the Application Form

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Check one:
□ Sonography Student
□ Sonographer
□ Physician
School of Cardiac & Vascular Ultrasound
1910 E. Thomas Rd Suite 220
Phoenix, Arizona 85016
Last
Name:
Ultrasound Physics Registry Review
First
Name:
Middle:
Facility:
DOB:
Personal
Mailing
Address:
City:
Suffix:
State:
Business
Phone:
Cell
Phone:
Fax:
Email:
SDMS
Member #:
ARDMS
Registry #:
CCI
Registry #:
ARRT
Member #:
Sonography
Canada Reg #:
Degree:
ZIP Code:
Terry Reynolds, who “Wrote the Book”, will take participants through
each component of the ultrasound physics national board exam
Pre-Registration Required
(Minimum 7 days prior to course date)
$225.00
Location
Arizona Heart Foundation
1910 E Thomas Road, Suite 220
Phoenix, Arizona 85016
Schedule
Day One: 6:00 PM – 8:00 PM Day Two: 8:00 AM – 5:00 PM (Lunch included)
Preferred Date
□ July 17-18
□ August 14-15
□ October 16-17
Accreditation:
This activity is tracked by SDMS CME Tracker and has been approved for 10 Sonography Principles and Instrumentation CME
credits.
The Arizona Heart Foundation is accredited by the ACCME to provide continuing medical education for physicians. AHF
TM
designates this live activity for a maximum of 10 AMA PRA Category 1 Credits . Physicians should claim only the credit
commensurate with the extent of their participation in the activity.
Objectives:
Upon completion of the course participants will be able to:
1. Define the basic principles of ultrasound physics.
2. Describe how sound propagates through soft tissue.
3. Identify ultrasound transducers and describe their applications.
4. Identify pulse echo instruments and describe their applications.
5. Apply the principles required to interact with pulse echo instruments.
6. Describe appropriate procedures to store and display images.
7. Define the basic principles of conventional Doppler and color flow Doppler.
8. List and interpret the most common ultrasound imaging artifacts.
9. Describe the appropriate procedures for quality assurance.
10. Identify potential ultrasound bioeffects.
11. Identify new imaging modalities and techniques and apply in clinical imaging.
12. Apply learned principles to the national ultrasound physics board examination.
Payment:
Credit Card Number ___________________________________ Name on Card ___________________________________________
Expiration Date _____________ Security Code on Card _________
Visa
MasterCard
American Express
Discover
Signature of Cardholder ______________________________________________
OUR GUARANTEE: If you fail to pass the physics registry exam after attending this course
you will be entitled to repeat the course one additional time AT NO CHARGE.
Return completed application and payment to: Nancy Ashland at nashland@azheartfoundation.org
Phone: 602-604-5009; Fax: 602-265-8885.
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