Ultrasound consists of five major specialties: general ultrasound, cardiac ultrasound, obstetrical ultrasound, vascular ultrasound and most recently muscular skeletal ultrasound.  Each of these specialties usually crosses over into other specialties to varying degrees.  Generally the more rural or smaller the facility the more crossover you see.  Each of these areas has a national registry. There is one historically dominant registry called the American Registry of Diagnostic Medical Sonography or ARDMS.  The ARDMS requires all of its registrants to pass two exams one covering the physics of ultrasound and the other in the specialty being applied for.  The next largest credentialing body in ultrasound is Cardiovascular Credentialing International or CCI.

For general imaging the credential is Registered Diagnostic Medical Sonographer or RDMS.  This credential allows for specialization they are: AB for abdomen, BR for breast, FE for fetal echocardiography, NE for neurosonology and OB/GYN for obstetrics and gynecology.  In radiology departments you may find that all of the sonographers should carry the RDMS credential. If being scanned at a breast center or in a radiology department for breast cancer it is acceptable to request someone with the BR specialty. The same is true when it comes to obstetrical examinations, someone who specialized in that area should perform them.  The fetal echocardiography (FE) credential actually falls within the cardiac or general registry, however it is most commonly found in the cardiac setting.

Cardiac imaging has two major credentialing bodies the above-mentioned ARDMS and CCI.  The cardiac credential by the ARDMS is Registered Diagnostic Cardiac Sonographer or RDCS.  There are three areas of specialization inside the RDCS: Adult Echocardiography (AE), Fetal Echocardiography (FE) and Pediatric Echocardiography (PE).  CCI has two credentials the RCS or Registered Cardiac Sonographer and RCCS for Registered Congenital Cardiac Sonographer. Traditionally the RDCS credential holds more weight within the ultrasound and cardiac community, however the RCS credential has equal weight when it comes to accreditation and reimbursement form insurance and government agencies. The RCS credential is thus gaining ground because of this.

Both credentialing bodies offer registries for vascular ultrasound technologist. Registered Vascular Technologist or RVT is the dominant credential traditionally. Again, CCI offers a vascular credential called Registered Vascular Specialist or RVS.  You will find that more senior sonographers prefer the RVT credential as well as vascular sonographer’s working in dedicated vascular laboratories or surgical offices.  The RVS credential is usually found more in cardiac practices or radiological centers.   CCI also offers a credential just in the area of phlebology or study of veins. The Registered Phlebology Sonographer or RPhS credential is only a couple of years old and will be seen in the vein center setting going forward.  Sonographers who carry the RPhS credential should also have one of the other vascular credentials as well.

The newest frontier in ultrasound is the MSK credential offered by the ARDMS in the area of muscular skeletal ultrasound.  It applies to but is not limited to sonographers, sports medicine professionals, osteopathic surgeons, radiologists, orthopedic surgeons, podiatrist and also physical medicine and rehab physicians.  You should see this credential when getting injection of joints, nerves and other ultrasound guided procedures involving the muscular skeletal system.

So as you can see ultrasound is not just the imaging of babies. Every sonographer will tell you that “do you see a baby” line gets old after a couple thousand times.  Another thing to consider is that a sonographer with 5 registries isn’t necessarily a good thing. Yes it proves they can pass a written test. That has nothing to do with the quality or experience performing the exam.  I often ask if they know of someone who does plumbing and electrical work.  I then ask would you have that person put in the electrical on a new home over someone who just did electrical work.  The same applies to imaging.  Someone performing 8-12 high-end vascular exams will or should be far more experience in vascular compared to someone who performs 3 abdomens, 2 breasts, 2 gallbladders, 1 echo and a vascular exam in a given day.

You should request someone who is specialized in the testing area you are having.  Ask them how long have they been doing it, how old is the equipment, who reads the exams, etc.  If they are not specialized, don’t have experience or can’t answer your questions, it is in your right to leave or request an experienced sonographer.  You wouldn’t let an inexperienced person handle any other part of your life, so why would your health be any different.

Categories: Banter, health, medical imaging, phlebology, radiology, ultrasound education, vascular surgery

Tags: credentialing, diagnostic medical ultrasound, MSK, RCCS, RDCS, RDMS, RPhS, RVT, school, sonography, ultrasound