National Credential
Credential: Advanced Cardiac Sonographer (ACS)
Credentialing Agency: Cardiovascular Credentialing International (CCI)

Cardiovascular Credentialing International (CCI), Advanced Cardiac Sonographer (ACS) is for sonographers working at an advanced level in the echocardiography laboratory. ACSs prepare preliminary echo assessments, perform advanced echocardiograms, mentor fellows, students, residents, and staff, develop and implement educational plans, facilitate continuous quality improvement, and coordinate cardiac ultrasound research. To earn the ACS, applicants must have a high school diploma or general education diploma, satisfy one of the eligibility requirement options, and pass a written exam.

More information can be found on the certifying agency's website.

Renewal Period: 3 years

Advanced Cardiac Sonographer (ACS)

The following Army Occupations provide training and/or experience that contributes to attaining this credential:

Personnel Category Occupation Occupation Type Related As Promotion Points Skill Level Star Proponent Funded Gap Analysis
Enlisted 68N Cardiovascular Specialist MOS some  Promotion Points: This certification has been approved for promotion points. Click for more information.        

Army Table Legend


Related As

The military occupations shown in this table are related to this credential in one of four ways: Most, Some, or Other.

Most: This credential is directly related to most of the major duties associated with the military occupation (at least 80%). Note that the credential may require additional education, training or experience before you are eligible for it.

Some: This credential is related to some tasks associated with the duties of the military occupation (related 80% to at least one or more critical tasks but less than 80% of all of the entire military occupation). Note that the credential may require additional education, training or experience before you are eligible for it.

Other: This credential is related to this military occupation, but is more advanced or specialized and therefore will likely require additional education, training, or experience.

Promotion Points Promotion Points icon

This credential has been approved for promotion points for this MOS towards promotion to Sergeant and Staff Sergeant. Clicking the Promotion Points icon will open a link to the promotion points fact sheet.

Skill Level Designation

Skill Level I: This skill level consists of all Soldiers in the ranks of Private (pay grade E-1) up to Specialist (pay grade E-4). Time in Service (TIS) is generally between initial entry and four Years of Service (YOS). This skill level is Entry-level positions requiring performance of tasks under direct supervision.

Institutional training:

  • Structured Self-Development (SSD) level I
  • Basic Leader Course (BLC)

Skill Level II: This skill level is obtained when promoted to Sergeant (paygrade E-5). TIS is generally between 4-8 YOS. Positions requiring performance of more difficult tasks under general supervision; and in some instances, involving supervision of Soldiers in SL1.

Institutional training:

  • Structured Self-Development (SSD) level II
  • Advance Leader Course (ALC)

Skill Level III: This skill level is obtained when promoted to Staff Sergeant (paygrade E-6). TIS is generally between 8-12 YOS. Positions requiring performance of still more difficult tasks and involving first line supervision of Soldiers in SL1 & SL2.

Institutional training:

  • Senior Leader Course (SLC)
  • Structured Self-Development (SSD) level III

Skill level IV: This skill level is obtained when promoted to the rank of Sergeant First Class (paygrade E-7). TIS is generally between 12-18 YOS. Positions requiring relatively detailed knowledge of all tasks specified for a given MOS, normally involving first-line supervision of Soldiers in SLs 1, 2, and 3, and involving managerial duties.

Institutional training:

  • Master Leader Course (MLC)
  • Structured Self-Development (SSD) level IV
  • Senior Enlisted Joint Professional Military Education (SEJPME) I Course

Skill level V: This skill level is obtained when promoted to the rank of Master Sergeant (paygrade E-8). TIS is generally between 18-22 YOS. Positions requiring direct and indirect leadership roles with expertise in company and battalion-level operations and competency across a given CMF, serving as members of a staff at every level in the Army, with a full understanding of the allocation of resources and their utilization in order to accomplish Army functions and missions.

Institutional training:

  • United States Army Sergeants Major Academy (USASMA)
  • Structured Self-Development (SSD) level V

Skill level VI: This skill level is obtained when promoted to the rank of Sergeants Major (paygrade E-9). TIS is generally between 22-30 YOS. Positions requiring organizational leadership roles with multi-dimensional expertise in units and teams on division, corps, and Army staffs, integrated with Joint, Interagency, Intergovernmental, and Multinational (JIIM) partners with a full understanding of the Force Generation process, operations at all echelons, and how the Army runs.

Star Credential Star icon

Star credentials are MOS enhancing, as designated by the Proponent. MOS enhancing credentials are directly related to an MOS or ASI, are taught either partially or completely as part of a Program of Instruction (POI), and improve the MOS technical proficiency.

Proponent Funded Funded icon

This icon indicates credentials which Soldiers may have funded through their MOS proponent. Some proponents offer credentialing opportunities in conjunction with military training and/or as part of MOS development beyond the training base.

Gap Analysis Has Analysis icon

A detailed analysis comparing the credential requirements to the military occupation has been completed. Click on the gap analysis icon to view the analysis page.

Advanced Cardiac Sonographer (ACS)

Eligibility Requirements ()

Note: This credential may have multiple options for becoming eligible. Listed below are the minimum requirements based on the minimum degree required. To view other options, see the Eligibility tab.

