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Exam Number : ARDMS
Exam Name : American Registry for Diagnostic Medical Sonography - 2022
Vendor Name : Medical
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ARDMS test Format | ARDMS Course Contents | ARDMS Course Outline | ARDMS test Syllabus | ARDMS test Objectives


Anatomy, Perfusion, and Function (30%)
Assess physical characteristics of anatomic structures
Assess perfusion and function of anatomic
structures

Pathology, Vascular Abnormalities, Trauma, and Postoperative Anatomy (42%)
Assess anatomic structures for pathology
Assess anatomic structures for vascular
abnormalities
Assess anatomic structures for trauma-related
abnormalities
Assess aspects related to postoperative anatomy

Abdominal Physics Apply concepts of equipment/image optimization
Apply concepts of imaging artifacts 8%

Clinical Care, Practice, and Quality Assurance (20%)
Incorporate clinical data with performed study
Incorporate clinical standard/guidelines with
performed study
Obtain accurate measurements
Assist/support during procedures

Anatomy, Perfusion, and Function
Knowledge and/or skill related to anatomy, perfusion,
and function
1.A. Assess physical characteristics of anatomic structures (normal anatomy, anatomic variants, congenital anomalies)
1.A.1. Biliary 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
1.A.2. Breast
1.A.3. Chest
1.A.4. Liver
1.A.5. Neck (including: thyroid, parathyroid, salivary glands, lymph nodes)
1.A.6. Pancreas
1.A.7. Penis
1.A.8. Peritoneal cavity (including: stomach, bowel, appendix)
Ability to recognize, evaluate and document congenital anomalies
1.A.9. Prostate
1.A.10. Retroperitoneum (including: great vessels & branches)
1.A.11. Scrotum
1.A.12. Spleen
1.A.13. Superficial structures (for example:abdominal wall & subcutaneous tissue)
1.A.14. Urinary system
1.B. Assess perfusion and function of anatomic structures
1.B.1. Biliary 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
1.B.2. Chest
1.B.3. Liver
1.B.4. Neck (including: thyroid, parathyroid, salivary glands, lymph nodes)
1.B.5. Penis
1.B.6. Peritoneal cavity (including: stomach, bowel, appendix)
1.B.7. Prostate
1.B.8. Retroperitoneum (including: great vessels & branches)
1.B.9. Scrotum
1.B.10. Spleen
1.B.11. Superficial structures (for example: abdominal wall & subcutaneous tissue)
1.B.12. Urinary system 2. Pathology, Vascular Abnormalities, Trauma, and Postoperative Anatomy
Knowledge and/or skill related to pathology, vascular abnormalities, trauma, and postoperative anatomy
2.A. Assess anatomic structures for pathology
2.A.1. Abdominal wall for hernia (for example: ventral, inguinal, incisional)
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
2.A.2. Adrenal glands for masses, hemorrhage, etc.
2.A.3. Biliary system for infection, masses, metastatic disease, obstructions, etc.
2.A.4. Breast for infection, abscess, masses, etc.
2.A.5. Chest for fluid, masses, etc.
2.A.6. Gastrointestinal system for masses, obstruction, pyloric stenosis, intussusception, etc.
2.A.7. Joints for abnormalities (for example: fluid)
2.A.8. Liver for hepatitis, fatty infiltration, cirrhosis, neoplasm, abscess, cyst, etc.
2.A.9. Neck (including: thyroid, parathyroid, salivary glands, lymph nodes) for diffuse parenchymal disease, inflammation, masses, etc.
2.A.10. Pancreas for infection, masses, obstruction, etc.
2.A.11. Penis for abnormalities
2.A.12. Peritoneal cavity (including: stomach, bowel, appendix) for fluid
2.A.13. Popliteal fossa for abnormalities (for example: masses, fluid)
2.A.14. Prostate for parenchymal disease or masses (for example: benign prostatic hypertrophy)
2.A.15. Retroperitoneum (including: great vessels & branches) for fibrosis, lymphadenopathy, etc.
2.A.16. Scrotum for fluid, hernia, masses, infection, parenchymal disease, etc.
2.A.17. Spleen for splenomegaly, parenchymal changes, masses, etc.
2.A.18. Superficial structures (for example: abdominal wall, subcutaneous tissue)
for foreign bodies, infection, fluid, masses, etc.
2.A.19. Urinary system for masses, obstruction, parenchymal disease, infection, etc.
2.B. Assess anatomic structures for vascular abnormalities
2.B.1. Liver for Budd-Chiari syndrome, arteriovenous fistula, portal vein thrombosis, collateralization, 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
2.B.2. Retroperitoneum (including: great vessels and branches) for aneurysm, dissection, thrombus, etc.
2.B.3. Scrotum for torsion, varicocele, etc.
2.B.4. Spleen for infarction, hemangiomas, etc.
2.B.5. Urinary system for renal artery stenosis, arteriovenous fistulas, etc.
2.C. Assess anatomic structures for trauma-related abnormalities
