- How the RVS Exam Blueprint Is Built
- Exam Format: 170 Questions, Four Item Types
- Domain Weights at a Glance
- Domain 5: Arterial Examinations of the Upper and Lower Extremities (22%)
- Domain 4: Extracranial/Intracranial Examinations (20%)
- Domain 6: Venous Examinations of the Upper and Lower Extremities (19%)
- Domain 2: Physics and Hemodynamics (15%)
- Domain 1: Maintaining Patient Care and Safety (11%)
- Domains 3 and 7: Abdominal/Visceral and Hemodialysis
- Sequencing Your Study Weeks by Domain
- Registration, Fees and Credential Mechanics
- Frequently Asked Questions
- The Registered Vascular Specialist exam has seven domains; arterial extremity examinations carry the largest share at 22%.
- Arterial (22%), extracranial/intracranial (20%) and venous (19%) domains together make up about 61% of your score.
- The exam is 170 questions (150 scored, 20 unscored) in 170 minutes, with a passing scaled score of 650.
- Item formats include multiple choice, multiple response, image hot spot and drag-and-place, so recognition skills matter.
How the RVS Exam Blueprint Is Built
The Registered Vascular Specialist (RVS) credential is awarded by Cardiovascular Credentialing International (CCI) and is a vascular ultrasound certification. It is a one-part, registry-level examination: there is no separate physics exam followed by a specialty exam. Physics, hemodynamics, patient care and every vascular bed are tested together on a single test, which makes understanding the blueprint essential. This is not the ARDMS RVT, the CCI RPhS, or an ARRT vascular-interventional radiography credential, so materials written for those exams should not be your primary source.
The seven domains below are CCI's official examination objectives from the current live RVS Examination Matrix and Task List (reviewed October 14, 2026). They are exam objectives, not preparation-curriculum headings, and the percentages are CCI's published approximate shares of the exam score. If you want a broader orientation before diving into domains, start with What Is RVS Certification? and then return here.
Exam Format: 170 Questions, Four Item Types
The exam contains 170 questions: 150 are scored and 20 are unidentified, randomly distributed unscored items. You cannot tell which are which, so treat every question as if it counts. You have 170 minutes (2 hours 50 minutes) to answer. The appointment is three hours because it includes an additional 10 minutes for a tutorial and survey. It is delivered at Pearson VUE test centers year-round.
CCI's Question Types section and Applicant Handbook support four item formats:
- Single-best-answer multiple choice: pick the one best response.
- Multiple response: select every correct option, which punishes partial knowledge.
- Image hot spot: click the region of an image that answers the question, such as a waveform feature or an anatomic structure.
- Drag-and-place: arrange or match items, such as placing labels or ordering steps.
One paragraph on the same CCI page describes only four-option multiple-choice questions, but the Question Types section and the Handbook indicate the broader mix above, so prepare for all four. The exam is closed book. An on-screen calculator and an erasable board are supplied, and you may skip questions or mark them for review. Two valid identification documents are required at check-in.
The passing score is 650 on CCI's 0-900 scaled-score range. That is a scaled score, not a percentage of questions answered correctly. For deeper discussion, see RVS Passing Score 2026: Exactly What You Need to Pass.
Domain Weights at a Glance
| Domain | Name | Approx. Share of Score |
|---|---|---|
| 1 | Maintaining Patient Care and Safety | 11% |
| 2 | Applying Principles of Physics and Hemodynamics | 15% |
| 3 | Performing Abdominal/Visceral Examinations | 10% |
| 4 | Performing Extracranial/Intracranial Examinations | 20% |
| 5 | Performing Arterial Examinations of the Upper and Lower Extremities | 22% |
| 6 | Performing Venous Examinations of the Upper and Lower Extremities | 19% |
| 7 | Performing Hemodialysis Examinations | 3% |
Notice how the weighting is lopsided in a useful way. Three clinical domains (4, 5 and 6) account for roughly 61% of the score, while Domain 7 is only 3%. A candidate who is strong on peripheral arterial, cerebrovascular and venous work and solid on physics has a realistic path even if abdominal and hemodialysis content is shakier. That said, CCI reports a 56% first-time pass rate for 2025, so no domain can be ignored. Context on that figure is in RVS Pass Rate 2026: What the Data Shows.
Domain 5: Arterial Examinations of the Upper and Lower Extremities (22%)
This is the heaviest domain on the exam, so it deserves your largest block of study time. Questions here typically ask you to interpret what an arterial study shows and decide what it means, rather than to recall isolated facts.
Domain 5 Priorities
Be able to connect waveform shape, velocity and physiologic testing to disease location and severity.
