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Exam Code: ARDMS-SPI
Exam Name: ARDMS Sonography Principles and Instrumentation (SPI) Exam
Number of Questions: The exam consists of exactly 110 multiple-choice questions.
Time Allotted: Total examination time: 2 hours (120 minutes).
Passing Marks and Scoring System: Primary Result: The exam yields a simple PASS or FAIL decision
Scaled Scoring: In addition to the pass/fail outcome, a scaled score is provided, ranging from 300 (minimum) to 700 (maximum)

Anatomy, Perfusion, and Function 30%

Assess physical characteristics of anatomic structures (normal anatomy, anatomic variants, congenital anomalies)
- Biliary system
- Breast
- Chest
- Liver
- Neck (including: thyroid, parathyroid, salivary glands, lymph nodes)
- Pancreas
- Penis
- Peritoneal cavity (including: stomach, bowel, appendix)
- Prostate
- Retroperitoneum (including: great vessels & branches)
- Scrotum
- Spleen
- Superficial structures (for example: abdominal wall & subcutaneous tissue)
- Urinary system
• Knowledge of normal anatomy, anatomic regions, and anatomic variants
• Knowledge of sonographic appearance of anatomic structures
• Ability to recognize and utilize anatomic landmarks in obtaining and documenting diagnostic images
• Ability to recognize and apply proper scan technique in obtaining and documenting diagnostic images
• Ability to recognize, evaluate and document congenital anomalies

Assess perfusion and function of anatomic structures
- Biliary system
- Chest
- Liver
- Neck (including: thyroid, parathyroid, salivary glands, lymph nodes)
- Penis
- Peritoneal cavity (including: stomach, bowel, appendix)
- Prostate
- Retroperitoneum (including: great vessels & branches)
- Scrotum
- Spleen
- Superficial structures (for example: abdominal wall & subcutaneous tissue)
- Urinary system
• Knowledge of normal vascular anatomy and hemodynamics
• Ability to recognize appearance of normal vascular flow patterns
• Ability to recognize and utilize anatomic landmarks in evaluating and documenting perfusion and function
• Ability to recognize and apply proper scan technique in evaluating and documenting perfusion and function

Pathology, Vascular Abnormalities, Trauma, and Postoperative Anatomy 42%

Assess anatomic structures for pathology
- Abdominal wall for hernia (for example: ventral, inguinal, incisional)
- Adrenal glands for masses, hemorrhage, etc.
- Biliary system for infection, masses, metastatic disease, obstructions, etc.
- Breast for infection, abscess, masses, etc.
- Chest for fluid, masses, etc.
- Gastrointestinal system for masses, obstruction, pyloric stenosis, intussusception, etc.
- Joints for abnormalities (for example: fluid)
- Liver for hepatitis, fatty infiltration, cirrhosis, neoplasm, abscess, cyst, etc.
- Neck (including: thyroid, parathyroid, salivary glands, lymph nodes) for diffuse parenchymal disease, inflammation, masses, etc.
- Pancreas for infection, masses, obstruction, etc.
- Penis for abnormalities
- Peritoneal cavity (including: stomach, bowel, appendix) for fluid
- Popliteal fossa for abnormalities (for example: masses, fluid)
- Prostate for parenchymal disease or masses (for example: benign prostatic hypertrophy)
- Retroperitoneum (including: great vessels & branches) for fibrosis, lymphadenopathy, etc.
- Scrotum for fluid, hernia, masses, infection, parenchymal disease, etc.
- Spleen for splenomegaly, parenchymal changes, masses, etc.
- Superficial structures (for example: abdominal wall, subcutaneous tissue) for foreign bodies, infection, fluid, masses, etc.
- Urinary system for masses, obstruction, parenchymal disease, infection, etc
• Knowledge of etiology/pathophysiology of abnormal perfusion and function
• Ability to recognize ultrasound findings related to abnormalities of anatomy, perfusion, and function in obtaining and documenting diagnostic images
• Ability to recognize and apply proper scan technique in evaluating and documenting pathology
• Ability to recognize foreign bodies, infection, fluid, masses, etc.
• Knowledge of hernia types and their sonographic appearance

Assess anatomic structures for vascular abnormalities
- Liver for Budd-Chiari syndrome, arteriovenous fistula, portal vein thrombosis, collateralization, etc.
- Retroperitoneum (including: great vessels and branches) for aneurysm, dissection, thrombus, etc.
- Scrotum for torsion, varicocele, etc.
- Spleen for infarction, hemangiomas, etc.
- Urinary system for renal artery stenosis, arteriovenous fistulas, etc.
• Knowledge of anatomic and vascular changes associated with vascular abnormities
• Knowledge of sonographic findings associated with vascular abnormalities
• Ability to recognize and apply proper scan technique in evaluating and documenting vascular abnormalities

Assess anatomic structures for trauma-related abnormalities
- Hepatic system • Knowledge of sonographic appearance as a result of trauma
- Penis
- Scrotum
- Spleen
- Superficial structures (for example: abdominal wall, subcutaneous tissue)
- Urinary system
- Focused exam for free fluid related to traumatic events
• Ability to rapidly prioritize and evaluate sonographic findings due to trauma
• Ability to perform focused exam for free fluid following a traumatic event
• Ability to recognize and apply proper scan technique in evaluating and documenting trauma

