- How the RPhS Exam Blueprint Is Built
- Two Matrices, One Transition: Which Version Applies to You
- Domain 1: Maintain Information, Facility, and Safety
- Domain 2: Patient Diagnosis
- Domain 3: Performance of Diagnostic Testing
- Domain 4: Conservative Treatment/Therapy of Patients
- Domain 5: Minimally Invasive and Invasive Treatment of Patients
- Reading the Weights Honestly
- Question Formats and Exam-Day Mechanics
- Sequencing Your Preparation Around the Domains
- Frequently Asked Questions
- The RPhS exam, issued by Cardiovascular Credentialing International (CCI), has five domains; Performance of Diagnostic Testing is the largest at 36%.
- The current matrix weights are 9/27/36/9/20; a separate February 1, 2027 matrix uses 7/25/38/10/20.
- Applicants received August 1-December 31, 2026 are assigned to the February 2027 window and need the February 2027 matrix.
- The exam has 170 questions (150 scored, 20 unscored) and a passing scaled score of 650 on a 0-900 range.
How the RPhS Exam Blueprint Is Built
The Registered Phlebology Sonographer (RPhS) credential is awarded by Cardiovascular Credentialing International (CCI), and the examination is delivered at Pearson VUE test centers. Everything you will be tested on is organized by CCI's Examination Matrix and Task List, which divides the exam into five duty/task domains. Understanding that structure is the single most efficient way to decide where your study hours go.
One point worth stating plainly: these five domains are examination objectives, not preparation-curriculum chapters. They describe the duties a competent phlebology sonographer performs, and the exam samples from those duties. A domain such as "Patient Diagnosis" is not a textbook chapter; it is a cluster of tasks that you will meet across many question styles. If you are still sorting out the credential itself, the overview in What Is RPhS Certification? covers the basics, and RPhS Requirements 2026 walks through the eligibility pathways.
| Domain | Current Matrix Weight | Priority |
|---|---|---|
| 1. Maintain Information, Facility, and Safety | 9% | Lower, but easy points |
| 2. Patient Diagnosis | 27% | High |
| 3. Performance of Diagnostic Testing | 36% | Highest |
| 4. Conservative Treatment/Therapy of Patients | 9% | Lower, but easy points |
| 5. Minimally Invasive and Invasive Treatment of Patients | 20% | High |
Two Matrices, One Transition: Which Version Applies to You
This is the part of the 2026 blueprint most candidates miss. CCI's credential page publishes two matrices side by side. The currently published matrix (which carries no printed issue year and applies before February 1, 2027) uses weights of 9/27/36/9/20. A second matrix, effective February 1, 2027, keeps the same five domain headings but changes the weights to 7/25/38/10/20.
| Domain | Pre-Feb 1, 2027 Matrix | Feb 1, 2027 Matrix |
|---|---|---|
| Maintain Information, Facility, and Safety | 9% | 7% |
| Patient Diagnosis | 27% | 25% |
| Performance of Diagnostic Testing | 36% | 38% |
| Conservative Treatment/Therapy of Patients | 9% | 10% |
| Minimally Invasive and Invasive Treatment of Patients | 20% | 20% |
Going forward, testing occurs in February and August only. That replaces the more flexible scheduling many candidates expect from a generic credentialing exam, and it also constrains the general 45-day minimum retake interval, since a retake can only happen when a window opens. For the scheduling mechanics, see RPhS Exam Dates 2026.
The practical takeaway: the domain-by-domain discussion below describes the current matrix scope, but the shift between versions is small in headline terms. Performance of Diagnostic Testing grows slightly, Patient Diagnosis and Domain 1 shrink slightly, and Conservative Treatment grows slightly. Studying all five domains thoroughly protects you under either version.
Domain 1: Maintain Information, Facility, and Safety
Maintain Information, Facility, and Safety (9% current; 7% Feb 2027)
This domain covers the operational and safety backbone of a venous ultrasound practice. It is the smallest domain, but its questions tend to be the most straightforward, which makes it a reliable source of points for well-prepared candidates.
- Patient information handling, documentation, and confidentiality in a vascular lab or vein clinic
- Equipment readiness, transducer care, and infection-control practices for ultrasound and procedure rooms
- Safety expectations around patient positioning, sterile technique, and procedural environments
- Professional conduct, including awareness of the CCI Code of Ethics
Do not dismiss this domain because of its weight. At 9% of the current matrix, it represents a meaningful slice of the 150 scored questions, and a missed block here is hard to recover from if you are borderline in the heavier domains. The Code of Ethics is also worth knowing in its own right, since ethics compliance is required at every renewal.