- Normal triphasic versus biphasic and monophasic Doppler waveforms, and what each implies about proximal and distal disease
- Duplex criteria for grading stenosis, including peak systolic velocity and velocity ratios
- Physiologic testing concepts such as segmental pressures, ankle-brachial index and toe pressures, and when calcified vessels make them unreliable
- Post-intervention surveillance: bypass grafts, stents and the warning signs of graft stenosis
- Upper-extremity arterial evaluation, including thoracic outlet and vasospastic patterns
- Non-atherosclerotic findings such as aneurysm, dissection, pseudoaneurysm and arteriovenous fistula
Because image hot spot and drag-and-place items can appear anywhere, practice labeling vessels and waveform segments rather than only choosing among text options.
Domain 4: Extracranial/Intracranial Examinations (20%)
The second-largest domain covers the carotid and vertebral systems in the neck and the intracranial circulation assessed with transcranial techniques. Expect questions that mix anatomy, protocol and interpretation.
Domain 4 Priorities
Know the cerebrovascular anatomy cold, then layer hemodynamic interpretation on top.
- Carotid anatomy: common, internal and external carotid arteries, bulb, and how to distinguish internal from external branches
- Stenosis grading categories and the velocity and plaque findings behind them
- Vertebral artery flow patterns, including direction of flow and findings associated with subclavian steal
- Plaque characterization and its relationship to embolic risk
- Circle of Willis anatomy, intracranial windows and flow direction concepts
- Post-stent or post-endarterectomy surveillance considerations
Image-based items are especially likely here, so rehearse recognizing normal versus abnormal spectral Doppler tracings and color flow images of the neck vessels.
Domain 6: Venous Examinations of the Upper and Lower Extremities (19%)
Venous testing is the third pillar. It covers both acute thrombosis and chronic venous disease, and it frequently tests technique as much as interpretation.
Domain 6 Priorities
Master compression technique, flow augmentation and the distinction between acute and chronic findings.
- Deep venous thrombosis criteria: compressibility, echogenicity, vein distention and absent or abnormal flow
- Acute versus chronic thrombus characteristics and how each appears on imaging
- Reflux testing: provocative maneuvers, valve closure time thresholds and which veins are assessed
- Superficial venous anatomy, including the great and small saphenous systems and perforators
- Upper-extremity venous evaluation, including central vein flow clues such as loss of respiratory phasicity
- Mapping concepts for vein harvest and access planning
Learn the specific diagnostic thresholds your study material uses and be consistent with them. Many candidates lose points on reflux timing and on distinguishing normal respiratory variation from obstruction.
Domain 2: Physics and Hemodynamics (15%)
Because the RVS is a single combined exam, the physics portion lives inside Domain 2 rather than a separate test. At 15% it is the fourth-heaviest domain, and it also underpins how you read every clinical domain above.
Domain 2 Priorities
Think of this domain as the explanation layer for everything you see on screen.
- Doppler principles, the Doppler equation and the effect of insonation angle on measured velocity
- Pulsed versus continuous wave Doppler, aliasing, the Nyquist limit and how to correct it
- Gain, scale, wall filter, baseline and sample volume adjustments
- Resolution, transducer selection, focal zone and frequency tradeoffs for superficial versus deep vessels
- Artifacts and how to recognize and minimize them
- Hemodynamics: pressure, flow and resistance relationships, laminar versus turbulent flow, and the effects of stenosis on velocity and downstream waveforms
An on-screen calculator is provided, so be comfortable setting up Doppler shift and related calculations quickly. Practice both the formula and the intuition behind it. The exam favors applying the concept to a scenario over reciting a definition.
Domain 1: Maintaining Patient Care and Safety (11%)
Domain 1 is easy to underestimate. At 11% it is worth more than the abdominal domain, and the questions reward practical judgment rather than memorization.
Domain 1 Priorities
Expect scenario-based items about how to run a safe, professional exam.
- Patient identification, communication, consent and privacy expectations
- Infection prevention, transducer and equipment cleaning, and standard precautions
- Patient positioning, comfort and safe transfer or handling
- Recognizing and responding to patient distress or adverse events during an exam
- Ergonomics and sonographer safety, including scanning posture and repetitive strain prevention
- Documentation, ethical conduct and appropriate communication of findings within scope of practice
These items are often the most winnable on the exam for working sonographers. Read each scenario carefully for the safest, most professional action rather than the most technically clever one.
Domains 3 and 7: Abdominal/Visceral and Hemodialysis
Domain 3: Performing Abdominal/Visceral Examinations (10%)
This domain covers the vascular structures of the abdomen. Study the aorta and its major branches, the inferior vena cava, and the visceral and renal circulation. Know normal flow patterns, aneurysm assessment, and the findings associated with renal artery stenosis, mesenteric ischemia and venous obstruction. Labs that focus mostly on peripheral and cerebrovascular work often have the biggest gap here, so a targeted review of protocols and normal values pays off.