2.C.1. Hepatic system Knowledge of sonographic appearance as a result of trauma
Ability to rapidly prioritize and evaluate sonographic findings due to trauma
Ability to perform focused test for free fluid following a traumatic event
Ability to recognize and apply proper scan technique in evaluating and documenting trauma
2.C.2. Penis
2.C.3. Scrotum
2.C.4. Spleen
2.C.5. Superficial structures (for example: abdominal wall, subcutaneous tissue)
2.C.6. Urinary system
2.C.7. Focused test for free fluid related to traumatic events
2.D. Assess aspects related to postoperative anatomy
2.D.1. Anatomy of transplanted organs Knowledge of hemodynamics of transplanted organs
Knowledge of common causes of transplant failure
Ability to recognize signs of rejection
Ability to adjust scan technique based on patient condition and surgical history
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
2.D.2. Perfusion and function of transplanted organs
2.D.3. Complications related to organ transplants
2.D.4. Abnormalities in postsurgical anatomy
2.D.5. Abnormalities in postsurgical breast
2.D.6. Abnormalities (for example: recurrent disease, lymphadenopathy) in postsurgical neck
2.D.7. Implanted medical devices (for example: transjugular intrahepatic portosystemic shunt [TIPS])
3. Abdominal Physics Knowledge and/or skill related abdominal physics
3.A. Apply concepts of equipment/image optimization
3.A.1. Use appropriate transducer (for example: curvilinear, linear, phased array)
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
3.A.2. Use two-dimensional, real-time, grayscale imaging (for example: B-mode, compound, harmonic)
3.A.3. Use Doppler (for example: color, power, pulsed wave)
3.B. Apply concepts of imaging artifacts
3.B.1. Assess artifacts of gray-scale imaging (for example: shadowing, resonance, comet tail)
Ability to recognize artifacts and correlate them with anatomy and pathology
Ability to manipulate machine settings to enhance or
3.B.2. Assess artifacts of Doppler imaging minimize artifacts (for example: twinkle, spectral broadening)
4. Clinical Care, Practice, and Quality Assurance
Knowledge and/or skill related to clinical care, practice, and quality assurance
4.A. Incorporate clinical data with performed study
4.A.1. Assess indications for examination requested
Knowledge of appropriate indications and contraindications for a specific test and/or procedure
Knowledge of potential effects of patient medications on an test 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 test based on information from other modalities
Ability to localize pathology for sonographic correlation
Ability to modify the test based on real-time findings
Knowledge of modalities associated with the test being performed
Ability to utilize resources, such as physicians, literature, or peers
4.A.2. Assess relevant clinical lab values for examination being performed
4.A.3. Assess relevant family history and patient signs/symptoms for examination being performed
4.A.4. Correlate ultrasound findings with previous imaging results
4.A.5. Evaluate images from other imaging modalities (for example: computed tomography, magnetic resonance imaging, nuclear medicine, x-ray)
4.B. Incorporate clinical standard/guidelines with performed study
4.B.1. Communicate effectively with the patient, physician, and others, including communication of findings that require immediate action
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 test 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 test and knowledge of factors that may affect patient preparation (for example: patient history, patient condition, sequencing requirements of multiple modality exams)
4.B.2. Inform patient or referring practitioner of examination preparations (for example: fasting for biliary imaging)
4.B.3. Maintain and protect patient confidentiality/privacy
4.B.4. Modify the examination based on patient condition and/or sonographic findings
4.B.5. Use multiple patient positions and scan planes to evaluate anatomic structures
Knowledge of sonographer scope of practice and regulations regarding patient information and interactions
4.C. Obtain accurate measurements
4.C.1. Obtain measurements of anatomic structures
Knowledge of normal measurement ranges
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)
4.C.2. Obtain measurements of Doppler waveforms
4.D. Assist/support during procedures
4.D.1. Obtain consent form and patient lab results prior to the procedure
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
4.D.2. Provide ultrasound guidance for procedures
4.D.3. Evaluate for post-procedural changes/complications