Domain 2: Patient Diagnosis
Patient Diagnosis (27% current; 25% Feb 2027)
This is the second-largest domain and the bridge between clinical knowledge and the scan itself. It tests whether you understand the venous disease picture well enough to know what you are looking for and why.
- Venous anatomy of the lower extremity: deep, superficial, and perforator systems, plus common anatomic variants
- Pathophysiology of venous insufficiency, reflux, obstruction, and thrombosis
- Clinical presentation and risk factors: how symptoms, history, and exam findings point toward a diagnosis
- Interpreting ultrasound findings in the context of patient presentation and deciding whether findings fit the clinical picture
- Recognizing urgent findings that require immediate communication to a physician
Candidates who come from a pure scanning background often underestimate this domain because it feels clinical rather than technical. Expect scenario-style questions that give you a presentation and ask you to reason about the likely condition, the expected sonographic appearance, or the next appropriate step. Strong anatomy is the foundation: if you can name and locate the great saphenous, small saphenous, and perforating veins and their relationships without hesitation, a large share of this domain becomes manageable.
Domain 3: Performance of Diagnostic Testing
Performance of Diagnostic Testing (36% current; 38% Feb 2027)
The heaviest domain by a wide margin, and the one that most directly reflects daily sonographer work. At 36% of the current matrix, it is larger than any other domain and grows slightly under the February 2027 matrix.
- Ultrasound physics and instrumentation as they apply to venous imaging: Doppler principles, gain and scale settings, angle of insonation, and artifact recognition
- Exam protocols for venous duplex studies: patient positioning, transducer selection, and systematic scanning technique
- Compression technique and what compressibility does and does not tell you
- Reflux testing methods, provocative maneuvers, and how to document valve closure time and flow direction
- Venous mapping of superficial veins, including measurements and documentation that support treatment planning
- Optimizing image quality and troubleshooting a suboptimal study
This is where image-based question types matter most. The exam includes image hot spot and drag-and-place formats, which suit questions that ask you to identify a structure, mark the location of a finding, or order steps in a protocol. Practice recognizing normal and abnormal spectral Doppler waveforms and gray-scale appearances, not just memorizing definitions. Physics concepts are fair game, but they are framed around their consequences for a venous study rather than abstract theory.
Key Takeaway
Domains 2 and 3 together account for 63% of the current matrix (27% + 36%). If your study time is limited, a weak performance in either one is very difficult to offset with strength elsewhere. Build your plan so that no more than a fraction of your hours goes to the two 9% domains until diagnosis and diagnostic testing feel solid.
Domain 4: Conservative Treatment/Therapy of Patients
Conservative Treatment/Therapy of Patients (9% current; 10% Feb 2027)
This domain covers non-procedural management of venous disease, the first-line measures patients typically try before or alongside intervention.
- Compression therapy: purposes, general principles, and patient education on use
- Lifestyle and self-care guidance related to venous disease
- Wound and skin-change awareness in advanced venous disease
- Understanding when conservative management is appropriate versus when escalation to a procedure is warranted
- Patient counseling, expectations, and follow-up
Questions here tend to be conceptual and practical rather than image-heavy. Because the weight rises slightly under the February 2027 matrix (from 9% to 10%), it is worth giving this domain a real review pass instead of skipping it. It also connects naturally to Domain 2: the reasoning that identifies a diagnosis often leads directly into a conservative-management question.
Domain 5: Minimally Invasive and Invasive Treatment of Patients
Minimally Invasive and Invasive Treatment of Patients (20% current; 20% Feb 2027)
This domain holds steady at 20% in both matrices and covers the interventional side of phlebology, where the sonographer supports and guides procedures.
- Endovenous ablation concepts: thermal and non-thermal approaches and the sonographer's role in guidance and monitoring
- Sclerotherapy principles, including ultrasound-guided approaches
- Pre-procedure mapping and planning, and post-procedure surveillance studies
- Recognizing procedure-related complications on ultrasound, such as thrombus extension
- Procedural safety, patient preparation, and sterile technique in the treatment setting
Who hires for these skills matters here: vein clinics, vascular surgery practices, interventional and phlebology-focused offices, and hospital vascular labs are the typical employers where sonographers work alongside physicians on these procedures. The exam's emphasis reflects that reality. Expect questions that ask what you would see, what you would document, and what you would escalate. For more on the career side, see RPhS Jobs and the RPhS Salary Guide 2026.