Assess aspects related to postoperative anatomy
- Anatomy of transplanted organs • Knowledge of hemodynamics of transplanted organs
- Perfusion and function of transplanted organs
- Complications related to organ transplants
- Abnormalities in postsurgical anatomy • Ability to adjust scan technique based on patient condition and surgical history
- Abnormalities in postsurgical breast
- Abnormalities (for example: recurrent disease, lymphadenopathy) in postsurgical neck
- Implanted medical devices (for example: transjugular intrahepatic portosystemic shunt [TIPS])
• Ability to distinguish characteristics of common anastomosis sites
• Ability to recognize fluid collections
• Ability to interpret and integrate surgical history with sonographic findings
• Knowledge of surgical procedures used in organ transplant
• Knowledge of surgical zones of the neck
• Ability to evaluate and document findings within surgical zones of the neck
• Knowledge of patterns and sonographic appearance of disease recurrence
• Ability to evaluate transjugular intrahepatic portosystemic shunts (TIPS)
• Ability to recognize and apply proper scan technique in evaluating and documenting postsurgical findings
• Knowledge of common causes of transplant failure
• Ability to recognize signs of rejection

Abdominal Physics 8%

Apply concepts of equipment/image optimization
- Use appropriate transducer (for example: curvilinear, linear, phased array)
- Use two-dimensional, real-time, gray-scale imaging (for example: B-mode, compound, harmonic)
- Use Doppler (for example: color, power, pulsed wave)
• Ability to select the appropriate transducer and machine presets based on body habitus
• Ability to use acoustic windows creatively to optimize visualization
• Ability to adjust machine settings to maximize penetration while minimizing resolution loss
• Knowledge of appropriate application of Doppler techniques
• Ability to manipulate color, power, and pulsed wave settings to accurately display and measure blood flow

Apply concepts of imaging artifacts
- Assess artifacts of gray-scale imaging (for example: shadowing, resonance, comet tail)
- Assess artifacts of Doppler imaging (for example: twinkle, spectral broadening)
• Ability to recognize artifacts and correlate them with anatomy and pathology
• Ability to manipulate machine settings to enhance or minimize artifacts

Clinical Care, Practice, and Quality Assurance 20%

Incorporate clinical data with performed study
- Assess indications for examination requested
- Evaluate images from other imaging modalities (for example: computed tomography, magnetic resonance imaging, nuclear medicine, x-ray)
- Assess relevant clinical lab values for examination being performed
- Assess relevant family history and patient signs/symptoms for examination being performed
- Correlate ultrasound findings with previous imaging results
• Knowledge of appropriate indications and contraindications for a specific exam and/or procedure
• Knowledge of potential effects of patient medications on an exam or procedure
• Knowledge of lab values relevant to specific examinations
• Ability to obtain and evaluate patient history relevant to the exam
• Ability to assimilate patients signs and symptoms and modify the exam/or describe the findings
• Ability to modify the exam based on information from other modalities
• Ability to localize pathology for sonographic correlation
• Ability to modify the exam based on real-time findings
• Knowledge of modalities associated with the exam being performed
• Ability to utilize resources, such as physicians, literature, or peers

Incorporate clinical standard/guidelines with performed study
- Communicate effectively with the patient, physician, and others, including communication of findings that require immediate action
- Inform patient or referring practitioner of examination preparations (for example: fasting for biliary imaging)
- Maintain and protect patient confidentiality/privacy
- Modify the examination based on patient condition and/or sonographic findings
- Use multiple patient positions and scan planes to evaluate anatomic structures
• Ability to communicate with patient in a professional and appropriate manner to effectively explain procedures, deal with inappropriate behavior, and
engage patient cooperation • Ability to communicate using appropriate medical terminology
• Ability to modify exam preparation, patient position, and/or image acquisition based on patient condition and/or sonographic findings
• Ability to recognize findings and/or situations that require immediate action and respond effectively
• Knowledge of appropriate patient preparation for an exam and knowledge of factors that may affect patient preparation (for example: patient history, patient condition, sequencing requirements of multiple modality exams)
• Knowledge of sonographer scope of practice and regulations regarding patient information and interactions

Obtain accurate measurements
- Obtain measurements of anatomic structures • Knowledge of normal measurement ranges
- Obtain measurements of Doppler waveforms
• Knowledge of proper techniques for measuring anatomic structures
• Knowledge of hemodynamics
• Knowledge of normal and abnormal Doppler waveforms
• Ability to analyze Doppler measurements
• Ability to distinguish artifacts from real blood flow
• Ability to apply knowledge of measurement techniques (for example: Doppler and gray-scale)

Assist/support during procedures
- Obtain consent form and patient lab results prior to the procedure
- Provide ultrasound guidance for procedures
- Evaluate for post-procedural changes/complications
• Knowledge of sonographer's role in obtaining consent
• Ability to verify and document patient consent
• Ability to verify correct patient, side (laterality), and site
• Knowledge of contraindications for specific procedures
• Knowledge of proper safety precautions in interventional procedures
• Knowledge of equipment and materials used for a specific procedure
• Knowledge of interventional procedures and sonographer's role
• Knowledge of protocols during surgical procedures, related to the sonographer's role
• Ability to adapt protocol due to different circumstances
• Ability to optimally display the needle path and tip
• Ability to recognize implanted medical devices
• Knowledge of potential post-procedural complications