CCI RVS Exam: The Complete Guide (2026)
Last Updated: January 2026 | Reading Time: 20 minutes
Quick Summary: The CCI RVS (Registered Vascular Specialist) exam is a 165-question, 3-hour test for vascular sonographers. Administered by Cardiovascular Credentialing International (CCI), it covers cerebrovascular, peripheral arterial, peripheral venous, and visceral vascular 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 RVS Exam?
Why the RVS is Challenging
The RVS is often considered one of the more challenging exams because:
- Comprehensive scope: The exam covers all vascular territories from carotid arteries to peripheral veins, requiring mastery of diverse anatomy and pathology
- Clinical application: Questions emphasize real-world scenarios including interpretation of spectral waveforms and disease classification
- Protocol knowledge: You must understand examination protocols, patient positioning, and optimal imaging techniques for each vascular bed
- Hemodynamic principles: Deep understanding of blood flow dynamics, pressure relationships, and waveform analysis is essential
RVS 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 vascular images |
| Testing Centers | PSI (in-person or online proctoring) |
| Exam Fee | $365 (as of 2026) |
Understanding the 7 Content Domains
The RVS exam is divided into 7 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: Maintaining Patient Care and Safety (9%)
Approximately 15 questions
Domain 2: Applying Principles of Physics and Hemodynamics (15%)
Approximately 26 questions
Domain 3: Performing Abdominal/Visceral Examinations (11%)
Approximately 19 questions
Domain 4: Performing Extracranial/Intracranial Examinations (20%)
Approximately 34 questions
Domain 5: Performing Arterial Examinations of Upper and Lower Extremities (21%)
Approximately 36 questions
Domain 6: Performing Venous Examinations of Upper and Lower Extremities (20%)
Approximately 34 questions
Domain 7: Performing Hemodialysis Examinations (3%)
Approximately 5 questions
ABI = Ankle systolic pressure / Brachial systolic pressure
Normal ABI: 1.0 - 1.4
ICA/CCA ratio (for stenosis grading) = ICA PSV / CCA PSV
50-69% stenosis: PSV 125-230 cm/s, EDV 40-100 cm/s
≥70% stenosis: PSV >230 cm/s, EDV >100 cm/s
Near occlusion: Variable, high-resistance flow
Total occlusion: No detectable flow
Superficial veins: Reflux >0.5 seconds
Deep veins: Reflux >1.0 second
Perforating veins: Reflux >0.35 seconds
Free RVS Practice Test Questions
Test your knowledge with these sample RVS exam questions. Answers and explanations are provided below.
Question 1
A patient presents with an ankle-brachial index (ABI) of 0.6 in the right leg. This finding indicates:
Question 2
During a carotid duplex examination, you measure an ICA peak systolic velocity of 280 cm/s and end-diastolic velocity of 120 cm/s. These values are most consistent with:
Question 3
Which finding on lower extremity venous duplex is most indicative of acute deep vein thrombosis?
Question 4
A patient with suspected mesenteric ischemia undergoes duplex evaluation. A fasting peak systolic velocity >275 cm/s in the superior mesenteric artery suggests:
Question 5
During superficial venous reflux testing, reflux is considered pathologic in the great saphenous vein when it exceeds:
Question 6
A renal artery duplex examination shows a renal-to-aortic ratio (RAR) of 4.2. This finding indicates:
Question 7
Which waveform pattern is expected in the common femoral artery of a healthy individual at rest?
Question 8
A subclavian steal is suspected when the ipsilateral vertebral artery demonstrates:
Question 9
Which imaging plane is optimal for measuring the diameter of an abdominal aortic aneurysm?
Question 10
A segmental pressure examination shows a 35 mmHg drop between the high thigh and above-knee cuffs. This finding suggests occlusive disease in the:
Answer Key with Explanations
An ABI of 0.6 indicates moderate peripheral arterial disease. Normal ABI is 1.0-1.4, mild PAD is 0.91-0.99, moderate PAD is 0.41-0.90, and severe PAD is ≤0.40. Values >1.4 suggest non-compressible calcified vessels.
A PSV >230 cm/s combined with an EDV >100 cm/s is consistent with ≥70% stenosis according to Society of Radiologists in Ultrasound consensus criteria. This degree of stenosis typically warrants consideration for intervention.
Acute DVT typically presents as an echogenic or anechoic, non-compressible vein with absent or diminished flow. Acute thrombus may appear hypoechoic initially. Calcified walls and extensive collaterals suggest chronic disease.