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Warum sind Cyberrisiken so schwer greifbar?

Als mehr oder weniger neuartiges Phänomen stellen Cyberrisiken Unternehmen und Versicherer vor besondere Herausforderungen. Nicht nur die neuen Schadenszenarien sind abstrakter oder noch nicht bekannt. Häufig sind immaterielle Werte durch Cyberrisiken in Gefahr. Diese wertvollen Vermögensgegenstände sind schwer bewertbar.

Obwohl die Gefahr durchaus wahrgenommen wird, unterschätzen viele Firmen ihr eigenes Risiko. Dies liegt unter anderem auch an den Veröffentlichungen zu Cyberrisiken. In der Presse finden sich unzählige Berichte von Cyberattacken auf namhafte und große Unternehmen. Den Weg in die Presse finden eben nur die spektakulären Fälle. Die dort genannten Schadenszenarien werden dann für das eigene Unternehmen als unrealistisch eingestuft. Die für die KMU nicht minder gefährlichen Cyber­attacken werden nur selten publiziert.

Aufgrund der fehlenden öffentlichen Meldungen von Sicherheitsvorfällen an Sicherheitsbehörden und wegen der fehlenden Presseberichte fällt es schwer, Fakten und Zahlen zur Risikolage zu erheben. Aber ohne diese Grundlage fällt es schwer, in entsprechende Sicherheitsmaßnahmen zu investieren.

Erklärungsleitfaden anhand eines Ursache-Wirkungs-Modells

Häufig nähert man sich dem Thema Cyberrisiko anlass- oder eventbezogen, also wenn sich neue Schaden­szenarien wie die weltweite WannaCry-Attacke entwickeln. Häufig wird auch akteursgebunden beleuchtet, wer Angreifer oder Opfer sein kann. Dadurch begrenzt man sich bei dem Thema häufig zu sehr nur auf die Cyberkriminalität. Um dem Thema Cyberrisiko jedoch gerecht zu werden, müssen auch weitere Ursachen hinzugezogen werden.

Mit einer Kategorisierung kann das Thema ganzheitlich und nachvollziehbar strukturiert werden. Ebenso hilft eine solche Kategorisierung dabei, eine Abgrenzung vorzunehmen, für welche Gefahren Versicherungsschutz über eine etwaige Cyberversicherung besteht und für welche nicht.

Die Ursachen sind dabei die Risiken, während finanzielle bzw. nicht finanzielle Verluste die Wirkungen sind. Cyberrisiken werden demnach in zwei Hauptursachen eingeteilt. Auf der einen Seite sind die nicht kriminellen Ursachen und auf der anderen Seite die kriminellen Ursachen zu nennen. Beide Ursachen können dabei in drei Untergruppen unterteilt werden.

Nicht kriminelle Ursachen

Höhere Gewalt

Häufig hat man bei dem Thema Cyberrisiko nur die kriminellen Ursachen vor Augen. Aber auch höhere Gewalt kann zu einem empfindlichen Datenverlust führen oder zumindest die Verfügbarkeit von Daten einschränken, indem Rechenzentren durch Naturkatastrophen wie beispielsweise Überschwemmungen oder Erdbeben zerstört werden. Ebenso sind Stromausfälle denkbar.

