates May Be Lower
- Clinical application: Questions often present clinical scenarios requiring integration of multiple concepts
- Quantitative analysis: Many questions involve hemodynamic calculations and valve area assessments
- Pathology recognition: You must recognize echocardiographic findings of various cardiac diseases
- Protocol knowledge: Understanding when to modify protocols for specific clinical indications
Understanding Your Score Report
Your score report includes:
- Overall pass/fail status
- Scaled score (400 minimum passing)
- Performance breakdown by content domain
What If You Don't Pass?
First, know that you're not alone—many examinees don't pass on their first attempt.
- Waiting period: 30 days before you can retake
- Maximum attempts: 4 attempts per 12-month period
- Re-application: You must submit a new application and fee for each attempt
How to Register for the RCS Exam
Step 1: Create a CCI Account
Visit cci-online.org and create an account. Complete your profile with accurate contact and education information.
Step 2: Verify Your Eligibility
CCI offers several pathways to RCS eligibility:
- Pathway 1: Graduate from a CAAHEP-accredited cardiac sonography program
- Pathway 2: Graduate from a CAAHEP-accredited diagnostic medical sonography program with cardiac concentration
- Pathway 3: Hold an approved allied health credential plus documented cardiac sonography experience
- Pathway 4: International applicants with equivalent education and experience
Step 3: Submit Your Application
Select the RCS examination, provide documentation of your eligibility pathway, and pay the examination fee ($340 as of 2026).
Step 4: Receive Your Authorization to Test (ATT)
CCI reviews applications within 2-4 weeks. Upon approval, you'll receive an ATT via email. Your ATT is typically valid for 90 days.
Step 5: Schedule with Prometric
Visit Prometric.com, select CCI as the testing program, choose your preferred testing center, and schedule your exam date and time.
What to Expect on Exam Day
For In-Person Testing
Before arrival:
- Get adequate rest the night before (7-8 hours)
- Eat a balanced meal—avoid heavy foods that may cause drowsiness
- Arrive at the testing center 30 minutes early
- Bring two forms of valid, unexpired ID (primary must have photo and signature)
At the testing center:
- Check in with the test center administrator
- Store all personal items in a provided locker (phones, watches, bags)
- Biometric identification (palm scan or photo) may be required
- Review and accept the testing rules and non-disclosure agreement
During the exam:
- You have 180 minutes (3 hours) to complete 165 questions
- Scratch paper and calculator will be provided
- You may take breaks, but time continues to run
- Flag questions for review and manage your time wisely
For Online Proctoring
System requirements:
- Stable high-speed internet connection
- Webcam with clear video capability
- Working microphone for communication with proctor
- Windows or Mac computer (check current system requirements)
Environment requirements:
- Private, quiet room with closed door
- Clear desk/workspace—remove all materials
- No secondary monitors or devices
- Adequate lighting for proctor to see you clearly
How Long Should You Study?
The ideal study timeline depends on your background:
| Situation | Recommended Study Time |
|---|---|
| Recent graduate (cardiac sonography program) | 6-8 weeks |
| Working cardiac sonographer (1-2 years experience) | 4-6 weeks |
| Experienced sonographer transitioning to cardiac | 8-10 weeks |
| Re-certification or returning after break | 6-8 weeks |
Sample Study Schedule
Week 1-2: Foundation & Echo Views
- Review Domain A: Patient preparation and positioning
- Study Domain B: Standard echocardiographic views and image optimization
- Practice identifying cardiac anatomy in all standard views
- Complete 100-150 practice questions on imaging basics
Complete 100-150 practice questions
Week 3-4: Valvular Assessment (Critical)
- Study Domain C: Valvular echocardiographic findings (25% of exam)
- Master assessment of stenosis and regurgitation for all four valves
- Learn prosthetic valve evaluation and complications
- Practice pressure half-time and continuity equation calculations
Complete 200+ practice questions
Week 5-6: Hemodynamics & Pathology
- Study Domain D: Anatomy, physiology, and hemodynamics (29% of exam)
- Review cardiomyopathies: dilated, hypertrophic, restrictive
- Study pericardial disease and congenital heart disease basics
- Master diastolic function assessment and filling pressure estimation
Complete 200+ practice questions
Week 7: Physics & Comprehensive Review
- Study Domain E: Physics of ultrasound (13% of exam)
- Review Doppler principles, artifacts, and image optimization
- Take first full-length practice exam under timed conditions
- Identify weak areas from practice exam results
Complete 165 (full exam) practice questions
Week 8: Final Preparation
- Take 2-3 additional timed practice exams
- Focus review on consistently missed topics
- Review key formulas and normal values
- Light review and rest the day before your exam
Tips to Pass the RCS Exam
1. Master the Hemodynamic Calculations
The Bernoulli equation (4V²) and continuity equation are fundamental to the RCS exam. Practice these calculations until they become second nature. Know when to apply each formula and understand their clinical significance.
2. Focus on Valvular Assessment
With 25% of the exam dedicated to valvular findings, spend significant time on stenosis and regurgitation assessment. Know the grading criteria (mild, moderate, severe) for each valve and multiple methods for assessment.
3. Understand Diastolic Function
Diastolic function assessment appears throughout the exam. Know the E/A ratio, E/e' ratio, deceleration time, and how to grade diastolic dysfunction. Understand how various conditions affect these parameters.
4. Know Normal Values Cold
Memorize normal ranges for chamber dimensions, wall thickness, ejection fraction, valve areas, and Doppler velocities. Many questions test whether findings are normal or abnormal.
5. Study Cardiomyopathies and Pericardial Disease
Understand the echocardiographic features that distinguish dilated, hypertrophic, and restrictive cardiomyopathies. Know the findings in pericardial effusion, tamponade, and constrictive pericarditis.
6. Practice with Images and Videos
Echocardiography is a visual specialty. Supplement your text-based study with echo images and clips. Practice identifying pathology, measuring structures, and recognizing artifacts.
FAQs
How many questions are on the RCS exam?
The RCS exam contains approximately 170 multiple-choice questions.
What is the passing score for the RCS exam?
You need a scaled score of 400 or higher to pass the RCS examination.
How long is the RCS exam?
You have 3 hours (180 minutes) to complete the exam—approximately 65 seconds per question.
How much does the RCS exam cost?
The examination fee is $340 (as of 2026).
What is the difference between CCI RCS and ARDMS RDCS?
Both credentials validate cardiac sonography competency but are administered by different organizations. CCI (Cardiovascular Credentialing International) offers the RCS, while ARDMS offers the RDCS. Both are widely recognized, though some employers may prefer one over the other.
How long must I wait to retake the RCS exam if I fail?
You must wait 30 days between exam attempts. You may attempt the exam up to 4 times within a 12-month period.
What content domains are covered on the RCS exam?
The RCS exam covers five domains: Domain A - Preparing for Echocardiographic Procedure (5%), Domain B - Performing Echocardiographic Imaging (24%), Domain C - Evaluating Valvular Echocardiographic Findings (25%), Domain D - Evaluating Anatomy, Physiology, and Hemodynamics (29%), Domain E - Applying the Physics of Ultrasound (13%).
How do I maintain my RCS credential?
RCS certification is valid for 3 years. To maintain your credential, you must complete 30 continuing education credits during each 3-year cycle and pay the renewal fee.
Can I take both the RCS and RDCS exams?
Yes, many cardiac sonographers hold both credentials. This can increase your marketability and demonstrate comprehensive competency validated by multiple organizations.
Related CCI Exam Guides
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This guide is updated regularly to reflect the latest CCI RCS exam information. Last reviewed: January 2026.