Reading the Weights Honestly
The right way to use the weights is directional. Domain 3 deserves the most time, Domain 2 the second most, Domain 5 a solid third, and Domains 1 and 4 a focused but smaller investment. Also remember that 20 of the 170 questions are unscored and unidentified, so you cannot tell which items "count." Treat every question seriously.
Question Formats and Exam-Day Mechanics
Knowing the domains is half the preparation; knowing how they are tested is the other half. The exam includes four question formats: single-best-answer multiple choice, multiple response, image hot spots, and drag-and-place items. The multiple-response and hot-spot formats in particular reward precise knowledge, because partial understanding is harder to bluff through than a standard four-option question.
| Exam Detail | What to Know |
|---|---|
| Total questions | 170 (150 scored, 20 unidentified unscored) |
| Appointment length | Three hours, including a ten-minute tutorial/post-exam survey |
| Answering time | Two hours 50 minutes (170 minutes) |
| Passing score | 650 on a 0-900 scaled-score range, not a raw percentage |
| Exam fee | USD 365, including a USD 100 non-refundable application-processing component |
| Rules | Closed-book; on-screen calculator and erasable board; item marking and review within remaining time; two acceptable original IDs |
The 650 passing score is a scaled value, so you cannot convert it into "I need X questions right." For a deeper treatment, read RPhS Passing Score 2026. CCI publishes a 75% first-time RPhS pass rate for 2025; note that this is a first-time figure for 2025 only, not a 2026 or all-attempt rate. The context is in RPhS Pass Rate 2026, and the difficulty question is addressed in How Hard Is the RPhS Exam?. For the full fee picture including renewal, see RPhS Certification Cost 2026.
Because item marking and review are allowed within the remaining time, a sensible approach is to answer what you know, mark anything uncertain, and return to it. With about 170 minutes for 170 items, pacing works out to roughly one minute per question, which leaves a small cushion for image-based and multiple-response items that take longer.
Sequencing Your Preparation Around the Domains
Generic study advice matters less than ordering your preparation to match how the domains depend on each other. Anatomy and physics underpin almost everything, so they come first. Here is a domain-driven sequence you can adapt to your testing window:
Foundations for Domains 2 and 3
- Venous anatomy, including superficial, deep, and perforator systems
- Ultrasound physics and Doppler principles as applied to venous imaging
Domain 3 Depth
- Venous duplex protocols, compression technique, reflux testing, and mapping
- Waveform and image recognition for hot-spot style questions
Domain 2 and Domain 5
- Pathophysiology, clinical presentation, and diagnostic reasoning
- Ablation, sclerotherapy, and post-procedure surveillance
Domains 1 and 4, Then Mixed Review
- Safety, documentation, ethics, compression therapy, and conservative management
- Timed mixed practice across all five domains in each question format
Adjust the proportions if you are testing under the February 2027 matrix, giving slightly more weight to Domains 3 and 4 and slightly less to Domains 1 and 2. For a fuller planning framework, see the RPhS Study Guide 2026 and the compact RPhS Cheat Sheet 2026 for last-pass review. When you are ready to test your recall under realistic conditions, the RPhS practice test lets you drill all five domains in the same mix of formats you will face. You can also revisit the RPhS exam domains overview to check your mapping against the blueprint.
Frequently Asked Questions
The RPhS exam, administered by Cardiovascular Credentialing International, is organized into five domains: Maintain Information, Facility, and Safety; Patient Diagnosis; Performance of Diagnostic Testing; Conservative Treatment/Therapy of Patients; and Minimally Invasive and Invasive Treatment of Patients.
Performance of Diagnostic Testing is the largest at 36% on the current matrix, rising to 38% on the matrix effective February 1, 2027. Patient Diagnosis is second at 27% currently and 25% in the 2027 version.
Applications received August 1-December 31, 2026 are assigned to the February 1-28, 2027 testing window, so those candidates should study against the matrix effective February 1, 2027. Earlier-approved candidates follow their ATT dates, so confirm yours with CCI.
The published approximate weights of 9, 27, 36, 9, and 20 sum to 101%, while CCI's total row states 100%. No explanation is published, so treat the weights as approximate guides and do not rely on them for exact question counts.
No. The exam includes single-best-answer multiple choice, multiple response, image hot spots, and drag-and-place items, so your preparation should include image recognition and multi-select practice, not just recall of facts.
Mastering the five domains, and knowing which matrix version governs your testing window, is the foundation of an efficient RPhS preparation plan. Weight your time toward Performance of Diagnostic Testing and Patient Diagnosis, protect the smaller domains with focused review, and validate your readiness with timed practice on the RPhS Exam Prep practice test.