Menschliches Versagen/Fehlverhalten

Als Cyberrisiken sind auch unbeabsichtigtes und menschliches Fehlverhalten denkbar. Hierunter könnte das versehentliche Veröffentlichen von sensiblen Informationen fallen. Möglich sind eine falsche Adressierung, Wahl einer falschen Faxnummer oder das Hochladen sensibler Daten auf einen öffentlichen Bereich der Homepage.

Technisches Versagen

Auch Hardwaredefekte können zu einem herben Datenverlust führen. Neben einem Überhitzen von Rechnern sind Kurzschlüsse in Systemtechnik oder sogenannte Headcrashes von Festplatten denkbare Szenarien.

Kriminelle Ursachen

Hackerangriffe

Hackerangriffe oder Cyberattacken sind in der Regel die Szenarien, die die Presse dominieren. Häufig wird von spektakulären Datendiebstählen auf große Firmen oder von weltweiten Angriffen mit sogenannten Kryptotrojanern berichtet. Opfer kann am Ende aber jeder werden. Ziele, Methoden und auch das Interesse sind vielfältig. Neben dem finanziellen Interesse können Hackerangriffe auch zur Spionage oder Sabotage eingesetzt werden. Mögliche Hackermethoden sind unter anderem: Social Engineering, Trojaner, DoS-Attacken oder Viren.

Physischer Angriff

Die Zielsetzung eines physischen Angriffs ist ähnlich dem eines Hacker­angriffs. Dabei wird nicht auf die Tools eines Hackerangriffs zurückgegriffen, sondern durch das physische Eindringen in Unternehmensgebäude das Ziel erreicht. Häufig sind es Mitarbeiter, die vertrauliche Informationen stehlen, da sie bereits den notwendigen Zugang zu den Daten besitzen.

Erpressung

Obwohl die Erpressung aufgrund der eingesetzten Methoden auch als Hacker­angriff gewertet werden könnte, ergibt eine Differenzierung Sinn. Erpressungsfälle durch Kryptotrojaner sind eines der häufigsten Schadenszenarien für kleinere und mittelständische Unternehmen. Außerdem sind auch Erpressungsfälle denkbar, bei denen sensible Daten gestohlen wurden und ein Lösegeld gefordert wird, damit sie nicht veröffentlicht oder weiterverkauft werden.

Ihre Cyberversicherung sollte zumindet folgende Schäden abdecken:

Cyber-Kosten:

  • Soforthilfe und Forensik-Kosten (Kosten der Ursachenermittlung, Benachrichtigungskosten und Callcenter-Leistung)
  • Krisenkommunikation / PR-Maßnahmen
  • Systemverbesserungen nach einer Cyber-Attacke
  • Aufwendungen vor Eintritt des Versicherungsfalls

Cyber-Drittschäden (Haftpflicht):

  • Befriedigung oder Abwehr von Ansprüchen Dritter
  • Rechtswidrige elektronische Kommunikation
  • Ansprüche der E-Payment-Serviceprovider
  • Vertragsstrafe wegen der Verletzung von Geheimhaltungspflichten und Datenschutzvereinbarungen
  • Vertragliche Schadenersatzansprüche
  • Vertragliche Haftpflicht bei Datenverarbeitung durch Dritte
  • Rechtsverteidigungskosten

Cyber-Eigenschäden:

  • Betriebsunterbrechung
  • Betriebsunterbrechung durch Ausfall von Dienstleister (optional)
  • Mehrkosten
  • Wiederherstellung von Daten (auch Entfernen der Schadsoftware)
  • Cyber-Diebstahl: elektronischer Zahlungsverkehr, fehlerhafter Versand von Waren, Telefon-Mehrkosten/erhöhte Nutzungsentgelte
  • Cyber-Erpressung
  • Entschädigung mit Strafcharakter/Bußgeld
  • Ersatz-IT-Hardware
  • Cyber-Betrug