A fasting SMA PSV >275 cm/s indicates ≥70% stenosis. Normal fasting SMA PSV is typically 100-180 cm/s. The SMA PSV increases postprandially in normal subjects but remains elevated in stenotic vessels.
Pathologic reflux in superficial veins (including the great saphenous vein) is defined as retrograde flow exceeding 0.5 seconds. Deep veins use a 1.0 second threshold, and perforating veins use 0.35 seconds.
A renal-to-aortic ratio (RAR) ≥3.5 indicates ≥60% renal artery stenosis. The RAR is calculated by dividing the peak systolic velocity in the renal artery by the peak systolic velocity in the aorta. A PSV >180-200 cm/s also suggests significant stenosis.
Normal peripheral arteries at rest demonstrate triphasic waveforms: rapid systolic upstroke, brief flow reversal in early diastole (due to peripheral resistance), and a small forward flow component in late diastole. Monophasic flow suggests proximal disease or distal vasodilation.
Subclavian steal occurs when proximal subclavian artery stenosis/occlusion causes blood to flow retrograde down the ipsilateral vertebral artery to supply the arm. This manifests as partial (alternating) or complete flow reversal in the vertebral artery.
AAA diameter should be measured in the transverse plane, from outer wall to outer wall (adventitia to adventitia), perpendicular to the long axis of the aorta. This method provides the most reproducible measurement for surveillance and surgical planning.
A pressure drop >20-30 mmHg between adjacent cuff levels indicates significant occlusive disease in the arterial segment between those levels. A high thigh to above-knee drop localizes disease to the superficial femoral artery.
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RVS Exam Scoring & Pass Rate
Current Pass Rates
According to official data, the RVS first-time pass rate is approximately Not publicly reported. This makes it one of the more challenging exams.
Why Pass Rates May Be Lower
- Broad vascular coverage: Must master cerebrovascular, peripheral arterial, venous, and visceral vascular systems
- Waveform interpretation: Requires ability to recognize normal and abnormal spectral patterns across all vascular beds
- Protocol complexity: Different examination techniques and criteria for each vascular territory
- Clinical correlation: Questions often require integrating findings with patient symptoms and clinical scenarios
Understanding Your Score Report
Your score report includes:
- Overall scaled score (pass/fail)
- Performance breakdown by content domain
- Areas of strength and weakness for remediation
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 RVS Exam
Step 1: Create a CCI Account
Visit cci-online.org and create a new account or log in to your existing CCI profile.
Step 2: Verify Your Eligibility
CCI offers several pathways to RVS eligibility based on education and clinical experience:
- Pathway 1: Graduate from a CAAHEP-accredited vascular technology program
- Pathway 2: Graduate from a CAAHEP-accredited diagnostic medical sonography or cardiovascular technology program with vascular clinical experience
- Pathway 3: Hold current ARDMS RVT credential
- Pathway 4: Documented clinical vascular sonography experience with prerequisite credential
Step 3: Submit Your Application
Select the RVS examination, choose your eligibility pathway, upload required documentation (transcripts, clinical logs, current credentials), and pay the examination fee ($340 as of 2026).
Step 4: Receive Your Examination Authorization
CCI reviews applications within 2-4 weeks. Upon approval, you'll receive authorization to schedule your examination. Your authorization is typically valid for 90 days.
Step 5: Schedule with Pearson VUE
Visit Pearson VUE, select CCI as your testing program, choose your preferred testing center and date, and confirm your appointment.
What to Expect on Exam Day
For In-Person Testing
Before arrival:
- Get 7-8 hours of sleep the night before
- Eat a balanced meal before the exam
- Arrive at the testing center 30 minutes early
- Bring two forms of valid ID (primary must have photo and signature)
At the testing center:
- Check in with the test administrator
- Store all personal belongings in a designated locker
- No phones, smart watches, or study materials permitted
- Biometric verification may be required
During the exam:
- You will have access to an on-screen calculator
- Scratch paper/whiteboard provided by testing center
- Breaks count against your examination time
- Flag questions for review and return to them if time permits
For Online Proctoring
System requirements:
- Stable high-speed internet connection
- Functioning webcam and microphone
- Windows or Mac computer meeting technical requirements
- Download and test proctoring software in advance
Environment requirements:
- Private, quiet room with closed door
- Clear desk with only computer present
- No dual monitors allowed
- Adequate lighting for webcam visibility
How Long Should You Study?
