Neurosonology Exam ? Q & A

Neurosonology Exam – Q & A

Q: If a person is taking (not a re-take) only part of the exam because they passed the other two parts in the past, do they need to resubmit verification of CME within the last 3 years?
A: No, since they had enough CME hours at the time they took the exam initially, they do not need to submit documentation of CME within the last three years. They do, however, need to submit documentation verifying their interpretation of whatever section they are taking (Carotid or TCD).

Q: Are AMA Category I credits the only type of CME credit that counts towards the exam CME requirement?
A: These are the most common type of credit. Other credits will be considered by Drs. Alexandrov and Tegeler on a case by case basis.

Q: International examinees often do not have access to AMA Category 1 CME credits. What type of CME do they need to be eligible and re-certify?
A. 40 CME credits (or equivalents hours of didactics specific to ultrasound). They do not need to be AMA Category 1.

Q: Is a DO (Doctor of Osteopathy) eligible to sit for the exam if they meet all other criteria?
A: Yes

Q: Do CMEs need to be neurology specific or can they be any type of ultrasound (e.g. nerve and muscle CME)
A: Pertinent CME needs to be something related to neurovascular ultrasound (physics, principles, techniques, clinical applications, quality improvement for lab, lab accreditation, etc) in order to qualify.  This is consistent with the definitions use by IAC-Vascular Testing when evaluating CME for medical directors or medical staff applying for accreditation of their carotid or TCD labs. 

Q: Can a person only pass one part of the exam and still be certified in the section that they passed?
A: No. A person MUST pass physics AND one additional part of the exam to be considered certified.

Q: Can one count CME from a larger meeting if it is related to neurovascular ultrasound?
A: If one attends AAN, RSNA, or any other meeting, it will depend on what portion was related to ultrasound, or lab function.  It is often necessary to have them send in a list of the topics (copy of the program) for a meeting to document which are appropriate, if they wish to count CME from a larger meeting.

Q: If one does not have enough CME at the time they apply to sit for the exam, and they plan to attend the ASN Annual Meeting to obtain the rest of their required CME credits, is that acceptable?
A: Yes. They must include a statement in their application materials stating that this is what they plan to do, and their certificate is mailed to them only after we receive their CME documentation from the meeting.

Q: How does an exam applicant show verification of their 100 TCD/Carotid interpretations? Do they need to submit documentation of each case? Does the supervising individual need to be an MD that is certified by ASN?
A: No! We do not want them to send in each case interpretation. They simply need to submit a letter from the supervising physician verifying that they have performed at least 100 interpretations.

Additionally, adequate supervision is whatever mechanism is in place in a lab that has credentialed people to do their work. We are not requiring all applicants to be from ICAVL accredited labs nor all supervisors to be ASN certified.

ASN would accept studies performed by an applicant. What needs to be clearly stated is that the applicant who performed the test also provided a preliminary report that was later read by an MD credentialed at a given facility to do that. Whether this MD is certified by ASN or not is irrelevant. A preliminary report demonstrates that the applicant has interpreted their own studies. Supervision by a chief technologist is also acceptable as it reflects practice of the lab where the preliminary report is OK'd by the most experienced person before it goes out to reading by MDs.

Q: Can CME credits older than three years be used towards sitting for the exam?
A: This will be decided by Dr. Alexandrov and Dr. Tegeler on a case by case basis.

Q: Can CME credits older than three years be used towards the exam maintenance requirement?
A: Generally, no. If there seems to be a special circumstance or extenuating situation then the inquiry can be passed along to Drs. Alexandrov and Tegeler to make the call.

Q: Does the fulltime fellowship requirement mandate that the fellowship be in neurovascular ultrasound?
A: The important factor in regards full-time fellowship is not what flavor it was, but actually whether it included training in neurovascular ultrasound.  If so, then we need a letter from the Program Director confirming that experience, that it included at least 40 hours of ultrasound-focused CME, or the equivalent.

Q: Aside from the ASN Annual Meeting, where else can physicians earn relevant neurovascular CME credit?
A: The IAC Vascular Testing website offers a list of CME resources for physicians:

Q: What are the time frames for each exam section?
TCD Only - 120 mins
Carotids Only - 120 mins
Physics & Carotids - 120 mins
Physics & TCD - 120 mins
Physics, Carotids & TCD - 240 mins
Physics, Carotids, TCD & Peds - 240 mins

Q: What is the correct wording for exam certificates?
All three parts: Applied Principles of Physics and Fluid Dynamics, Carotid Duplex, Transcranial Doppler
Two parts: Applied Principles of Physics and Fluid Dynamics, Carotid Duplex
Two parts: Applied Principles of Physics and Fluid Dynamics, Transcranial Doppler

Q: Will a UCNS fellowship in Neurocritical Care (or other neuro subspecialty) satisfy the fellowship requirement for the Neurosonology Exam?
A: The answer depends on your fellowship curriculum. If your fellowship provides you with an opportunity to learn TCD at least for SAH and brain death, and you either performed or interpreted TCDs for these or other indications under supervision and continuously thru fellowship, this would qualify you to register for the exam.