Domain 7: Performing Hemodialysis Examinations (3%)
Domain 7 is the smallest, but the topic is specialized and unfamiliar to many candidates. Review native arteriovenous fistula and graft anatomy, mapping for access creation, and the findings that suggest stenosis, steal, aneurysm or maturation problems. At only 3% of the score, it should get a compact, efficient review rather than an extended campaign.
Key Takeaway
Do not drop Domains 3 and 7 entirely. Together they are roughly 13% of the score, which can be the margin between a 650 and a retake. Give them a short, focused review and spend the rest of your energy on Domains 4, 5 and 6.
Sequencing Your Study Weeks by Domain
Rather than studying in numeric domain order, sequence by dependency and weight. Physics comes first because it explains everything else, then the three heavyweight clinical domains, then the lighter ones. This is a suggested approach, not an official CCI schedule. For a full preparation plan, see the RVS Study Guide 2026.
Domain 2: Physics and Hemodynamics
- Doppler equation, angle effects, aliasing and instrument settings
- Pressure-flow relationships and stenosis hemodynamics
Domain 5: Arterial Extremity Examinations
- Waveform interpretation, velocity criteria and physiologic testing
- Grafts, stents and upper-extremity arterial patterns
Domain 4: Extracranial/Intracranial Examinations
- Carotid and vertebral anatomy, grading and flow patterns
- Intracranial windows and Circle of Willis
Domain 6: Venous Examinations
- DVT criteria, acute versus chronic findings and reflux testing
- Superficial venous anatomy and mapping
Domains 1, 3 and 7, then full review
- Patient care and safety scenarios, abdominal/visceral vessels, hemodialysis access
- Timed mixed-format practice with image and drag-and-place items
Take timed practice sets that mimic the 170-minute pace, which works out to roughly one minute per question. If you want a compact refresher near test day, the RVS Cheat Sheet condenses must-know facts, and you can test yourself against realistic questions on the RVS practice test site.
Registration, Fees and Credential Mechanics
Understanding the logistics helps you plan your domain study around a real test date. The examination fee is $365 USD, which includes a $100 nonrefundable application-processing portion. Applicants need a high school diploma or GED plus one qualifying pathway, supported by typed documentation and the applicable medical or program-director verification letters.
| Pathway | Core Requirement |
|---|---|
| RVS235 | Health-science diploma, associate or baccalaureate qualification; one year of full-time-equivalent vascular ultrasound work; at least 600 vascular studies |
| RVS4 | Graduates of programmatically accredited vascular ultrasound programs; pregraduation testing requires documentation, with credential release contingent on graduation |
| RVS5 | Graduation from a non-programmatically accredited vascular ultrasound program with at least one year of vascular training and 800 clinical hours completed within the program |
| RVS6 | Active ultrasound credential, six months of full-time-equivalent vascular ultrasound work and participation in at least 100 vascular studies |
RVS1 closed to first-time applicants on July 1, 2023. Full eligibility details are covered in RVS Requirements 2026, and fee context is in RVS Certification Cost 2026.
After You Are Approved
Your Authorization to Test opens a 90-day testing window. If you do not pass, a retake requires a new application, the examination fee and a 45-day wait. CCI's published processing estimates and rescheduling deadlines are not fully consistent, so confirm the applicable deadlines directly with CCI and Pearson VUE rather than assuming a fixed turnaround. See RVS Exam Dates 2026 for scheduling considerations.
Keeping the Credential Active
The initial credential period is 9-12 months. First renewal costs $165 with a Code of Ethics attestation and no CEUs. After that, renew every three years for $165, attest to the Code of Ethics and complete 36 CEUs, at least 30 of them cardiovascular-related. The remaining CEUs must be medical-related under CCI's dedicated CEU policy. One CCI renewal page suggests the remaining six can cover any topic, but the dedicated CEU requirements and FAQ specify a medical-related field, so plan on the medical-related restriction.
Frequently Asked Questions
Domain 5, Performing Arterial Examinations of the Upper and Lower Extremities, carries the largest share at 22%. Domain 4 (extracranial/intracranial) follows at 20%, and Domain 6 (venous examinations of the upper and lower extremities) at 19%.
No. The RVS is a one-part, registry-level examination. Physics and hemodynamics are tested within the same exam under Domain 2, which carries about 15% of the score.
The exam has 170 questions, of which 150 are scored and 20 are unscored items you cannot identify. You have 170 minutes to answer, within a three-hour appointment that includes 10 extra minutes for the tutorial and survey.
The passing score is 650 on CCI's 0-900 scaled-score range. It is a scaled score rather than a percentage of correct answers, so you cannot convert it directly into a number of questions.
No. An archived 2022 overview lists older allocations of 9/15/11/20/21/20/3. Use the current live matrix percentages of 11/15/10/20/22/19/3 for study planning, and do not mix the two sets.
Mapping your preparation to these seven domains, weighted by their share of the score, is the most reliable way to turn a broad vascular ultrasound skill set into a passing result. For related background, you can also read What Is RVS? and RVS Training.