The ideal study timeline depends on your background:
| Situation | Recommended Study Time |
|---|---|
| Current vascular sonography student | 8-10 weeks |
| Recent graduate (< 1 year) | 6-8 weeks |
| Working vascular sonographer (1-3 years) | 4-6 weeks |
| Experienced sonographer adding credential | 4-6 weeks |
Sample Study Schedule
Week 1-2: Cerebrovascular Evaluation
- Review carotid anatomy and hemodynamics
- Master ICA stenosis grading criteria
- Study vertebral artery and transcranial Doppler
- Practice carotid waveform interpretation
Complete 150-200 practice questions
Week 3-4: Peripheral Arterial Evaluation
- Study upper and lower extremity arterial anatomy
- Master ABI interpretation and segmental pressures
- Review arterial waveform patterns (triphasic, biphasic, monophasic)
- Study PAD classification and intervention criteria
Complete 200-250 practice questions
Week 5-6: Peripheral Venous Evaluation
- Review deep and superficial venous anatomy
- Master DVT diagnosis criteria and imaging protocols
- Study chronic venous insufficiency and reflux testing
- Review venous mapping for bypass and dialysis access
Complete 200-250 practice questions
Week 7-8: Visceral Vascular & Physics
- Study renal artery stenosis criteria and imaging
- Review mesenteric arterial evaluation (celiac, SMA, IMA)
- Study abdominal aortic aneurysm measurement protocols
- Review Doppler physics and instrumentation principles
Complete 200-250 practice questions
Week 9-10: Comprehensive Review & Mock Exams
- Take 2-3 full-length timed practice examinations
- Review all missed questions and weak content areas
- Focus final review on lowest-scoring domains
- Light review day before exam; rest and prepare mentally
Free Video Lessons
Free Video Lessons
Watch these free video lessons to help you prepare for the RVS.
Tips to Pass the RVS Exam
1. Master Stenosis Grading Criteria
Memorize the velocity thresholds for carotid, renal, and mesenteric stenosis classification. These are frequently tested and must be recalled accurately. Create flashcards with PSV, EDV, and ratio criteria for each vascular bed.
2. Understand Waveform Patterns
Know the difference between high-resistance (triphasic) and low-resistance (monophasic) waveforms and what clinical conditions cause each pattern. Practice identifying waveform changes proximal and distal to stenoses.
3. Focus on Clinical Protocols
Understand the complete examination protocol for each vascular bed, including patient positioning, transducer selection, and required views. Know when to use color Doppler vs. spectral Doppler.
4. Review Anatomy Thoroughly
Vascular anatomy is foundational. Know the branches, normal variants, and collateral pathways for arterial and venous systems. Understand which vessels are examined in each study type.
5. Practice ABI Calculations
Be comfortable calculating and interpreting ankle-brachial indices and segmental pressure gradients. Know the significance of different ABI ranges and when additional testing is indicated.
6. Take Timed Practice Exams
The RVS exam allows approximately 65 seconds per question. Practice under timed conditions to build stamina and pacing. Aim for 80%+ accuracy on practice exams before scheduling your test.
FAQs
How many questions are on the CCI RVS exam?
The RVS exam contains approximately 170 multiple-choice questions.
What is the passing score for the RVS exam?
You need a scaled score of 400 or higher to pass the RVS examination.
How long is the RVS exam?
You have 3 hours (180 minutes) to complete the exam, which allows approximately 65 seconds per question.
How much does the RVS exam cost?
The examination fee is $340 (as of 2026).
What is the difference between CCI RVS and ARDMS RVT?
Both credentials certify competence in vascular sonography. The RVS is administered by CCI (Cardiovascular Credentialing International) while the RVT is administered by ARDMS. Both are widely recognized by employers, and some sonographers hold both credentials.
How long must I wait to retake the RVS exam?
You must wait a minimum of 30 days between examination attempts. CCI allows up to 4 attempts per year.
What content areas does the RVS exam cover?
The RVS exam covers five main domains: cerebrovascular evaluation, peripheral arterial evaluation, peripheral venous evaluation, visceral vascular evaluation, and physics/instrumentation.
Can I take the RVS exam before graduating?
CCI may allow students in their final semester of an accredited program to apply. Check current CCI eligibility requirements and contact CCI directly to confirm student eligibility options.
How do I maintain my RVS credential?
The RVS credential requires continuing education credits for renewal. CCI requires completion of approved CE activities within the certification cycle to maintain active credential status.
Related CCI Exam Guides
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This guide is updated regularly to reflect the latest CCI RVS exam information. Last reviewed: January 2026.