Your fellowship director simply needs to state in the letter that learning TCD is included into your fellowship curriculum. The reason I gave you details above is that one needs to have an in depth exposure to TCD (exam is tough on physics and hemodynamics).

Q: What title do they hold for passing the ASN Exam? ASN Neurosonology Exam Diplomate?
A: This is not a board exam, so does not allow one to claim to be a “diplomate”.  It is also not an accreditation process, which is left to IAC-Vascular.  It is a certification exam, so all one can really say is that one is has successfully completed/passed the ASN Neurosonology Certification Exam, is certified in Neurosonology, or has an additional credential in Neurosonology (with specific TCD or carotid if only one or the other).  This has always been a tightrope for us.  Thanks for sharing, and it is always good to make sure we are being consistent in what we are saying and doing. 

Q: What is the cost to re-take the exam?
A: Member = $300, Non-member = $500 and Physician in Training = $200

Q: "Verification of performance and/or interpretation of at least 100 studies under supervision for each component to be tested (e.g. TCD and carotid) does not say that it require both performance and interpretation rather than it says performance and/or interpretation, so anything either performance (verified by supervising physician) or interpretation alone (verified by the in-charge of WFSM course) should be fine.
A: In the current ICA standards posted 8/32015  there is nothing about 'performing' the studies, only about interpreting (observing or participating) in testing procedure (see below).
1. IAC STANDARD – Medical Staff
1.3A A qualified medical staff must be designated for the facility. All members of the medical staff must be licensed physicians, MD or DO, and must be qualified to interpret noninvasive vascular examinations.
1.3.1A Medical Staff Required Training and Experience: The medical staff must demonstrate an appropriate level of training and experience by meeting one or more of the following: Formal Training – Completion of a residency or fellowship that includes appropriate didactic and clinical vascular testing facility experience as an integral part of the program. For those testing areas in which training is provided, the physician must have recent experience within the past three years in interpreting the following minimum number of diagnostic studies under supervision:

  • extracranial cerebrovascular – 100 cases
  • intracranial cerebrovascular – 100 cases
  • peripheral arterial physiologic – 100 cases
  • peripheral arterial duplex – 100 cases
  • venous duplex ultrasound – 100 cases
  • visceral vascular duplex ultrasound – 75 cases

Informal Training – The informal training pathway allows for qualification of interpreting physicians through a combination of Continuing Medical Education (CME) and supervised practical and supervised interpretive experience.

A minimum of 40 hours of relevant Category 1 CME credits must be acquired within the three-year period prior to the initial application.

  • 20 hours must be courses specifically designed to provide knowledge of the techniques, limitations, accuracies and methods of interpretations of noninvasive vascular examinations the physician will interpret.
  • 20 hours may be dedicated to appropriate clinical topics relevant to vascular testing.
  • Eight of the 40 hours must be specific to each testing area the physician will interpret.

The physician must acquire a minimum of 8 hours supervised practical experience for each testing area to be interpreted; observing or participating in testing procedures in a facility accredited for vascular testing. Comment: Experience must be documented with a letter from the Medical Director of the facility where the experience was obtained. 

The physician must acquire experience in the interpretation of examinations while under the supervision of a physician who has already met the IAC Vascular Testing Standard. Experience must be acquired in each of the testing areas in which the physician will be providing interpretations for the following minimum number of studies:

  • extracranial cerebrovascular – 100 cases
  • intracranial cerebrovascular – 100 cases
  • peripheral arterial physiologic – 100 cases
  • peripheral arterial duplex – 100 cases
  • venous duplex ultrasound – 100 cases
  • visceral vascular duplex ultrasound – 75 cases

Comment: Interpretive experience must be documented with a letter from the supervising physician of the facility where the experience was obtained indicating the dates of participation and the number of cases in each testing area.

Physician Credential for Vascular Interpretation

  • Registered Physician in Vascular Interpretation (RPVI)
  • Certification from the American Society of Neuroimaging (ASN)

Comment: ASN certification is accepted for physicians who interpret extracranial and intracranial examinations only. 

Q: Would a blind interpretation by the applicant of a study previously read by a credentialed MD be Ok?
A: My initial impression is that it is fine for Dr. Gropen to create his own reads based on review of data from studies that had been previously read.  That is no different from doing reads from an archival system, or at a course.  However, it would seem important to also have the other physician that is accredited/certified/or experienced, review the reports he had created with Dr. Gropen so that it would be a learning experience.  Key being the …”under supervision”… aspect of the requirement.  So as per his question, yes, he would need to have someone review his work with him.

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