  • Credential Prerequisite: Active echocardiography registry credential
  • Experience: 10 years
  • Education: High School Diploma/GED
  • Training
  • Membership
  • Other
  • Fee

Exam Requirements ()

  • Written Exam
  • Oral Exam
  • Practical Exam
  • Performance Assessment

Renewal Period: 3 years

  • Continuing Education
  • Exam
  • Continuing Education OR Exam
  • Fee
  • Other

Cardiovascular Credentialing International (CCI)
1500 Sunday Drive
Suite 102
Raleigh, NC  27607
Phone: (800) 326-0268
Fax: (919) 787-4916
Email: Applicant_Support@cci-online.org

Advanced Cardiac Sonographer (ACS)

Applicants must have a high school diploma or general education diploma AND meet one of the following eligibility requirement options:

Option 1:

Applicant must be a graduate of an Advanced Cardiac Sonography educational program which has been accredited by the Committee on Accreditation for Advanced Cardiovascular Sonography (COA-ACS).

Option 2:

Applicant must be a graduate of a programmatically accredited program in cardiac ultrasound/echocardiography AND hold an active echocardiography registry credential (includes but not limited to Registered Cardiac Sonographer (RCS), Registered Congenital Cardiac Sonographer (RCCS) or Registered Diagnostic Cardiac Sonographer (RDCS)) AND have seven years of cardiac ultrasound clinical experience as a registered echocardiography sonographer.

Option 3:

Applicant must be a graduate of a diploma, associate, or baccalaureate academic program in health science (including, but not limited to, cardiovascular technology, ultrasound, radiologic technology, respiratory therapy, or nursing) AND hold an active echocardiography registry credential (includes but not limited to Registered Cardiac Sonographer (RCS), Registered Congenital Cardiac Sonographer (RCCS), or Registered Diagnostic Cardiac Sonographer (RDCS)) AND have eight years of cardiac ultrasound clinical experience as a registered echocardiography sonographer. 

Option 4:

Applicant must hold an active echocardiography registry credential (includes but not limited to Registered Cardiac Sonographer (RCS), Registered Congenital Cardiac Sonographer (RCCS), or Registered Diagnostic Cardiac Sonographer (RDCS)) AND have ten years of cardiac ultrasound clinical experience as a registered echocardiography sonographer.

Note: An accredited program is accredited by an agency recognized by the Council for Higher Education Accreditation (CHEA), United States Department of Education (USDOE), or Canadian Medical Association (CMA), that specifically conducts programmatic accreditation for cardiovascular technology, diagnostic cardiac sonography, or vascular technology.

The Advanced Cardiac Sonographer (ACS) credential has the following other requirements:

  • Applicants must agree to abide by the CCI Code of Ethics.

Advanced Cardiac Sonographer (ACS)

  • Performing Preliminary Echo Assessments (56%)
    • Review Echo image Quality and Completeness
    • Identify Cardiovascular Abnormalities
    • Create Preliminary Echo Report
    • Ensure Report Completeness and Accuracy
  • Performing Advanced Echocardiograms (25%)
    • Ensure Patient Safety and Satisfaction
    • Assimilate History and Clinical Findings
    • Develop Echo Protocols
    • Acquire Echo Images
    • Tailor Echo Exam
    • Perform Echo Measurements and Calculations
  • Mentoring Fellows, Students, Residents, and Staff (3%)
    • Assess Mentees' Competence and Skills
    • Provide Critical Feedback and Technical Guidance
    • Assign Improvement Projects
  • Developing and Implementing Educational Plans (8%)
    • Identify Desired Outcomes
    • Prepare Educational Materials and Plan
    • Deliver Educational Materials
    • Measure Continued Performance
  • Facilitating Continuous Quality Improvement (6%)
    • Develop CQI Program
    • Implement CQI Processes
    • Analyze CQI Results
    • Execute an Action Plan
    • Facilitate Echo Lab Accreditation
  • Coordinating Cardiac Ultrasound Research (2%)
    • Identify a Research Topic
    • Assist with Research Design
    • Collect Research Data
    • Analyze Research Data
    • Disseminate Research Results

There are a number of resources available to help you prepare for the Advanced Cardiac Sonographer (ACS) examination:

An additional resource is Safari Books Online, a searchable digital library that provides online access to thousands of books, training videos and conference sessions. See the Educational Resources page here on COOL to learn how to get free access.

Testing for this credential is handled by Pearson VUE. The test centers are located in the U.S. They also have some test centers on military bases.

To find out more, use the following links on the Pearson VUE website:

For more information on the Cardiovascular Credentialing International (CCI) testing process, visit the agency website.

Advanced Cardiac Sonographer (ACS)

Renewal Period: 3 years

The Advanced Cardiac Sonographer (ACS) credential has the following recertification information:

  • ACS certification is renewed every three years after the first renewal. The first renewal, which is 9-12 months after earning the certification, requires submitting a signed Code of Ethics policy and paying a renewal fee. Following the first renewal, every three years certification holders must attest to the completion of 36 continuing education units (CEUs), 30 of which must be cardiovascular related, submit a signed Code of Ethics policy, and pay a renewal fee.

  • Certification holders who re-take and pass the ACS exam or a CCI Registry level exam within the triennial cycle are waived from the CEU requirement.

    Additional information can be found on the CCI website.

Advanced Cardiac Sonographer (ACS)

Additional considerations for the Advanced Cardiac Sonographer (ACS) include:

  • It is anticipated, but not required, that ACS applicants applying under eligibility requirement option 2, 3 or 4 have performed a minimum of 8,000 echocardiograms in their career, which is defined as work experience and/or formal clinical education program.